Mark's Musings - October 21

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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Breathing Techniques: A Guide to the Science and Methods (176 views)

You know how I talk about breathing as an option for managing #ChronicPain and stress? Well, I just found this excellent resource on how breathing works - how/why it's important, how we often don't do it right, and a detailed how-to on techniques for specific outcomes. "Healthy breathing" comes from "breathing through your nose, and the need to draw breath into your diaphragm and belly, not your chest." It's about balance of O2 and CO2 - "We can also run into problems when our carbon dioxide levels are too low. Proper breathing techniques help us to maintain a proper balance." I did the test and have room for improvement so I'm going to apply what I learned. Beyond the benefits of education and better habits - doing this costs you nothing. In other words ... FREE! Invest 10 minutes to digest this info for a great start to your week! A helpful term that was used in the article was "attentive breathing." In other words, paying attention to technique will help deliver better results (of so many things). I never knew breathing should be this sophisticated or strategic. You'll be more conscious of your breathing as you digest the following subjects:

• Where Does Improper Breathing Come From?
• Mouth Breathing Versus Nasal Breathing: What’s the Difference?
• How to Assess Your Body’s Carbon Dioxide Tolerance
• Different Types of Breathing Techniques, including: The 365 Breathing Method, The 4-7-8 Breathing Exercise, Ayurvedic and Pranayama Breathing Techniques, Box Breathing, Buteyko Breathing Methods, Qi Breathing, and Breathing Techniques for Asthmatics.
• How Does Stress Alter the Way We Breathe?
• How Can Controlled Breathing Techniques Help Neutralize Stress?
• How to Incorporate Breathing Exercises into Daily Life, including: Make It a Coping Technique, Combine Breathing Regulation with Good Posture, Try Out Yoga and Meditation, and Practice Breathing Before Bed.
• Breathing Techniques Myths and Truths, including: Myth 1: “Deep Breathing” Is Healthy, Myth 2: We Need As Much Oxygen As We Can Get, Myth 3: Breathing is Automatic and I Don’t Need to Think About It, and Myth 4: All Breathing Techniques Have the Same Effect.
• Potential Risks for Breathing Techniques

Breathing is important. Taking it for granted (and probably doing it wrong) is a mistake.

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The Most Important Factor for Wellness Has Nothing to Do With Food, Exercise, or Time Management (172 views)

Kindness is a key ingredient to being #healthy. Here are two quotes that I especially liked:

"Whether you live a long, healthy, happy life or a short, stunted one has a great deal to do with whether the world metaphorically picks you up and cuddles you or just hands you kibbles through the door of your cage."

"We spend a fortune on medical care in this country -- far more than other countries per capita. But we're not getting the health results we want ... it's probably because we're really doubling down on the medical care and not investing in our social world the way that we could."

Have you noticed that kindness (or lack thereof) is infectious? But have you also noticed that a decision to be kind should not expect a similar response? It's not about what you get - it's about what you give. An attitude of kindness (which brings positivity, humility, and servanthood along with it) yields a better life.

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FDA, DEA Issue Joint Warning Letters to Illegal Online Opioid Sellers (269 views)

I never knew online #opioids (includingTramadol) was an issue. Apparently the FDA and DEA did. Buyer beware because the products from these online sellers can be “counterfeit, contaminated, expired or otherwise unsafe.” A discounted price should never trump safety.

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CMS Issues Education Regarding Concurrent Use of Opioids and Benzodiazepines (496 views)

A great resource from CMS' Medicare Learning Network and MEDVAL's blog with guidance for "Concurrent Use of Opioids and Benzodiazepines". Spoiler alert - It's a dangerous combination (as I've been saying since 2003) that should be avoided or VERY carefully handled (including strategic tapering) ongoing. These resources include some very helpful info for the reasons why along with "five principles" to consider when co-prescribing them:

1. Avoid the initial combination by offering alternative approaches
2. If new prescriptions are needed, limit the dose and duration
3. Taper long-standing medications gradually and, when possible, discontinue
4. Continue long-term co-prescribing only when necessary and monitor closely
5. Provide rescue medication (for example, naloxone) to high-risk patients and their caregivers

In addition to this blogpost I suggest you read the full CMS document. It hits the ground running in the very first paragraph ...

"When you prescribe opioids and BZDs to the same patient, there are potential negative consequences, such as:

? Higher risk of overdose deaths

? Higher risk of suicide

? Worse treatment outcomes

? Increased health service use"

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‘Rage Yoga’ Releases ‘Negative Energy’ With Alcohol, Profanity And Obscene Gestures (392 views)

Rage Yoga? Is this a good thing? Seems like a "USA in 2019" adulteration of the general premise (a soothing cleansing of the mind). It's definitely not kid friendly. I understand that some people may mutter obscenities under their breath when a difficult pose has to be held for a long time but that's a little different than being encouraged to do so out loud. And I don't understand how alcohol helps. I guess I'm getting old ...

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The gut-brain connection (428 views)

I have used the term "butterflies in my stomach" before but had not thought about the biological connection between the gut and the brain. Stress can create stomach or intestinal problems and vice-versa. Read this article to understand how it works. And to recognize it (which might mean you can better manage it).

• Physical symptoms: Stiff or tense muscles (especially in the neck and shoulders), headaches, sleep problems, shakiness or tremors, recent loss of interest in sex, weight loss or gain, restlessness.
• Behavioral symptoms: Procrastination, grinding teeth, difficulty completing work assignments, changes in the amount of alcohol or food you consume, taking up smoking, or smoking more than usual, increased desire to be with or withdraw from others, rumination (frequent talking or brooding about stressful situations).
• Emotional symptoms: Crying, overwhelming sense of tension or pressure, trouble relaxing, nervousness, quick temper, depression, poor concentration, trouble remembering things, loss of sense of humor, indecisiveness.

"A review of 13 studies showed that patients who tried psychologically based approaches had greater improvement in their digestive symptoms compared with patients who received only conventional medical treatment." Reducing stress (brain) improved their digestive (gut) issues. The more you analyze the more it becomes obvious that your brain is the key to success in almost every aspect of psychological and physical wellness.

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And in case you missed it, it was announced last week that I am joining the Advisory Board for Harvard MedTech, a cutting edge developer of evidence-based “smart technology” for the management of pain. I've been fascinated with the ongoing tech revolution when it comes to pain management, especially virtual therapy. However, I've typically thought of it only as a form of distraction. What I am learning (and will grow in my understanding thanks to my affiliation) is how it is an instigator of positive rewiring of the brain (neuroplasticity) for how to perceive and manage pain. I won't say it's the future because it's really the present, but the future is exciting as is the opportunity I have to participate in the growth of their platform. Their CEO and founder, Shan Padda, kindly wrote this for my LinkedIn profile:

"Having Mark on our advisory board is extremely exciting for us as a company. Mark offers a very unique, and much needed, new perspective on innovative ways to help patients heal. He is very forward looking and holistic in his perspectives. In a conservative industry, Workers Comp, Mark is a tireless advocate for change through new, healthier approaches. As he messages to the industry, the same old is not necessarily the best option, as the opioid crises has shown. As an innovative technology company that is introducing a radical new approach to helping patients heal through Virtual Reality and other Digital Health technologies, we appreciate his counsel on how best to serve patients and the market. He was one of the first to grasp the revolutionary potential of our platform and approach"

This is in addition to my Advisory Board membership at Simple Therapy and my current responsibilities at Preferred Medical. It's all about growth!

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In addition, I published two blogposts:

• "Mark's Musings - October 13" on October 15
• "Mainstreaming Marijuana" on October 18 by WorkCompWire

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

#PreventTheMess + #CleanUpTheMess = The Answer.