Step 7 of Dr. Lavine’s Ten Step Program to Conquer Chronic Illness
Physical exhaustion and low mood, often inseparable from chronic pain, shouldn’t be ignored. In fact, surveys of fibromyalgia sufferers show that more than 80% experience an almost overwhelming level of fatigue that at times is worse than the pain.
The emotional aspect of physical fatigue is depression.
Of course, fatigue and depression are complex, and self-help guidelines such as these can’t possibly address your unique individual issues. I also recommend that you consult your personal physician, nutritionist, or mental health professional as appropriate.
For Step 7 of Dr. Lavine’s Ten Step Program to Conquer Chronic Illness, I recommend two self-help strategies. One is a simple method to address distortions of your mood. The second involves tested sleep strategies to improve the quantity and quality of sleep.
Nearly everyone wants to lose a few pounds. In many cases, more than just a few.
In fact, it’s been theorized that if everyone who wanted to lose an extra 10-20 pounds actually lost the weight and kept it off, the cumulative disappearance of body mass would destabilize the earth’s orbit and send the planet hurtling off into interstellar space. (Actually, no reputable physicist has theorized that at all. I just made it up myself.)
But control of body weight is an important health and diet concern. And it’s a challenging medical issue.
The March 25, 2013 edition of JAMA Internal Medicine tells the story: doctors are still ordering far too many low back MRI’s of questionable value.
Investigators first established “expert” guidelines that identified situations in which MRI’s were likely to yield useful clinical information.
For today’s guest article I’d like to thank Laurie G. Jacobs, M.D., director of the Jack and Pearl Resnick Gerontology Center, Albert Einstein College of Medicine and Vice Chair, Clinical and Educational Programs, Montefiore Medical Center.
This blog post first appeared in The Doctor’s Tablet, the official blog of Albert Einstein College of Medicine.
Frailty: How a Constellation of Symptoms Leads To Risk
by Laurie G. Jacobs, M.D. on March 12, 2013
Fragile: This Side Up. Few of us find much ambiguity when faced with a mail parcel marked with those four words. Yet the related word “frailty” often causes confusion among doctors and patients alike. The word “frail” applies to people, not things—and that’s where the topic becomes tricky.
In March, 2013, the New England Journal of Medicine published the results of a Dutch study on the value of MRI in assessing patients with sciatica.
Scientists took MRI’s of patients with sciatica and followed up with a second MRI one year later. They also charted patients’ recovery from back pain. Meanwhile, some of the patients had undergone disc surgery. Others hadn’t.
Those who had had surgery were less likely to have a herniated disc show up on their follow-up MRI. But the MRI picture of the discs didn’t correlate with freedom from pain. After one year, those who still had a visibly herniated disc were equally likely to be pain-free.
Even if the MRI showed the disc bulging out and pinching a nerve, it didn’t mean that the person was more likely to have pain.
Here’s a quote from study author Wilco C. Peul, MD, PhD, Department of Neurosurgery, Leiden University Medical Center, The Netherlands:
People with low back pain often also have poor control of low back movement. Fortunately, we’ve come a long way from the days when all we knew about control of low back movement was the idea of having “strong abs”. The dynamic control of posture and spinal movement is far more subtle. Scientists can now quantify some of the details:
In spondylolisthesis, one vertebral body slides forward relative to its neighbor to the south. There can be several different causes of this. The two most common types of spondylolisthesis are isthmic spondylolisthesis and degenerative spondylolisthesis.
Here are some of the major differences:
Every year, more than half a million people get a vertebral compression fracture due to osteoporotic, thinning bones.
Among younger people, motor vehicle accidents and other trauma can also cause fractures of the vertebrae. Tumors metastasizing to the spine and weakening the bones are a third cause.
Each of these categories of vertebral compression fracture presents its own problems.
Folate (also known as vitamin B9) plays an essential role in many chemical reactions in your body, including DNA synthesis and amino acid metabolism.
One important folate-dependent chemical reaction is clearing the body of homocysteine by converting it to methionine. If it doesn’t get broken down properly, homocysteine can build up in your artery walls and contribute to atherosclerosis.
Spinach is a power-packed source of folate, with other dark green leafy vegetables not far behind (yeah kale!) Folate is also found in a wide variety of other foods, including fruits, beans, meats, and more.
Despite its broad availability in the American diet, public health authorities have determined that many people are at risk of folate deficiency, and have required that fortified grains include extra folate.
But natural sources of folate, even with fortified grains added in, may not be enough.
Thanks to today’s guest author Fran Parker, a psychotherapist, executive performance coach, and expert in movement and non-verbal communication.