Archive for the ‘Uncategorized’ Category

Guest Post: My wife, Donna on living with someone in pain.

Monday, October 18th, 2010

I didn’t really talk about it here, as it was really just too damn painful to talk about at the time, but last week, I finished dealing with a 2 week long stint of kidney stones. This was not the first time I’ve had them, but hopefully will be the last. For those of you who don’t know, kidney stones are about the most painful thing people can feel, and they are truly awful. Donna wanted to share a few insights about her experiences dealing with me while in pain:

Gripping the chair with two blanched knuckles, my husband stops, mid-sentence, to wince in pain.  It’s been nearly a week, and the kidney stones have not let up.  He’s still seeing patients, manages to return phone calls, keep up on his blog, and even stand-up and give a toast at his best friend’s wedding.  Others could be clueless about the stones; the medical student marvels at Andy’s ability to hold it together while in the patient room, for example.

But for all these little heroics, the pain starts to fray him, and all of us, around the edges.  Dealing with the kidney pain leaves him little energy for anything else and cuts his patience short.    Forget the chores and although he wants to find affirmative ways to live in his body, the experience challenges our intimacy.  Who could blame him, really?

Thankfully, the kidney stone passes after a week, but we discover that it’s left a cousin behind.  By the end of the second week, the second stone passes.  Within a day, I start to get back in touch with what an amazing, funny husband I have.  “Andy’s back!” I post on Face Book.  How wonderful.

Luckily, our ordeal was short-lived.  It left me feeling a heightened sympathy not only for those in the Back Together world who live with pain, but for their beleaguered partners and children.  I was too caught up in the experience to think of too many helpful tips this time around.  But I did notice myself involved in a strategies that helped a bit.  First, marveling at my husband’s heroics helped somewhat, (but I also allowed myself a cynical moment or two: “Great, he can keep it together for his patients, but what about the kids?”).  Second, although I remained empathetic, I tried my hardest to not personalize his pain.   Finally, I sought out the sympathetic ear of friends.  This was easy, because everyone knows how trulyawful kidney stones are.  As well, when I complained, I didn’t do it too loudly or too often, so I don’t think that people felt like I sounded like a broken record.

During this little ordeal, I don’t think that I evolved great insights about living with a partner who is in pain.  I simply renewed my sympathies.  I wonder what others out there do or need and I invite those of you whose partners live in pain to share their thought and strategies.

In appreciation,

Donna


The GREATEST back pain tip ever!!!!

Thursday, August 5th, 2010

As a Trekkie, I cannot help but love this workplace poster. Perhaps the best part of it, is that it is posted in the bathroom at the Lawrence Berkley National Laboratory. (Heisted from XADAMX.) I just need to find a bigger copy for my office!!

Yoga & Back Pain- Thoughts on keeping yourself injury free…

Saturday, July 17th, 2010


A few times each week, I post a brief tip or suggestion about avoiding or relieving back pain on my Facebook fan page. These posts are usually independent of anything I post here on the blog, and are just meant to provide folks with bite-size tips, and are rarely controversial. Last week I posted the suggestion that one never bend and twist at the same time (meaning, that if you need to pick something up off the floor, or reach down for some other reason, turn your body to face what you are grasping rather than twisting to one side or another while bending.) Well, this resulted in a whole bunch of mail and posts- particularly about how this suggestion would effect folks’ participation in yoga. Yoga does involve some bending and twisting- and in theory should ultimately help one to avoid back and neck pain rather than cause it. Here is a video post offering a few quick suggestions on ways to avoid back and neck injury while doing yoga. The tips are reposted in text version at the bottom of the post if you want to forward them to any of your friends or fellow yoga participants. I would enjoy hearing your thoughts and experiences regarding regarding back pain and yoga- whether it provided you relief or made you feel worse.

Enjoy!

yoga

(In the first take of this video, the woman behind me was waving into the camera. I asked her to please stop- but by golly she made sure her arm was featured in the video anyway. Congratulations lady- you now have a famous arm!)

Here are your tips to avoid yoga related back and neck injuries:

-As always, hydrate before, during, and after yoga. Even slight dehydration will increase the likelihood of straining or even tearing a muscle, and the enhanced fatigue that comes with dehydration will increase your chances of using poor body mechanics.

-Before a class, take a brisk 10-15 minute walk. This will warm up your muscle groups and prepare them for the challenge ahead. This helps even when getting read for a ‘hot yoga’ class.

-If you are new to yoga, work up to doing multiple classes per week. Your enthusiasm may push you to try and do 5 classes per week, but slow down. An NFL team I worked with brought in a well known yoga instructor to help with flexibility, and I cannot tell you how many low back sprains, neck strains, and groin pulls I wound up treating as a result of pushing too much, too fast.

-Listen to your body. If a new posture is painful- back off that posture. If you feel your discomfort is simply due to it being ‘new’, build up to it slowly. If pain continues, be sure you are approaching the posture with correct body mechanics (your instructor should be able to guide you.) If the pain persists, it may signal that something is wrong- see your doctor.

Thanks for stopping by!

-Andy

Spooning…with Kylie Minogue!

Wednesday, July 7th, 2010

Well, perhaps more accurately would be Spooning AND Kylie Minogue- but I got your attention, didn’t I?

OK, so you know this is primarily a blog about back and neck pain, and while I occasionally touch upon subjects which delve into other areas of health and wellness, back and neck pain is essentially where I’ve stayed. Well, today being my birthday, I have decided that I can write about pretty much anything I want- and while the first part of today’s post is an ergonomic suggestion of sorts, the second half is purely an indulgence on my part- a review of Kylie Minogue’s new album, Aphrodite.

Spooning…

Spooning, the holding of one’s intimate partner, back to front- particularly while sleeping, is one of the most comfortable and comforting gestures one can show to their significant other (I wanted to say ‘lover’ but thought better of it after some thought.)

Spooning- to the photographer who took this image, sorry to have nicked your work. If you send me your name I will gladly credit you!

While spooning is a wonderful way to sleep, the position does put the partner on the ‘outside’ for shoulder and neck pain, as their ‘bottom’ arm usually needs to be extended upwards to clear the ‘inside’ partner’s shoulder.

Some tips for comfortable spooning:

-The ‘inner’ partner should slide downwards so that the top of their head is below the chin of the ‘outer’ partner. This prevents hyperextension of the shoulder.

-Since you are both lying on your side, be sure to place a small pillow between your knees to provide support for your hips.

-You will be sharing body heat, so you can probably get away with a lighter blanket, preventing overheating and sweatiness.

-Whether you are on the inside or outside, you will be laying on your side. Be sure to have sufficient support for you head so that your neck isn’t in an overly flexed or extended position.

Just my two cents!

Aphrodite…


This week I posted my first book review, and today I will post my first (and perhaps last) music review of Kylie Minogue’s new album, Aphrodite, released this week.

I have enjoyed Kylie’s music for many years. I have always admired her unpretentious dance sound. Her music has always been about having a good time, and with all of the nonsense going on in the world, that’s something we all really need from time to time.

Kylie’s last album, X, was her first after a difficult battle with breast cancer. While I was pleased to see her back in the studio, all in all that album was slightly disappointing to me. There were some good tracks, but overall, X lacked focus and drive.

I am pleased to report that Aphrodite is a welcome return to form, and will likely be recalled as her ‘comeback’ album following her illness, rather than X.

The opening track, All the Lovers, is incredibly hooky- nearly as much so as her dance masterpiece Can’t Get You Out of my Head, and sets the tone for what proves to be one of the most polished pop albums I have ever heard, recalling ABBA as well as some of the dancier numbers from her own earlier work. Better Than Today will certainly be placed amongst the best of her work, with a great lyric and acoustic rhythm guitar backing that totally gets you out of your seat.

Kylie has been huge throughout most of the rest of the world, while only having sporadic hits here in the States. Her tour of North America last year was well received, and I can only hope she will return here to support her new album. The title track ‘Aphrodite’, backed by a solid step show / drum line beat contains the lyric “It’s the truth, It’s a fact, I was gone, and now I’m back.” I for one, am glad.

Overall rating: 5 vertebra (out of 5)

Conclusion: Best dance album of the summer.

iPhone 4 ergonomics, and the iPad- this DOES change everything AGAIN.

Thursday, June 17th, 2010

The new iPhone goes on sale next week…

So, this is the second technology review ever on BackWords, and once again for an Apple product. I know this is not a tech site, but as all of my Back Together resources are created on Apple devices, and they place a large emphasis on ergonomics and user friendliness, I didn’t think it was too off topic.

This week, I was finally able to touch an iPhone 4. I should tell you right off that my iPhone 3G NEVER leaves my side, and has been one of the most reliable and rewarding pieces of technology I have ever used- and was going to be a hard act to follow. The iPhone 4 is a tactile masterpiece- it feels more like a piece of jewelry than a phone- very solid and meticulously manufactured. We are off to a good start.

Now the ergonomics of a phone are not usually of a whole lot of concern- they all pretty much handle the same way (particularly ‘smartphones’-which are held in one hand, and operated with the other. In this case the equation changes somewhat, due to the introduction of 2 things: The iPad, and the new iPhone operating system.

I really wanted an iPad- REALLY wanted one. But as I stated in my review, I was perplexed by the absence of a front-facing camera. I understood not putting  a photo or video camera on the back- the size and form factor would make operation awkward at best. A front facing camera would allow video chat and, for my purposes, the recording of video blog entries. Without the front facing camera, the iPad- while extremely cool- did not permit me to leave my notebook computer at home- and since it didn’t do anything that I needed (largely because I still needed to carry my computer and phone anyway) I did not get one. And this is where the ergonomics of the iPhone 4 come in…

The iPhone 4 has a front-facing camera, a significantly upgraded rear-facing photo and video camera, the new operating system which permits true multitasking, and most importantly for my purposes, the ability to sync with a bluetooth capable keyboard. Essentially, there is enough computing power here to allow me to leave my notebook computer home! With the iPhone 4 (and the WordPress application for example- the system which runs this very blog) I am able to do much of the work I do on my computer from a Phone instead. I can pack a lightweight keyboard with me for creating longer documents- a VIOLA- I am in business. And, with the improved email client, and other upgrades, I suspect many others will find it possible to leave their computer at home.

In short:   LESS WEIGHT CARRIED AROUND = LESS BACK & NECK PAIN and LESS LIKELIHOOD OF INJURY!!!!

Now- it is not a perfect solution for not carrying around your notebook. The small screen will likely cause you to have to tilt your head/neck to accommodate its size, and as of yet there are no bluetooth keyboards with an integrated stand to make it a more user friendly package (although I suspect there may be some coming down the pike.) One thing- I understand there will be a way to output movies to a TV, but as of yet there is no way to hook the iPhone 4 up a TV or screen to run its applications- That would allow you to set up an ergonomic workstation at home or at work (or both) and still only need to carry the lightweight device around with you.

These are, in my opinion, a reasonable trade-off for not having to carry around a 6-7 pound computer.

Other than that, there’s not much to say that you don’t already know: The screen is magnificent, the A4 processor is fast, and while I couldn’t check it out- the battery life is supposed to be significantly longer. All good things. There’s still no Flash, and based upon the war-of-words going on between Apple and Adobe, I don’t suspect it’s coming any time soon.

In short, I have not been this excited about a new piece of technology since the original iPhone release. While that one was amazing- this one solves several problems for me, and will make travel to and from work, to the hospital, (or anywhere else for that matter) significantly easier. I suspect that many of you may find the same benefits. See you in line at the Apple store next week!!

Be well!

-Andy

Tips for coping with health insurance troubles (Part 2)…

Tuesday, May 11th, 2010

So yesterday, I shared with you the reason I decided to do this piece in the first place. As I mentioned, I still believe that most insurers have every intention of doing right by you- but that being said- things can still go wrong. As I set about trying to resolve our issue with our insurance rejecting Donna’s entire hospitalization, I spoke with people all over the place- claims adjusters, claims evaluators, insurance agents, billing experts- you name it. I wanted to approach this problem with as much ammo as I could- after all, it was that or find some way to earn an extra $260K.

Here are some of the most useful tips I compiled:

-First of all, when you get a denial of payment for a medical insurance claim, don’t panic- you need to have a clear, methodical approach to getting the issue resolved, and freaking out will not serve your needs.

-When you get health insurance, or make changes to the policy you have, get an actual copy of the policy, and take some time to review it. I am always surprised when I discuss issues like precertification with patients, and they have no idea what I am talking about. Pay particular attention to clauses which might result in an exemption. It was one of these small, innocuous looking clauses which resulted in Donna’s denial of payment.

-Periodically, you may get updates, amendments, or addendums to your policy in the mail. It can be easy to overlook these and throw them in the trash. As insurers try to tighten their belts, you may find that services that were once covered, no longer are. Keep these letters in a notebook with your policy so you can remain current on what is covered and what is not.

-Know what your deductible is- again, this sounds obvious, but many people are not aware that there can be different deductibles for different services. Outpatient services may have one deductible, and hospitalization may have another, and deductibles from one ‘pile’ usually don’t apply to the other. This is important so you don’t get any unwanted ‘surprises’ when your explanation of benefits and subsequent bill show up in the mail.

-If you have been rejected for payment for a service you thought was covered, look over the explanation of benefits (EOB) statement you will get from the insurer, and find the codes they used to justify the denial of coverage. Be sure that code applies to your situation- the EOB is not the final word on your coverage, and sometimes a billing specialist will mis-key an entry resulting in your denial. A simple mistake could cost you a lot of money if you are not paying attention.

-This is a big one: If you have been denied coverage for a medical condition, or a diagnosis which for some reason is not covered by your policy, get ahold of the records regarding that service (the office notes, chart- whichever) and schedule a time to discuss the care with your physician. It is likely that your doc wants to get paid for his/her good work, so they will usually be happy to take the time to review the chart with you, and if needed, produce a letter explaining why a service was medically necessary, or why a specific diagnosis should not be exempt from coverage. This may take some time, but will be well worth the effort.

-In the same vein, if  your denied claim has been reviewed by a medical reviewer, be certain to get a copy of their report and review that with your physician so that you may be certain that their findings were not based on a misconception or error.

-Be sure to document all of your phone calls to representatives to the insurance company, and keep copies of all of your correspondence.

-If you have a claim that is under review, be certain to get a letter documenting the review, and provide it to any of the providers who may be billing you. This will prevent your bill from being sent to collections while the appeal is under review.

-If all else fails, you are unable to resolve the issue, and are faced with a difficult or unpayable bill, contact the billing office of the physician you owe, and explain your situation. Many offices will offer a reduced payment, or perhaps a payment plan to help make things a little more manageable. I know this option isn’t optimal- but at least it can reduce the pain a little.

I hope you never have to deal with one of these complicated situations, but if you do- I sincerely hope these suggestions will provide you some assistance.

Thanks for stopping by,

Andy

'Doors' by Steve Tobin (stevetobin.com)

'Doors' by Steve Tobin (stevetobin.com)

Plumber butt, coin slot, crack problems: OK, so this is not technically a back issue…I guess.

Friday, April 30th, 2010

I know this is not really a back issue, but I felt it would be irresponsible for me to not report on it anyway- and technically, it does cover ones’ sacrum.

Finally a product for people wearing low cut jeans who don’t want to display their butt crack for everyone to see. I will rely upon the website to describe this unique and interesting product:

The Backtacular Gluteal Cleft Shield, created by designer Kimberly Brewer, is a stylish cover that prevents any unfortunate butt-crack revelations.

Made of hypo-allergenic denim, and decorated with studs and rhinestones for added bling, the Backtacular Gluteal Cleft Shield is applied directly to the skin, and sits above the waistband protecting the wearer’s modesty and morals like a tiny, fashionable nun.

The BGCS can be bought online from Brewer’s Kimberlily site.

Now all she needs to do to make it really take off is offer a customised version, which instead of rhinestones just features an advert for your plumbing services. She’d be on to a winner.

article-1272372272011-095244D1000005DC-938264_636x300

I’m gonna order mine today!

Thanks for stopping by, and be well!

-Andy

iPad follow up, Gardening, Spring flu

Wednesday, April 7th, 2010

iPad

Well, it looks as though plenty of my viewers are ‘early adopters’ of the new iPad (see my ergonomic review here.) Several of you agree with my thoughts on the 45 degree tilt for the screen. Fortunately, it looks as though at least 2 manufacturers will soon release iPad covers with an integrated, adjustable  angle stand. Based upon the early sales, I suspect there will be plenty of companies jumping on the iPad accessory bandwagon.

In the mean time, please let me know your experiences with your iPad- ergonomic concerns or others. I cannot wait to get mine!

Gardening

Thank you for the kind words about ways to make your gardening more back friendly. I received a couple of other suggestions from viewers:

“I use a small dolly to scoot around the garden when I am on the flagstone portion of our patio, that way I don’t need to keep getting up and down. Thank you for your other tips”   -Stan

“I really couldn’t handle getting up and down over & over again, and bought a set of garden tools with long handles from Smith & Hawken- I can do pretty much all of my gardening from a standing position.”   -Judy

And there’s this one, which I received in various versions from 4-5 different viewers:

“I let my kids do our gardening”

If you have any other thoughts or suggestions, please send them my way.

The Spring Flu

Over the past several weeks, I have treated a bunch of patients with a Spring flu- something I don’t usually see here in the Philly area, where the flu usually runs it’s course by the end of February. Well, yesterday the flu hit me- and I cannot tell you how awful it actually is. I’ve had to cancel patients and close my office today, so I may take a day or two off writing (it’s totally knocking me down just typing this.) Check back for updates, and THANK YOU to my wife, Donna, for taking care of this difficult patient.

Back Together- Simple, Safe & Effective Solutions for Back Pain available NOW from Amazon. Click here to order.

Lifestyle approach to relief from back pain- ORDER NOW!

Health Care Reform: A few thoughts from a doctor in the trenches…

Monday, March 22nd, 2010

So yesterday, the House passed the most sweeping overhaul of America’s health care system since the enactment of Medicare in 1965. I am sure you have heard the pundits from both sides of the aisles. With everything you’ve heard, it can be easy to become overwhelmed with the huge amounts of information and disinformation out there. Now I am not here to give you an opinion one way or the other on this legislation (there are things I like about it, and things I really don’t) but regardless of where you fall on the political spectrum, the debate has forced us to consider some uncomfortable issues as a whole- Issues which I as a solo family practitioner, am faced with almost daily. These are topics which warrant attention regardless of your political leanings, and these issues are finally the topic of conversation- and frankly, I am glad to hear the discourse:

-The United States is WAY behind the curve when it comes to preventive care. An unbelievable amount of savings could be found in simply facilitating early screenings and preventive measures for a whole host of disease- from heart disease to Type II diabetes. For the first time ever I am hearing discussion of this issue.

-We are lacking when it comes to prenatal care, and have a caesarian rate far above those recommended by the World Health Organization and virtually every Ob/Gyn governing body in the world. I am hearing many of my Ob/Gyn colleagues talking about the importance of primary care, and preventive screenings to facilitate the reduction in C-section rates and birthing complications.

-I am seeing the discussion of nutrition finally becoming serious. Rather than just saying ‘we should eat healthier’, I am hearing about school districts facilitating healthy eating for kids, fast food restaurants actually giving considerations to the contents of their products- there is even a new reality TV show where a chef is trying to improve the eating habits of an entire town.

-The nations poorest individuals are also the least likely to have insurance and subsequently, routine care. This population is almost never part of the popular discussion on the topic of health care. Now they are.

The American lifestyle seems tailor made for a whole plethora of health problems, and for the first time we, as a culture, seem to be thinking about the factors which contribute to this deleterious lifestyle.  Regardless of whether you lean right or left,  you would be hard pressed to deem this line of thought as anything other than positive.

Be well, and thanks for stopping in.

-Andy

Display at the Welcome center in the Royal Victoria & Albert, London. All of the pills an individual took over the course of a lifetime.

Display at the Welcome center in the Royal Victoria & Albert, London. All of the pills an individual took over the course of a lifetime.

B.T.T.o.D: See your family doctor regularly.

Tuesday, March 9th, 2010

See your family doctor regularly for general check ups- there are some conditions that cause back pain and have nothing to do with your back. Some of these conditions are serious- and they can involve almost any of your internal organs. Early intervention can often mean the difference between relief and a catastrophe.

If you have new-onset pain which lasts more than a few days, see your doctor right away- particularly if your pain does not have a clear cause (like you’ve been gardening or moving furniture all week!)

Many people develop back pain, and believe they will ‘work through it’ or that it will simply go away. Don’t fall into this trap, and you will save yourself lots of aggravation.

Thank you for stopping by!

Best,

Andy

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