New guidelines for back pain move away from meds, scans
“The Blair Witch Project”, “The Others” and “Halloween” are spine-tingling horror films. While they’ve raked in a total of $595.9 million at the box office, if that’s not a sensation you want to experience, you can just walk away.
Unfortunately, it’s not that easy to avoid the spine-dinging ache of lowback pain. Over 80 percent of Americans contend with LBP at some point, often from arthritis, heavy use at work, doing sports, or following an accident. So what’s been the go-to solution? First a NSAID or other antiinflammatories, then a scan and opioids. They are the treatments that Medicare/insurers push.
Well, that’s about to change — we hope. New clinical practice guidelines from the American College of Physicians recommend that doctors move away from scans and prescribing drugs, and embrace nonmedicine based treatments for LBP, including yoga, mindfulness and cognitive behavioral therapy. Why? According to a Canadian review, for 95 percent of LBP patients medical interventions are no more effective than placebo! This echoes a study from 2016 in the Annals of Internal Medicine that found that massage, tai chi, yoga, physical therapy and acupuncture were effective therapies.
So if you’re knocked off your feet with LBP, ask your doc about nonmedicine-based treatments. If the pain lasts more than six weeks, then you should be referred to a specialist and get an MRI. We bet Medicare/ insurers also will embrace this effective, cost-saving approach! (LBP costs the U.S. over $100 billion annually; two-thirds of that in lost productivity and decreased wages!)
Mindfulness for weight loss
On an episode of “Brooklyn Nine-Nine,” three of the crew go on an extreme diet from
Park Slope Portions, a meal-delivery service. Scully (who’s not on the diet) reminisces about diet pills from the 1970s. Terry, who’s doing the diet, says “Weight-loss science has come a long way since then.” He pulls out his pre-delivered lunch
— a carrot in a bag — and reads the label: “Ingredients: carrot. Gotta respect that.”
We all know someone who’s gone to nervewracking extremes to lose weight. But more and more research is showing that there’s a way to shed pounds that’s the opposite of stressful and it’s more successful: mindfulness. A new analysis of 19 studies that included 1,160 participants found mindfulness-based interventions are effective in improving eating behaviors and are linked to better weightloss results.
So here’s how to make mindful eating work for you. The key is being aware and present in the moment. Apply these tips to your meals and snacks:
■ Think about what you’re eating and why.
■ Ask yourself as you’re eating if and when you feel satisfied.
■ If you’re making unhealthy choices or giving in to cravings, ask yourself why that might be and think about how you feel in that moment.
As you start to feel more aware of being in the meal moment, you’ll become more empowered to make healthier choices and won’t have to go to the “Park Slope” extreme.
Question: I’m thinking about getting a vasectomy. We have two kids, and that’s perfect for us. This seems like the best method of birth control. Are there any downsides? — Glen H., Cincinnati
Answer: Any operation increases your risk of infection, but a vasectomy is a relatively safe and simple procedure: The vas deferens (sperm canal) is detached from each testicle. You’ll need an ice pack to control swelling and will experience slight discomfort, but you should be up and running in seven to 10 days.
The process is 99.9 percent effective as birth control and as a bonus, there’s some new, good news about an unexpected benefit for men who’ve undergone the procedure: The conventional thinking has always been that the only change after a vasectomy is the loss of sperm in the ejaculate (it makes up only about 5 percent of the fluid). A man’s sex drive, erections and orgasms were thought to be unaffected. But apparently that’s not so. When a guy wants to and does eliminate the possibility of pregnancy, his enjoyment of sex increases.
According to a study from Germany’s Frankfurt University of 279 heterosexual men who had vasectomies, guys develop a stronger sex drive, have sex more frequently and experience better orgasms post-vasectomy — and a woman’s satisfaction isn’t reduced. Proving, once again, the strongest sex organ is between your ears!
But beware! It can take up to three months to clear the sperm out of your ejaculate, so stick with your current birth control method during that time. And if, down the road, you have a change of heart or circumstances , you can have a vasectomy reversal. After a reversal, pregnancy rates range from 30 to 70 percent; however patency rates — the return of sperm in the ejaculate — can reach 95 percent.
Q: Yesterday I didn’t have high blood pressure; now, even though my numbers haven’t changed, my doc says I have prehypertension, whatever that is! What’s going on? — Greg F., Chicago
A: The American Heart Association is catching up with our recommendation (first published in our books in the 1990s) that defined high blood pressure as anything above 130/80 mmHg. After a very careful review of old and current research, the AHA lowered its definition of stage 1 hypertension from 140/90 to 130/80. It also has recommended a plantbased diet. Bravo!
But there’s more…
■ Normal BP is now considered less than 120 over less than 80!
■ Prehypertension is 120-129 over 80 or less.
■ Stage 2 hypertension is 140 or higher over 90 or higher.
■ Hypertensive crisis is 180 and/or 120 or higher.
If you’re in Stage 1 or 2, talk to your doc about taking anti-hypertensive medication and making lifestyle changes, including more physical activity, less animal protein and more stress management! In Stage 1 you may be able to reduce your blood pressure to below 130/80 and keep it there with lifestyle changes, but work with your doc and the meds first, then decide together how to move forward. Never stop HBP meds abruptly!
Lifestyle changes you should embrace include:
■ Shedding just nine pounds (if you’re overweight). That could lower systolic pressure (the top number) by 4.5 mmHg and diastolic pressure (the bottom number) by 3 mmHg.
■ Adopting the DASH or a Mediterranean diet that emphasizes fresh produce and elimination of processed foods and red meats. Also, cut sodium consumption and limit alcohol to two drinks daily for men, one daily for women. FYI: Cutting salt intake by 3 grams for a few weeks could lower systolic BP by 5-7 mmHg and diastolic by about half that.
■ Taking potassium supplements (they relax blood vessels), unless you have kidney disease, or take meds that block potassium secretion. Ask your doc!
■ Getting 10,000 steps daily and two to three strength-building sessions weekly. That can lower your systolic number by 5-8 mmHg.