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A Mediaplanet Guide to Boosting Immunity and Improving Pain Management

Personal Health

Whitney Miner The Eat Plants & Prosper founder shares why a stronger immune system starts with better nutrition

Keep your heart healthy with these tips from the American Heart Association Learn how vaccine status and antimicrobial mindfulness can curb infectious disease

DECEMBER 2021 | FUTUREOFPERSONALHEALTH.COM

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FLU CAN BE DEADLY Know The Warning Signs & Get Vaccinated FAMI L I E S F I G H T I N G F L U .O R G

Why Caregivers Need to Take Care of Themselves Being a caregiver is no easy task. It often demands sacrifıce. You might be caring for children and a partner while also caring for sick parents. You might be enrolled in school while making treatment decisions for an ailing child. Your spouse may be battling a serious illness while you negotiate with insurance providers, medical equipment suppliers, and a host of other people. It gets even more complicated if you also have health concerns. So, as a caregiver, how do you make your role easier to tackle without sacrifıcing yourself in the process? First, it’s important to take advantage of your family’s and friends’ offers of support, and do not feel guilty asking for help. Lists and charts can help you stay organized, and will help you manage your day with a clear head. You will be less flustered if you can reference your notes throughout the day instead of trying to just remember all the small details. You can engage a formal palliative care program early in the illness, rather than creating your own patchwork system to address pain and discomfort issues. This will help keep loved ones out of the emergency department or hospital, and support your decisions regarding care. To reduce stress and support your mental health, fınd ways to lighten the load. If you like inspirational quotes, paste one on the bathroom mirror, etc. Consider joining a support group. Finally, carve out time for yourself in the form of daily exercise, whether that’s a short walk, yoga, or anything else that gets you moving. If you are looking for information on respiratory diseases, please visit the American Thoracic Society and check out our Patient Information Series. Lynn Schnapp, M.D., ATSF, President, American Thoracic Society

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How Cardiovascular Health Keeps You Well for Years to Come Cardiovascular disease, including heart disease and stroke, has been the leading cause of death in the world for a century. Fortunately, those death rates have declined sharply since the late 1960s. Looking to the future, I can even imagine a day when cardiovascular diseases are considered rare. How? By focusing on cardiovascular health early in life. Life’s Simple 7 The American Heart Association defines cardiovascular health through seven measures: blood pressure, cholesterol, blood sugar, body weight, diet, physical activity, and smoking status. We call these “Life’s Simple 7.” People with high cardiovascular health live healthier, longer lives. They experience less cardiovascular disease, cancer, dementia, arthritis, and many other chronic diseases that become more common as we age. As we’ve seen with COVID-19, and decades before with the flu,

Donald Lloyd-Jones M.D., Sc.M., FAHA, Volunteer President, American Heart Association

people with better cardiovascular health are in better shape to fight off viral infections as well. What may surprise you is how early in life factors begin to impact your future cardiovascular health, and that not all of it is in your control. For example, many people face barriers to health because of “social determinants of health,” which are the conditions where people are born, live, learn, work, and play. Data supports the notion that throughout childhood, the single best predictor of a child’s cardiovascular health is their mother’s cardiovascular health. Earlier is better In short, wellness involves creat-

ing and maintaining high cardiovascular health from birth. Our nation and world are still grappling with a global pandemic and syndemic issues related to social justice and economic recovery. Adversity often leads to opportunity, and our current opportunity is to craft a better, healthier future for ourselves and generations to come. We know how to do this. Over a span of 42 years, we reduced cardiovascular death rates by 70 percent. We did it through science, education, and collaboration between healthcare and the public. That’s how we’ll tackle this, too. It starts with each of us taking small steps in a healthy direction. Take a walk. Know your numbers (for cholesterol, blood glucose, blood pressure, and body mass index). Make that doctor’s appointment you’ve put off (or make one for your relative). Get vaccines when they are available to you. Donate nutritious food to the local food bank. It ends with healthier, longer lives for all.

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Publisher Samantha Jahoda, Joanna Tronina Business Developer Katie Konf ino Managing Director Luciana Olson Lead Designer Tiffany Pryor Designer Celia Hazard Lead Editor Mina Fanous Copy Editor Dustin Brennan Director of Content and Production: Jordan Hernandez Cover Photo TK Consulting & Design All photos are credited to Getty Images unless otherwise specif ied. This section was created by Mediaplanet and did not involve USA Today.

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4 Ways to Keep Colds and the Flu Away This Holiday Season It’s the holiday season and you don’t want to get sick this time of year. Here are four ways you can keep your family as healthy as possible. 1. Get your flu shot

This is the fırst step to keep you and your loved ones from getting sick. The Centers for Disease Control and Prevention (CDC) recommends annual vaccinations for everyone 6 months old and up. If your family hasn’t gotten their flu shot yet, it’s not too late. 2. Keep eating healthy

This seems impossible during the holidays, but think of food as medicine. Eating nutritious foods will strengthen your immune system and keep everyone feeling their best. Balance heavy party meals and desserts with green vegetables, berries, citrus fruits, whole grains, and water. Look for holiday recipes and snacks with these foods to make it fun. 3. Get plenty of sleep

Your children will want to stay up late to maximize their holiday fun, but getting adequate rest is crucial to their development. So when you have a late movie or game night, try not to plan an activity early the next morning so you all can sleep in. Or take naps throughout your day. 4. Wash your hands

When children are excited, they sometimes forget to wash their hands thoroughly. Remind your kids that they should wash their hands for at least 20 seconds between activities, before they eat, and after using the bathroom. When you are out and about, make sure you have hand sanitizer, just in case. I hope these tips help everyone stay healthy and safe this holiday season! Anna King, President, National PTA

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How Flu Led to the Death and NearDeath of Two Siblings You may have forgotten about the flu, but one family has been living with the devastating consequences of the virus for almost two years.

uring the 201920 flu season, 400,000 people were hospitalized and 22,000 died from the flu. Kayauna and her younger brother, Josiah, are two of the faces behind those statistics. Twenty-year-old Kayauna worked in an elementary school classroom and had recently married. When she first got sick with the flu, she stayed home for a few days. However, her symptoms returned and then got much worse. She was hospitalized with pneumonia and sepsis, a blood infection. Her skin was purple and her heart stopped three times. She died after a week in the hospital.

PHOTO: FAMILIES FIGHTING FLU

Missed funeral The day after his sister died, 18-year-old Josiah went to urgent care for evaluation of his own flu symptoms. Like his sister, he got worse and was too sick to attend Kayauna’s burial. His father took him to the hospital where he was immediately put on a ventilator. Doctors created a hole in his chest to allow fluid to drain and keep infections out of his lungs. A month later, as the country went into lockdown for COVID19, his mom was no longer allowed to be at her son’s bedside while he fought for his life in the ICU. She was told she might never see him alive again. Fortunately, after many weeks in the hospital, Josiah

recovered and was sent home with continued follow-up care. He is currently recovering from the surgery that closed the window in his chest. Kayauna and Josiah’s stories might have had a happier ending if they had been vaccinated against the flu. Like COVID-19 vaccines, flu vaccination may not prevent all infections, but can drastically decrease the risk of hospitalization and death. Don’t let your story end with “What if I had gotten vaccinated?” In memory of those who are not with us to celebrate the holidays, get vaccinated against the flu and COVID-19.

Families Fighting Flu

The Virus Doesn’t Care, and It Never Will SARS-CoV-2, the virus that causes the disease COVID-19, does not care about politics, an individual’s socioeconomic status, race, gender, sexual orientation, or age. It has one mission: infect whoever and as many as it can. Over the past year and a half, we’ve realized just how quickly pathogens can travel from person to person. This has caused us to adjust infection prevention protocols, including increased cleaning and disinfection efforts, face coverings, social distancing, and more. Someday, we will look back, discuss, and debate our response to the pandemic. But right now, we must come together and take every step we can to care for one another, because the virus doesn’t care. Sanitation experts I am a registered biosafety professional. Until I joined ISSA, the worldwide cleaning industry association, to lead its Global Biorisk Advisory Council™ (GBAC) division, I had been a leader in environmental, health, and safety. I was known for my work in biosafety and biorisk management. For most of my career, I have provided biosafety support to research

organizations involved in human and animal healthcare. I have worked with teams that put some of the first AIDS drugs on the market, treated four of the Ebola patients that came to the United States in 2014, and trained amazing individuals in Africa on biorisk management principles. Was I surprised when the pandemic hit? Not exactly. In January 2020, I wrote an article that was published in ISSA Today called “Facing the Next Pandemic.” In the article, I discussed how we weren’t prepared. Biosafety and healthcare professionals predicted for some time that a pandemic was coming, we just didn’t know when and what the exact virus would be. We know this will not be the last emerging virus to infect humans. I tend to look at things through a holistic lens. We must protect people, communities, and the environment around us. We are currently fighting a war with an invisible opponent. It exploits every weakness we show. There isn’t just one solution that will end this war. With a layered response that includes resources, trust, and leadership, we can defeat COVID-19.

line includes all of us in the cleaning industry. At the beginning of this pandemic, we saw the impact of limited resources. Healthcare workers did not have the appropriate amount of personal protective equipment to keep themselves safe while caring for the sick. Facility managers struggled to acquire cleaning and disinfecting equipment as manufacturers around the globe faced supply chain issues. The public panicked, leading to a shortage of common household items. This lesson has shown how critical it is to ensure that our essential workplaces and workers have the necessary training and tools to stay safe and continue fighting on the front lines. This extends to custodians within essential facilities, including those handling healthcare, education, food service, and travel, as they clean for health and protect everyone who works, visits, or passes through. We must learn to trust one another, especially the experts who have spent countless hours researching, studying, and determining how to get us out of this pandemic. We can’t trust just any online information that is spreading faster than the virus. It’s important to have conversations with medical, biorisk, and infection prevention professionals who understand the complexity of the virus and the best solutions we must use to fight it. Finally, we must lead from within. Not only do we need leadership that inspires and moves organizations and communities forward, but we need to become leaders ourselves. We choose our own behaviors every day, thus choosing the outcome of this pandemic. Our decisions today will impact our future years from now.

Resources and training A prepared and well-trained front

Patricia Olinger, Executive Director, GBAC, a Division of ISSA

How Chronic Lung Conditions Can Cause Flu Complications People living with chronic lung disease are among the most vulnerable during flu season. It is critical that these individuals, and people in high-risk categories, are aware of the symptoms of the flu and COVID-19, and have a plan in place with their physician well before they get sick. This flu season, as COVID-19 continues to spread across the country, people eligible for immunizations are encouraged to receive their influenza (flu) and COVID-19 vaccinations early for maximum protection. For those who have a lung disease, such as COPD, asthma, or pulmonary fıbrosis, immunization and early detection can be lifesavers. Lung disease symptoms, such as shortness of breath and coughing, can often mask the flu. When these symptoms are accompanied by sore throat, muscle aches, fever, nasal congestion, headache, and even nausea and vomiting, the culprit is often influenza. Typically, the time to seek medical attention for the flu is when you fırst show signs of shortness of breath, chest pain, confusion, prolonged fever, and/or dehydration. There are now potential treatments available that can reduce the duration and severity of symptoms for many flu sufferers. Get your shot

The best way to protect yourself is to receive vaccinations both for the flu and COVID-19. It is important to note that these vaccinations are as much about protecting others as they are about protecting yourself. For those with a compromised immune system and children younger than 6 months, who are too young to receive the flu vaccine, their health depends on vaccinated adults, who have a lower chance of spreading the virus than unvaccinated ones. All individuals 6 months and older are recommended to get a flu shot annually. While the best time to get the shot is in the early fall, it is not too late to get the shot throughout the flu season. Stephanie Levine, M.D., FCCP, Former President, American College of Chest Physicians

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Accessing and Sharing Vaccination Status Information With COVID-19 booster shots for adults now available nationwide, keeping track of your vaccination records is extra important. But where do you turn for this information?

You may be surprised to learn that your vaccination record is not kept by the Centers for Disease Control and Prevention (CDC) or another federal agency. Instead, each state keeps those records. They’re stored in secure systems called immunization information systems (IISs). What is an IIS?

An IIS, also known as an immunization registry, is a confıdential, population-based, computerized database that records all immunization doses administered by participating providers to people who live in a certain geographic area. What information is stored in an IIS?

Most IISs include patient name, birth date, sex, birth state/country, along with the types and dates of vaccines given. The exact information stored in an IIS depends on the information collected by healthcare providers from patients, which can vary. How is my information protected?

An IIS is designed to protect the privacy of all users. Per CDC, each IIS must have a written privacy policy that clearly defınes access, use, and disclosure of all data collected. Those who use an IIS must sign an agreement to become an authorized user. IIS users also must follow strict confıdentiality and security laws that comply with federal privacy rules. While an IIS is a valuable tool in fıghting vaccine-preventable diseases, it’s only as good as the information it contains, and IISs rely on providers and their systems to share information and submit accurate data. Sharing information about you or your family’s vaccination status with your healthcare providers will help minimize the spread of avoidable health conditions. Rebecca Coyle, Executive Director, American Immunization Registry Association

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The Implications of Antimicrobial Resistance for Patients and Providers Antibiotics are commonly used to fıght bacterial infections, however, bacteria can change in response to the use of these medicines, resulting in antibiotic resistance. More broadly, antimicrobial resistance encompasses resistance to drugs to treat infections caused by bacteria, parasites, viruses, and fungi.

he use of antimicrobials in modern medicine has helped advance treatment options over the past several decades. Germs (bacteria, viruses, fungi) are everywhere. Some are beneficial to our bodies and others make us sick. Antimicrobials are intended to kill germs that make us sick or cause infections, however, germs can adapt and develop resilience to prescribed antimicrobial treatments, resulting in resistant germs. These resistant germs can multiply and spread their learned resilience to other germs. Eventually, this replicated resilience can create multi-drug resistant organisms (MDROs), decreasing the efficacy of antimicrobials. Once antimicrobial resistance emerges, it can spread into new settings and between countries, restricting our ability to treat diseases effectively. Antimicrobial resistance spreads readily and often without noticeable transmission. This poses significant threats to modern-day medicine and specifically to populations requiring ongoing medical treatment, such as patients with kidney failure. Antimicrobials are critical for treating infections in individuals with kidney failure who receive life-saving dialysis treatment.

According to the United States Renal Data System, more than 458,125 patients received dialysis treatment in 2017. MDROs are particularly relevant to patients who receive hemodialysis because rates of colonization and infection are among the highest in these patients. Slowing the spread Because antimicrobial exposure is the main risk factor for the emergence and spread of MDROs, it is necessary to minimize inappropriate antimicrobial use. Research suggests that among facilities providing hemodialysis treatment to patients with kidney failure, approximately 30-35 percent of antimicrobial doses administered are unnecessary. Antimicrobial stewardship, which the Centers for Disease Control and Prevention (CDC) defines as “…the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients,” has consistently shown a decrease in inappropriate antimicrobial use. However, according to some infectious disease specialists, the current COVID-19 pandemic poses potential threats that could affect antimicrobial stewardship activities and drive antimicrobial resistance, further contributing to the emergence of MDROs.

For instance, many people who present with mild disease without pneumonia or moderate disease with pneumonia receive antibiotics. The World Health Organization (WHO) reports azithromycin is being widely used with hydroxychloroquine, although it is not yet recommended outside of COVID-19 clinical trials. The WHO released a clinical management of COVID-19 guide that provides recommendations that include promoting appropriate antimicrobial prescribing and use during the COVID-19 pandemic. Specifically, guidelines suggest not to prescribe antibiotics to suspected or confirmed COVID-19 patients with low suspicion of a bacterial infection, in an effort to immediately avoid side effects of antibiotics among patients and to reduce long-term consequences of increased antimicrobial resistance. Addressing the threat of MDROs and antimicrobial resistance requires preventing infections in the first place, slowing the development of resistance through appropriate antibiotic use, and stopping the spread of resistance if it develops. Amber Paulus, Ph.D., RN, CPHQ, CPPS, Chair Designee, Research Committee, American Nephrology Nurses Association (ANNA)

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How Dietary Supplements Can Support Your Immunity As the COVID-19 pandemic continues nearly two years later, people have been searching for new ways to take control of their healthcare routines to support their overall wellness. This interest in self-care has led to increased interest in immune-strengthening strategies, including the use of dietary supplements aimed to optimize immune function. While there are no supplements that can prevent or treat COVID, a combination of healthy lifestyle practices and the responsible use of science-backed supplements can keep the immune system functioning at its best. A weakened immune system cannot fully protect your health and help you fıght back against any germs you may encounter. In addition to taking preventive steps like washing your hands, wearing a mask, and social distancing, other important immune-strengthening activities include eating a healthy diet, exercising regularly, and getting plenty of sleep. Supplementing immunity

There are many science-backed supplements that fıll nutrition gaps that may help support your immune system response. For example, herbs like elderberry and echinacea have been extensively studied for immune health, and emerging categories like probiotics are demonstrating how gut health is directly tied to immune health. Despite perpetuated myths, supplements are regulated by the U.S. Food and Drug Administration, and are often subjected to third-party and retailer quality review. If you are exploring new ways to support your health, do your research and speak with your doctor or pharmacist to help fınd the right supplement(s) for you. Duffy MacKay, N.D., Senior Vice President, Dietary Supplements, Consumer Healthcare Products Association

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Why a Stronger Immune System Starts With Better Nutrition The founder of Eat Plants & Prosper shares tips on how to achieve wellness by changing your diet. As a child, Whitney Miner was plagued with migraines, sinus infections, colds, and stomach bugs. Through the years, she grew tired of taking antibiotics and making trips to the doctor’s office. “After being sick for five weeks straight from getting the flu and a sinus infection backto-back in 2018, I knew I no longer wanted to live my life constantly sick,” explained Miner, a holistic nutritionist and blogger. “I started researching the best way to naturally boost my immune system, and found out that 70 percent of our immune systems are in our gut. That means that what we’re eating is either contributing to our wellness or making us sick.” Making a change Miner decided to give plant-based eating a go, on a trial basis. “If I didn’t get sick, I knew it was legit,” she said. “I didn’t get sick in 90 days for the first time

in my life. I shed pounds, had a ton of energy, and my skin was glowing. I felt amazing. It was then I knew that we truly are what we eat. We have the ability to impact our health through what is on the end of our forks.” Miner believes the best way to take control of your health involves mindful eating that includes as many whole, plant-based foods as possible. She suggests exercising at least three times a week and meditating to decrease stress and improve mental focus, clarity, and psychological balance. Being proactive Through her website and social media, Miner helps others find their own healthy lifestyle. With the cold and flu season approaching, she says it’s crucial for everyone to keep their immune systems strong. “I always say God is so smart; he put the medicine in the food. All we have to do is eat it,” Miner said. “Boost your immune system by consuming as many antiviral, immune-boosting foods as possible, including garlic, ginger, onions,

green tea, and fermented foods like sauerkraut, kimchi, and miso, along with cruciferous vegetables, berries, citrus, and mushrooms.” According to Miner, herbs that can boost your immune system include echinacea, turmeric, elderberry, astragalus, oregano, oil, and thyme. Slowly, but surely One of the biggest misconceptions about changing eating habits is that nutrition has to be all or nothing. Taking even small steps can make a difference. “Including a meatless day of the week is a great way to start adapting to the lifestyle,” Miner said. “You can then work your way up to one meatless meal a day. Before you know it, you’ll be comfortable eating only plant-based foods. Even just committing to adding a serving of fruit and vegetables to every meal can help people get adjusted to including more plants in their diet, by crowding out the more unhealthy items on their plate.” And meals don’t need to be complicated. “I’m all about making

this lifestyle as simple and accessible as possible,” Miner said. “Keeping staples like beans, brown rice, and green vegetables on-hand makes throwing together meals easy. Cut-up veggies with hummus, fruits, and nuts are great to have around for snacking.” Changing your mindset Unfortunately, Miner says, in this country, we aren’t taught much about the value of nutrition. ”As a society, we’re largely uneducated about the impact our diet has on both the prevention of illness and the healing transformational power of nutrition when we are already sick,” she said. Education is the way to change that. “That’s why I started Eat Plants & Prosper, with the mission of reaching as many people as possible with the message that food, not medicine, is healthcare.” Miner adds, “Pay attention to your wellness, or you will be forced to pay attention to your illness. Give yourself the gift of good health by consuming more whole, plant-based foods.” Cindy Riley

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As the winter months approach, everyone is looking to stay healthy, and the best approach is to strengthen your immune system. Registered dietician Grace Pascale shares some of her favorite foods and ingredients for healthy immune support.

Each color touts its own unique nutritional benefits, but elderberries are most known for being rich in anthocyanins; a compound with strong antioxidant properties. These anthocyanins — which cause dark pigmentation, so are most abundant in black elderberries — can help support a healthy immune system, making elderberries a much-sought-after food. However, they are toxic to eat if not properly cooked beforehand.

Very Berry Açai & Elderberry Smoothie Ingredients: • 1 packet of frozen açai • 1 banana • 1 cup of fresh or frozen berries: strawberry, blueberry, raspberry, and blackberry • 1/2 cup almond or oat milk • 1-2 tbsp of Sambucol Black Elderberry Syrup • Sliced almonds to garnish (optional) Instructions: 1. Add everything to blender and blend to enjoy a delicious smoothie packed with vitamins and antioxidants to support your immune system. 2. Garnish with fruit and a sprinkle of sliced almonds to add texture and a bit of crunchiness.

“I first found out about black elderberry syrup in grad school, and we made it for ourselves,” Pascale said. “We had to sterilize jars, we had to keep elderberries and boil them, and then we had to mix in the sugar — it was a whole messy process.” Easy immune support Fortunately, Sambucol has made it easier than ever to mix this superfood into your daily

PHOTO: MOYO STUDIO

“You want to see a rainbow in your refrigerator,” said Pascale, a San Diego-area dietician who offers healthy nutrition tips to her followers on Instagram (@BabyByChickpeas). Pascale says eating a lot of colorful fruits and vegetables gives your body the antioxidants and vitamins (e.g., zinc, selenium, iron, protein, and vitamins C and D) it needs to ward off free radicals, the molecules that are produced when your body breaks down unhealthy foods or you smoke tobacco. Elderberries are a great example of why “eating the rainbow” is a savvy nutritional goal. These berries, which have been eaten and used as dyes in many cultures for thousands of years, come in a variety of colors, including red, blue, purple, and — most notably — black.

The Best Foods for Supporting Your Immune System

routine. Their black elderberry syrups, gummies, tablets, and more are safely pre-cooked and ready to eat. Sambucol products are made using only the premium Haschberg variety of black elderberries, which grows at high elevations in soil-rich Central Europe. These berries ensure Sambucol is packed with the antioxidants and immune-supporting nutrients families are looking for.

“Sambucol Black Elderberry really helps out our family,” said Pascale, a mother of two. “We’re dealing with preschools and daycare, and just all the germs, so it’s really important that our family stays as strong immune-wise as possible.” Pascale says you can add Sambucol Black Elderberry to smoothies, peanut butter and jelly sandwiches, overnight oats, and much more to create delicious, immune-boosting meals. “I’ll stir a little bit into sparking water to create an evening mocktail,” she said. “One of my favorite applications is to mix a little bit into maple syrup, and my kids will go ahead and dip pancakes into that.” Dustin Brennan

If you’re looking for a delicious and easy way to support your immune system for the winter months, you can shop for Sambucol Black Elderberry products online at sambucolusa.com/ collections/shop-all.

PB&J Elderberry Overnight Oats Ingredients: • 1 cup rolled oats • 1 cup plant milk • 1 tbsp chia seeds • 1/2 tbsp maple syrup • 2 tbsp peanut butter • Strawberry jam • Fresh fruit of choice • 2 tbsp Sambucol Advanced Immune Black Elderberry Syrup Instructions: 1. Combine oats, plant milk, chia seeds, maple syrup, and peanut butter in a bowl. Mix and refrigerate for 2+ hours or overnight. 2. Remove from fridge and layer in fresh fruit, globs of crunchy peanut butter, a dollop of strawberry jam, and drizzle with Sambucol Advanced Immune Black Elderberry Syrup for added immune-supporting sweetness. By Gracie Pascale @babybychickpeas MEDIAPLANET

ported during those sleeping hours,” Hayden said.

A Chiropractic Approach to Treating Chronic Pain Dr. Robert Hayden, a spokesperson for the American Chiropractic Association, shares his expertise on diagnosing, treating, and managing chronic neck and back pain.

any things can cause chronic neck and back pain, from strained muscles and ligaments, to aging and osteoporosis, but a common cause is repetitive actions or postures associated with work. Dr. Robert Hayden, a chiropractor and spokesperson for the American Chiropractic Association, works with clients who have developed chronic pain over decades. “I’m seeing a retired dentist,” Hayden said. “He spent his entire career sitting in a chair and leaning to his left. When you look at his X-ray, you see a spine leaning to the

left. He assumed that posture so often and for such long hours through the day, that the musculature around his skeleton either contracted or stretched to accommodate that position. Now he’s trying to walk erect and he’s getting pain from it.” Chronic postural pain is very common for people who work at a desk all day, looking at a computer. “People who sit at a desk a lot, I sometimes ask them to describe or take a picture of their workstation,” Hayden said. “Are their feet on the floor? Is the back supported and straight? Sitting properly is really important.”

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Getting to the root Hayden, who initially practiced as a cardiovascular clinical nurse specialist, became a chiropractor because of its noninvasive approach that addressed the structural causes of physical pain, rather than simply treating pain symptoms. “We understand that structure determines function,” he said. “If we look at the natural history of a condition, look at how it evolved, intervene at the source, and correct the underlying structure, we’ll get really good results without having to create holes in people or do surgery.” To evaluate the cause of

chronic pain, chiropractors look at the combination of many factors. “It starts with a very careful history,” Hayden said. “When I take a history on somebody, I’m going to ask a lot of questions that will seem a little odd. I’m going to ask them what they did for a living. Are they interested in sports? What I’m looking for is how they stressed their skeleton in the past.” Sleeping postures also have a large impact on a patient’s physical history. “You spend a third of your life in that posture, so I need to know what that is and how well your skeleton is sup-

The best medicine Prevention of the underlying causes is typically the best treatment. “To prevent chronic pain, we recommend a lot of low-impact, aerobic exercise,” Hayden said. “I have a lot of people who are runners, and 10 or 15 years down the line, they have a lot of knee problems from the impact. You can get the same cardiovascular workout with a brisk walk.” There are other surprising causes of chronic pain. A 2016 study has shown that cigarette smoking can have a direct link to back pain. “The research says there are substances in cigarette smoke that destroy vitamin C,” Hayden said. “Vitamin C is necessary for retaining cartilage. If your cartilage is worn, you’re looking at osteoarthritis.” While back and neck pain manifest physically, sometimes the cause can be mental. “In chronic pain, whether it’s back pain, headaches, etc., there are psychological factors,” Hayden said. “Depression and anxiety affect the whole body and will intensify a pain experience.” Hayden stressed the importance of treating pain holistically. “If you concentrate only on your physical exam, you may miss the primary diagnosis if you don’t listen to what someone is telling you about their psyche,” he said. “This is something that a lot of patients won’t share, but you’ll find it if you look at how they’re carrying themselves.” Ross Elliott

How Heat Therapy Can Help Relieve Chronic Pain Now more than a year into the COVID-19 pandemic, the stress of balancing work, life, school, and more from home, all while feeling uncertain about the future, has taken an immeasurable toll. In addition to causing mental health issues, such as depression, anxiety, and panic attacks, sustained periods of stress can cause physical damage to the body as well. People

who are constantly under stress are more likely to experience high blood pressure, chronic headaches, chest pain, and sleep deprivation. They’re also more likely to have chronic pain. “It is generally accepted that there is a link between stress and overall well-being,” said Arielle Milara, product manager for Conair. “All these stressful circumstances can understandably lead to a phys-

ical response that can be a contributing factor to body pain.” In addition to increasing stress levels, the pandemic forced many people to work from improvised home offices. While not having to commute to work was convenient, it also meant not having the ergonomic support that’s customary in modern offices, which meant sitting with poor posture for entire eight-hour (or longer) work days.

“Whether that was the dining room chair or living room sofa, sitting for long periods of time without the proper support can wreak havoc on the back,” Milara said. Finding relief In 2018, the Centers for Disease Control and Prevention estimated 50 million Americans were living with some form of chronic pain, and that number could rise due to the factors

mentioned above. If you’re one of the many people who experience pain on a regular basis, you may benefit from heat therapy. This type of therapy works by applying heat to a problem area of the body to increase blood circulation, which helps soothe muscles and relieve discomfort. It’s touted as one of the best non-pharmaceutical solutions for relieving both acute and chronic pain. “For best results, apply heat 20 minutes at a time, sit back, and relax,” Milara said. If you decide to use a heat pad to relieve pain, avoid applying it for long periods of time, like when you’re sleeping, as this can cause injury and burns. If you’re unsure about the root cause of your pain, consider talking to your doctor before starting heat therapy.

Dustin Brennan

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My History With Chronic Pain and Advocacy Each of us has challenges we must learn to cope with throughout our lives. But no matter what we have to face, having each other to turn to for support, sharing, and love in our moments of defeat and success is vital to our capacity to cope with these challenges.

rying to take on life alone — along with not searching for peace and purpose despite the challenges — can become too overwhelming and for some, a reason to lose hope. My biggest experience of darkness came as I suffered from an undiagnosed condition without answers for endless years. This condition was finally given a name about 16 years ago, when I was 54; Ehlers-Danlos syndrome (EDS). Doctors finally discovered that my condition, invisible to others, actually was real despite all the skeptics. I was born with it, yet no one was able to figure it out sooner. And then a year later, a second diagnosis was added on top of it. I had spent years living with pain, losing the ability to

walk for four years, managing breathing issues, and even having catatonic episodes. I had to wait for answers, but when they finally came, they weren’t the ones I had hoped for. No end to chaos So, I had to move on to learning to live life permanently with chronic pain with two presently incurable conditions that have required 26 surgeries. Each day requires a calculation to keep safe and attempt to minimize pain levels, often leaving one on edge and, unfortunately, sometimes waiting for the next shoe to drop since there will be no end to the chaos brought into life by my medical conditions. Coping with my dark issues, I continue to find those moments in my life that help to shut down negative thinking, like when I kick in the

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pool and my mind shuts off, or when I try meditating each morning and run through for what I am grateful. It does not come for free to focus on the positive while working to attempt to eliminate the negative. We all need to work hard to quiet our minds so we can believe there are better moments ahead. I always remind myself that tomorrow will be a new day and has a chance of being better than the one with which I am struggling. We have to allow ourselves a chance to mourn our losses when they first hit our lives, but we also then have to eventually pick ourselves up and remind ourselves this is our life — the only one we get to live. So, one has to figure out how to regain purpose and meaning. For me, that process began by writing over 100 poems to

express my horror, sadness, and confusion over my diagnosis. About a year later, I began to learn to accept this was the life I was to live now, and it was up to me to figure out what I could do to regain purpose and meaning. I wanted to have my husband, children, grandchildren, and friends look back at me as one that didn’t cave in but instead chose to accept and move on with life. And believe me, it would have been easier to not try so hard to meet this goal, but that just wasn’t in me! What lies ahead As we have learned all too well, life is not easy. Especially lately, we are all struggling to make sense of life — trying to understand blatant hatred, lies, uncertainty, climate disasters, shootings, and so much more. Despite the craziness around

us all, we have to find our inner circle of peace. That begins with sharing our lives with each other and showing support for both the good and the bad. When darkness comes to life, may you have success with training that mind to shut off the negative. May you find the courage and light toward finding purpose and emphasizing our common humanity. Strive for your new normal with purpose in life, despite your challenges. And remember, you matter, you have purpose, and you have meaning. And you are loved. May life be kind to you. Previously Published by US Pain Foundation Ellen Lenox Smith, CoDirector of Medical Cannabis Advocacy, Board Member, U.S. Pain Foundation

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Reconsidering How We Evaluate Nontraditional Therapies The National Institutes of Health comprises 27 institutes, all of which deal with specifıc disease conditions and general health. There is no institute for chronic pain, however, there is the National Center for Complementary and Integrative Health (NCCIH). NCCIH is currently finalizing its five-year plan, which will emphasize the need to treat the whole person and will promote efforts to “determine the value of complementary health approaches in enhancing cognitive, emotional, behavioral, and physical resilience and well-being in people who are subjected to stressful or adverse circumstances.” To many of us, there is a fair amount of irony in these goals, since numerous medical providers and advocacy organizations, including U.S. Pain Foundation, have been promoting a similar vision for as long as we can remember. The immediate reaction is, therefore, “Better late than never, but how long is the next phase going to take?”

Barriers NCCIH is fully aware of the countless impediments to the implementation of its goals (e.g., access, affordability, healthcare disparities), but it does not consider two fundamental questions. First, isn’t there a basic contradiction inherent in the study of complementary approaches based on treatment of the whole body with the same scientific techniques traditionally used to study the effectiveness of traditional medications or treatments (e.g., physical therapy for sciatica, surgery for low back pain, NSAIDS for fibromyalgia)? The draft five-year plan states interventions like meditation and acupuncture affect the central mechanism of pain perception and processing, and it goes on to discuss the “scientifically plausible mechanisms” for these interventions. However, many of these interventions are rooted in essentially Eastern philosophies of medicine. They are known to be effective in Eastern medicine, but now we are attempting to analyze them

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by employing the standard techniques used for studies of Western remedies, namely seeking “scientifically plausible mechanisms.” Second, are we attempting to analyze whole-body treatments using the traditional techniques, which the NCCIH acknowledges are designed for the analysis of separate organ systems? For example, in traditional Chinese medicine, acupuncture is considered to balance the flow of energy or life force flowing through pathways (meridians) in the body, with the goal of rebalancing the energy flow. Similarly, traditional mindfulness is rooted in Buddhist and Hindu teachings. Buddhism includes a journey toward enlightenment, which encompasses attention, awareness, and being present. Is it appropriate to assess these holistic systems using western technology, such as fMRI machines or pain scales? Westernization of Eastern medicine Over the past few years, Western cultures have

adapted such treatments to the Western taste. For example, licensed acupuncturists undergo rigorous education and fieldwork, but there are also practitioners of acupuncture who undergo brief courses and acquire minimal education in the holistic elements of the treatment, regarding it more as the mechanical insertion of needles. There are practitioners of mindfulness who essentially employ it as a relaxation technique (e.g., artistic mindfulness, interpersonal mindfulness, forest mindfulness). Similarly, yoga is frequently presented as just another exercise program with all sorts of Western adaptations (prenatal yoga, sweat yoga, and even goat yoga). Such adaptations may provide an element of pain relief, and the placebo effect is not to be discounted, but they are a long distance away from the original, holistic healthcare approaches that are so successful in Eastern culture. The westernization of Eastern medicine into easily marketable packages runs counter

to the NCCIH’s definition of “integrative health” as the treatment of the whole person as opposed to separate organ systems. This raises the question: Are we attempting to analyze a three-dimensional treatment through a one-dimensional lens? As NCCIH moves forward with its draft five-year plan, I hope there will be more acceptance that Eastern medicine and its treatments have succeeded because they are holistic and reflect local cultural norms and philosophies of life. They are not “complementary” or “alternative.” Unless we educate our medical professionals about the importance of treating the whole body, we will not be able to address the fundamental health issues underlying the prevalence of chronic pain in our society. This article was previously published by U.S. Pain Foundation. Malcolm Herman, Director, National Coalition of Chronic Pain Providers and Professionals (NCCPPP), a program of U.S. Pain Foundation

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The Many Factors That Can Cause Scoliosis in Adults

Serena S. Hu, M.D., is a professor and the chief of spine surgery service in the Department of Orthopaedic Surgery and (by courtesy) Neurosurgery at Stanford University, School of Medicine. She shared her insights on scoliosis in adults, and how all people can improve their spine health. What types of scoliosis are there in adults and what are the common symptoms? Adults may have scoliosis that developed when they were young, like teen or preteen years, called idiopathic, or develop scoliosis from degeneration of the spine, which we call degenerative. Although people like to know which type they have, it can sometimes be difficult to make a definitive diagnosis. Fortunately, the principles for treatment are the same for both. Common symptoms are pain in the back; asymmetry of the back, waist, or shoulders; and pain, tingling, or numbness in the legs. The symptoms may increase later in the day with fatigue, or with long periods of being upright or walking. What are some common nonoperative treatments and therapies for adult scoliosis? Physical therapy is usually the first treatment. Improving core strength and cardiovascular fitness also helps. Walking, cycling, pool therapy, and swimming can all be used for the latter, as can other aerobic exercise. Anti-inflammatories (e.g., ibuprofen, naproxen) can help reduce symptoms.

If the patient has nerve compression and pain or tingling down the legs from this, epidural injections may be helpful. Some patients benefit from the use of gabapentin or pregabalin to make the nerves less irritable. Assessing the person’s bone health is important, regardless of age. Poor bone density is a risk factor for progression and should be part of general health maintenance of all adults. Post-menopausal women (especially those with a family history), people who have taken medication that may decrease bone density (e.g., steroids, anti-seizure meds), and people with lactose intolerance or nutritional problems (e.g., anorexia, malabsorption, gastric bypass surgery), should ask their primary care physician or orthopedic surgeon about bone density testing. What additional options should patients discuss with their doctor? Many patients ask about bracing. Bracing only works when the spine is still growing. If used by an adult, their own muscles will lose strength, so the opposite of what physical therapy is intended to do. Acupuncture and other complementary medicine options can be considered, but there is no data on how effective they may or may not be. What advice do you have for patients who are still looking for the best way to manage their chronic pain? The most fit people I see are the ones who seem to do best at keeping their symptoms under control.

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TEXT NECK IS REAL! HOW MUCH PRESSURE ARE YOU PUTTING ON YOUR SPINE? 0˚

15˚

45˚ Text Neck is a condition that describes the effects of poor posture due to heavy cell phone and laptop use.

This condition often results in: | Neck and back pain

10-12

POUNDS OF

PRESSURE

| Shoulder tension & stiffness | Headaches

Source: https://spinenation.com/conditions/neck-pain/what-is-tech-neck-and-how-to-prevent-it

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