Healthy Living

Over the past few months I have talked to more friends who have back pain and have noticed a greater number of people calling our wellness center seeking relief from back pain. I began remembering my own experience with a back injury, more than 10 years ago, while lifting a heavy patient with a team of three other nurses. It took more than a month of physical therapy, chiropractic treatments and home exercise to relieve the acute symptoms. At the time it seemed like a purely physical experience that just unfortunately had happened to me.

More than four hundred years ago philosopher and mathematician Rene Descartes held that the mind and body were totally separate and should be studied separately. Matters of the mind were relegated to psychology, the spirit to religion, and the body to medicine and science. He likened the body to a machine and believed that fixing the part that wasn’t functioning would restore it to health. His theory shaped the practice of medicine in our country and still largely influences the practice of mainstream medicine today.

There is, however, a growing recognition that the mind, emotions and spirit can influence disease and injury as well as the healing process. There is still a great deal that is not understood about how our thoughts, belief systems and emotions can translate into physical symptoms – yet we are all aware that the connection exists. When we are angry or fearful we can feel our heart beating faster, when we are deeply sad we know the feeling of heaviness in our chest or when overly stressed we may feel headache or stomach pain. These are examples of what is called the mind-body connection.

This is not a conscious process. We are not to blame or deficient in some way because we are sick or injured. Nor does the connection of the body with our emotions, mind and spirit mean the physical pain or illness isn’t real. Of course it is very real. Being willing to explore the connection of the mind and body can be a big step toward empowering us to be an active part of our growth and recovery.

As a culture we tend to be passive and expect our doctors to somehow make our symptoms go away and quickly. We all agree that we are hurt but seldom do we take the time to ask ourselves why. This is an important opportunity to understand what may contribute to the root cause of our injury or illness.

Two questions may be helpful.

Why this part of my body? And why at this time in my life?

In my case, looking back, I was experiencing some major life changes, was anxious about the changes and needed more support than I realized. Interestingly, the low back in mind- body medicine represents the seat of security and support particularly related to family and relationships. There may be something we feel over-burdened by or “can’t stand” or “can’t stand up to” as one psychotherapist has noticed. We may be “backing away” from something difficult to feel.

In seeking treatment some people will have complete relief from back pain with surgery or by using a combination of chiropractic care, yoga, massage, tai chi, healing touch, reiki or physical therapy. Some may feel discouraged after finding little lasting relief with surgery or any treatment and may find they have continuous or periodic bouts of debilitating back pain.

A friend who had tried many approaches to relieve her intermittent bouts with acute back pain was given the book, “Healing Back Pain, The Mind-Body Connection” by Dr. John Sarno, a professor and attending physician at the New York University Medical Center. Although at first skeptical, she said she found herself on every page.

Dr. Sarno, who has been a pioneer in the treatment of back pain believes that when difficult emotions begin to come up, our mind subconsciously may decide that the feelings are too uncomfortable to handle. The underlying tension may then trigger the painful episode or contribute to our vulnerability to an injury. Dr. Sarno believes that the resulting preoccupation with the severe back, neck, or other body pain is serving to completely distract us from the underlying emotions. He calls this TMS or tension myositis syndrome (myo meaning muscle). An important part of his treatment approach includes the simple acknowledgement that there may be an emotional component to the back pain.

This is a challenge for most of us because we can point to a specific event that caused the injury, have test results that confirm physical changes and therefore assume, as in my case, that it must therefore be only physical.

Further, he has found that when the fear is alleviated through education many people who have believed they have to restrict their activities, sit in certain chairs, give up exercise or travel to avoid pain, begin to live life more fully again.

My friend feels that she has benefited tremendously from this approach and whenever she feels any twinges of back discomfort uses the insights she has gained to alleviate the problem.

If you have back pain:

• Get medically evaluated to rule out any urgent surgical need.
• Gather all the information you can and explore conventional (e.g. surgery, physical therapy, epidural injection) and complementary (e.g. acupuncture, tai chi, yoga, massage, healing touch, reiki) treatments.
• Look for the root cause. Consider when and why the pain started (emotional stress or when some other ailment went away). Use mind-body approaches like Dr. Sarno’s if appropriate for you.
• Be open.
• Choose what makes the most sense for you. Use your intuition. People know on a level deeper than the mind just what they need to do to be well again.

Amy Dunion, a registered nurse and massage therapist, is Coordinator of The William W. Backus Hospital’s Center for Healthcare Integration.This column, which runs in the Norwich Bulletin newspaper on Tuesdays, should not replace advice or instruction from your personal physician. E-mail Ms. Dunion and all of the Healthy Living columnists at healthyliving@wwbh.org

If your garden was anything like mine this year, it took all about 30 seconds to pick your pumpkin harvest. I am certainly not going to be the next Larry Checkon who holds the 2005 word record for the largest pumpkin, a 1,469-pound monster. While that variety of pumpkin would make the best jack o’ lantern, smaller is best when choosing pumpkins for cooking. The best selection is a sweet pumpkin such as Cinderellas, Sugars or Sonias ranging from 2-7 pounds.

There are plenty of healthy reasons to include pumpkins in your diet, especially to cook with fresh pumpkins. Just like any fresh fruit or vegetable, compared to the canned variety the flavor is at its peak of ripeness. The bright orange color is a dead giveaway that the pumpkin is loaded with beta-carotene, an important antioxidant that performs many important functions in overall health. A diet rich in beta-carotene may reduce the risk of developing certain types of cancers, offers protection against heart disease as well as protection against other diseases as well as some degenerative aspects of aging. In addition, pumpkins are high in potassium, high in vitamin A, low in fat and serve up a pretty decent fiber supply. All this plus the taste is remarkable.

Although preparing pumpkins can take some time, it is worth the effort. Canned pumpkins can be used in some recipes, but most recipes that call for canned pumpkin are desserts or sweet in nature. Pumpkin muffins, pancakes and breads are delicious with the adjustment of white flour with whole-wheat flour, being conscious of the added fat and with the addition of nuts and or flax seed for added vitamins, minerals and omega 3 fatty acids.

There are certain ticks to the trade when selecting pumpkins. Select one with 1 to 2 inches of stem left – if the stem is cut down too close to the pumpkin, it will rot faster or may be already decaying. Avoid pumpkins with blemishes and soft spots. They should feel heavy; the shape is unimportant -- a lopsided pumpkin is not necessarily a bad pumpkin. Figure one pound of raw pumpkin is about 1 cup of finished pureed pumpkin.

Now for the work:

 Spread newspaper over a work surface area and start to remove the stem with a sharp knife.
 If you are planning to use the seeds, I highly recommend roasting for a snack, smash the pumpkin against a hard surface to break it open otherwise cut the pumpkin in half with a sharp knife.
 In any case, remove the stem and scoop out the seeds and scrape away all of that stringy mess. An ice cream scoop works well.

One easy way to start cooking with fresh pumpkins is to substitute peeled cubes for potatoes, sweet potatoes or carrots in your favorite recipe, such as soup. Roasting pumpkins make a wonderful side dish to any meal:

 Place cut pumpkin cut side down on a large baking sheet coated with olive oil and bake at 450 degrees for about 30 minutes or until fork tender.
 If your goal is to puree the pumpkin for a recipe, use a food processor or potato masher to form.
 Pumpkin puree freezes well. Place in a freezer container or bag, leaving a ½ inch headspace, date and label and freeze at 0 degrees for up to one year.

As for pumpkin lore, the use of pumpkins for removing freckles and curing snakebites is bogus. But the benefits of antioxidants in our diets are here to stay.

Give fresh pumpkins a try; it will be worth your time.

Sarah Hospod is a registered dietitian in the Food and Nutrition Department at The William W. Backus Hospital in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Hospod and all of the Healthy Living columnists at
healthyliving@wwbh.org.

Most parents are aware of how to make their home safe for babies, but I still encounter mistakes that concern me when it comes to infant care. Here are some important tips to keep newborns safe:

Minimize crowds
Babies should be fairly isolated in their first month – it is important not to take them into crowded places, such as a grocery store, because their immune system is still not fully mature. Keep the crowds down at home as well, especially in the winter months. And if anyone wants to hold the baby, they need to wash their hands first.

No smoking in the house
I still see a lot of people who are ignorant about what smoking can do to a newborn’s lungs – it can permanently damage a growing lung for the rest of a child’s life. Newborns’ lungs grow for about two years after they are born, and if they are exposed to smoke and irritants, the lungs may not develop properly. Smoking also is a risk factor for Sudden Infant Death Syndrome.

Avoid sunscreen and bug spray
Sunscreen and bug spray should not be used on infants younger than six months. The chemicals may be absorbed through the skin because of the high level of body surface area compared to their weight. When outside, infants should be kept in shady areas, as they have a higher risk of being burned because the skin is not fully matured.

No walkers
According to the American Academy of Pediatrics, baby walkers send more than 14,000 children to the hospital every year. Before age 1, a child has not developed a sense of balance. It is developed over time, when babies learn to sit, crawl, pull up and then walk. Walkers make babies vertical before they develop a sense of balance, and their weight is the driving force, so they may go in any direction, and the infant has no control to stop. Stationary bouncers are fine, just nothing with wheels.

Install car seats correctly
It is one of the most important things people do wrong and they do not realize it. Used properly, car seats reduce the risk of death by 71 percent for infants and 54 percent for toddlers. Although the LATCH system in newer cars is helpful, parents should still get their car seats checked at a car seat clinic, like the one Backus Hospital offers on the first Friday of every month at the Norwich Fire Department. Also, parents should never put blankets underneath infants or swaddle them before buckling them in.

Ravi Prakash, MD, is Chief of Pediatrics at Backus Hospital and a private practice pediatrician with Prakash Pediatrics in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Prakash and all of the Healthy Living columnists at healthyliving@wwbh.org.

The media is filled with headlines about people who have made irrational decisions. Recently, TV viewers witnessed soccer star Zinedine Zidane’s head-butt of an opponent. An NFL player used his spikes to stomp on another player’s head and a college football brawl between the University of Miami and Florida International University shocked millions. Mike Tyson actually bit off a piece of Evander Holyfield’s ear during a boxing contest in 1997.

While sports fans around the world ask themselves why incidents like these occur, they need look no further than human neurophysiology for the answer.

In our efforts to achieve new levels of human performance, we incorporate the “fight or flight” response. This consists of the human reaction to real or perceived danger. The adrenal glands basically kick into overdrive, which results in sweating, tremors, increased muscle strength and rapid heart rate.

It is this rapid heart rate that has been studied most extensively. Normal heart rate generally runs in the range of 60-80 beats per minute (bpm). Dave Grossman, a former army officer and author, believes the range where stress improves performance is between 115-145bpm. After 145bpm, motor coordination begins to deteriorate. At 175bpm, circulation to the brain decreases and cognition slows. Behavior may become inappropriately aggressive.

There is an intimate relationship between the heart and brain, which is emphasized during stressful events. Since we are all susceptible to extreme stress at any time, preparing our bodies through exercise and healthy lifestyles is of paramount importance. Consider how one’s body may react to a heated argument, “road rage,” or suddenly becoming lost.

In order to avoid ill effects, our bodies can be trained for moments of hyper-intensity.

As residents, trauma surgeons prepare for many hours under harsh conditions so they can perform optimally in a crisis. Military officers develop skills to lead troops while under fire. Police departments now avoid high-speed chases to diminish the risk of poor judgment while apprehending a criminal. Teenage drivers need to master varied driving situations to become proficient at making split-second decisions. Older drivers must understand their limitations and avoid driving at night or in unfamiliar areas, which could cause fear and panic.

While you wouldn’t expect fear and panic to overwhelm a soccer star, boxing champion or football players, that is exactly what happened.

Anthony G. Alessi, MD, MMM is a neurologist in private practice at NeuroDiagnostics, LLC in Norwich and a member of the Backus Hospital Medical Staff. He is also an Associate Clinical Professor of Neurology at UCONN. This column should not replace advice or instruction from your personal physician. E-mail Alessi and all of the Healthy Living columnists at healthyliving@wwbh.org.

As a rheumatologist I am often asked “what kind of arthritis do I have?” Clinicians divide arthritis into three categories:

 Inflammatory arthritis (e.g. Rheumatoid Arthritis, Lupus)
 Osteoarthritis (the wear and tear kind)
 Crystalline arthritis (Gout, Pseudo gout)

The reason we place patients into these categories is it helps identify the aggressiveness of the disease, and can lead to better management of the illness. The more aggressive the arthritis, the more important it is that we take action sooner rather than later.
Rheumatoid Arthritis (RA) is the most common form of inflammatory arthritis.
Approximately 1 percent of Americans have RA, which translates into 2.5 million people. In some patients the disease can be so aggressive, that joint damage can be seen by MRI’s in the first 4-6 months. The American College of Rheumatology has five clinical criteria for the diagnosis. They are:

 Morning stiffness lasting for more than 1 hour. Patients usually complain of stiffness rather than pain. They say that by the afternoon they witness a gelling phenomenon, when they start feeling pretty good. This cycle repeats itself every day. The stiffness in some patients is so severe that they do not want to get out of bed.
 Involvement of small joints of the hands and feet: RA typically involves small joints, though large joints can also be involved. The joints usually are the knuckles in the hand. The patients are usually not able to see the knuckles in the morning because of the swelling.
 Usually symmetric: The illness may start off as being asymmetric with different joints being affected on both sides of the body but, with time, most patients have the same joints involved on both sides of the body.
 Swelling and stiffness that last for at least 6 weeks in three or more joints. The reason – some patients can have a self-limiting form of arthritis that improves on its own with in 6 weeks.
 Presence of Nodules. Called rheumatoid nodules, they are commonly present on the elbows, wrist and behind the ankle joints. These are mobile early on and are boggy in consistency.

Once these signs and symptoms are identified we order lab tests and X-rays to confirm the diagnosis. Once the diagnosis is confirmed we review options for management of the disease based on the aggressiveness of the illness.
– Sandeep Varma, MD, is a rheumatologist and Medical Director at the Backus Arthritis Center, located at the Backus Outpatient Care Center in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Varma and all of the Healthy Living columnists at healthyliving@wwbh.org