Online Health

Back Pain and Holiday Blues: 18 Tips to Reduce Your Holiday Stress

spine-health — Fri, 07 Dec 2007 13:00:24 -0800

December 7, 2007
by: Sylvia Marten

Ah yes, the holidays are upon us once again, and with them the holiday blues. Not everyone is in festive spirits, especially those of us with chronic pain. Often, chronic back pain leads to [url:138,type=|term|,content=|depression|], and alternately depression can worsen physical pain. The added anxiety and stress of all the holiday planning and expectations can intensify feelings of sadness. Travel blues may factor into the equation too - vacation blues catch us off guard as we're taken away from our normal routines and pain management support like special [url:158,type=|term|,content=|ergonomic chairs|] and [url:161,type=|term|,content=|mattresses|]. Even if it's just a temporary bout of the holiday blues, that doesn't mean you have to simply accept it. Here are some things you can do to reduce your holiday stress.

Talk with friends on the phone, or over coffee.
Talk with other people who suffer from back pain or chronic pain on the Spine-Health.com forums:

See your family doctor or psychiatrist - you may have a physiological disorder that requires antidepressants.
Improve your diet and exercise regularly, at least on non-party days. Don't stress about weight gain at the big family gathering or work holiday party. Having food you enjoy and chatting with friends releases endorphines. Live a little! On other days, make sure that you eat in moderation and get at least a half hour of cardiovascular exercise, even if that means nothing more than taking a walk. If you have difficulty with certain types of exercises due to back or neck pain, try these [url:1183,type=|node|,content=|exercise tips for people with back pain|].
Seek sunshine - the real thing is best, but if it's dark and dreary outside, spend a few extra dollars and get yourself some full spectrum lighting.
Set realistic goals and don't be the ultimate people-pleaser. Decide what's important and don't overextend yourself.
Plan a small gathering of friends or neighbors such as a dinner or wine party.
Read these Spine-Health.com articles:

[url:1079,type=|node|]
[url:6615,type=|node|]
[url:1081,type=|node|]

Make sure your plans move you toward your goal, and celebrate even minor achievements.
Cook, buy yourself some new music and/or new books to have on hand. (no depressing music!)
Go to a museum or concert.
Plan a short trip to a place you enjoy, either by yourself or with a good friend, and don't forget to take along these [url:1107,type=|node|,content=|pain-free travel tips|].
Rent movies from your local movie store or an online DVD rental company.
Hug somebody! This is no joke, hugging has positive and real physical benefits. The BBC even published the results of a study stating that hugs increase oxytocin and reduce blood pressure in women.
Meditate. According to researchers at James Cook University in North Queensland, Australia, meditation offers similar mood benefits to running or other physical exercise. If your pain restricts you from strenuous exercise, consider meditation. Don't know how? You can learn to meditate.
Go ergonomic. If you're at home, it makes sense to have [url:158,type=|term|,content=|ergonomic seating|] available. If you're going to sit and watch TV, eat dinner or pay bills, do everything you can to reduce your pain by giving your back the proper support. [url:170,type=|term|,content=|Pain management|] is a key component in managing depression during the holidays as well as throughout the year.
[url:1927,type=|node|,content=|Get enough sleep|]. Yes, you have to get to the store, wrap those gifts, bake that cake, etc...but sleep deprivation is a big contributor to depression. Be disciplined - go to bed and get 6 to 8 hours of sleep! If you have difficulty sleeping due to chronic pain, you might want to check out our articles on the [url:1315,type=|node|,content=|best mattresses for back pain|].
Clean up the house and get organized. A clean space can make you feel better about any other holiday projects you have going on.

BONUS "BEAT THE HOLIDAY BLUES" TIP:

Honor your own feelings. While nobody wants to feel depressed, recognizing your sadness can mean that something isn't working in your life the way that you would like it to. If it's something you want to change, hey, it's almost time for those New Year's resolutions, right? Pay attention to what your body is telling you, and if necessary, seek the help you need.

Consumer Reports for Pain Medications?

Fri, 14 Sep 2007 17:03:48 -0700

September 14, 2007
by: Sylvia Marten

Sure. Savvy consumers often look to the expertise of Consumer Reports before buying a car, a washing machine, or a video camera. But what about for pain medications?

Well, Consumer Reports is also in the medication rating business and has issued another report in their free medication series that covers drugs for Nerve Pain and Fibromyalgia.

What I like about the report is that it’s peer-reviewed by medical experts, combines effectiveness, safety/risk, and pricing information, and is written for consumers. [Note: the information has not been affirmed by Spine-health.com’s medical board and you’ll need to check with your doctor anyway regarding any information in there.]

For someone newly diagnosed with a condition or if your doctor is recommending switching to a new medication, it may be helpful to make a pit stop and review a report like this. Particularly for people with chronic pain conditions who may need to take a pain medication for an extended period of time, the reality of cost has to be part of the equation of managing the condition. Physicians are often more focused on the pain problem and may be less attuned to cost differences when there is a choice of drug.

Additional resources:

[url:1915,type=|node|]
[url:137,type=|term|,content=|Chronic Pain Health Hub|] – for a variety of pain relief options (not just pain meds)
[url:830,type=|node|,content=|Depression Guide|]

Incredibly Effective Ways to Check Out Your Surgeon

Wed, 29 Aug 2007 19:38:44 -0700

August 29, 2007
by: Stephanie

When it comes to selecting a surgeon, I'll take skill over personality anytime. But the $64,000 question is, how do you assess a surgeon's skill? When you buy a new TV or vacuum cleaner, you can rely on Consumer Reports and talk to friends who have the same model. But there's no "Consumer Reports" for doctors, and it's infinitely harder to find someone you know and trust who has had the same surgery for the same condition.

To help you navigate the murky waters of getting the real scoop on your surgeon, here are several little known and highly effective ways to find out about your surgeon's skills and expertise:

Talk to the nurses
The nurses see the surgeon's results – they see the successes and they see the mistakes -- and they know the difference. If you need surgery ask to speak with the operating room (OR) nurses who cover that surgeon, and speak with the anesthesia personal as well. Be specific in asking them "If you needed this surgery, who would you have do it?" Do this very early in the process at the hospital you will be going to. Of course the nurses usually won't come right out and say "That surgeon's a dirtbag." But you can usually pick up on their overall opinion of the surgeon through your discussion anyway (e.g. by what they don't say, but what they omit, with their facial expressions). For example, if the nurse says, "I sent my Dad to him" that's about the highest praise there is. Conversely, if the nurse says "He's such a nice guy" but declines to comment on his surgical skills, that is a big red flag. Just be careful how you interpret what they say. For example, when ERNurse (on our Pain Forums) asked the OR nurses about her surgeon one made a face and said, "He's so *** picky in the OR," she ignored the nurse's negativity and instead interpreted it to mean that the surgeon was precise, picky about sterile fields, and wanted everything to be right – all good things.

Most people are not too comfortable "cold calling" on nurses to ask them questions in the hospital, and many times hospital policies discourage people from walking around and asking random questions. If this is the case, you can first ask to speak with the Nursing Director, tell her what you're doing and why, and use the Director's authority to gain access to the rest of the nurses you need to speak with.

Nurses you'll want to speak with include:

Operating room nurses (and anesthesia personnel), who see how the surgeon performs in the operating room
Nurses who work on the floor where surgeon's patients usually go after surgery (they see the recovery experience of that surgeon's patients vs. other surgeons patients)
If you're still not sure, you can ask to speak with the Risk manager of the hospital, who is usually a supervisory nurse. Again, she will give you just basics but the tone in which she talks with you might allow you to pick up on subtleties.

Get specific references
Ask for references from three patients, but don't ask the surgeon for these. Ask the physician who referred you to the surgeon (this will typically be your primary care physician). That way you're more likely to get a balanced view. Then, provided those patients give the surgeon good marks, ask your surgeon for two more references, and this time ask for references only from patients who have had your specific surgery for the same diagnosis.

For those of you who are wondering, yes, you can ask your doctor for references from other patients. A good surgeon will be happy to give you references and does this sort of thing all the time. A good surgeon will have plenty of patients who are happy to serve as references. And a good surgeon knows that if you're confident about your decision to have surgery and your choice of surgeon, then you'll do better after the surgery.

Ask around
You really can't do too much of this. If you have any friends who work in the healthcare field, see if they can find out about your surgeon. The healthcare universe is actually quite small when it comes to surgeons, and often it just takes a couple phone calls for someone who works in health care to find out about the reputation of a surgeon.

Know the answers to some questions
When you ask your surgeon questions, make sure you have an opinion about the correct answer to some of the questions so that, even though you don't have an MD or DO, at least you will be able to gauge the credibility of some of their answers. To do this, look up everything you can about your surgery -- there are a many free information sources on the Internet (just be sure you can trust the source). Use the knowledge you gain as a basis for an interview with your surgeon. For example, if your surgeon is recommending an ALIF for lumbar degenerative disc disease, look up the principal risks of this surgery on Spine-health.com and then ask the surgeon what they are. If he fails to mention one or several of the main risks, this is a red flag.

the very least, confirm that he or she is board certified or board eligible in his or her specialty, and see if he or she has any issues with the state medical board or other reported issues. Also read as much advice as you can on how to select a surgeon, such as [url:6634,type=|node|].

All of the above takes time, but when you consider the gravity of the situation and all the risks involved with having surgery (including, when it comes to having [url:165,type=|term|,content=|back surgery|], the risk of having continued or even increased pain after the surgery), then it is definitely worth the time and effort.

Special thanks to the collective insights and experiences of Spine-health's active and vibrant Pain Forums for contributing most of the above points.

Good luck!

Posted by: Stephanie

More reading:

[url:6643,type=|node|]
[url:6592,type=|node|]

Cyber Hugs: How Online Support Groups Help with Chronic Pain

Wed, 18 Jul 2007 19:29:21 -0700

July 18, 2007
by: Stephanie

If you're dealing with [url:137,type=|term|,content=|chronic pain|], you probably already know what a devastatingly lonely experience it can be. Even with the most supportive family and friends, you still feel alone, because they don't know – they can't know – what it's like to endure chronic pain each and every day of your life. And just so sick and tired of explaining yourself and having it affect all the most important relationships in your life.

This is where online support groups come in – an online discussion forum where people with the same kinds of pain are dealing with the same things your are. These groups provide you with a circle of friendship, support and camaraderie to help you through the worst and celebrate the good times as well. These people won't tell you its all in your head, they won't keep asking if you think you feel better yet, and they won't mind when you just need to vent.

Contrary to how many people view online chronic pain support forums, the people in these groups are not whiners and attention seekers. At least on Spine-health.com's back pain forums and chat rooms – we find people are almost universally constructive, supportive and at times downright hilarious.

So what are the main benefits of an participating in an online support community?

They validate your feelings – no, you're not crazy or imagining it!
They give you hope even in your deepest times of need
They spur you on to keep coping and looking for pain relief even after you're exhausted and want to give up
They help you with daily living problems. Should I get a shower seat? How do you arrange the pillows at night to get back support? What are recipes that are easy to prepare and nutritious?
They are available day or night. Up with intense pain at 2:00 am and feeling all alone? Log on and you'll have company – your online friends can help you get through the night.
And sometimes best of all, you get the satisfaction of helping others. You can reach out to others when they post questions, need an emotional lift, or just need to talk.

A good pain management program and other approaches can hopefully help you from a medical perspective. And if you're really depressed, take care to get help from a professional right away. (You can use this [url:819,type=|node|,content=|Symptoms of Depression|] checklist as a guide to see if you - or someone you care about - needs help.) And by all means don't forget to take good care of your emotional, spiritual and psychological health too by finding a good support group. You may have to visit a number of discussion boards and chat rooms to find one that suits you best, but I guarantee you it will be well worth it. If you prefer to meet in person, contact your local hospital or your pain management physician and they should be able to give you a list of local chronic pain support groups in your area.

You will be amazed at how many people suffer from the same pain and related challenges as you do, and how refreshing it is to meet others in such similar situations. Cyber hugs to all!

Posted by: Stephanie

Additional Resources:

American Pain Foundation Pain Resource Locator
Back Pain and Chronic Pain Discussion Forum
[url:830,type=|node|]

6 Sites for Checking Out Your Hospital

Sun, 15 Jul 2007 14:20:59 -0700

July 15, 2007
by: Sylvia Marten

Are you scheduled for [url:165,type=|term|,content=|back surgery|] or considering it? In addition to a thorough check of your surgeon, you should probably check out your hospital too. While the surgeon is arguably the key factor in the procedure itself, the hospital staff, environment, and guidelines can impact things like choice of medication and use of antibiotics – choices that can cause variances among different hospitals, such as post-op infection rates for back surgery patients.

The notion of “hospital quality” would have been nearly impossible for consumers to ascertain even a few short years ago. But now, as part of the push to improve health care quality and lower costs, hospital information is becoming public.

Thanks to Theo Francis at the Wall Street Journal for compiling a list of hospital comparison resources available to the public.

Two major categories of data cover:

Best practices - which tracks how often hospitals follow recommended guidelines for particular procedures. Online resources include:

Procedure outcomes - which tracks how patients that have particular procedures actually fare. This data often covers mortality rates, readmissions and complications. Online resources such as:

This hard data should be considered along side the qualitative data provided by talking to others:a hospital’s reputation for back surgery (and ideally, for the particular type of surgical procedure e.g., fusion surgery, artificial disc replacement) in the community, the experiences other patients have had at that hospital, what a hospital’s employees say, and what a prospective patient learns and feels by calling up the hospital’s quality department or talking with the medical staff.

What other resources have you found helpful in assessing hospital quality?

Posted by: Sylvia

More reading:

[url:1556,type=|node|]

For Physicians: Paging Dr. Google

Tue, 03 Jul 2007 04:33:42 -0700

July 3, 2007
by: Sylvia Marten

As you may know, Google is the preferred search engine for finding online health information among both health professionals and consumers. At least in the U.S., Google has become the de facto search engine for most search activity.

But how accurate (and helpful) is the information contained in Google’s health search results? A recent study decided to put Google to the test.

Two British doctors took 26 complex patient case histories and tried to use Google to diagnose the causes (Source: Tang, H. British Medical Journal. 11/10/06. BMJ.com).Their findings? Google was right almost 60% of the time. The researchers concluded that “...in difficult diagnostic cases, it is often useful to ‘google’ for a diagnosis.”

But there is a catch: for each case, the doctors carefully selected the most appropriate search terms to start with and they used their expertise to select from among the results. To this, they state “patients doing a Google search may find the search less efficient and be less likely to reach the correct diagnosis.”

As a health professional, the implications include:

Google may be considered a useful tool for you and your medical staff, as long as medical expertise is applied upfront to the search terms and as a screen to help choose among the search results. The use of Google in conjunction with your other tools, e.g., PubMed, provides another source of potentially relevant, quick and current information and keeps you abreast of what your patients are experiencing online.

Patients can also reap benefits from using Google to research their condition, but will need guidance from you as to the appropriate search terms and how to select from among the search resultsTo help your patients with online research, you can:

Document the specific condition and treatment options that apply to each patient, so they know the right terms to use online. You can literally write out the terms and give the patient relevant handouts to take home. You’ll save your patients a ton of time and frustration by narrowing their search.

Guide patients to the highest quality online health sites so they can better sift through the search listings that result from any one health term search. The hallmarks of quality health sites? Among others, the site should:

Have qualified medical/health experts write balanced, fact-based articles
Blind peer-review all articles prior to publication
Clearly distinguish peer-reviewed health content from advertising and from content written by sponsors
Publish dates and sources on their medical content

Contrary to what some medical “experts” say, you cannot use a site’s domain name extension to determine the trustworthiness of its content. You can find high quality (and not-so-good quality) content on .com sites but also on .org, .edu and .gov sites. Judge instead based on the three quality criteria above.

Review and clarify what your patients find online. Patients, especially those with chronic conditions like back pain, should be applauded for trying to learn all they can about their condition. There’s a lot of bad info out there that can create confusion and even harm. Understand what they are reading and help them sort out the good from the bad.

Additional resources:

[url:6728,type=|node|,content=|Spine-health.com philosophy|]
HON Code of Conduct (HONcode) for medical and health Web sites

For Health Information, Enter Wikipedia at Your Own Risk

spine-health — Wed, 20 Jun 2007 17:12:38 -0700

June 20, 2007
by: Stephanie

Thanks to KevinMD for highlighting a hilarious post by anesthesiology resident Michelle Au about residents using (aka misusing) Wikipedia to look up health information.

The idea behind Wikipedia is admirable, and I think it works well in many categories - looking up places, historical facts, etc. But in the areas of health - at least in the 100 or so pages I've worked on editing - it is such fodder for commercial interests it's scary.

For example, on the Back Pain page some phrases are clearly commercial - eg. "Dr. John Keating talks about some of the ways to treat the pain in this VIDEO LINK" (links to Youtube video of a dr. talking about his approach to fixing si joint dysfunction). Other interests are presented less obviously. Dr. Sarno's approach to treating back pain used to dominate the page and still keeps popping up from time to time.

But even if one were to zealously hunt out and delete the obvious commercial plugs, there are some intrinsic problems with Wiki that will always make it unreliable for health information.

Conflicting information. Example: the Back Pain and Low Back Pain pages give conflicting information - each presented by "authority" sources - about whether various treatments (spinal manipulation, epidural injections, acupuncture) work or not.
Lack of detail. I don't really care about the above conflicting treatment information, because it's so high level its moot. Who cares if epidural steroids "may be" beneficial for low back pain? Patients need to know what specific back conditions the injections work for - do they work for patients with low back pain from [url:815,type=|node|,content=|degenerative disc disease|]? Do they work for low back pain from muscle strain? Otherwise, who cares.
Poor writing. Typos, grammar problems, redundancy .... don't even get me started.
Lack of balance. Since anyone can insert (or delete) anything at anytime, the pages often come across as ramblings rather than anything cohesive. For example, on the degenerative disc disease page, following two very high level paragraphs about the full range of surgical and non-surgical treatments, there was a third paragraph that dives deep into osteopathic treatments and why it is preferable. I fully support osteopathic treatments for low back pain, but it is given way too much weight here.

I used to be very active with helping build Wikipedia. I thought the idea of so many people who were experts in a given field contributing to make a common, free educational resource was very exciting. Now I'm just frustrated.

All IMHO.

(P.S. Just went back and fixed the Degenerative Disc Disease page - couldn't resist!)

Posted by: Stephanie

Google Health Weighs In on Online Patient Information

spine-health — Tue, 19 Jun 2007 15:15:00 -0700

June 16, 2007
by: Stephanie

One of the clearest, most understandable posts I've seen yet about the challenges of managing your health - especially if you have a chronic or serious condition - posted by Roni Zeiger, M.D., of the Google Health Team . IMO Dr. Zeiger hit the nail squarely on the head with this simple statement:

"...better-informed patients recover faster, manage chronic illnesses better and may even avoid some illnesses altogether. And patients should feel in control of their situation."

Those are the main reasons patient education websites should exist.

Posted by: Stephanie

More resources:

Google health: a virtual doctor in your family