Saturday, July 29, 2017

Gonna make you sweat...


With a recent interview during patient hours, I had gone through my usual Q&A to develop a picture of the 2nd person in the room.  One of my pillars to a balanced antiinflammatory lifestyle change is activity.  EVERYONE HAS TO the US we conceptualize walking as a chore thinking there is status in not having to walk so far from the front door or being at the back of the line or being able to watch 200 channels after a huge dinner, paying for your pre-made food instead of having to make it or chop veggies or cook from scratch.
My patient said he goes to the gym for 60-75 min about 3 x weekly.  NICE!!! Then I ask what are the activities he relies on (thinking I may be able to change or rearrange his routine to get the most his time in the gym).  He said 15minutes is spent in the sauna, another 15 spent in the whirlpool...then he gets on the treadmill or uses machines.   So you are thinking, 30minutes getting warm, then the rest of the time expending energy on the gym floor.  Fits into the AHA's recommendations of 30min 3-5 days a week.  BUT...this is a business owner that has 2 jobs and works around 60-70 hours a week and shoots for 6-8 hours of sleep nightly.  Even with his enjoyment of heat and concept of relating sweating as a form of exercise....this is where the life coach in me says to better utilize total hours per week, cut out the heat and try to condition the cardiovascular system to tolerate HIIT, (driving the heart rate high in a short amount of time and sustaining it for 30min -DONE!) time in the gym, get sweaty and with the 90minutes of "freed up time" per week, we can dive into a mindful practice development or enjoy a walk or family time.

(So I like using the American Heart Associations saying of minimum activity is 3-5 days a week of 30min of moderate intensity exercise weekly. )

So speaking of the cardiovascular system, when the heart beats faster than resting state, it is a muscle and muscle generates heat.  The reason the heart beats fast is to supply freshly oxygenated blood to muscles that are moving.  All this muscle heat has to be offloaded for fear that the brain will heat up to high temps - and result in a seizure.  One way to neutralize temp, SWEAT.  Perspiration moves water to skin layer and evaporation is cooling.  Some proponents of detoxing say a lot of toxins will leave the body with sweat but ....regarding weight.  NO overall change when you reload the fluid you sweat out in the gym over the course of the next 12 hours.

1-sweating ok (unless you are on a water pill at which point you can drop blood volume too fast)
2-perceived exertion of sweating should be associated with breath and pulse rate
3-walk when ever you can, stand instead of sit, feel the body high of moving fast for short times
4-tie in healthy eating to healthy activity to healthy mindful practice (stillness in silence )
5-HIRE a COACH if you are stagnant with what you do / bored / plateaued on benefits

Sunday, January 18, 2015

Hormones like a teenager

In my prime-I was a muscle head.  Lived in Wildwood New Jersey.  Had 3 roommates (1 bartender and 2 bouncers).  Worked out at Atilis Gym in 1982, that summer the gym owners asked me to compete in a Mr East Coast and Mr Natural New Jersey.  I was 18 and didn't give a sh*t so I joined and won both (teenage divisions).  I lifted weights with some Venice beach-like-male-airheads and refined my "Muscle and Fitness magazine" body building movements.  (Joe Weider's publication was a bible back then)

I seemed to develop a lot of muscle mass with what I was taught so I took it with me to college and later.  I believe when we adapt a "routine" that: works, doesn't cause injury and gives size gains.....that becomes religion for the remainder of our exercise lives (at least for guys).  The lucky ones can still continue with the "usual" exercises no matter what age (maybe tailoring the routine to help with weight gain).  The not so lucky end up in physical therapy for some age related ache and are given a 3-6 week sentence with a physical therapist.  From that point on, free time limitations and achey reminders keep the "new routine" fresh.    

I stumbled upon alternative and complementary therapies when I tried to avoid rotator cuff surgery from a rock climbing injury in my 40's.  I did my own rehab and kept it to bare essential movements to maximize time in the gym and still get a "pump".  (can't let go of the feeling to muscle fiber with targeted movements with weights!!)  I beat the knife but it took a few years; I also dived into marathon running, yoga and more recently hiking.  Still can't stay away from trying to chisel a little muscle definition-so I have been doing this truncated weight/cardio work out (called peripheral heart action or circuit weight training before there was cross fit) guys do and getting by to work the heart and keep fit.

I started a new chapter in my life by signing a contract to go back to running a primary care office like I did in the 90's.  (worked in family medicine and carved a niche with my sports medicine clinic in Wheaton).  This week I decided to go back to using cables to work my shoulders.   [In a gym there are free weights, Nautilus-type machines to isolate body parts, universal cable machines for some restricted movement then Smith Machines for universal bars and big plates (wagon wheels).  So there I was.....pushing the envelope with repetitions, grunting from pain (had my bluetooth headsets on) and since it was empty-running between 3 stations back to back like a college crew teams would do.  As I finish my last of 3 giant sets, I feel a great pump to delts and ache...good heart rate....well targeted and I'm done!!  It just hit me, I was so used to the bare basics of quick power lifting movements that I forgot my old techniques of fine muscle tuning.  The feeling brought me right back to days at the gym in Wildwood NJ!!  Then I look up and see:


Saturday, March 29, 2014

Lose weight; change your life; don't get hurt.

Spring is here and most people are scrambling to start dieting.  If you are like everyone else playing catch up, don't expect to do things the same way this year.  The 2014 snow season kept most runners in, most drivers delayed, most exercisers bundled up.  The usual dietary reflex in the deepest cold is to seek nutrient dense comfort foods.  In other words, the bears are coming out of the den with an extra padding of fat this year.  It just so happens  there are also 2 drugs that are building up steam as part of the "cheat-code" for initiating weight loss.  Qsymia and Belviq were released in mid to late 2013 (and so far no deaths!!).  Of course the most important impact anyone can have to lasting weight control is total lifestyle change.
I maintain my patients seek to address 3 components of life:


The eating part everyone says "I know what to do, I just have to do it".  I disagree 100%!!!  If adopting a nutritional change was as easy as shopping the periphery of the grocery and choosing labels of low fat, our nation would be lean and healthy.  The World Health Organization published a controversial ranking of health throughout the world in 2000 and the US was 37th out of 190 countries (but we spent the most money per person in the world).  Seems out of proportion but just look at the check out line and notice how many people look overweight (1 in 3).  I just came back from an indoor water park and it was disappointing to see out of shape kids (waiting a few minutes I would see the inspirational out of shape parent float by) but then I thought this was job security for me.  However I refuse to just prescribe medicines and watch people become behaviorally addicted to weight loss drugs.  Anyone that goes to see me out of network knows if you want meds like phentermine, I must hear from your team of coaches to make sure I agree you are a "responsible adult".  When I hear the catch phrase above, it usually leads my brain to image how this person will look in 10 years.  (It's always the same-10 pounds heavier with 3 new medicines and 1 new surgical disease diagnostic procedure).  It takes more than just reading a few chapters from an author and experiencing 10 pounds of fat burning in 2 weeks back in college days to say you know what works for you.  In my short 20+ years of medicine, I have learned that community can overcome disease but disease can overcome the individual.  We have all the answers on how humans work (down the the DNA sequence) but a patient requires the knowledge to be applied in an individual designed lifestyle plan.  There is alot of great reproducible evidence out there (pubmed, google scholar) but I find myself "piece mealing" snippets of plans together to initiate, modify and maintain the routines people come in to see me for.  And it usually has to be reformulated in stages.  The "giving spirit" in me tries to keep people from spending their hard earned money on me and rather on nutrition, exercise and meditation coaches.  Infallibly, the plan works for a while but has to be reformulated as the goal was achieved and the next pinnacle has to be planned. I guess this is where most people throw the towel in, they hit a plateau, don't see further gains and just regress back to previous life/weight with disappointment.  So they tasted victory but lost the focus to maintain it, and the picture of summiting Mt Everest sticks in the memory more so than the pain of losing all your fingers and toes.

"I know what to do".   I believe most people with guidance can daisy chain small bursts of change to ultimately get to a goal that is healthy and rewarding.  It takes the right tweek from the right specialist to hit the next pinnacle.  I dont mean a medical specialist, this is more of a makeover specialist-the specific trained coach that can overcome the specific obstacle we run into.  (...could be flexibility, nutrition, self esteem, spouse issues, injury, food allergy....we are multifaceted and complex and problem solving requires a community of healers).  Currently, my best vaccine for the disease of weight gain is listening.  I don't mean you sit on a couch and regurgitate all frustrations to me-that would be a waste of my time and your money. Quid pro quo interviewing is the best way to get me started in creating a template for change.  Unfortunately this takes an average of 60-90 minutes for me while medical insurance has been chipping away at the proverbial office visit (13 minutes total to break even).  Those basic areas of change do require some trust.  When people say they know what to do - I translate that to mean they are not willing to change.  Experimentation is hard because it requires a step into the unknown but if I can summon the help of Jim Fixx, Linus Pauling, Atkins, Benson, Ornish, Weil, Chopra......there will be a wealth of knowledge to help catch you when you fall; (everyone falls!!)

When I hear "I know I need help", the creativity of my right brain takes the logic from my left brain a beautiful painting is created.  

To experience the Saguil Approach to lifestyle change, sign up for the April lecture at Advocate Sherman Hospital in Elgin (Randall Rd and 90)  Link to Event Tickets

Saturday, January 11, 2014

Back pain from Shoveling

The last 10 days has been a massive winter "dump".  The snow fall seems un-ending and I have been getting alot of great outdoor time.  I love the clean look of a driveway after shoveling but hate that one crack in the sidewalk that catches my shovel tip just as I am going full speed with a big avalanche.  Well I also noted when my fingertips were painful, throbbing, I didn't realize my back was telling me "take a break!!!".  My mind was saying oh, just finish the last part of your driveway and it will stay dry magically forever.  Pain is usually delayed like whiplash....the next morning as the eyes open and the first step of the day is met with "whoa....did I sleep wrong?....oh....I shoveled yesterday!"  Then the realization is that it's still snowing so you have to do it again.
Muscle spasm if the activity is aggressive and blunt, will be felt accordingly at the time.  If activity is long and repetitive, the pain and inflammation is delayed up to 2-3 days.  It doesn't have to be an ache in one spot, pain can be a flare up of an old pinched nerve/bulging disc type pain.
The way the back is made is skin to outer layer, muscle covering (epimysium), muscle, fascia and bone.  The muscle is built to contract repetitively for life (think of the heart that beats every second for your entire life)  The problem our back muscles come into is the brain gets "superman strength" when reasoning about taking a break vs getting the job done now and going onto another chore.  With fatigue the muscle can still be stimulated to contract and do the job but lactic acid will accumulate, energy (ATP) will be used up, and some tendon fibers will tear (microscopically) and imbibe blood/edema slowly (versus a skin cut where blood comes out fast).  With a slow leak throughout broad low back muscle, swelling and stiffness will occur after about 12-24 hours.  Usually felt next morning.....same concept as whip lash.  With my previous post on whip last, there can always be pinched nerves, broken back bones, herniated discs....but those are usually sudden onset.  (only way to tell is to see a professional)
My best advise is to
1-do no further harm, lay off further shoveling, no exercise for 3 days, take brakes if you have a sitting job.
2-start with antiinflammatories immediately, that could be supplements like turmeric/magnesium, topicals like helicrysium/capsaisin/wintergreen, or prescription medicines/muscle relaxers/NSAIDS/narcotic pain relief.
3-get hands on healing, your choice of chiropractor, massage therapist, physical therapist, a relative with strong hands
4-raise the flag and see an MD/DO if urine or bowel incontinence occurs, pain doesn't allow sleep, numbness or tingling start, cant get out of bed, symptoms longer than 3 days

Tuesday, December 10, 2013

Shoulder Pain

I turned 40 in 2002 and as I approached that age, I was involved with a lot of x-games sports.  I remember rock climbing and attempting a "dyno".  (this is when you grab onto the ledges, pump up and down building up momentum and launch up to grab a hand hold somewhere above you .....Tom Cruise in MI 1) and missed.  It resulted in a year of not being able to bench press, lift overhead, and catching of my shoulder with any movement.  Some of my old patients may remember when I was working with a huge ice pack on my shoulder for 3 weeks.  I had seen my physical therapist who specialized in throwers, I took some of the best prescription medicines available, even got ready for arthroscopic surgery after the 6th month of not being able to exercise.

At that point, I had stumbled on alternative healing.  While an employee of CDH, one of the stipulations in my contract was to have my CMEpaid for, I chose a seminar in California with some guy that was teaching acupuncture to pain medicine doctors.  I planned on signing my name on the roster, blowing off the lecture and hanging out at the beach.  The keynote was made by Dr Joesph Helms and I remember sitting in the front row in a room of 800 doctors and with my long hair (midlife crisis) challenging him with questions on acupuncture in sports medicine, acupuncture in pediatrics, acupuncture for medical diseases.  But this guy nailed all my questions with very intelligent answers!  Then when he asked for a volunteer, I gave him my body (very skeptical and anxious to get to the beach).  Remember my shoulder was still painful and limited with range of motion from the rock climbing injury earlier in the year.  He place 3 needles into my shoulder and within 10 minutes, I had pain free, range of motion just like my pre-injury state!   I was sold on this weird 2500 year old concept of healing.  Thus began my journey into alternative and complementary medicine.
Note that I still had to do my rotator cuff exercises, my scapular stability exercises, take glucosamine sulfate, and have acupuncture 2-3 times a week for a few months.....but I avoided surgery and now have regained full range, better strength than before and can do hand stands in yoga at 51 years of age.  (the acupuncture isnt just a passive treatment, it helps the body heal so anyone with injury or disease still has to put in the sweat equity and maintain the building blocks to health and healing (see my Anti-inflammatory Lifestyle video here).

Sunday, May 26, 2013

Tight Hips

Had a new guy start in my Meditative Yoga class at Northwest Community Hospital Wellness Center.  Spotted the usual difficulty with keeping still during opening breath work in Sukasana (sitting crosslegged).  Figured either anxiety sufferer or leg problems.  He came up after and turned out to have a hip problem.  Guys usually have big muscles and poor flexibility.  The short-cut in figuring which machines to use or barbell movements to rely on is do what is most popular in the mags or just go down the machine line and hit one body part at a time.  Problem with applying general body region movements or machines is you have to be in posession of an "average" body.  In my sports medicine clinic, even between twins I find differences in knee alignment, foot arches, posture, muscular thickness, pain tolerance.  So applying general guidlines to and individual person is a formula for failure due to non-sustainability. 

What also is a "curve ball" in developing a personal exercise/movement routine=what are the end goals.  Cross training for running, shoulder development for looks, bounding height for dunking, flexibility for mixed martial arts, power for contact sports.....this is where it is so important to get a "second opinion" on applying an exerciser routine to your life.  I don't mean with a sportsmedicine doc, I highly value to ingenuity of exercise physiologists in figuring risks, strengths to embrace, weaknesses to address and lifestyles that would limit a long term sustainable life change.  So this is where my tight hip/50+ year old yoga student has entered into the "melee" of personal fitness programs.  For the short 8 weeks of having him come for guidance, I can at least help him in planning a continued exercise/overload program.  If we can use 3 easy poses of yoga as a staple or preexercise warm up, over time he should be able to gain progressive lengthening to a very contracted hip capsule.  Keep up with the basics no matter how deep he gets into other sports/activities and one day he'll have the flexibility of a highschool gymnast. 

Problem with hips is most americans view the groin and hips as very private.  The figurative concept of hiding from sight always translates to physiologic function.  Although a painful image, think of a sexually abused kid dreading the gyne office PAP smear when she gets into her 30's.  The psychology of injury always limits the form and function.  One of the reasons I save hip poses for the end of class is for the first 45 minutes, I not only get students to warm up body temperature but they also have worked on breath and relaxation so any psychological worries are not as distracting compared to before class.  If all distractions (I mean psychological ones like "my hip is about to break" or "feels like the muscle is going to tear" or "shoulder is about to come out!") are calmly removed from the forefront of one's attention, it will usually be able to apply exercise/overload.  Getting to the point where the hip is tight in the movement but not terribly painful....then holding at that point, concentrating on breath, and when guided-slowing coming out of the pose with control.  When I was captain for my school Track and Field team, I would lead warm up and remember bouncing the joint in the 1980's to provide warm up, flexibility, and stretching-usually on cold ground!.  (How wrong I was!!!)  The slow entrance into range of motion, gradual addition of torque and length, and relaxed breath will usually convince the muscle group to release it's contracted state after minutes.  Some will note after a long hold the sudden realization that the knee is now touching the floor in pigeon pose or the forehead is on the knees in forward fold.  (Others it takes a few months)

Here is a video link to a few poses that I showed my student and helped him to adapt (via use of yoga blocks and blankets) for daily repetition/ritual. 

Of note is it took me 2 years to attain pigeon pose equal on both right and left.  I suffered a hamstring tear going around the back stretch 110yards in a 440yard medley for state championship and coach said he heard a pop from across the field.  Cost the team 1st place and always held that in the back of my mind (and the back of my hip)...and that was 1979!

Saturday, May 4, 2013

Mommy Wrist

Something about the having a baby is just beautiful, ask any mom.  Then there's the fragmented sleep, weight gain, transition back to running a house and working......and wrist problems.  Carpal Tunnel has been so published/talked about in the last 20 years that anyone will be able to figure out if their symptoms are similar and find conservative treatment to start online. 

I had a patient come in referred by ob/gyn.  Second time around mom with wrist pain that was "different".  Started about 6th week after leaving the birthing center and has been persistent since.  Mom is now 3 months out and suffering.   Tried to use the brace from walgreens for carpal tunnel with no help.  Pain grabs her with certain movements and now is interfering with sleep.  No history of this before and no trauma.  Still breast feeding but planning to wean off and return to work in about a month.  (Incentive to get the wrist pain resolved since she uses a computer 8 hours a day)

There are a few things I watch out for in anyone complaining about joint pain.  First is always broken bone or tumor.  Luckily with the wrist, small joint, easy to evaluate.  Then I think in mechanical terms and locate the area of pain/dysfunction.  Finally look above, below and referred.  In rare cases the pain will come from soft tissue like infection, other tissue, blood vessel or metabolic problems.  If I can't find a good solution or patient has tried everything, time to add traditional chinese medicine  and break out the needles to "move stuck energy" until conventional modalities start to work. 

If the pain is evaluated early, usually history gives the diagnosis (physical exam and testing backs up the dx).  If the pain has been "lived with" for a long time, the presentation can be different as the average person will compensate and may not remember the new symptoms vs the old symptoms.  Detective work ensues (experience and listening) and chipping away at confusing red herrings starts until the true problem reveals itself.

In this case, I ruled out scaphoid fracture (very important bone in the wrist that if ignored, leads to chronic disability) and went straight for the gusto-finkelsteins test.  BINGO! reproduced pain exactly.  This is notorius for moms as they reach to pick up 3-4month old (baby has good head stability by then) and lift up play face to face.  Gave a specific splint for thumb immobilization, advil (only antiinflammatory ok with breast feeding moms).  Also suggested facilitating healing with diet control (no dairy or wheat), turmeric and magnesium (ok with baby) topical treatment (helicrysium, tea tree, traumeel, ice massage) and acupuncture as back up if not better in 3 weeks.   If all else fails, steroid injection into the sheath of the tendon will help, and shouldnt effect breast mild production.  By then occupational/physical therapy will problably be necessary.