Mark's Musings - March 18

Below is an aggregation of the stories I posted on LinkedIn since my last edition. I curate them through the prism of an "intersection of chronic pain and appropriate treatment" and so they come attached with my opinion.

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SIIA Endeavors (579 views)

Thanks to the Self-Insurance Institute of America, Gretchen Grote and Mike Ferguson for publishing my article "The conundrum of an impaired workforce for Workers’ Compensation self-insurers" on their SIIA Endeavors publication. It corresponds to the 12-minute video I recorded for their Canoe video platform (you must be a SIIA member to access it).

"So what is impairment? There are two potential definitions of being 'impaired' according to Merriam-Webster:

1. 'unable to function normally or safely (as when operating a motor vehicle) because of intoxication by alcohol or drugs'
2. 'diminished in function or ability'

Both come down to the productivity of an employee for an employer. In other words, can they do the job."

Just an excerpt. You'll have to read the entire article to understand the "conundrum" and possible solutions. One of the bottom lines I included is this quote: “We need to focus on the whole person so when the injury occurs, they’re more fit psychologically, emotionally and physically, so that the injury isn’t catastrophic, and they’re not out of work as long.”

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Attitude is Everything, Even When It's Not (266 views)

Thanks, Bob Wilson, for sharing the story of your father. I would call that the definition of #resilience in the face of reality. Attitude has a disproportionate impact on outcomes - either positive or negative. Both for the person and those around them (his positive attitude is probably not just affecting his family and caregivers but also other patients). We can all learn from your father. Best wishes for the journey ahead. Bob's primary takeway? "His attitude not only facilitated some improvement, but it eased the burden of his family and caretakers during a very stressful time. It has made his own life easier and less stressful, as anger and bitterness would only suffocate him in that environment. He would be far worse off today if he were simply an antagonistic and unhappy old man." That's good advice for everyone ... Being angry, bitter and unhappy because of current difficult circumstances only make the present (and future) potentially even more dire. While grieving what's lost (in this instance, what you used to be able to do) is a process that has it's place and should not be avoided, making it a lifestyle is counterproductive. Easier to say than to do, for sure, but having a resilient positive attitude is the best approach.

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What happens when you flip the script? (115 views)

Thanks, Erik Scholl, for sharing. A worthy investment of less than four minutes. The epiphany for this physician and his colleagues in this relatively small county in Minnesota that had the 3rd highest per capita #opioid prescribing in the state were the treatment guidelines. There was an alternative for real pain management. The way forward was conversation, relationship and working together between prescriber and patient. In other words, common sense and the golden rule. Nowhere did he say that opioids were not part of his practice anymore (there was a decline of 43 percent - not 100 percent - in opioid prescriptions from 2017 to 2018), just that he was more educated about options. "The conversations about opioids has helped re-focus on patient-centered care" - nobody can sensibly argue that's anything but a good change. The three principles for the opioid guidelines published in March 2018 (read the full guideline here) are:

1. Prescribe the lowest effective dose and duration of opioid analgesia when an opioid is indicated for acute pain. Clinicians should reduce variation in opioid prescribing for acute pain.
2. The post-acute pain period - up to 45 days following an acute event - is the critical timeframe to halt the progression to chronic opioid use. Clinicians should increase assessment of the biopsychosocial factors associated with opioid-related harm and chronic opioid use during this period.
3. Chronic Pain - The evidence to support chronic opioid analgesic therapy for chronic pain is insufficient at the this time, but the evidence of harm is clear. Providers should avoid initiating chronic opioid therapy and carefully manage patients who remain on opioid medication.

As with all of the other guidelines published by the federal government, state governments and private organizations, there is nothing that says "no opioids ever" but instead reiterates "be very careful." And that was ultimately the epiphany this Minnesota physician needed to evaluate what he was doing and why.

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Are there better ways to treat chronic pain? (244 views)

Thanks for sharing, Dr. Stephen Grinstead:

"This is short, simple and to the point. It does not go in depth rather lists what is believed to be needed in resolving the chronic pain epidemic we are now experiencing that has a large part in the current Opioid Crisis. Read the entire report."

"Balanced, individual patient-centered approach" indeed! Of the nine items included, I especially appreciated "more education and training" because that speaks to the heart of the issue - better information will yield better choices.

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1 in 3 Young Adults Suffers From Loneliness in U.S. (201 views)

Some researchers have said we have a national "loneliness epidemic" (yes, another epidemic). For sure, being alone is not the same as being lonely. But 240 of the 1200 people aged 18 to 24 said "they at least sometimes felt lonely, isolated and 'left out.' Overall, those people gave lower ratings to their physical and mental health." Some more statistics:

• One third of patients under 25 reported feeling lonely while only 11 percent of adults older than 65 reported the same
• Nearly half of 20,000 adults reported in 2018 being lonely "at least sometimes"
• "Only 53 percent said they had meaningful face-to-face interactions everyday"

If you're going thru difficult times (including #ChronicPain), often loneliness and isolation happen. Which is the absolute worst time for that to happen. In my opinion, our society encourages disconnectedness. That means you have to work even harder to be connected. It's worth it. This gets back to one of the stories I included in "Mark's Musings - March 11" where the NBA Commissioner said "many players choose to isolate themselves from their teammates which exacerbates the depression and anxiety some of them feel." Being alone (which can sometimes provide invaluable introspection and a time for recharging) is not the same as being lonely. But choosing to be isolated, or by virtue of your circumstances having isolation forced upon you, is usually not healthy (physical or mental). So if you're lonely or isolated, find a way towards relationship.

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What Is Diaphragmatic Breathing? (596 views)

If you've been following me for awhile you know I've extolled the virtues of deep diaphragmatic breathing. It's something you can do yourself (you don't need a "prescription" from a clinician to start). It doesn't cost any money (your checkbook will be untouched). And the benefits are proven (everybody has taken a deep breath at some point to calm down). Among all of the listed benefits this one may be most pertinent to those going thru a difficult time (including #ChronicPain) - "One of the biggest benefits of diaphragmatic breathing is reducing stress." Does this technique solve all your problems? No. Does this relieve stress, help relax, lower heart rate & blood pressure, etc. for everyone? No. But should you at least read this article to see if it might be a helpful tool for you? Absolutely.

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How Much Sleep Do We Really Need? (321 views)

Did you know today (Mar 15) is #WorldSleepDay? According to the preeminent source Wikipedia, "The goal is to celebrate the benefits of good and healthy sleep and to draw society's attention to the burden of sleep problems and their medical, educational, and social aspects, and to promote the prevention and management of sleep disorders." The amount of sleep an individual should get for maximum effectiveness is individually variable but in general the National Sleep Foundation suggested 7-9 hours for someone my age. So looking back at my Fitbit: Thu night = 6h53m (55m REM), Wed night = 6h59m (46m REM), Tue night = 8h2m (1h44m REM), Mon night = 7h4m (1h18m REM). One advantage - No travel this week so I had a lot more control over my schedule. There is some great info in this article on how to determine the amount of sleep you need (e.g. "Do you depend on caffeine to get you through the day?") and how to improve it (e.g. "Exercise daily"). Are you strategically sleeping? Don't rely on stimulants to get you started, to stay awake or be focused. Instead, rely on quality and quantity of sleep. If you're addicted (yes, I specifically used that term) to coffee, try this one time - get eight hours of sleep and start your morning off with a 32 ounce glass of water.

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In addition, I published one blogpost:

• "Mark's Musings - March 11" on March 12

And I was the guest on a Healthcare Solutions Podcast published by Cristy Gupton of Custom Benefit Solutions:

• "How Real Leadership is Solving the Opioid Crisis" on March 15

And ... after weeks of development ... I launched my own YouTube channel!! I started it with seven total videos currently separated into "Long Form", "Live Events" and "Minute with Mark" playlists. With more to come, as soon as next week. So please Subscribe and keep up with this new video option for my content.

• "Musings by the RxProfessor"

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"It's Never the Wrong Time to do the Right Thing" - Martin Luther King, Jr.

#PreventTheMess + #CleanUpTheMess = The Answer.