Monday, August 31, 2015

Your tendons on cake

My friend and colleague James Crownover recently wrote a wonderful blog post about the relationship between glucose metabolism and tendon injury

Wednesday, August 26, 2015

Upcoming Fall Races: 5K, 10K, marathon, fun run, and more

I remember the first 5K I ever did.  It was the charity walk/run called the Furry 5K in Seward Park that benefited the Seattle Animal Shelter.  As a non-runner, I was hesitant at first to sign up because I imagined all these seasoned athletes sprinting past me while I was left in their dust.  Boy was I ever wrong!  The amazing lessons I learned that day were: A. I could power walk at MY pace and still cross the finish line and B. EVERYONE who signs up for these walking/running events is there to support and cheer one another on. 

Whether you are a competitive runner who is pushing their physical capacity in a timed race or a beginner testing the walking/jogging waters in a fun run, there is ALWAYS a race for you!  I am going to share some upcoming races in the Seattle area that I have researched, but remember, do your own research too!  A great website I utilized is which lets you filter through the types of runs you are looking for.  So check out some of these runs below and as always, stay active and be the BEST version of yourself!


·         “Walk to Defeat ALS”- September 12, 2015 (our clinic completed).  This is a little less than 5K run/walk around Seward Park.  This event is to raise money for local ALS Association chapters to sustain care services and support research.  I will be doing this walk again this year!

·         “End Aids Walk and 5k Run Seattle”- September 26, 2015.  This is a 5K run/walk around Volunteer Park.  The monies raised will go towards support in HIV prevention and care services.


·         “Magnolia 10K & 5K”- October 4, 2015. This is a 5K and 10K run/walk in the Magnolia neighborhood of Seattle.  At the finish line, there is a festival in the Magnolia Village that includes exhibitors, food and a beer garden.

·         “Biggest Loser Seattle Half Marathon/5K”- October 25, 2015.  This is a half marathon/5K run/walk at Lake Stevens in Snohomish County.  There will be appearances by former contestants from "The Biggest Loser" as well as the Biggest Loser finisher's medal and awards for the best times.


·         “The Ugly Sweater Run Seattle”- November 28, 2015 (our clinic completed).  This is a 5K run/walk around Marymoore Park.  You can expect to see tons of ugly sweaters, holiday cheer and and other goodies at the finish line.  Also, this event raises monies for the non-profit Save the Children.

·         “Seattle Marathon and Half-Marathon”- November 29, 2015 (our practice manager Laura completed; she and medical assistant James will be at this year’s race).  These marathons are primarily for runners though the race does offer a smaller walker category.  The routes begin near Seattle Center and head out towards Lake Washington.  The best times from the race can be used as a Boston Marathon qualifier; there will also be other medals and awards.


·         “Run 4 Wine”- December 12, 2015.  This is a 5K run/walk around the Warehouse Wineries in Woodinville.  Pair your love of running with your love of wine!  After the race, you can enjoy some of our state’s finest wine tasting.

·    "Jingle Bell Run/Walk Seattle"- December 13, 2015.  This is a run/walk near Westlake Center in the Seattle area.  Spread your holiday cheer while raising monies to benefit research for the Arthritis Foundation.  You will see lots of holiday themed runners, booths and get a free beverage in their beer garden after! 

Tuesday, August 25, 2015

Behind the scenes…What goes into my appointment?

If you’ve ever been to a doctor’s office, you may have wondered at some point...What exactly are they doing??   At Lake Washington Sports & Spine, our new patient consultations range from 45-60 minutes while follow up appointments range between 15-30 minutes.  Follow-ups can include imaging/lab reviews, checking your response to a previously done procedure and/or following up after you’ve completed recommendations set forth by the doctor.  A lot of patients do not recognize the time and effort that is put into each appointment from start to finish.  We want to share with you a “look behind the scenes” at what we are doing to ensure YOU have the best experience and care with us!

Front Office…Our front office staff includes the patient care coordinator and billing manager.  They work together to make sure the appointments are scheduled correctly, any necessary insurance authorization or other provider chart notes have been obtained and direct calls to the appropriate staff.  Overall, they make sure that scheduling, check-in and check-out run smoothly. 

The patient care coordinator is the first face you see when you walk in.  They contact patients to make sure they arrive on time for their check-in time and organize patient paperwork all the while answering phones with great customer service.  They explain referrals/orders to patients upon check-out and work with the rest of the staff to make sure the patient has everything they need before they leave.  They work to send your medical records to the appropriate clinics and facilities. The coordinator also schedules your follow-up appointment as you check out, and works with you to find the best day and time available. 

The billing manager checks insurance eligibility for patients and contacts them prior to their appointment with any concerns.  They answer insurance-related questions in real-time that either the patients or doctors may have, as well as discuss balances due with the patients.  They work with the medical assistants and doctors during appointments especially before procedures are done and/or scheduled in order to ensure all aspects of the procedure billing goes well.  They code and bill claims that require immediate payment as you check-out so you leave with a zero balance.

Clinical Staff… Our clinical staff includes the medical assistants to both our fabulous doctors!  They arrive early to prepare the day for the doctors so when patients are ready to be roomed they have the full appointment time booked with the doctor.  That is why it is so important for our patients to arrive at their check-in time versus their appointment start time.

The medical assistants typically review the chart notes for upcoming patients a day or two ahead of time.  If a patient is scheduled for an imaging and/or lab review appointment, they double check with the other facilities to make sure the images and reports are completed.  If the patient has not completed the needed orders, they work with the patient care coordinator to contact the patient in order to reschedule their appointment and/or find out when the orders will be done.  For patients following up for an in-office procedure, the medical assistants set up the equipment needed ahead of time for the doctor and also make sure necessary injectables are ready to be used (like PRP kits, Euflexxa, steroids, ect). 

Throughout the day, the medical assistants are constantly prepping for the next appointment, while also answering and returning patient calls.  They clean and prepare exams rooms before each appointment and work with each other to ensure that each doctor has access to the room/equipment he needs.  The medical assistants also input data from new patient and follow-up paperwork and generate referrals your doctor may recommend.

This is just a small glimpse into the amount of work being done to make sure you have a 5 star experience at Lake Washington Sports & Spine.  Our team is dedicated to keeping you active and we will ALWAYS go above and beyond to ensure that you receive the best musculoskeletal care around!

Friday, August 21, 2015

Happiness Based Musculoskeletal Medicine: The Power of Woo

 Drs. Hyman & Chimes are the pioneers of Happiness-based Musculoskeletal Medicine. Our practice focuses on more than just injury treatment and prevention- we help you optimize your health!
Here's a fun clip to help improve your posture & boost your mood: THE POWER OF WOO!

Tuesday, August 18, 2015

Tips for Beating the Heat!

As a relatively recent transplant to the Pacific Northwest, I have quickly realized that summer in Seattle is a magical time.  All of a sudden the clouds float away and we are left with an array of outdoor activities at our finger tips.  As our excitement grows, however, it is also important to recognize the dangers of being out in the heat for too long and without the right precautions.  Below are a few tips that will allow you and your family to have the happiest and healthiest of PNW summers!

1.  Get a Big Gulp….of WATER!
                This one may seem obvious but it is absolutely critical that we all remain hydrated during these flaming hot days.  It is important to remember that the time to start drinking is NOT once you feel thirsty; by this point, you are already behind.  Make sure to drink plenty of water before starting your activity and then continue to sip water while exercising.  If you plan to do vigorous exercise, it may be wise to bring along a diluted sports drink to replace electrolytes that our lost when you perspire.  Always remember to drink plenty once you’ve completed the activity too!

2.  Temperature isn’t the only thing that matters!
                Most of us are in the habit of checking just the temperature before we head outside.  Although the temperature is indeed telling of how bearable exercising outside might be, humidity is also a critical factor.  One of the body’s main cooling systems is perspiration (sweating) and the sweat evaporating off of our skin is what cools us down.  Humidity, however, makes it much more difficult for sweat to evaporate and in turn, makes is much more difficult for us to regulate our internal temperature.

3.  Fashion police!
                I’ll be the first to admit that I don’t spend a lot of time choosing the perfect exercise gear.  However, on hot and humid days, the clothing you wear can really play a large role in how well you handle the heat.  Fabrics like cotton, although typically comfortable, are not very breathable and can make a hot, outside workout feel unbearable.  The better choice is to wear breathable, synthetic fabrics (polyester, nylon, etc) that will wick away your sweat.  It is also important to wear a hat or visor and, of course, apply plenty of sunscreen before heading outside.  

4. Know your limits        
                If this is your first outdoor workout this summer, try to go in the morning or the evening when temperatures are cooler.  Also, change your workout for different heat levels.  If it’s a scorching hot day, taking a bike ride may be healthier and safer than a long run in the sun.  Most importantly, LISTEN TO YOUR BODY.  If you start feeling dizzy, nauseous, or otherwise not 100%, STOP.  You are not doing yourself or your body any favors by pushing through a workout when you’re feeling sick. 

The main thing to remember during these last days of a beautiful Seattle summer is that there are myriad opportunities to play outside but just be sure to take care of your body so your workouts are both fun AND safe! 


Monday, August 10, 2015

How to choose the right bed: what we can learn from the Pepsi Challenge

One question patient's frequently ask me is "what is the right bed for me?"

Like many things in musculoskeletal medicine, the answer is "it depends."  There is no one best bed for everyone, and the best choice will depend on a few different factors

One thing to pay attention is your preferred position for sleeping.  As a general rule of thumb, the most important thing to pay attention to is the position you wake up in, rather than the position you try to fall asleep in.  I had a patient the other day who thought she was a back sleeper, but she always wake up on her right side, which tells her that her body wants to sleep on the right side.

A second factor is paying attention to placement of your hands.  One of the hardest parts of finding a good night's sleep is figuring out where to place your hands relative to your upper body.  This is especially true for side sleepers.   The constant tossing and turning to find the right hand position reminds me of the scene from the movie Talladega Nights, where Will Ferrell's Ricky Bobby character can't figure out what do with his hands during his first interview.

The same thing happens with me when I sleep, especially if I am in a bed with pillows I am not used to, or sleeping in a bed that is too small for me.

One inexpensive item that can make a huge difference is using a full-length body pillow.  You can do what I do, and get a cheap one for $15 at Costco, or you can certainly get a much nicer one at a store like Relax the Back.

A third factor to consider with sleeping is the appropriate level of firmness when you sleep.  There is no best level of firmness for everyone, but I do find that patients often sleep with a bed that is a bit softer than would be optimal for them.  I think the reason for this is that the level of firmness that is most comfortable when you first lay down on a bed is generally a bit softer than the preferred level of firmness for a good, restful night of sleep.

By way of analogy, Malcolm Gladwell had a great anecdote about the Pepsi Challenge from the 1980s in his wonderful book Blink.   For generations, Coca-Cola was a the clear #1 brand in cola sales, with Pepsi a very strong #2.  Pepsi would set up booths in public areas and ask consumers to try a sip of the two products, and then reveal the brand of the cola they preferred.  Based on this "sip test", consumers strongly preferred Pepsi.

This challenge started in 1975, but took traction in the 1980s, enough so that Coca-Cola started to see drops in sales.  It eventually led to Coca-Cola reformulating their market-leading product, and producing a newer version of Coca-Cola called "New Coke" in 1985, designed to be sweeter like Pepsi.

New Coke is one of the all-time great marketing disasters, and soon Coca-Cola brought back their original, less-sweet Classic version.  So what happened?

It turns out that the attribute that makes a cola tasty for a small sip is not the same thing that makes a cola tasty for drinking several large glasses.  When asked to drink a thimble-sized sip of a cola, tasters generally prefer whatever is sweeter.  When drinking an entire glass, however, most people prefer something less sweet, as excessive sweetness can be cloying and unpleasant.


Getting back to beds: The quality that makes a mattress comfortable when you first lie is generally how soft it is.  However, the quality that makes for a good nights sleep is how supportive it is, which is a different quality.   Softness and support are not oppositional- a mattress can be both.  It's just important to recognize they are different qualities.

Some things I would consider when buying a bed:
1. Give yourself ample time to mattress shop.  Plan on a few hours
2. Before you go, figure out what position you wake up in, and test beds in that position
3. Give yourself at least 15-20 minutes on each mattress to determine if it is a comfortable fit for you

Some specific stores I would consider when mattress shopping:
1. The Relax the Back store.  We've had very good experiences with specific owners of the Bellevue store.  They have excellent customer service and spend a lot of time with customers.  In the past, I've had concerns about Tempur-Pedic beds because of heat retention, but the newer generation of Tempur-Pedic beds no longer have that issue (although some competing brands of memory foam do, so I'd only recommend the Tempur-Pedic brand).
2. Bedrooms & More.  Located in Seattle near I5, they offer high quality natural latex mattresses, and also have excellent customer service.
3. Sleep Number.  The sleep systems, using individual air chambers, can be nice for couples who desire a different level of firmness.  This is what I have used for myself for about 7 years, and I'm happy with it.  I can't speak to the customer service of stores in the Bellevue/ Seattle area.

Wednesday, August 5, 2015

Single-Limb Exercises

What’s an extremely easy way to burn more calories, improve your stability, and increase overall strength? Start doing your exercises on a single limb!

We’ve talked about single-limb exercises frequently on this blog, and that’s because we think they’re the bee’s knees, the cat’s meow, the duck’s quack … and just to keep the dated references going – well, we think they’re just swell.

Single limb exercises obviously challenge your balance, but they do much more than that. They can help eliminate any strength imbalances since you can’t rely on your stronger side to make up for your deficiencies. Also, single-leg exercises are similar to movements you do in everyday life or while playing sports, such as walking, running, or leaping.  In addition, they can help you burn more calories since it takes twice as long to complete a single exercise.

But you might be thinking: “I’m not Gaston!” And that’s right. You’re not Gaston. No-one’s as burly or brawny, or as slick or as quick. Then again, no-one eats five dozen eggs every day (think of the cholesterol!) But that doesn’t mean you can’t perform single-arm pushups or single-leg squats like Gaston (probably does). You’re just going to have to build up to it. The act of performing a single-limb exercise is going to be very difficult for most people. Not only will balance be an issue, strength will be as well. Ease into it! You can modify exercises to fit within your strength level. Here are a few examples.

-          Upper body push: Single-arm Pushups against a Wall. Face a wall or doorway, spread your legs about shoulder-width apart, and raise your arm until it’s about chest height. Perform a one-armed pushup, making sure to keep your elbow close to your body. These might seem too easy at first, but I think you might be singing a different tune after 20 or 30. Remember to keep your core tight before you start your pushups. An easy way to make sure your core is tight is to clench every muscle in your body (your legs, butt, abs, and even your hands). To up the intensity, bring your hand to a lower plane, like a heavy table, a kitchen counter, a chair pushed against a wall, and eventually, the floor!


-          Upper body pull: Single-arm Door Pulls. Open a door and stand facing the edge of the door so the doorknobs are perpendicular to you (round ones help here). Grab one doorknob with one hand, the other knob with your other hand, then bend your knees until you’re in a half-squat. Lean back until your arms are straight. Then pull your body towards the door. If you can, perform the pull with just one arm. Remember to keep your back straight and your shoulder blades in a stable position. To make things easier, use both arms, or move your feet further away from the door so you’re standing more vertical. To make things more difficult, place your feet behind the doorknobs so they’re further away from you/you have to squat more; or simply hold the contraction longer.


-          Lower body push: Single-leg squats. Start by holding onto a doorframe or other sturdy object (like a couch) to make sure you don’t fall over. Don’t worry about cheating with your arms; you’ll still feel a burn after doing 10+ single-leg squats even if you help yourself up. Lift one leg off the ground and hold it either in front of or behind you. Then, squat as deeply as you can on your standing leg. Suspension straps can help TREMENDOUSLY with this exercise, as seen here:

Two things to remember:
1) Make sure you keep your bending knee from leaning inward – this is called a valgus fault, and can lead to injury. Activate your gluteal muscles to remedy this, as well as keeping your knee steady/leaning out. 
2) Don’t let your knee go over your toes. You want to be sitting back and activating those glutes. Letting your knee go over your knees can lead to injury.

-          Lower body pull: Single-leg Romanian Deadlift. Stand on one leg.  Keep your leg straight but without your knee locked out. Hinge at the hips, and bend over while keeping your back straight. Maintain a controlled pace and movement – think more Drinking Bird toy, less stapler snapping closed.


If there’s a running theme throughout these exercises, it is that FORM MATTERS. If any of these exercises are too difficult to do with proper form, then you may need to modify them further.  Also, these exercises are only a guide, not a complete work-out plan. There are many resources (books, personal trainers, online forums, etc) to find more information on complete work-out plans.