VITALITY SIGNS

Being an informed patient is an empowering concept.¹ In the modern healthcare marketplace, the doctor-patient relationship has become a two-way street. It’s no longer a situation in which the doctor tells the patient what to do. Today, patients can be full partners in managing their care and well-being.²

What does it take to be an informed patient, one who can participate in a meaningful way and not be merely the passive recipient of the doctor’s instructions and recommendations?

The first key is to identify a doctor - a chiropractor or family physician, depending on the circumstances - in whom you have confidence. Here are a few essential points to consider —

The questions you ask are not just to keep talking and capture more of the doctor’s time spent with you. An informed patient does some preparation – some homework – before the actual office visit. The Internet offers a lot of valuable information on both chiropractic and medical treatment. And, it’s important to remember that not all information is accurate and authoritative —

Do your best to evaluate the doctor’s recommendations. First, what are the expected results? How quickly should you begin to feel better? Are there potential side-effects of the recommended treatment? What are the alternatives?

Alternatives may include other forms of therapy within the doctor’s office and may also include consultation with another specialist. The main point is not to be left with a confusing array of choices, but to have enough information to go forward with a treatment plan that makes the most sense, both to your doctor and to you.

If a prescription is involved, make sure you write down the exact spelling of the medication and the exact dosage and frequency. Prescriptions are usually scribbled, and both doctors and pharmacists can make a mistake. Don’t let your doctor simply hand you an illegible piece of paper. Insist on ensuring that you understand what is being prescribed, and be sure to ask your doctor about potential side effects, risks, and interactions with any other medicines you may be taking.

As in all relationships, the doctor-patient relationship is based on clear communication and mutual trust and understanding.

You can help your doctor help you by being informed and participating in the decision-making process.

¹Informed Consent. “Ethics in Medicine”. University of Washington School of Medicine. link
²“Be an active healthcare consumer”. Agency for Healthcard Research and Quality. link

Since mid-Fall TV commercials have been trumpeting the horrors of the “flu season”. “It’s never too soon to begin fighting this year’s bug” they blare. Public health announcements urge us to get our “yearly flu shot”, as if this is something we’ve got permanently scheduled in our Blackberries. All the leading over-the-counter pain medications offer special seasonal “flu” mixtures, and their ads deluge daytime and prime-time broadcasting.

For the health consumer, namely us, it seems as if this annual “war on the flu” is received wisdom. We’re just defenseless human beings at the mercy of the all-powerful flu virus.

What’s wrong with this picture?

What’s never mentioned in the “flu warning” marketing is the versatility and adaptability of our remarkable immune system. We’re the lucky owners of a built-in state-of-the-art biowarfare system, on-the-job 24/7 to combat microscopic foreign invaders of our health and well-being. Once our immune system has detected a foreign protein it mounts an immediate defense, attacking and destroying the alien molecules. And, the memory of that particular invader is permanent, enabling a future immune response to be swift and effective.¹

The big issue with influenza is that new strains appear each year. We’ve never encountered these germs before. But, the whole basis and strength of our immune system is flexibility. It is specially designed to respond quickly to new attackers. And, for the most part, it does this very, very well.

Of course, no one wants their dinner companion to sneeze in their plate of pasta, as Elaine did on an infamous episode of “Seinfeld”. Through a typical cascade of unfortunate events, Jerry’s and George’s comedy pilot was almost scuttled because the network executive was Elaine’s date, and he got violently ill by being on the receiving end of her blast of micro-bugs.

In the real world, our immune systems can be weakened due to life habits, circumstances, and stress. Stress is a notorious compromiser of immune defenses.² And, of course, being human, there’s plenty of stress from dawn to dusk. If worry and anxiety pile on top of not-enough-sleep or sub-optimal nutrition, getting sick is a pretty likely outcome. So, developing and maintaining healthy habits of living and successful strategies for managing stress is really the key.³

If you do the simple things that keep you healthy and well, in the winter months you can pretty much “let the flu go around you”. You can be confident, knowing you’ve done the work to fight off the latest flu threat. Someone else’s germs are their germs, not yours. If your immune system is on the job, you’re far less likely to “catch” something.

And, even if you do succumb, you’ve got a much better chance of getting well again quickly.

¹Sompayrac L: How the Immune System Works, 2nd ed. Blackwell, 2002.
²Wein H:Stress and disease - new perspectives. NIH Word on Health, October 2000.
³The Truth About Your Immune System - What You Need To Know. Harvard Health Publications, 2007.

“There I am,” a very fit patient is saying, “out on my five-mile run, motoring my way up a steep incline. Suddenly, I feel a throbbing pain in the middle of my right shin. Oh, no, I think, not again.”

As things turned out, the patient recovered from the shin splints¹ quickly, but he knew he’d dodged a bullet. “Why did I get hurt?” he wanted to know. “I wasn’t doing anything wrong.…What can I do to make sure this doesn’t happen again?”

All very good questions. One answer is – basically - we need a plan for exercise. A powerful strategy that helps us train smart and train safe. When you’re working this way - training smart and safe - then you can also train hard.

Training safe and smart means paying attention to what’s happening in your body as you do your workout. “Paying attention” is a learned skill. It requires focus and repetition. Visualization is an important part of focus - and, if you’re working on visualization, you’re definitely paying attention!

You can visualize when you’re running, too.
• Visualize an erect, fluid spine and strong abdominal muscles.
• Your head is upright, you’re looking forward and slightly down, and your chest is open.
• Your arms are active yet relaxed, and your shoulders sit comfortably on your rib cage.
• Visualize a long stride, a soft landing, and a strong pushoff, with your leg kicking straight behind you.

Training smart means trusting your instincts, rather than listening to your ego. This is a tough one. At the time, it seems so important to do that last rep. Now, you can do that last rep if you maintain your form. Form is everything. If you have to sacrifice form in order to do those last few reps, you may get an unexpected, unwelcome result.

Likewise in running. When your form breaks down, that’s a signal to slow down and recover your good mechanics. If your training is done with attention to proper, effective form, you’ll be more likely, when the time comes, to run a good race at a good pace.

And, of course, we want to do these things to be healthy and well. The American College of Sports Medicine² states, “Resistance training, particularly when incorporated into a comprehensive fitness program, reduces the risk factors associated with coronary heart disease and non–insulin-dependent diabetes, prevents osteoporosis, promotes weight loss and maintenance, improves dynamic stability and preserves functional capacity, and fosters psychological well-being.”

As in much of life, there’s a fine line between training hard and overtraining. Remember, the benefit of training is for the long term.

Visualization - The Zen of Exercise

Visualization – inner seeing – is a powerful tool for creating the life you want. Remarkably, visualization is also the secret ingredient in powerfully effective exercise.
Visualization enhances the mind-body connection. When you “see” your muscles working in your “mind’s eye”, the “wiring” between your brain and your muscles grows. More nerve-muscle connections are made, and your muscles get smarter and stronger. It’s a remarkable process.
And it doesn’t take any extra effort. Just think about it!

¹Couture CJ, Karlson KA: Tibial Stress Injuries: Decisive Diagnosis and Treatment of “Shin Splints”. Physician and Sportsmedicine 36(6):29-36, 200
²Kraemer WJ, et al: Progression Models in Resistance Training for Healthy Adults. Med Sci Sports Exercise 34(2):364-380, 2002.

Out of the blue, your back starts to hurt. At first, it’s just an annoyance. You can live with it. You’ve had lower back pain before and it went away on its own.

Now it’s a few weeks later. You’ve got a low-grade pain that’s not getting any better. You’re actually worse, in fact, because your back hurts most of the time.

What to do?

You don’t want to run to a doctor. After all, it’s just back pain. Everybody has back pain. So you begin to solicit advice from your friends. And, of course, your friends have plenty of advice. “Do these exercises my doctor gave me.” “Do these stretches - they worked for me.” “Go to yoga class.” “I know a great Pilates instructor. She’ll get you in shape and your back will stop hurting.” “Take vitamins and drink more water.” “Meditate.”

Your friends mean well and it’s all very good advice. But none of it seems to work. Another month goes by and now the pain is increasing. It’s even affecting your sleep.

It’s time to see a doctor. But which one? For the most part, medical physicians are not experts on back pain. Typical recommendations include rest, moist heat, and anti-inflammatory medication.^1,2 But, really, you’ve done all that. You need more specific advice.

Choices might include doctors of chiropractic, orthopedic surgeons, and physical therapists.

Many orthopedic surgeons are spinal specialists, but what they do is surgery. This would be a last resort, typically, after other treatment options have failed.

Physical therapists are highly skilled practitioners who focus on exercise, rehabilitation, and re-training. They are not primary care providers, and typically patients are referred to physical therapists by family physicians, chiropractors, and orthopedic surgeons.

Doctors of chiropractic are spinal specialists, too, and what chiropractors have to offer is expert conservative therapy.³ Chiropractors treat back-related problems all day, every day, and are the right doctor to see first.

As spinal specialists, chiropractors receive extensive training in evaluating patients with back pain. Chiropractors consider all aspects of the problem, and develop sound treatment plans based on the facts. If a person does not respond as anticipated, their chiropractor has a “Plan B” in place for further evaluation and possible referral.

When choosing a doctor, you’re allowed to ask questions and participate in the process. The strategy for follow-up is critically important.

First, if you’re improving and doing well, how will can you help keep the problem from recurring? Will your chiropractor prescribe stretches, exercises, and other self-care action steps to help you keep yourself well?

And, what steps will be taken if your problem and pain are not improving? Where might you be referred for further tests and evaluation? Chiropractic treatment is a powerful tool in most cases of back pain. Symptoms should begin to improve quickly. Have your chiropractor outline the “Plan B” if you are, in fact, not getting better.

Your doctor of chiropractic will be able to answer these questions.

¹Zuhosky JP, et al: Industrial medicine and acute musculoskeletal rehabilitation. Arch Phys Med Rehabil 88(3 Suppl 1):S34-39, 2007.
²Cayea D, et al: Chronic low back pain in older adults. What physicians know, what they think they know, and what they should be taught. J Am Geriatr Soc 54(11):1772-1777, 2006.
³DeVocht JW: History and overview of theories and methods of chiropractic. Clin Orthop Relat Res 444:243-249, 2006.