Who is responsible for the health care crisis?!

By Sara Nelson, PT, DPT

We have all felt the pinch of growing insurance premium and copay/coinsurance. If you have tried to get help for a medical condition recently, you may have noticed increasing red-tape to try to get an appointment.   Despite attempts to cut expenses, the per capital cost of health care in the US has reached $10000 per person.  Other first world nations are spending far less and still living longer than we do.  Health care expenditure in the US is 17% of the GNP.  Clearly something is amiss.   This is a complex problem that can’t be fully addressed in this article.  Blaming the Affordable Care Act is over simplification.  To begin to understand the problem, get to know the players and the roles they play.

The medical system.  The practice of medicine has pressure from different directions.  Some of the changes and costs come from the risk of law suits.  Care is provided to reduce the risk of legal action.  In addition, attempts to streamline care to be more efficient has taken away from the personal relationship of the doctor and patient.

Insurance companies.  These groups are trying to remain profitable by requiring more information up front before they will pay.  This means longer wait times to make an appointment, more paperwork to use your insurance benefits, and having this third party in on making decisions on your care.

Big Pharma.  We are the only first world nation that allows marketing of pharmaceuticals on television.  This has planted a message in all of us that your health problems can be fixed with a pill. These companies have strong lobbies that pressured congress to bar Medicare from negotiate prices on drugs.  So we end up paying more.

Big Food.  Packaging food so it appeals to our taste buds sells more food.  Putting sugar, fat and salt in food will trigger the brain to create more desire for the food.  Processed food sells, and has contributed to a disastrous epidemic of obesity and chronic illness.

Public Health Policy refers to community and government initiatives that encourage healthy behaviors, or not.  Policies that favor cars over walking and bikes contribute to inactivity and poor health.

You! These may all seem bigger than you but ultimately each individual influences the cost of health by making choices that will keep them as healthy as possible.  If we all eat healthy, whole foods, that’s what the stores will sell.  If we become more active in our lives, government and business will respond to requests for products and services to make being active easier.  If we ask our doctors what we could do to replace medication, they will start talking to us about how to do that.  This will bring health care costs down!

By 2025 it’s expected that 49% of the population will have a chronic disease.  Many of these would be prevented or diminished in their effect if we all took action to make healthy choices now.  You can start today to make a dent in health care costs!

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Healthy or Health Nut?

By Sara Nelson, PT, DPT

Years ago, we had someone come through our physical therapy clinic for treatment of a chronic condition.  The process of treatment and self-care training for the condition were explained to the individual.  We included what we offered to help alleviate the condition and what skills were taught on how to manage the condition independently.  The person called back later to cancel appointments and say she didn’t want to do self help.

We have successfully convinced ourselves that health behaviors are not needed, that the powers of drugs, procedures and surgeries will compensate for inactivity, stressful living and poor food choices. I believe that the people providing those services would agree procedures and pills support healthy living, not replace it.

The fact of the matter is that the chronic conditions we suffer as a society are on the rise, and although some are living longer, they are suffering more. While our general health is declining, insurance companies are putting their foot down on reimbursements for treatment of chronic conditions.  They point out that originally insurance was meant for catastrophic events, not the expected effects of aging.

If you are interested in enjoying life and feeling good most of the time, you are going to have to do something about it.  The time for action is now.  Start today to develop health habits that will in the end cut your health care costs and make your day better.

Getting started is hard for most people.   Find a group that fits you and your goals.  Group exercise will provide you with the motivation and fun you need along with safety and accountability.  Group instruction provides you with the information you need to feel good.

A new development in the fitness industry, is fitness for people who are chronically ill and don’t feel up to the typical gym.   We have several options around town.  Don’t let illness or a lack of motivation keep you away.  Often starting with physical therapy is a good entry into an individualized fitness program.  In answer to the title question, you don’t have to be a health nut to be healthy, you just have to make a positive choice today.

Post-Natal Care

Prenatal care for expectant mothers is provided automatically.  However, after the baby is born there is seldom any assistance to help mom return to her pre-baby state.  In Physical Therapy world, we think every new mom deserves post-natal care!  This was understood centuries ago, when postpartum care was given to mothers and newborns in India in the form of massage.

It is still a good idea today.  If you are expecting a baby, here are reasons to continue with professional care after you have your baby:
1.  Get your body back faster — Carrying a baby distorts the actions of your core muscles from the abdominal wall, back, respiratory diaphragm and pelvic floor muscles.  For instance, a separation of the abdominal wall, known as diastasis recti, can lead to back problems.  This can be helped with proper rehabilitation.  A physical therapist specializing in pelvic health can help you on the road to recovering your body sooner and preventing future problems.
2.  Prevent organ prolapse.  The effects of carrying the baby, delivering the baby and the ensuing lifting and carrying baby after delivery can contribute to dropping of the pelvic organs (bladder, uterus, and rectum).  This is correctable with the proper exercise and guidance.  As much as one third of surgical repairs of bladder prolapse fail, and this may have to do with the need for behavioral and muscular retraining.  A physical therapist specializing in pelvic rehabilitation may help prevent the need for surgery in the future,  in this early post-partum stage.
3.  Restore normal bowel and bladder function.  It is not uncommon after having a baby to have some problems with urinary or fecal leakage.  Physical therapists can help you correct this through behavior and muscle retraining.
4.  Return to sex with less pain.  We get very little guidance on how to return to sexual intercourse after having a baby.  A physical therapist can give you some tips to avoid pain with intimacy.
5.  Address pain before it becomes a constant.  Postpartum can mean continued back, hip, pubic and sacroiliac joint pain.   A busy mom may put her own pain aside to meet the demands of new motherhood and all its responsibilities.  It is important to address pain right away.  There is no need to suffer.  If a c-section was necessary, addressing the scar tissue can help prevent future problems as well.
If you don’t learn how to correct some of these issues, they can follow you for decades!  Consider including post-natal Physical Therapy care as part of your health care in the pregnancy, birth and post-partum experience.

Limitless!

By Sara Nelson, PT, DPT

As a physical therapist, I see a lot of people with physical problems that appear insurmountable.  Through the years I began to believe that some people just couldn’t move because of their pain or limitation.  I looked for ways to help them survive within those limitations.  This view is common in the medical world.   My son taught me this is an erroneous view.  My son is an Ironman.  If you don’t know, that is a competition in which participants swim 2.4 miles, Bike 112 miles and finish off by running a marathon (26.2 miles).  I was so concerned he would hurt himself when he did his first Ironman, he hadn’t even run a marathon.  He showed me that with proper pacing, fueling and self care, you can do almost anything.   He finished that Ironman and has gone on to do four of these races.  His wife was able to use his guidance and her own consistent effort to participate in and finish an Ironman herself, with 11 months of training.  She accomplished that with no joint injuries, and having not been a swimmer.

There were lessons for me as the observer of these accomplishments that I have put to use in my own life and passed on to my patients.  As a result, I am seeing people over come significant problems.  These lessons include (1) be careful what you believe about your body, you may be putting unnecessarily limits on yourself, (2) Pushing through injury and forcing limitations will NOT help you achieve physical goals.  Learn to work within your capacity and with your body to expand your abilities, (3) Modify workouts or take a break when you are hurting, until you can find the path forward where your will and body can work in harmony to achieve a goal. (4) Proper ‘fueling’ is absolutely necessary to go the distance.  In other words, practice healthy eating which includes adequate hydration and nutritious food eaten at regular intervals. (5) If you hurt, do something to feel better.  Self care is a powerful healer, and it includes massage, Epsom salts baths, learning about your body and how it works and how to help it heal, and more.

When I ask my son what he learned from the experience, he says he has learned that you can’t let your thinking intimidate you.  No matter how far you have to go, you only have to take one step at a time.

If you need help knowing what steps to take, talk to a physical therapist!

Help Stop This Epidemic!!!

We have a health epidemic on our hands.  It’s contributing to a plethora of physical injury as well as chronic disease (heart disease, asthma, stroke, cancer and more), and mental health problems (PTSD, anxiety, depression) and it’s contagious.  And you can stop it.   I am talking about the known effects of violence. In the United States, violence claims an enormous $450 billion toll and nearly 60,000 lives annually. (cureviolence.org)

Using physical force to cause harm or damage to someone or something has become a mainstay of how we express our opinions and even how we entertain ourselves.  Watching violent images has led to a numbing effect that has built up our tolerance of some pretty awful actions.  In addition, using social media to air our darker more violent tendency has the same effect.  We are seeing this behind the scenes practice of meanness and hatred on social networks spill out into the world of actions.  And yes, these not only causes physical injury to those involved, it causes harm to all of us in the form of poorer health. It makes it easier for all of us to be violent and thus it spreads.

The antidote is quite easy and no cost and has equally strong positive health benefits.  That is the practice of kindness.  Descriptors of kindness include gentleness, caring, compassionate action, and going out of your way for others.  These can simply be a smile, or opening a door for someone.

Scientific research has shown that kindness has measurable health benefits and is also contagious.  Performing or watching an act of kindness causes the body to release a hormone called oxytocin which lowers the blood pressure and can protect your heart.  Oxytocin also reduces inflammation levels and can therefore slow the aging process. Acts of kindness also increases the release of dopamine, your body’s natural opioid.  With more dopamine, you will feel happier and even reduce pain.

Here are some actions you can take today to improve your health and the health of those around you.

1. Perform a random act of kindness regularly.
2. Print out this pdf about the health effects of kindness and share it with people you know. https://www.dartmouth.edu/wellness/emotional/rakhealthfacts.pdf
3. Be kind to yourself. Rest, eat nourishing food, spend time in nature, laugh, and move!
4. If you find yourself overcome with anger, rage or bitterness; if the view point of another different than yours enrages you; consider working with a counselor.
5. Envision and practice the hypothesis of compassion. Think the best of others, rather than the worst.  Put yourself in their shoes, imagine what life is like for the other person.
6. Learn about how you can help prevent violence. For more information check out this website: http://cureviolence.org/understand-violence/violence-as-a-health-issue/
7. Don’t support violent entertainment, seek out entertainment that supports positive human qualities.
8. Practice kindness in your language on social media. If you disagree, find a way to express that with respect and seeking to understand.

 

Kind words are ever more mighty than swords.

– Peter Burn

 

Women and Heart Health

Carrie Fisher’s death in 2016, highlighted a problem facing women: 90% of women have one or more risk factors for heart disease or stroke, but many do not even know they have a problem prior to a fatal heart attack. In fact, symptoms of heart disease are often different for women compared to men and are often misinterpreted as acid reflux, the flu, or normal aging. In addition, women have a higher lifetime risk of stroke than men. According to the American Heart Association, 1 in 31 American women die from breast cancer every year, but one in three dies of heart disease (stroke and heart attack), making heart disease the No.1 killer of women in the U.S. Younger women are not excluded from silent heart attacks either. Learning the risks of heart disease and making lifestyle changes as preventative measures can not only save you from a heart attack, but also can be less expensive and more pleasant.

 

What is cardiovascular disease?

Cardiovascular disease is a broad term that includes a variety of heart and blood vessel conditions. It can be referred to as coronary artery disease, peripheral arterial disease, heart attack, stroke, high blood pressure, heart valve disease, and congenital heart disease, to name a few. The most common cause of cardiovascular disease is atherosclerosis which is a build-up of cholesterol and plaque on the inner walls of the arteries, thus restricting blood flow to the heart. Chronic low-grade inflammation is prevalent in all stages of atherosclerosis. Without adequate blood, the heart becomes starved of oxygen and vital nutrients it needs to work properly, causing chest pain called angina. When one or more of the coronary arteries becomes blocked, a heart attack can occur.

Heart attack symptoms in women (American Heart Association)

• Uncomfortable pressure, squeezing, fullness or pain in the center of your chest. However, women can experience a heart attack without chest pressure.
• Pain or discomfort in one or both arms, the back, neck, jaw or stomach
• Shortness of breath with or without chest discomfort
• Breaking out in a cold sweat, nausea or lightheadedness
• Chest pain is the most common heart attack symptoms in men and women. However, women are somewhat more likely than men to experience shortness of breath, nausea/vomiting and back or jaw pain

 

So what can you do to prevent heart disease? Get going on these 8 ways to get on track!

1. Quit smoking. Your risk for heart attack and stroke decreases by 50% after just one year of quitting
2. Improve cholesterol levels by lowering your LDL levels, the “bad cholesterol”
3. Control high blood pressure. Regularly check your blood pressure
4. Get active! Start an exercise program involving walking 30 minutes/day
5. Follow a heart-healthy diet. Choose healthier fats such as leaner cuts of meat, fish, nuts and olive oil
6. Get to a healthy weight
7. Control diabetes. The World Health Organization suggests 6 tsps (25g) of sugar/day
8. Manage stress and anger. Practice relaxation techniques such as deep breathing, yoga, enjoyable hobbies

 

 

 

Thyroid Dysfunction: a hidden cause of joint pain.

By Sara A Nelson, DPT

Over years of providing physical therapy in the outpatient setting, patterns become more apparent.  One pattern I became aware of was women with joint pain and underactive thyroid glands.  When I went searching, I found the connection.

The thyroid gland is a small butterfly shaped organ at the front of the throat.  Although small, it has far reaching effects in the body.  Thyroid hormone regulates metabolism and growth.  It has an effect on many functions including breathing, heart rate, body weight, muscle strength, menstrual cycles, body temperature, cholesterol levels and more!

When the thyroid produces too much hormone, symptoms include anxiety, nervousness, trembling, and hair loss.  When there aren’t enough thyroid hormones, symptoms include fatigue, dry skin and hair, depression, sensitivity to cold, and joint and muscle pain!

There are several possible causes for thyroid dysfunction.  If you suspect you have problems you need a thorough evaluation by a medical doctor.  Genetic predisposition can play a role.

Autoimmune thyroiditis, also called Hashimoto’s disease, is seven times more common in females compared to males. Did you now that 4-10% of women will develop postpartum thyroid inflammation during the first year after giving birth?  About 20% of these women develop Hashimoto’s disease in later years.

Treating the inflammation can assist with reducing joint pain and help you have a healthier thyroid gland.  Good thyroid function is supported with a healthy diet, exercise, rest and stress management.  Yes, one more reason to develop your health habits!  Learning how to exercise when inflammation is present may take the help of a professional (like a physical therapist!)  to find how to move without aggravating joints and worsening inflammation.  There are some special diet recommendations that come from natural medicine.  You can consult a naturopath for more information on that approach for healthy thyroid.

Don’t wait for problems to develop.  It is much more cost effective to prevent than cure!