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:

Thinking

Eating

Activity

(see my video)

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

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