New Perspective on Low Back Pain

By Jordan Hui, Candidate of Doctor of Osteopathy 2017
Courtney Cheng, DO, MSHS 2017

In the US, mechanical low back pain is the second most common reason for seeing a doctor. Every 4 out of 5 people will have at some point in their life low back pain.  Most of the time, the back pain resolves on its own within 2-4 weeks.  The body has a great ability to self-correct.  However, when insult to the body remains or if the structure is unable to be restored, the ability to function will be hindered and pain will be a loud cry from the body for help.

The cause of low back pain can be anatomical, neurological, or psychological in nature.  A health care professional can help to differentiate the cause of this problem and provide management for the resolution of the pain.  If not properly managed by a physician, the pain can worsen resulting in decreased quality of life.  Most low back pain is not due to a serious medical problem and can be treated with conservative measures.  This article provides some understanding and tips for conservatively managing back pain.  The suggestions provided are not intended to replace the role of a qualified medical professional.  If you try one of the recommendations with worsening of your condition, you should cease immediately and consult a health care professional.

CONNECT WITH YOUR BACK

What are some causes of Low Back Pain?  The majority of people (>85%) have an unclear etiology or abnormality in the spine causing low back pain.  Many people will attribute their back pain to osteoarthritis, spinal stenosis, herniated discs, strain to the ligaments in the back, poor posture, and multifactorial.

HARMONIZE WITH YOUR BACK

What can you do to improve and prevent LBP? Treatment modalities for low back pain are dependent on the underlying cause.  If there is a structural component, releasing any structural restrictions anomalies through proper stretching and strengthening can improve functional limitations.  Any muscle weakness in the supporting structures of the back including the gluteal muscles, back muscles and abdominal muscles as well pelvic floor muscles should be strengthened. Tightness in hamstring muscles, hip flexors should be released and stretched.  Although high-impact activities may worsen pain, light exercises such as walking, stretching and swimming can be therapeutic.

Awareness of proper posture and body balance can also help improve low back pain.   Studies have shown that tai chi class not only benefits postural awareness and balance but improves low back pain for many.  

Chronic low pain can result in changes in mood and ability to cope with daily activities.  Addressing the psychological component of low back pain can also help the healing process.  In a recent JAMA article, mindfulness-based stress reduction or cognitive behavioral therapy, compared with usual care, resulted in greater improvement in back pain and functional limitations.  

INTEGRATE OSTEOPATHY

Osteopathic Manipulative Medicine (OMM) is a treatment modality that allows the body to heal itself. Subtle movements that osteopathic physicians perform can release tension or strain on a muscle and allow the muscle to become relaxed.  In a recent study, OMM was found to be more effective when combining it with conventional therapy for chronic low back pain. If you are unable to find relief from corrective exercises and postural retraining, consider osteopathy or mindful meditation.

Further Resources

Licciardone, J. C., Gatchel, R. J., & Aryal, S. (2016). Recovery From Chronic Low Back Pain After Osteopathic Manipulative Treatment: A Randomized Controlled Trial. The Journal of the American Osteopathic Association J Am Osteopath Assoc, 116(3), 144.

Cherkin D.C., et. al. (2016). Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual care on Back Pain and Functional Limitations in Adults with Chronic Low Back Pain. JAMA. 2016: 315(12):1240-1249.

Image: https://i.ytimg.com/vi/LtWbmSbrMgk/maxresdefault.jpg

Coming to America: The Land of Opportunity and--Health?

By Diego Quiros, Candidate for Doctor of Osteopathic Medicine 2017

The issue of immigration—particularly Latino immigration—has become a hot-button topic of discussion in recent months given the proximity of the 2016 presidential election here in the United States. Much of the dialogue has centered around issues of deportation and legal status. While much of the press is negative, a 2006 Gallup poll showed that Americans’ views on immigration have actually improved since 9/11. 60% of blacks and 68% of non-Hispanic whites view immigration favorably. While most of the attention focuses on the legal status and economic impact of these immigrants, it is interesting to reflect on the social implications of immigration, particularly Latino immigration.

Researchers have made efforts to study the Latino immigrant plight. While there are indeed many obstacles facing immigrants, researchers have proposed that health may not be one of them. In 1986, Dr. Kyricaos C. Markides—then professor of sociomedical sciences at the University of Texas Medical Branch in Galveston, TX—first used the phrase Hispanic Epidemiological Paradox. Now commonly known as the Hispanic or Latino Paradox, this term is used to describe the phenomenon whereby Latinos immigrants—particularly 1stgeneration immigrants-- have more favorable health outcomes than their White and Black American counterparts despite significant socioeconomic hurdles. A Dallas Morning News article pointed out that, “Hispanics live 2.5 years more than whites and, in some states, 8 years longer than African Americans.” 

CONNECT WITH THE LATINO HEALTH PARADOX

Several theories have emerged in an effort to explain the Latino Paradox. One contributing factor cited by researchers such as Bruce Bower may be place of birth, though this has been disputed. A more popular theory is that simply living in communities with other Latino immigrants in similar situations may be protective in and of itself. These tight communities reinforce family bonds, forge lasting friendships, and create social networks which work together—often through community institutions like churches—to help each other. Conversely, while acculturation would seem to be helpful, it can actually be detrimental to the health of these individuals. Lara et al 2005 found that more assimilated individuals are more likely to abuse alcohol and illicit drugs and to have poor diets. 

While there is much research still to be done on this sometimes controversial topic, it is important to recognize that there are healthy patterns among these individuals. While the exact reasons behind this are still being put into focus, it seems clear that there are many factors involved.

HARMONIZE WITH THE COMMUNITY

While Latino immigrants make up only part of a much larger and more diverse community, there are lessons to be gleaned from their collective experience, particularly with regards to family and community. Here are some simple steps we can take in our own lives to help improve our own relationships:

Making more time for family: Set aside time from our busy schedules to spend an hour or two with our families. While this is not always possible given out hectic lives, it helps the mind, body, and soul. Having dinner together as much as possible is a simple way to do this.

Getting involved: It is important to make time for activities outside the home to get in touch with other members of society, perhaps by simply volunteering at our schools or churches. Even an afternoon of helping out at a local clinic or bake sale can fill one with great satisfaction.

Checking in on our neighbors: Simply getting to know those who live around us and checking in from time-to-time can help foster a more close-knit community feeling. This is especially true with our elderly neighbors. With an aging baby boomer generation, this becomes even more important. 

INTEGRATE YOUR OWN EXPERIENCES

It is important to note that all this is not to say that other sections of our society do not have their own lessons to contribute with regards to family, community, and society. Indeed, the beauty of this country is that we all come from unique backgrounds with our own individual experiences. This makes the opportunities to learn that much greater. In a climate where it is becoming easier to create dividing lines based on ethnicity, race, creed, sex, age, and gender, perhaps it is time to reflect on these differences in a more positive light and come together and learn from each other.After all, united we will always be a stronger community, nation, and world. 

“The land flourished because it was fed from so many sources–because it was nourished by so many cultures and traditions and peoples.”--Lyndon B. Johnson

Works Cited:

http://www.gallup.com/poll/23623/Americans-Views-Immigration-Growing-More-Positive.aspx

Markides, K. S.; Coreil, J. (1986). The health of Hispanics in the Southwestern United States: An epidemiological paradox. Public Health Reports, 101, 253-265.

http://www.dallasnews.com/opinion/sunday-commentary/20140117-decoding-the-hispanic-paradox.ece

Bower, Bruce (2004). "Immigration blues: Born in the USA: Mental-health deficit". Science News 166 (25–26): 387–8. 

Hoggatt, K., Flores, M., Solorio, R., Wilhelm, M., Ritz, B. The “Latina epidemiologic paradox” revisited: The role of birthplace and acculturation in predicting infant low birth weight for Latinas in Los Angeles, CA. Journal of Immigrant and Minority Health. 2011;1–10

Eschbach, Karl; Ostir, Glenn V.; Patel, Kushang V.; Markides, Kyriakos S.; Goodwin, James S. (2004). "Neighborhood Context and Mortality Among Older Mexican Americans: Is There a Barrio Advantage?". American Journal of Public Health 94 (10): 1807–12.

Lara, Marielena; Gamboa, Cristina; Kahramanian, M. Iya; Morales, Leo S.; Hayes Bautista, David E. (2005). "Acculturation and Latino Health in the United States: A Review of the Literature and its Sociopolitical Context". Annual Review of Public Health 26: 367–97.

http://www.pbs.org/newshour/rundown/seven-skills-americans-can-learn-from-immigrants/

Images: 

http://www.calstatela.edu/sites/default/files/univ/ppa/images/LaPared-hi.jpg

http://learnercenteredhistory.wikispaces.com/file/view/Farmerssugarbeet_workers_1920s.jpg/260405256/Farmerssugarbeet_workers_1920s.jpg

Mediterranean-Style Grilled Salmon (Serves 4)

By Chelsea Halprin, Candidate for Doctor of Osteopathic Medicine 2017

2 tablespoons chopped fresh basil

1 tablespoon chopped fresh parsley

1 tablespoon minced garlic

2 tablespoons lemon juice

4 salmon fillets

Black pepper

8 green olives, chopped

Balsamic vinaigrette

Directions: Prepare the grill. Lightly coat the grill rack with cooking spray. In a small bowl, combine the basil, parsley, minced garlic and lemon juice.  Spray the fish with cooking spray. Sprinkle with black pepper. Top each fillet with equal amounts of the basil-garlic mixture. Place the fish herb-side down on the grill. Grill over high heat. When the edges turn white, after about 3 to 4 minutes, turn the fish over and place on aluminum foil. Move the fish to a cooler part of the grill or reduce the heat. Grill until the fish is opaque throughout (about 4 minutes longer). Garnish with green olives. Add splash of balsamic, as desired.

Skin Deep: Controlling Acne

By Chelsea Halprin, Candidate for Doctor of Osteopathic Medicine 2017

Skin protects and, at times, defines us. Our face is our identity, almost like a social fingerprint. Therefore, it’s no wonder that patients--especially young adults--are disheartened by acne. To self conscious patients--those caught in the vicious cycle of “pick and cover”--to anyone who has ever had or may develop acne, to friends and family of sufferers: this article is for you.

The good news. You have many useful tools in your toolbox to fight against acne. The first step of a successful battle is knowing your enemy. Acne is the most common skin problem in the United States. About 40 to 50 million Americans have acne at any one time. Acne appears when a skin pore becomes clogged. Normally, dead skin cells are shed from the surface of a pore. When the body makes excess sebum (oil that keeps skin from drying out) dead skin cells stick together inside the pore. Instead of rising to the surface, cells become trapped inside. Bacteria that live on our skin (i.e., p. acnes) can grow inside clogged pores, causing the pores to become red and swollen. If the inflammation goes deep into the skin, an acne cyst or nodule appears.

CONNECT WITH YOUR SKIN

Since excessive skin oil is the root of the problem, acne can be avoided by controlling the environment that promotes oil production or exposure. Kitchens tend to be a place where grease accumulates in the air.  Hot showers can dry out the skin and cause compensatory oil production. Greasy skin or extremely dry skin promote clogging of pores with oil. It doesn’t matter whether excess oil comes from the environment or from the body’s attempt to correct oil losses. The end result of acne is the same.

Other causes of excessive body oil exposure include: Oil based cosmetics, shampoos, or sunscreens. Look for products without petroleum.

Here are some myths to be aware of. The following things do not make your acne worse, contrary to what people previously believed:

• Foods such as pizza and sweets. 
• Lack of proper hygiene. 

As such, avoid excessive scrubbing which dries and irritates skin further, making skin prone to acne outbreaks.  Limit face washing to a maximum of 2-3 times per day.

HARMONIZE: SEE YOURSELF ACNE FREE 

Management of acne flare-ups includes avoiding abraisive soaps and refraining from squeezing the lesions. These are examples of trauma that force pus into the dermis and result in scarring and inflammation. 

Over the counter and prescribed acne medicines generally work by three methods:

1. Kill bacteria that cause inflammation.
2. Remove excess skin oil.
3. Speed up removal of dead skin cells, while promoting growth of new skin cells 

 Benzoyl peroxide. Kills bacteria that cause acne, and helps remove excess oil and dead skin cells.
 Salicylic acid. Prevents accumulation of oil and dead skin cells.
Alpha hydroxy acids. Two types include glycolic acid and lactic acid. Remove dead skin cells and reduce inflammation, while stimulating the growth of new skin.
Sulfur. Prevents accumulation of oil and dead skin cells. Often combined with other ingredients, such as salicylic acid or benzoyl peroxide.

Other treatments for moderate to severe or refractory acne include:
Antibiotics. Doxycycline, Tetracycline, Erythromycin, Clindamycin
Oral Contraceptive pills (for females). There is an undeniable connection between hormones and acne. A woman's ovaries and adrenal glands normally produce low levels of androgens, including testosterone, which stimulate sebum production. Taking birth control pills that contain estrogen and progesterone inhibits androgen production in the body. This results in less sebum and, consequently, less severe acne.
Retin-A (Isotretinoin). Also known as Accutane; vitamin A derivative that dramatically reduces the size of oil glands and prevents dead skin cells from accumulating and clogging pores. 95% of patients taking Accutane report clearance of acne within 15-20 weeks. This is a very potent drug that requires liver and lipid profile monitoring. Female patients must use two forms of contraception while taking Accutane because of its ability to cause birth defects in developing fetuses.
Laser & light therapy. This therapy kills bacteria that cause acne, may also shrink oil glands.
Steroid injection. Most often used for painful acne with nodules and cysts. Decreases inflammation, promoting clearance of acne within 2-4 days. Side effects include thinning of skin, appearance of prominent blood vessels, loss of skin pigmentation.
Chemical peels, prescription strength. The doctor applies a mild chemical solution to skin, which unclogs pores and removes dead skin cells.
Drainage and extraction. The doctor uses special instruments to expose and drain clogged pores. Results are often temporary.

INTEGRATE SKIN HEALTHY ALTERNATIVES 

Consider these skin-friendly foods, which are rich in antioxidants and healthy fats:

• Carrots, apricots, and other yellow and orange fruits and vegetables 
• Cranberries, blueberries, blackberries 
• Purple and red grapes 
• Almonds, walnuts 
• Beans, peas and lentils 
• Tomatoes 
• Spinach and other green leafy vegetables 
• Salmon, mackerel and other fatty fish 
• Dark chocolate >70% Cacao 

Try some of these recipes today! Each features a skin-friendly ingredient.

• Green smoothie 
• Tomato Basil Bruschetta 
• Mediterranean-Style Grilled Salmon 

Resources

http://www.webmd.com/food-recipes/10-super-foods?page=2 https://www.aad.org/public/diseases/acne-and-rosacea/acne http://www.mayoclinic.org/diseases-conditions/acne/in-depth/acne-treatments/art-20045892?pg=1 http://www.organicmakeup.ca/ca/PetroleumCosmetics.asp http://www.webmd.com/skin-problems-and-treatments/acne/birth-control-for-acne-treatment http://www.acne.org/accutane.html

Tomato Basil Bruschetta (Serves 6)

By Chelsea Halprin, Candidate for Doctor of Osteopathic Medicine 2017

Baguette, cut into 1/2-inch-thick slices

2 tablespoons chopped basil

2 cloves garlic, minced

6 Roma tomatoes, diced

1 teaspoon olive oil

2 teaspoons balsamic vinegar

1 teaspoon black pepper

Parmesan, grated

Directions: Toast baguette slices with parmesan in oven until lightly browned, 400 F. Mix all other ingredients. Spoon mixture over toasted bread.

Green Smoothie (serves 4)

By Chelsea Halprin, Candidate for Osteopathic Medicine 2017

1 banana

1/2 cup strawberries

1/2 cup blueberries

Lemon juice (about 2 tablespoons)

1 cup raw baby spinach

1 cup ice

Directions: Place all ingredients in a blender and puree. Serves as an excellent source of vitamins A and C. 

Gastritis

by Rebecca Cho, Osteopathic Doctoral Candidate 2017

What is Gastritis?

Gastritis is the inflammation or irritation of the stomach lining. Some people can have sudden and short lasting episodes of gastritis (acute) or in some people the condition can last for months or years (chronic).  Chronic gastritis has different levels of severity depending on the level of damage to the mucosal lining.  Initially, the most superficial layer and some glandular parts of the lining is damaged.  As the condition progresses deeper, more of the glands are destroyed and lost.

What causes gastritis?

• Helicobater pylori – The most common cause of acute gastritis is by an infection of with H. pylori.  If left untreated, acute H.pylori gastritis can progress to chronic gastritis. 
• NSAIDs – Non- Steroidal Anti-Inflammatory drugs such as Aspirin, Ibuprofen (Motrin, Advil) or Naproxen Sodium (Aleve, Naprosyn). 
• Alcohol
• Chronic vomiting
• Stress
• Autoimmune Disorder – the body’s defense system attacks the stomach lining 

What are the symptoms of gastritis?

Symptoms of gastritis vary from person to person and can range from being asymptomatic to being very troublesome.

• Nausea
• Vomiting
• Hiccups
• Belching
• Abdominal bloating
• Indigestion
• Upper abdominal pain
• Loss of appetite
• Vomiting blood or coffee ground like substance
• Black, tarry stool

How is Gastritis Diagnosed?

Diagnosis of Gastritis requires the use of an endoscope which is a camera that is guided down to the stomach from the mouth to look at the lining of the stomach.  At the same time, your doctor may decide to do a biopsy which is the removal of a small piece of stomach tissue so it may be examined under the microscope.

What other tests can I expect?

Tests to check for H. pylori:

• breath test
• blood test
• stool test

Blood test to check for anemia
Barium swallow – this allows your doctor to see how things are moving along in your stomach via xray.

How is Gastritis treated?

Avoiding the causes of your gastritis is the first step.  (NSAIDs, alcohol, stress, hot or spicy foods, etc)

For H. pylori gastritis, a combination of 3 or 4 drugs is prescribed.  This combination of drugs include different antibiotics as well as a proton pump inhibitor to decrease acid production.

Other causes of gastritis can be treated by reducing stomach acid with various medications such as:

• Antacids 
• Histamine blockers
• Proton pump inhibitors

Who is at Risk for Gastritis?

People whose lifestlyes increase stomach acid are at increased risk for gastritis. Frequently eating fats, oils, citrus, coffee and alcohol can all increase risk for gastritis.

How can I prevent gastritis?

You can try to monitor your lifestyle and diet to avoid risk factors for gastritis. Avoidance of trigger foods as well as lowering stress may also help with prevention.

References

http://www.merckmanuals.com/professional/gastrointestinal-disorders/gastritis-and-peptic-ulcer-disease/helicobacter-pylori-infection#v892052

https://my.clevelandclinic.org/health/diseases_conditions/hic_Gastritis

http://www-uptodate-com.proxy.westernu.edu/contents/gastritis-the-basics?source=search_result&search=gastritis&selectedTitle=3%7E150

http://www.healthline.com/health/gastritis-chronic#Prevention8

Resilience: Overcoming Adversity with Success

Have you been bullied, rejected, criticized or traumatized?  When I was a child, my grandmother shared her wisdom of bouncing back despite the harsh reality of the suffering in life.  Although she would describe her life as a series of tragic events, those events not only shaped her resilient character but impacted mine as well.  Despite losing her parents and being bullied as a child and undergoing years of raising a family in internment during the war, she was able to persevere like the Daruma doll that held a place on her dresser before she developed dementia and passed.  Her stories of overcoming the odds continue to give me hope and inspiration.

Nana korobi yaoki | Fall down seven times, Get up eight

This Spring set of posts have been designed to bring awareness to overcoming just a few challenging life experiences (e.g., self-injury, alcoholism, dementia, cancer).  We all have our own challenging life experience to share that shapes our character.  This article presents some resiliency strategies to bouncing back from major adversity or trauma. Developing resilience is a personal journey. People do not all react the same to traumatic and stressful life events. An approach to building resilience that works for one person might not work for another. People use varying strategies. The recommendations presented should not replace the role of a qualified health care professional.  If you are struggling through difficult times, it is important to have a strong support network which should include your health care provider.  Many studies show that the primary factor in resilience is having caring and supportive relationships within and outside the family. Relationships that create love and trust, provide role models and offer encouragement and reassurance help bolster a person's resilience.

What is resilience?

After the Civil War and following the death of three of his children to spinal meningitis, Dr. Andrew Still, the founder of osteopathy, made it his life work as a physician to discover why certain people succumb to illness while others don't when confronted with the same attack, injury, or exposure to a tragic event.  He found the orthodox medical practices of his day ineffective, and sometimes harmful. Amidst the grieving of his own children as a physician, Dr. Still evolved his medical practice to include the following discovery regarding resilience: the body contains all the elements to maintain health if properly stimulated.  Being resilient doesn't mean going through life without stress or pain but rather being able to work through these difficulties in a healthy manner.  The key is to identify ways that are likely to work well for you as part of your own personal strategy for fostering resilience.

Connect with Self & Others

Encourage a positive self-image.  Developing confidence in your ability to solve problems occurs through willingness to fail before succeeding.  Trusting your instincts and appreciating your gifts and strengths helps build resilience.
Be willing to self-discover. People often learn something about themselves and may find that they have grown in some respect as a result of their struggle with loss. Many people who have experienced tragedies and hardship have reported better relationships, greater sense of strength even while feeling vulnerable, increased sense of self-worth, a more developed spirituality and heightened appreciation for life.
Make connections with trusted individuals. Healthy relationships with close family members, friends or others are important. Accept help and support from those who care about you and will listen to you. Some people find that being active in civic groups, faith-based organizations, or other local groups provides social support and can help with reclaiming hope. Assisting others in their time of need also can benefit the helper.

Harmonize with Healthy Values

Avoid seeing adverse events as hopeless problems. You can't change the fact that we all have our challenges and problems arise, but you can change how you interpret and respond to these experiences. Resilience involves adapting to future similar situations by learning from past struggles. Note any subtle ways in which you might already feel somewhat better as you deal with difficult events.
Keep things in perspective. Even when facing very painful events, try to consider the stressful situation in a broader context and keep a long-term perspective. Avoid blowing the event out of proportion.
Maintain a hopeful outlook. An optimistic outlook enables you to expect that good things will happen in your life. Try visualizing what you want, rather than worrying about what you fear.

Integrate Change in your Lifestyle

Take decisive actions. Act on adverse situations as much as you can. Take decisive actions, rather than detaching completely from problems and stresses and wishing they would just go away.
Accept that change is a part of living.  Certain goals may no longer be attainable as a result of adverse situations. Maximize your potential by accepting circumstances focusing on circumstances that you can alter.
Move toward your goals. Develop some realistic goals. Do something regularly — even if it seems like a small accomplishment — that enables you to move toward your goals. Instead of focusing on tasks that seem unachievable, ask yourself, "What's one thing I know I can accomplish today that helps me move in the direction I want to go?"

We can all be the change we want to become.  

It is just a matter of having the strength and courage to rise to the challenge knowing there will be struggles and obstacles along the way.  In order to succeed, we must be willing to fall down and get back up.

Exercise with Control

Physical activity is critical for overall health at every age and the benefits to daily exercise far outweigh the risks. Moderate intensity exercise is safe for most people, even those that have had previously sedentary or unactive lifestyles. Exercise, however, is not always without its risks. 

Many people are unaware of the high incidence of injuries that occur while exercising at home. According to data collected by the US Consumer Product Safety Commission, almost 460,000 people were sent to the hospital in 2012 for injuries related to exercise equipment, the vast majority involving a treadmill. An estimated 428,000 of these injuries were treated and released for their injuries—but the remaining 32,000 needed to be hospitalized for further careor even worse - were dead on arrival. The US CPSC further reports “about 19,000 people went to the emergency room from treadmill related injuries in 2009, including almost 6,000 children”. Most recently, Survey Monkey Chief David Goldberg passed away from a head injury acquired from falling on his treadmill at home. For these reasons, it is important to take the proper precuations to decrease your risk of injury. 

The Physical Activity Guidelines for Americans 2008 offers these guidelines for staying safe while exercising

1. Start with activities that match your fitness level: When you begin a new exercise program, it is a good idea to ease into a workout so as not to push your body too far and put yourself at risk for injury. 

2. Warm Up & Increase activity gradually. Moderation is the key to safe exercise. Gradually build up in intensity, frequency, and duration. Protect yourself by warming up to prepare for exercise. Warming up will get your heart rate and blood flow going, and loosen up your muscles, joints, and ligaments so they are ready for action. 

a. Use the proper equipment – Make sure you are wearing the proper footwear and loose-fitting, comfortable clothing that is breathable and will release excess body heat. 

b. Pay attention to the weather – If the weather is hot outside, make sure to hydrate and wear breathable clothing. Drink enough water to prevent dehydration and heat exhaustion. Drink 1 pint of water 15 minutes before you start exercising and another pint after you cool down. If exercising in cold weather, dress in layers to keep your body warm. 

3. Take your Time. During stretches or strength training, move through the full range of motion. Never stretch to the point of pain or beyond what is comfortable. Remember to breathe regularly to make sure your heart, brain, and lungs are receiving adequate blood flow and oxygenation.

4. Rest. Listen to your body. Take days off from exercise when you are feeling fatigued. 

5. Let your doctor know about your chronic medical conditions or if you are pregnant: Your doctor can help you tailor a fitness plan that is safe for you. 

Resources 

1. http://www.usnews.com/news/business/articles/2015/05/04/surveymonkey-ceo-died-of-head-trauma-in-exercise-accident

2. http://www.theguardian.com/technology/2015/may/01/surveymonkey-david-goldberg-died-head-injury-treadmill-fall

3. http://orthoinfo.aaos.org/topic.cfm?topic=a00418

Chemotherapy-Induced Peripheral Neuropathy

By Mana Baskovic, Osteopathic Physician Candidate 2016

You have CANCER! Arguably, one of the most frightening statements you can find yourself on the receiving end of. This one word can, within seconds, cast a shadow of fear, uncertainty, questions, anger, and sadness upon a person and their entire family. But, we now also live in an age where perhaps many cancers can be cured or treated. Women with breast cancer are now living well beyond the five-year time-point, where at five years you are considered to be in “remission” and cancer free (where the risk of the cancer returning is reduced to single digit percentages). So with all of the remarkable advances in cancer treatment, why is it that we find remnants of the disease that persist long after the cancer is removed; case in point, chemotherapy-induced peripheral neuropathy. 

What is Peripheral Neuropathy? The term “peripheral neuropathy,” “polyneuropathy,” and “neuropathy” are used interchangeably, even though each describes a unique entity of neurological disorders. Broadly, the terms refer to a generalized process affecting many of the peripheral nerves, while distal nerves are more greatly affected, specifically the nerves providing sensation to the fingers and toes. 

What Causes Peripheral Neuropathy? While there are numerous factors that can cause peripheral neuropathy, some of the more common culprits include platinum-based chemotherapy drugs, long-term diabetes, alcohol abuse, and less common neurological accidents and/or disorders. 

How Do I Know If I Have Peripheral Neuropathy? The symptoms of peripheral neuropathy usually include symmetrical loss of sensation, tingling, burning, and/or weakness. The symptoms are most prevalent in the fingers/hands and toes. However, some patients report having nerve symptoms in other locations as well.  The symptoms can lead to difficulty walking, as we rely on our toes for movement, and trouble with daily activities that require intricate use of our hands, for example typing, opening containers, combing hair, etc. The pain and discomfort of peripheral neuropathy are often times accompanied by sleep and mood disturbances, fatigue, and difficulties carrying out everyday life activities. 

Connect With Your Nerves

The central nervous system is made up of the brain and spinal cord. Information is transmitted to and from the central nervous system via nerves, similar to telephone wires. These “telephone wires” are called “peripheral nerves” in the human body. Peripheral neuropathy is characterized as any disorder that prevents the proper functioning and transmission of information through nerves. This damage can lead to decreased sensation or over-sensitization where the smallest stimuli, that may normally be painless, can cause severe debilitating pain.

What is Chemotherapy-Induced Peripheral Neuropathy (CIPN)? Commonly used chemotherapy drugs that have been linked to CIPN include ixebepilone, the vincaalkaloids (vincristine and vinblastine), the taxanes(paclitaxel and docetaxel, and platinum-based regimens (cisplatin, oxaplatin, and carboplatin). While some patients with CIPN appear to recover after treatment is discontinued, the same is not true for patient treated with platinum-based drugs. Researchers have found that 30-40% of patients undergoing chemotherapy go on to develop signs and symptoms of peripheral neuropathy. CIPN generally begins to rear its ugly head after the first dose of chemotherapy and the symptoms tend to worsen with each additional treatment/cycle, simply put the symptoms and damage become additive. The unfortunate reality of platinum-based chemotherapy drugs is that the damage that is caused to the peripheral nerves is usually long lasting, if not permanent. 

What are Possible Preventative Measures? According to the National Cancer Institute, the following preventative measures have shown promise in limited clinical trials. 

Glutathione | Low levels of glutathione have been found in “wasting and negative nitrogen balance,” as observed in diseases such as cancer. Glutathione acts as an antioxidant reducing and eliminating reactive oxygen species. 

Intravenous Calcium and Magnesium | In recent studies, researchers have found that only 4% of patients treated with IV calcium and magnesium, before and after each chemotherapy treatment, had to discontinue treatment due to neurotoxicity, compared to 33% that were treated with placebo only. Also, the same study found that of those patients treated with calcium and magnesium who went on to develop CIPN, the onset of symptoms was often delayed and lesser in intensity. 

Interleukin-6 (IL-6) | IL-6 in the human body is secreted to stimulate the immune response, ie. during infection or other tissue damage (cancer therapy). In recent animal studies, IL-6 has been found to prevent peripheral nerve damage. 

What are Possible Medical Treatment Options?

Gabapentin (Neurontin) | A medication used for both prevention of seizures and pain management. This drug is currently FDA-approved for use in seizure disorders and neuropathic pain following shingles. However, off-label use of the drugs has become common place in treatment of CIPN. 
Valproate (Depacon) | This drug is an anticonvulsant (anti-seizure) medication used in the treatment of many disorders including anorexia, panic disorder, anxiety, post-traumatic stress disorder (PTSD), bipolar, and migraines. This drug is also prescribed “off-label” for the treatment of diabetic neuropathy and hence why it has also been used in CIPN. 
Antidepressants | Another off-label use includes that for the antidepressant venlafaxine (Effexor) used in the treatment of CIPN. However, it is uncertain whether the drug actually combats the damage to the peripheral nerves or if the anti-depressant effects play the larger role. 

Harmonize With Your Body

What lifestyle changes can help? 

Stay Active | It has long been proven that patients who are active, within reasonable means, before, during, and after chemotherapy treatment tend to do better overall. The thought is to “move your body every day,” even if it is a short walk, gentle stretching, or anything with reasonable intensity. Listen to your body. 

N-Acetyl Cysteine | This supplement can help your body produce more glutathione, which as mentioned, is an incredible antioxidant that helps to detoxify your body as a whole. 

Alpha Lipoic Acid | This antioxidant in most natural health stores is found to be effective in CIPN prevention. 

Omega-3 Fatty Acids | This powerful antioxidant found in fish, but also available in tablets, reduces inflammation throughout all of the tissues of the body. 

Integrate Complimentary Integrative Medicine

What can be expected during an osteopathic manipulative treatment? 
Your osteopathic physician will begin by assessing your symptoms, both from a medical and lifestyle perspective. The physician will increase lymphatic circulation with various maneuvers to encourage elimination of waste and proper cleansing of the tissues.  Strain patters will also be addressed and released to allow increased blood supply and nerve conduction to various tissues. Another technique that can be of benefit is myofacial release of strains in the fascia (connective tissue below the skin), muscles, and joints. 

References:

1. http://www-uptodate-com.proxy.westernu.edu/contents/overview-of-polyneuropathy?source=search_result&search=neuropathy&selectedTitle=1%7E150#H3

2. https://www.columbianeurosurgery.org/conditions/peripheral-nerve-disorders/

3. http://www.cancer.org/acs/groups/cid/documents/webcontent/002908-pdf.pdf

4. https://www.caring.com/articles/peripheral-neuropathy-treating-it-the-natural-way