7 Reasons why YOU should take a walk TODAY!

1.  It's FREE!  No expensive exercise equipment or gym membership needed!  Just a pair of sneakers, maybe some catchy tunes or a podcast, and a positive attitude!

2.  It can help you reach your weight loss goals.  Walking quickly for just 30 minutes a day is a great addition to any weight loss regimen! Walking has also been shown to help keep food cravings in check and since we all know that the main factor leading to weight loss is proper nutrition, this is a double bonus!

3.  It strengthens and protects your heart.  More specifically, it lowers bad (LDL) cholesterol, increases good (HDL) cholesterol and stabilizes blood pressure.   That's why you should LOVE walking!

4.  It can help prevent osteoporosis & osteoarthritis.  Walking is a weight-bearing exercise and helps to strengthen bones, prevent bone thinning and maintain healthy cartilage.

5.  It can help improve your sleep.  Most of us are not getting nearly enough Z's each night but studies have shown that getting outside for a walk can help regulate our body's melatonin levels, which helps regulate the sleep cycle.

6.  It gives you a chance to form relationships.  Walking alone with some music or a podcast is fantastic, but so is taking the time to walk with your spouse, your children, or a friend!  Plus, buddying up during exercise makes it more enjoyable and, in turn, makes you more likely to stick to the routine.  So grab a pal and get walking!

7.  It lowers stress and increases happiness! Exercise of any sort releases our body's "happy drugs": endorphins!  Endorphins cause that sense of euphoria that comes after physical activity.  In addition, they can inhibit the transmission of pain signals.  Walking generates endorphins which increase happiness and decrease pain.  In other words, walking is medication (insert gasp here)!

Whatever YOUR reason, just strap on a pair of shoes and get walking!  The Lake Washington Sports & Spine team will be rooting for you!

Pursuit of Pure Medicine

Here is a feature on MedPage today about practice's decision to stop taking Medicare.  Based on early comments, more and more clinicians are feeling similarly.

Join the crusade to practice Pure Medicine, and put the needs of patients first, rather than the needs of compliance officers!

Great resource on hip mobility and strength

One of out favorite physical therapists, Adam Shildmyer, recently shared a great link on tactics for improving motion during athletic performance, motion, and stability.

Ultrasound Case of the Day- Ganglion Cyst

Today's case focuses on a ganglion cyst of the wrist.

This is the class bump to the back of the wrist that can form as a "wear and tear" injury.  In the olden days, these were typically treated by smacking the cyst with a Bible.  Bible smacking still works (sometimes), but we can also use ultrasound to help treat the cyst in a less brutal manner

I chose to show this image both because:1. It can help show patients the techniques Dr. Hyman and I use for treating different conditions in a more accurate and less painful way

2. It highlights an advanced technical point for other clinicians learning to use ultrasound

The ganglion cyst is the large black area highlight by the yellow area.  It appears large and black because the sound waves from the ultrasound machine penetrate easily through water, so it does not reflect back signal (as does the underlying bone)

The blue and red arrows are pointing to the extensor tendon of the ring finger.  This is the tendon that would help straighten out the ring finger if the finger was bent.  You can see a series of white parallel fibers that are extending from left to right across the screen.   One of the great strengths of ultrasound is that it is a MUCH higher resolution than an MRI.  On an MRI, then tendon would like like a simple black line, but using the ultrasound we can see the individual collagen fibers at a much higher level of detail.

The green arrow points at the underlying joints in the wrist (called a carpal joint).  This is an advantage of looking at the cyst under ultrasound - in this particular case, we can see that the cyst is very clearly NOT in continuity with the joint.  This has significance in terms of risk of infection or other complications

For this specific patient, we drained the cyst using ultrasound guidance.  In the past, we used to perform this procedure the way most doctors still do, which is feel around and just stick a needle into it.  The reason we use ultrasound guidance is to make sure we are not inadvertently injuring other structures (e.g., the carpal joint or the extensor tendon).  I can also do a detailed refinement called a fenestration, where I create multiple small holes in the cyst, which helps prevent the cyst from reforming.

Finally, a technical point for aspiring ultrasonographers- you may notice that the tendon immediately below cyst (the red arrow) is brighter than the tendon that is not beneath the cyst (the blue arrows).  This is an artifact called "through transmission."   What happens here is that the computer processor used by the ultrasound machine works under the assumption that the tissue density is uniform throughout the width of the ultrasound beam.  However, because the sound waves passing through the cyst have very little resistance, the computer processor will make everything deep to the cyst appear more bright (called hyperechoic) than it actually is.

One of the quirks with ultrasound is that because it shows so much detail, it is prone to artifacts that, in the wrong hands, can be misread as pathology in the patient.  This is why Dr. Hyman spend so much time travelling across the country working with other physicians to learn more about the nuances of ultrasound

Congratulations, Tony!

As part of our business culture, Lake Washington Sports & Spine supports & encourages our staff members to chase their dreams and become the best versions of themselves. We're proud to announce that Tony, medical assistant extraordinaire, was accepted into the DPT program at UNLV!! We'll be sad to see him leave the LWSS team, but we are so happy he is on the path to achieving his career goals! Go Tonyyyyy!!

Nutrition: 9 easy ways to get your fruits and vegetables

March is (drum roll...) 

NATIONAL NUTRITION MONTH!  

We asked our go-to nutritionist, Chelsey Ocean, to offer some simple tweaks to help add more fruits and vegetables to our diets.  For more information about Chelsey & the services she offers, visit her at www.myfoodexpert.com

9 easy ways to get your fruits and vegetables

Chelsey Ocean, MS, RDN, CD, CSSD

We all know that fruits and vegetables are healthy for us and you may even know 5-7 servings of fruit is what you should aim for on a daily basis. But how can you pack all those healthy servings in one day? See below for some easy tips to get those fruits and vegetables in your diet.

Breakfast

• Add spinach, kale and/or celery to a fruit based smoothie. It may turn the smoothie green, but with the sweetness of the fruit you will never know where that green color is coming from!

• Make a parfait with 0% plain Greek yogurt, fruit, nuts, cinnamon, mix and serve
• A chicken sausage, egg white scramble with mushrooms, onions, and peppers makes a high veggie protein meal

Lunch

• Use romaine lettuce leaves to make deli meat sandwiches or wrap your turkey burger with in a lettuce blanket
• Take a cantaloupe, cut in half, remove seeds and serve inside a scoop of tuna mixed with salsa
• Add cooked or pureed cauliflower, peas or squash to mac and cheese

Dinner

• Use spaghetti squash instead of noodles and serve with turkey meatball, marinara or parmesan
• Make a salad with at least three colors of the rainbow: red, green and purple (tomato, romaine lettuce, and purple cabbage)
• Make a mixed berry blend of strawberries, raspberries and blueberries sprinkled with vanilla extract, cinnamon, cardamom and clove serve as a sweet after dinne

The Health Cost of Complexity: the concept of Time Debt

This link from the Harvard Business Review does an outstanding job explaining the concept of "Time Debt."

One of the most common problem I run into with patients is that they have too much on their plate, and this leads to health consequences.  When the body is in a perpetual time debt state, the sympathetic nervous system kicks in, which is something physicians call "sympathetic overload."

The sympathetic nervous system is designed to handle our "fight or flight" response.  This is an appropriate response to being chased by a Tiger, or dealing with the occasional busy work deadline.

However, we as human beings were NOT meant to be in a state of constant "fight or flight," and our body does not handle it well.  Persistent sympathetic flow can lead to agitation, weight gain, poorly healing injuries, heart attacks, and death.

There is a great scene in the movie Parenthood, where Steve Martin's character Gil is confronted with a list of things he needs to do.  His wife asks him if he has to do something, and Gil responds "my whole LIFE is have to."

That sense of HAVING to do things is what drives the sense of Time Debt stress.  What I advocate patients do, to prioritize their health, is to re-evaluate the "Have to" items in their life.

This can often lead to some challenging decisions- you may need to re-evaluate your entire life.   When I was in the my late 30s, I realized my life was filled with too many "Have tos" in my life, which led to my decision to leave Academic Medicine, move across the county, and start prioritizing my own health.

Simplifying your life is not easy to do.   However, just because it is challenging to embrace simplicity doesn't make the concept less important.  It makes embracing simplicity MORE important.