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The Low-Down on Low Back Pain

BY: Dr. Benjamin Pun

Low back pain is continuously on the rise. According to research, over 70% of us have already experienced this pain in some form or another in our lifetime. Our lower back is designed to provide stability, strength, and flexibility to out entire upper body, so it is no mystery that low back pain can sometimes feel so debilitating to our everyday routine. That persistent dull, achy and spasming sensation in your low back is no fun to deal with, but more often that not that pain can be prevented or reduced.

Here are some common ways people become victims of lower back pain.

  • Poor posture: For the majority of Americans who spend working countless hours sitting at a desk in front of a computer, poor posture is inevitable. We sit for long hours hunched over, or leaning to one side or another without ever moving.

  • Not watching your weight: The more weight you carry, the more pressure is placed on your back. This increases the risk of injuries like muscle sprains and disc herniations.

  • Too much stress: Stress not only prevents your mind from relaxing, but it also makes your body and muscles become tense leading to lower back pain. With increased stress, most people then tend to eat poorly, exercise less, and have poor sleep.

  • Overused muscles: Daily repetitive lifting of heavy objects, or working out too much without proper rest days can lead to damage of the soft tissues that support your lower spine. Ligaments, tendons and muscles can be overly stressed leading to increased pain.

Here are some things you can do to help treat and prevent that back ache.

  • Make sure your workstation is ergonomic: This can go a long way for your back. Raise your monitor up so that your eyes hit the top half of the screen as you sit up. Position your keyboard and mouse to an area so that your elbows will be naturally bent to 90 degrees when you use them. Use a lumbar support for your office chair Most importantly, take FREQUENT breaks. Get up and move at least every hour to reset your entire body

  • Exercise regularly and stay active. Not only does this help maintain weight, it can also help strengthen the muscles supporting your spine. A sedentary lifestyle of excessive hours on your computer or laying in front of a TV can cause muscles in your core and your back to shut down- which can leave you feeling stiff.

  • Eating healthy. Cut back on those daily take out lunches and stay properly hydrated. Your back will thank you.

  • Stress Relief. Seeking mental health help from a psychologist or counselor can help you cope with stress better, take breaks from social media and find a hobby that you enjoy and take your mind off your worries.

  • Cold/Heat therapy: Cold therapy like an ice pack is good for immediate injuries to reduce inflammation. Heat therapy is good for achy and sore areas to help stimulate blood flow and nutrients to those areas. You can get a heating pad from any store, an apply for 15-30 minutes at a time.

  • A good night’s sleep. Getting an adequate amount of quality sleep is important for your body to properly heal. Sleeping positions can also make a big difference for your back. Sleeping on your stomach can often lead to strain on your back. Sleeping on your side with a pillow placed between your knees can help improve the alignment of your back and pelvis and help reduce pain.

  • Stretch your hamstrings: The hamstring muscle is located on the back of your thighs. When it becomes tight, it can stress your lower back and joints leading to pain. Stretch your hamstrings at least twice per day. Click Here to see a picture on a good way to stretch those hams.

  • What about chiropractic? A Chiropractic adjustment can reduce joint restrictions or misalignments in the spine. This can reduce inflammation and improve function of both the joints and nervous system. By increasing joint mobility and improving your nervous system function, your body has the ability to better manage symptoms caused by low back pain. Chiropractic techniques can also involve helping you stretch the joints and muscles to reduce tension in the low back.

With proper care, good diet, (and a good chiropractor), you can have less painful days and more time to do those fun activities this summer!

Swimming Safety

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Summer is here! Beautiful sun and weather are perfect for swimming in those pools!

However fun swimming can be, there are some hazards to be mindful about. Here are some important safety tips and information you need to know to keep you and your kids safe this summer.

Drowning. This kills more kids in the 1-4 year old range than anything else, even more kids under 1 year old. Not only that, but it is the leading cause of unintentional death in kids 1-14 years old. This is more than pedestrian injuries per year! Here’s how to prevent this:

  • Make sure there is a barrier, like a fence, with a self-closing gate around the pool

  • Always have kids wear some kind of life jacket when swimming

  • Teach kids how to swim as soon as they are able to

  • Learn CPR and how to rescue those who are near drowning – there are many classes

    available for these around local communities

  • Always and I mean ALWAYS supervise your children closely at all times – I cannot stress

    this enough, because it is when you aren’t looking that accidents happen

Disease. Drowning is not the only hazard. More often than not, these happen in the public pools. According to the CDC, diseases from pools have increased in the recent years.

  • Don’t go in the pool if you have had diarrhea recently or have diarrhea – just one

    diarrhea incident in the pool can release millions of germ particles like cryptosporidium

    (Crypto for short) and E.coli. Even with chlorine, crypto can survive in the water for up

    to 7 days! Share the fun, not the germs.

  • Make sure pH of water is at optimum levels – you can do your own self-test by using pH

    test strips

  • Tell kids not to swallow water

  • Do not pee in the water – take kids on bathroom breaks and check diapers every hour

Here is a great resource from the CDC for safety tips and information. Stay safe and remember to splish, splash and have a blast this summer!

Introducing Elevated Recovery – Opioid Dependence Treatment

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I wanted to fill you in on some exciting new things happening at Elevated Health. In order to continue to provide the highest level of care and convenience for our patients, we have decided to dedicate an entire office suite to the needs of our patients in recovery.

I am pleased to announce that Suite #670 is now our opioid addiction recovery unit, also known as Elevated Recovery. Elevated Recovery is an online addiction medicine treatment center and will be located just two floors below our main office (Suite #800) in Pacifica Tower.

While I will continue to be an integral part of the recovery team, we have added a new provider, Noelle Capulong, PA. Noelle is a Physician Assistant with many years of experience in the field of addiction medicine and pain management. She will be a very important part of the team in providing you with excellent service.

Elevated Recovery's new hours and contact information are as follows:

 

HOURS

Monday: Closed

Tuesday: 9:00 am - 12:00 noon

Wednesday: 4:00 pm - 7:00 pm

Thursday: 9:00 am - 12:00 noon

Friday: 4:00 pm - 7:00 pm

Saturday: 1:00 pm - 4:00 pm

CONTACT

Main Phone: (424) 403–2873

Dr. Matt’s Phone: (714) 477–7964

Noelle’s Phone: (424) 377–7103

Fax: (424) 999–0308

www.elevated-recovery.com

 

We have many more exciting changes in the works so stay tuned! We look forward to seeing you soon.

Is Skipping Breakfast Unhealthy?

A recent study in the Journal of the American College of Cardiology has received quite a bit of attention in the popular media in the past couple of months.  Check out these headlines:

  • “Skipping Breakfast Tied to Higher Risk of Heart Related Death”  CNN

  • “Eating Breakfast? Skipping a Morning Meal Has Higher Risk of Heart Related Death”  USA Today

  • “Study: Skipping Breakfast Increases Risk of Heart Disease Mortality by 87 Percent” FOX

But this study has received just as much attention from physicians and researchers who have been quick to point out the problems with studies like this, labeling it “bad science,” and even going as far as saying it should have been recalled or never published.

There are several problems with a study such as this.  Mainly, this is an observational study which means an observation or association was made, in this case between not eating breakfast and cardiovascular disease, but an actual experiment to test this observation or hypothesis was not done.  They basically pulled data from a nutrition survey done in the late 80’s and early 90’s, looked at who said they ate breakfast and who didn’t, and then followed up with them in 20 years on average to see who died from cardiovascular disease and who died from other causes.  

Was that the only difference between the 2 groups though?  It turns out that according to the study’s authors, those who didn’t eat breakfast were more likely to be former smokers, heavy drinkers, unmarried, physically inactive, obese, and diabetic.  They also had a lower family income, ate a poorer quality diet, and had higher cholesterol. So did they die of cardiovascular disease because they didn’t eat breakfast or because of one of these other reasons?  In these studies researchers always “adjust for” these other factors, but it is nearly impossible to accurately do that.

There are other problems with the study:

  • What did participants eat for breakfast?  The investigators did not collect information on what they ate or drank.

  • Did participants change their diet over the course of 20 years?  We don’t know since information was only collected at baseline.

  • What is the definition of not eating breakfast?  Investigators didn’t find out if they still ate 3 meals or ate more calories later in the day or simply just ate 2 meals after skipping breakfast.

The takeaway for most researchers that critically evaluated this study is that skipping breakfast was more likely a marker for a lifestyle and environment (other factors) that predisposed these people to cardiovascular disease, not that skipping breakfast itself caused cardiovascular disease.  

Interestingly, this article, looking at the association between eating breakfast and losing weight, came out 3 months before the above study.  This article questioned the science behind eating breakfast as a strategy for weight loss, and claimed it was propaganda manufactured by the cereal companies.  Studies cited in this article show that eating breakfast does not promote weight loss and skipping breakfast can be a useful strategy to lose weight.

My takeaway to you is this: take headlines and studies with a grain of salt and a critical eye.  Media outlets love titles and headlines like this because they know people will click on them to read further, and as long as there is a “study” quoted, they are not being journalistically inaccurate.  Ask us as your physicians for clarification or search for reviews or criticisms of studies. And if you want to eat breakfast eat it, if you want to skip it, skip it!

Just Another Rash?

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It’s morning and your little one wakes up with a rash on the body, face, legs or feet. What do you do? Why is this rash there? Do you call the doctor right away?

Before you have “rash” thoughts (no pun intended), here are a few things you can go through to see if this is a rash that needs immediate medical attention. With all the hype going on right now, not everything is a Measles rash!

  • Fever – anything above 100.4 F. This is a big indicator that something can be wrong. Viruses tend to have high fevers around 102 and 103, for a few days, then 2-3 days later a rash breaks out. Yes, Measles has high fevers, but so do benign viruses like hand foot mouth, roseola, or chicken pox. Tylenol or ibuprofen is helpful in reducing the fever and making your child feel a little better.

  • Allergies? New foods? New detergents, clothing, or new exposure? These are things to consider, especially if your little one just tried something new. If it is itchy, then it is probably an allergic reaction to something. These rashes are all over or localized to one spot and usually last a few days.

  • Energy or lack thereof? Toddlers are little balls of energy, so when they are tired and don’t want to do anything and fuss and cry all day, then there is something more to them then just a rash. But if your child is normal, eating and playful, sleeping well, no fuss, then there probably isn’t much to worry about.

  • Insect bites? With the summer approaching, one thing that people don’t realize is an allergy to mosquito bites, which look scarier than they really are. Some children (and adults too!) get a reaction to the anesthetic than mosquitos inject before taking your blood. Same thing with spider bites, which can also swell up. Look for evidence of bite marks, itching, and sometimes pain.

  • Blisters? Are there large bubble-like rashes on your child’s skin? These could mean there is an underlying illness with another organ system like the kidneys.

  • Oozing and crusting – this can mean a skin infection like with staph, a very common organism around children, or chickenpox especially kids that go to daycare or preschool. Have it checked out to prevent the spread to other kids.

  • Pain? If it is an “Ouchy” then it probably has more to it than they eye can see.

  • Location – how did it start? Is it in one location? Did it start on the face and then spread to the rest of the body (measles) or was it all over the body from the start (roseola, typical viral rash)? Is it only on the hands, foot, mouth and buttocks (Hand foot mouth disease AKA coxsackie virus)?

  • Other new abnormal symptoms: any upper respiratory symptoms may signal a viral rash. Measles comes with cough and eye discharge. Any vomiting or diarrhea should also prompt medical attention. A rash that doesn’t go away within a week or one that keeps getting worse can also mean more care is needed.

Remember kids get rashes all the time, and some come and go without leaving a trace. As a parent it is easy to lose control and worry, but always remember that your doctor at Elevated Health is only a text or call away!

Clinical Trials for Asthma at Elevated Health

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At Elevated Health, our physicians take education and medical research very seriously. We are proud to announce Dr. Matt is a sub-investigator for some upcoming clinical trials in Orange County. These studies will be very important to move the needle in research in our medicine armamentarium.

Despite being developed as early as 1900, we still do not have an affordable option for inhaled steroids to treat asthma. These inhaled steroids can cost hundreds of dollars each month, which makes them unattainable, except to the few that have great (read: expensive) health insurance. With ever increasing health insurance deductibles, many Americans are finding they have to pay thousands of dollars, out of pocket, before their insurance starts to cover their medications and medical care.

Over the coming months, we are looking for individuals that have asthma to participate in clinical trials  that will look at a generic version of these inhaled steroid medications.

As a part of this, besides being integral in the development of affordable life-saving medication, subjects will be compensated as much as $800 per study.

Below is a list of our upcoming studies and details of each:

Westward Asthma Study for ages 12 and up

Enrollment closes June 30, 2019

2-month study - 4 visits (1 visit is 13 hours)

Subject compensation = $750.00

Novum Asthma Study for ages 12-75

Enrollment closes September 2019

2-month study - 4 visits (1 visit is 13 hours)

Subject compensation = $590.00

TPI-TEVA Asthma Study for ages 18-75

Enrollment closes May 2020

2-month study - 4 visits (no 13-hour day)

Subject compensation = $525, plus $10.00 gas per visit

Fourth Study details still pending.

Please email us so we can put you in touch with the study coordinators. As part of the study, you will have a pre-screening visit and receive a  free lung function test. If you qualify, you will have the opportunity to be paid for all 4 studies.

Please share this with anyone you know who is affected by asthma and would be interested in being compensated for their willingness to help us in our medical research.

If you prefer, you may also call or text us at: 714-916-5210

Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5278812/

https://www.aafa.org/asthma-facts/


Measles Update

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The U.S. is in the midst of the largest measles epidemic in the last 25 years so naturally we are receiving a lot of questions about it. The majority of cases are in unvaccinated children, but some adults who have received 1 vaccine also make up about 10% of the cases.

To keep it in perspective, California has had 40 cases with 8 of them occurring in LA and Orange County in 2019. While not as bad as the situation in New York, it is still around us. Here are the latest CDC recommendations for who needs a booster:

  • If you were born before 1957, you do not need a measles booster because you were naturally exposed as a child, and are considered immune

  • If you were born between 1957-1989 and received 1 dose of the live vaccine, you are likely immune (1 dose is 93% effective, 2 doses are 97% effective). If you are not sure if you received the live vaccine or of your vaccination status, a blood test can be done to check for immunity. Many people vaccinated before 1968 received an inactivated and ineffective measles vaccine.

  • If you were born after 1989 and received 2 doses of the MMR vaccine, you are considered immune and do not need further testing or a booster

  • If you plan to travel internationally, are a health care worker, or a college/graduate student, you are considered higher risk and need 2 doses of the MMR vaccine

Here at Elevated Health we can draw your blood to check for immunity, and we offer the MMR vaccine as well. The cash price for the blood test to check immunity to measles, mumps, and rubella is $45. The price for immunity to measles only is $20. The cash price for the MMR vaccine is $80. These services may be covered by your insurance as well. Please call us if you have any further questions regarding measles or would like to schedule an appointment for testing or vaccination.

Women's Health: Preventative Exams

What’s a pap smear and why do I need to do it? Why do I need to get my breasts pancaked every 1-2 years? As a woman, these are probably questions you have on a yearly basis. Every woman knows they need to get pap smears, breast exams, and mammograms, but do you really know why?

These are known as screenings, and they do just that: screen for cancers.

A pap smear is a screen for cervical cancer, which is in the cervix, the opening to the uterus. Cervical cancer is commonly caused by a virus called HPV. HPV is transmitted through sexual contact, and males do not know they have it. More importantly, some condoms do not protect against the transmission of this virus. The pap smear looks for HPV and if there are any changes to the cells of the cervix. Some people, especially young females, can clear the virus over time.

Pap smear guidelines have changed frequently throughout the years, but the current recommendations have been around for some time now. Every female, including any person who has female body parts, needs to have a pap smear starting at the age of 21, regardless of sexual activity. They are repeated every 3-5 years depending on age and what kind of DNA test was done. If a female has not been sexually active, then a conversation must be started with your doctor regarding when it is best to have a pap. Cervical cancer is a slow growing cancer, and is very preventable, if caught early. That is why it is very important that this exam be done.

A mammogram screens for breast cancer. Starting at age 40, every woman needs to get this exam every 1-2 years. Yes, the breasts are squished between two x-ray panels, which makes this a very uncomfortable exam, but nonetheless a very important one. Some women have dense breasts, which may require more testing to make sure any cancers are properly seen. Dense breasts are normal and do not mean you have a higher risk of getting cancer. What does make you at higher risk? Family history, especially close relatives. Any changes to the breasts, like lumps that you or your partner may feel, can also mean something is wrong. That’s why it is very important to discuss with your doctor about any family history and any changes you notice yourself, and get your mammogram!

Don’t forget, you also need to make sure you get your yearly bloodwork to check your cholesterol, kidneys, liver, and thyroid- everything in your body is connected, and you have to make sure your WHOLE body is healthy and problem free!

Headache Got You Down?

BY: DR. BENJAMIN PUN

Have a headache? You are definitely not alone. Millions of Americans deal with a headache at some point in their lives. There are a variety of headache experiences- dull, throbbing, sharp, pounding, to name a few. It can be felt around the eyes, behind the eyes or even on only one specific part of the head. Some headaches can be debilitating and keep you away from your work and really get in the way of living your life.

Most headaches are tension headaches and migraines caused by poor posture, stress and repetitive activities. Here’s a list of some common causes:

- sitting and working too long on a computer and desk
- long driving times- LA and OC traffic!
- looking down at your cell phone a lot- we all have to check the latest on Instagram or Facebook!
- tummy sleeping
- anxiety or stress
- jaw clenching and teeth grinding- hurts your TMJ
- dehydration
- menstruation

Here are some good ways to ease that headache:
- limit stressful events or situations
- take frequent breaks to stretch during work or long driving
- avoid teeth clenching- mouth guards are useful for this
- Exercise- low impact like walking, swimming or biking a few times per week
- Drink plenty of water! Make up for water losses from your coffee and teas, and keep properly hydrated throughout the day

Crick in your neck? Could be the cause of your headache, called cervicogenic headache. Long word, but definitely treatable. The bones in your neck have all these muscles attached, and during times of stress, those muscles get tight, push on nerves, and slow down blood flow to your head. That lack of blood flow and nerve irritation causes a headache. One of the best treatments for tension headaches is chiropractic. Getting a chiropractic “adjustment” helps take away that pressure from your nerves and arteries and puts your spine in alignment. Just like cars need tire alignments for maintenance, so does your neck and body, to help you get through the day.