For the boy scouts, the first rule of hiking with a group is that “the group is only as fast as it's slowest member.” A friend had mentioned this to my husband and I a few years ago when we were hiking with two families. This seems counterproductive. If the slowest member is leading the group then the whole group goes slower as compared to just a few. And yet, the success of the group is only as good as the success of the slowest member of the team.
Salt, like fat, has gotten a bad wrap over the years. We have all heard that salt causes hypertension or high blood pressure which can lead to atherosclerosis, heart attack, stroke, kidney disease and early death. So much fear is associated with this, that we have attempted to remove all salt from our diets. Our salt shakers stay tucked away. When a recipe calls for “salt to taste” we assume it means it’s actually unnecessary.
What I aim to do here is bring the light onto salt to understand how it actually is essential to life and avoiding it at all costs can have a negative impact on your health and function. This blog is not a treatment for heart disease, rather an acknowledgement of the importance of essential electrolytes that we cannot survive without. (In case you were wondering, people sensitive to salt do in fact result in a hypertensive response, BUT this is a small portion of the population and those with renal disease are the most salt sensitive.)
Did you know that one in four Americans suffer from pain per the National Center for Health Statistics? Pain is the primary reason for seeking health care services. In 2010, the annual cost of pain was greater than the annual cost of heart disease, cancer and diabetes COMBINED. This pain is often caused by chronic inflammatory conditions like arthritis.
Common treatments for painful and inflammatory conditions includes Non-steroidal Anti-Inflammatory (NSAID) medications like Advil or Motrin or Celebrex. The mechanism of action to decrease pain is in the NSAIDs ability to block the COX-1 or COX-2 pathway which is why it reduces inflammation and pain. A common side effect of NSAIDs is gastrointestinal disruption especially with chronic use. More recently there was a study published demonstrating an increased risk of cardiac arrest with the use of NSAIDs.
Pain is a subjective experience determined by a localized response and a behavioral response. The localized response is driven by the pain receptors (mechanical, heat and chemical receptors) and nerve endings in the tissue of the injury or damaged area. This information is transmitted to the spinal cord via afferent nociceptors. At the spinal cord the message is relayed through a well-defined pathway to the higher centers in the brain. It is at the higher centers that the behavioral response is stimulated to begin behaviors that are directed at relieving or terminating the experience of pain.
To my readers,
I have recently entered a new blog topic called “Viewpoints.” This is for my opinions and my writing which explores more than the science of health and well-being. Please understand that the clinician in me prefers to stick to the science as that helps me understand the ‘why’ of things. However, in experiences of love, grief, loss and death (things that have encompassed my life recently) the science does little to soothe my heart. Rob Bell (In the Beginning) says, “The Bible is mostly written in mythos language. . . . Good religion traffics in mythos. . . . Mythos language is for that which is more than literally true. . . . Evolutionary science does an excellent job of explaining why I don’t have a tail. It just doesn’t do so well explaining why I find that interesting!” I suppose what I am saying is that at times, I personally need something more than science to express the “more-than-factual meaning” of my current life experiences. I hope not to offend any readers nor lose my credibility, but mostly that you may remain open to the concept that there is something bigger albeit unknown involved in your life to give you hope, whatever that looks like to you.
Dr. Carolyn Dolan, DPT
hope: (noun) 1) a feeling of expectation and desire for a certain thing to happen; 2) a feeling of trust
hopelessness: (noun) 1) a feeling or state of despair; lack of hope
I am not sure you, the only reader of the SOAR blog, have noticed, but it’s been quite a while since my last blog or podcast or really anything…but thank you for hanging in there. This past fall and winter have been and continues to be in a word….challenging. I am not asking for a pitty party or even really go into much detail at this point as I appreciate that every single one of us has challenges even if we eat our fruits and vegetables. Healthy eating can only go so far.
As many of you already know, my husband is an orthopeadic sports medicine surgeon. He is a gem and that isn't because I am biased...well maybe a little. As we have transitioned our family and made adjustments in our careers to reflect health and wellness not only for ourselves but also our community, Chris has continued to be consistent in using his gift to offer alternatives to patients fitting for his/her diagnosis and lifestyle. His ability to contintue to do that in a surgical specialty in today's health care climate is nothing short of miraculous. Miracles aside, it is truly his commitment to what he calls the Four Responsibilities that allows him to continue to be a SOARing surgeon, husband and father. This guest blog is a gift to me, but really to all of us. Learn more about the other Dr. Dolan MD here. Enjoy.
I believe I have four responsibilities as an individual. These responsibilities are a commitment to self, family, community and profession. It is important to note that these responsibilities and commitments are in order of importance.
Patience (n) : the capacity to accept or tolerate delay, trouble, or suffering without getting angry or upset.
Oh boy. Don't we all need a little more of this...patience.
A few weeks ago, I was rushing to pick up a friend for a much needed mommy date long over due to celebrate mutual birthdays that had long since passed. In my rush, I pulled out of the garage and hit my passenger side rear bumper into my mother-in-law’s car. This was her reward for helping me watch the kids of course... because no good deed goes unpunished. I jest here.
As my oldest has shifted to middle school with an earlier school start time I have had sleep on my mind. Selfishly because I want to sleep past 6AM, but also because I worry about what potential sleep deprivation will have on the young developing brain for learning and happiness.
Fortunately for us, my son goes to bed by 8PM and wakes naturally by 6 AM so it hasn’t been much of a problem for us….yet.
However, when I look at the other struggles parents have with the early morning start times I see worrisome trends. The rates of childhood obesity are rising especially in the middle school aged children, kids are glued to their phones at the bus stop – kids don’t look or listen to their environment to be sure they aren’t in harm’s way, not to mention the struggles with learning.
Yes, one solution may be to change the school start times, but what if the solution may be to actually change our sleep habits in the home? What if we continued to hold the same regulations on sleep through the teenage years as we did for infants? I remember RELIGIOUSLY dictating my young infants sleep routine because if my baby didn’t sleep, I didn’t sleep? What if?
Maybe these few studies will help stimulate you to oblige the SLEEP SCHEDULE a bit longer.
The importance of Vitamin D cannot be ignored. Vitamin D is a natural conversion of blood cholesterol in the presence of UVB spectrum sunlight hitting the skin. Specifically related to intestinal permeability, Vitamin D3 has been shown to preserve epithelial barrier function in the presence of intestinal injury, be it Crohn’s disease or ethanol-induced or poor lifestyle choices. The free source of vitamin D3 is full sun exposure to a majority of your skin, without burning. Yet, during certain times of the year or even job requirements, it is not possible to get the needed skin exposure to produce adequate and therapeutic amounts. You can check your area for when the sun is above the 50 degrees altitude in order to provide UV B exposure for Vitamin D conversion. Spending five to ten minutes for fair skin during peak UV B exposure on a large portion of skin is the most effective and efficient. It’s important to gauge your skins response to avoid burning.
Fish oil or omega 3 fatty acids help recovery and pain reduction because of their ability to reduce inflammation, protect joints, provide a substrate that is neuroprotective (protects the nervous system) with improved dopamine neurons. These fatty acids are primarily found in cold water fish, eggs, cod liver oil and also flaxseed oil.
A recent systematic review and meta-analysis evaluated the effects of Omega-3 fatty acids on patients undergoing surgery for gastrointestinal malignancy. The authors concluded that omega 3 fatty acids were effective in improving the nutritional status and immune function in patients undergoing surgery. The omega -3 fatty acids not only enhanced immunity but attenuated inflammatory response. Another experimental study demonstrated that omega-3 fatty acids significantly decreased wound area by day 7 in diabetic wounds. Additionally, the wound strength was significantly increased by day 15. In an animal model for osteoarthritis cartilage degeneration, docosahexenoic acid (DHA) an Omega- 3 fatty acid, showed promise as a therapeutic agent in osteoarthritis prevention. In the field of dentistry, omega-3 fatty acid effect reduces bone resorption following gingivalis infection. The benefits of omega-3 fatty acids continue to be supported to improve cognitive function as well as reducing central nervous system oxidative stress.
Vitamin C, a natural constituent of many fruits, is a powerful anti-oxidant. It helps to prevent free-radical damage that contributes to aging and degenerative disorders. Vitamin C also prevents other antioxidant vitamins from being oxidized. Eating citrus is a good way to get Vitamin C, but it may not be enough when recovering from injury or surgery to reduce pain and risk.
Specifically, for chronic pain states like Chronic Regional Pain Syndrome (CRPS), Vitamin C used preoperatively at 2 g, reduces the morphine consumption in the post-operative stage. Fifty days of use at 1g/d post-operatively may reduce the CRPS risk development. A meta-analysis supports use of Vitamin C for reducing CRPS risk despite not finding conclusive dosage. Another study concluded that the administration of Vitamin C in preventing CRPS after distal radius fracture is low cost and has few complications. Another systematic review also supports the use of Vitamin C for foot and ankle surgery at 500mg for 45-50 days. There are some conflicting reports on effectiveness of 500mg Vitamin C in reducing pain, and it is worth noting as it may be dose dependent.
Is it possible that bacteria could aid in healing from injury or surgery?
Yes. In fact it is important to promote the variety of bacteria in your gut to promote immune health, reduce pain and reduce risk of infection.
As described in an earlier post about the leaky gut syndrome, supplemental recommendations that may reduce pain and improve healing are geared to promoting gut health. Specifically, the microbiome diversity is strongly linked to gut and mental health. This gut-brain connection is at the core of much of the research around supplemental probiotics. A literature review evaluated the research around use of probiotic use and migraine headache. The findings of improving gut microbiota and reducing inflammation may have positive effects on strengthening the gut and improving brain function. This is important to surgery/injury in that gut health supports brain health which thereby will have a positive benefit in the role of the brain in the pain experience.
What do papaya and pineapple have in common besides being tropical fruit?
They contain potent vegetarian proteases. A protease is an proteolytic enzyme that helps break down protein.
How does this relate to healing from orthopedic injury or surgery? A lot actually.
Proteolytic enzymes aids in breaking down animal proteins when ingested, but also mediates tissue repair and break down of cellular debris associated with inflammation metabolism.
Common medications to address symptoms of pain following orthopedic injury or surgery are those targeted to reduce inflammation. The problem, is that these same medications that reduce pain via inflammatory regulation also impair healing, disrupt the integrity of the gut, and increase the risk for cardiovascular events. Fortunately there is a natural remedy that does not have the negative side effects.
Turmeric is an Indian spice from the ginger family used in curry. It is the spice that gives curry its yellow color. Curcumin is derived from turmeric and is the most active form. This is important because oral absorption of curcumin tenst to be poor due to its low solubility and instability in the intestinal environment. Yet, as an herbal remedy, it is historically used as an antiseptic, antibacterial, anti-inflammatory, pain killer.
There have been many recent events that I felt conflicted over as far as deciding whether or not to quit. For me, with my athletic history, I have felt that somehow, quitting meant failure. I have struggled with feelings of inadequacy as I admit something isn't working. Like maybe I wasn't committed enough, or available enough or smart enough....the list goes on.
As I have explored more about quitting, I discovered that it may not only be an appropriate action but necessary to achieve success, or more importantly, growth either mentally or physically or financially. Admitting something isn't working and learning how to quit is critical if you want to SOAR in life.
To be clear, you can't win without struggle along the way, but you can't win if your struggle doesn't get you anywhere.
Yet, how do you decide something is worth struggling through or when is it actually best to quit?
Should you wear a seatbelt while driving your car?
The answer seems obvious, right?
First, it’s the law and it’s an expensive fine if you don’t.
Second, you enjoy living, and seat belts save lives.
Honestly, do you know a person who would answer this question by saying seat belts don’t work no matter their education level nor economic status?
Well, here is my argument that you shouldn’t wear a seat belt, use a helmet, use a life jacket, use a parachute nor have health insurance….or at least pretend it’s not available.
The word “SOAR” started for me as an acronym to Spine Orthopedic Active Rehab when I ventured into my own private business. As I moved into a blend of health coaching and physical therapy, the meaning of the word soar became one of the four principles to health and wellness.
Soar means to fly or rise high above the usual level. There is something both majestic and effortless about watching a bird soar thru the air even though it must return to earth to feed and rest.
I don't write much about Crossfit. Mostly because the eye roll people give me gets a little old after I tell them I don't eat gluten. Sometimes though, I just have to pause and appreciate what my body is able to do. Every single time I go to Crossfit Initiative I get something unexpected.
Not pain....not injury...not tired (well, maybe sometimes)...not stronger....but...I get more comfortable with being uncomfortable.
Why is that good you ask?
It's good because it makes me a better parent. It makes me more comfortable doing the job that makes me the most uncomfortable.
That might not make sense to you, but maybe this explanation will help.
As you all know, I have been doing a lot of reading and research related to nutrition and health. Although I find the science enlightening, I also find the science of human behavior, psychology and neuroscience even more fascinating. Although it seems like I am hopping all over the place and one might question my "expertise" in anything outside of my traditional degree of physical therapy and now to include holistic nutrition, I'd argue that no one is an expert in anything. In fact, those you find you might respect their advice the most have a curiosity in ALL areas related to LIFE.
Really, the key point I want to make is that I am an "expert" on me which has made me a much better parent (improving as I learn and experience life). As I understand myself better, the more well equipped I am to help my kids understand how to be good at being who they are. I am not an "expert" on you either, only you can be that. I am not an "expert" parent either, but I try to do my best, E.V.E.R.Y day. Mostly, I am open to new information that may help me on this journey. I write to share with you in hopes it may help you too.
This list of books are some of the most pivotal for me personally in understanding myself better so I can translate that to better parenting. These are not the typical "parenting" books. They focus on principles related to stress, nutrition, psychology and even life skills.
I didn't read them all in one week. Some I have listened to on CD or audible. So please don't pressure yourself to get it all in quickly as each book has a very specific purpose. Spending time focusing on transitioning the principles in these books to life will have a powerful impact on your parenting and family life.
This is a repost from 4/20/2016. I recently just re-listened to Mistakes Were Made(But Not By Me). This book is so fascinating. As I look back at my own family transition and the struggles of current families, this book is entirely relevant. It is not uncommon for parents to have conflict with each other related to making lifestyle changes to how they raise their children. It is easier to stick with comfort than it is to make change, especially when change requires admitting mistakes were made. Although my husband and I are comfortable with our current lifestyle choices, that doesn't mean we didn't have struggle. In fact, I think the act of both of us reading and listening to this book allowed for some pretty dramatic changes in our relationship that continues to support us today in doing difficult work in communicating with each other in a productive manner. I went back to this blog to re-read and see if I feel any differently or have anything to add. The main thing is that this may become a book that I recommend all parents and couples read together as they embark on making lifestyle changes. We are all human and it is important to understand when working towards change and betterment of your self and family. Much of this blog is still pertinent and consistent with where I continue to be in my life personally and professionally, so I really haven't changed much. Cheers to all and I hope this book brings you some guidance in how to proceed in making lifestyle changes even in the face of what appears to be resistance from your partner or children. The more you understand yourself personally the better off everyone is around you.
Let me begin by saying, this isn’t going to be a blog where I give you a resolution to your problem. I am still working it out for myself. It is also a bit longer than normal but I hope you stay awake long enough to read it. I believe this may be my most important blog yet…..
A few months ago, my daughter's teacher shared a story with me. As the teacher was describing how she was running late because she had to make her and her kids lunches that morning, my daughter said something along the lines of , "You should make your lunch at night after dinner. That's what we do. And your kids should make their own lunch because it's their personal responsibility."
Yup. My daughter who is in first grade, said personal responsibility to her teacher.
I was proud of her for many reasons, but mostly astonished that she was actually "listening" to me all those times.
Improve Intestinal Integrity and Optimize Nutrient Absorption
I have written in the past about osteoarthritis and the contribution of metabolic health to joint health. You can read more here and here. You are also familiar with the leaky gut/intestinal permeability as a potential root cause of systemic inflammation and it's contribution to joint health among many other health related conditions.
Although the primary source of healing the gut and improve your joint pain is to eat real food, move your joints through their full range, gentle exercise, and adequate restorative sleep, often supplements are needed to aid recovery.
As I have mentioned before, SUPPLEMENTATION is only to aid in recovery of an already healthy lifestyle. If you suspect you have leaky gut, you can ask to be tested as described here.
This is a story that I hesitate to share only because I can see lots and lots of JUDGEMENT. Not just judgement of me personally, but of all those involved. I urge you to keep criticism to yourself, as all parties involved were attempting to help. Yet, if you know our family, you know that we live a life that is often “stranger than fiction.”
Keep in mind, this story has a happy ending.
One of our cats climbed a tree last week. Not just a little bit, but a lot. He climbed 40 feet up. My son heard him meowing for help after being gone for 24 hours over night. It’s likely climbing the tree was the escape from a coyote looking for dinner.
In case you are wondering, we do NOT own a ladder that goes that high…and they don’t make them actually. Because of safety and things….check this out here.
Oh dear...the DIET bashing....AGAIN....
I have something I need to say about diets. Here me out. A diet as defined by the Webster dictionary is "a special or limited selection of food and drink, chosen or prescribed for health or to gain or lose weight."
Many folks, whom may or may not understand the true purpose of a diet, are shaming very useful diet strategies because they are "difficult" to do and then discredit them. Check out the US News report. I think there is a misunderstanding about a diet versus lifestyle. An effective diet is NOT designed to be a lifestyle, but a TOOL to gain health. The "diet" is the tool designed to help you design your life, specifically related to what you put into your mouth, so that it can be a sustainable lifestyle. Many of the easiest and most popular diets are not healthy because they do not give you information about your body. Let me speak (write) clearly....
A diet is a TOOL to gain INFORMATION about yourself so that you can MODIFY your LIFESTYLE to fit your PERSONAL health needs.
DIET = TOOL
TOOL = INFORMATION
INFORMATION => PERSONAL HEALTH
Dr Carolyn Dolan DPT, Cert MDT, MSHN
Where physical therapy, nutrition and lifestyle meet, because how you live your life determines whether or not you soar. Inspiring action with information so you can reduce pain, optimize healing and improve function naturally during recovery from injury, surgery or painful condition. This is a website for the open-minded; obstinate need not apply.