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00:00learning to live with chronic pain is more than gritting your teeth and
00:09burying it it's more than managing your painkillers it's about adapting to a
00:14life that's not what you planned it to be but planning a life nonetheless but
00:19how do you do that would a counselor be able to help and how could changing your
00:23mindset change the pain standby go healthy for good starts right now
00:53hello and welcome to go healthy for good chronic pain can result from an accident from surgery from
01:06aging or from a health issue as was the case for Antoinette here's her story I was diagnosed with
01:12lupus in 1997 I didn't start having issues with it until 2004 that's my first stroke that I had
01:20and then after that I had start having small strokes in between there and then basically after
01:30that I started having lupus flare-ups from 2000 no I want to say 2008 to 2009 where I was okay
01:37everything had kind of calmed down and in 2009 I had the first heart attack and so from there
01:47I had like three heart attacks all together between 2009 and 2011 and lupus flares at the same time and
01:57the chronic pain began around there I started having the chronic pain around 2010 maybe is when the pain
02:12really started and then I started gaining more weight which was a problem because I was on higher doses of
02:18prednisone which made it you know even worse and then being in Michigan which is where I'm originally from
02:25the winters were harder on my body so that made it even worse being out in the elements I have a daughter so getting her back and forth to school and to different programs and activities that made it
02:40even harder on my body as well so the chronic pain affected me by it kept me from spending time with my daughter the more that it the worse that it got the more I was not able to participate in her school activities and then just do a lot with her that I would normally do it kept me in the house a lot it kept me from going outside and from just doing my
03:10doing the things that I was normally doing I started out with like Tylenol 3 Tylenol 4 and then whatever they call Norco right now and then I was constantly in the hospital for pain and lupus flares back to back it was so bad that I decided to leave Michigan
03:33On today's show chef Mark Anthony has a dish you're never going to believe we'll improve our fitness and have fun with Sean there's more from Antoinette and we're diving deeper into the management of chronic pain but now it's time for the news
03:48in the headlines today don't dope and drive risks for prolonged opioids and endometriosis pain control drivers who use prescription opioids have a significantly increased risk of being involved in a motor vehicle accident and of causing them researchers from Columbia University reviewed fatality analysis
04:18reporting data from six states from 95 to 2015 almost 37,000 drivers had undergone toxicology screening within an hour of a fatal car crash results showed an increased risk of being involved in a fatal car crash when the driver had opiates in their system older drivers on opioids were more likely to cause an accident every year about 3000 drivers are killed in car crashes while taking opioids the evidence is clear
04:48If you do need opioids do not drive no matter how long you've been on them
04:55Addiction and mood disorder may set us up for opioid use disorders
05:00Researchers examined ongoing opioid use after surgery in over 36,000 opioid naive patients and in a group of non-surgical controls
05:08Whether the surgery was major or minor did not affect the rate of post-op opioid use suggesting other risk factors might be at play
05:16Participants with pre-existing mood disorders pre-op pain or addiction to anything including tobacco were more vulnerable to continued opioid use
05:27Other research suggests that for every five Americans without addictions who take opioids for pain one will become addicted
05:34So if you need painkillers start by using non-opioid options first especially if you have any of those risk factors
05:41A recent study has confirmed that combined oral contraceptives or COCs provide effective pain relief for endometriosis
05:51A recent review of nine randomized controlled trials and nine observational studies found that compared to placebo
05:57COCs give a three-fold reduction in menstrual pain and were also effective for chronic pelvic pain
06:04Researchers found both cyclic and continuous dosing schedules were equally effective for pain though the continuous dosing worked more quickly
06:13The hormones in COCs inhibit the growth of endometriosis, reduce nerve density and suppress new blood vessel growth
06:22They are affordable and offer a good adjunct to a plant-based diet in the management of endometriosis-related pain
06:29I'm Dr. Nerida McKibbin and that's today's health news
06:36Today's guest is Kathy Scott, a licensed clinical social worker who works as the behavioral health coach on the integrative pain program
06:45At Eskenazi Health in Indianapolis, Indiana
06:48And that's where we caught up with her
06:50In my own experience those suffering with chronic pain are reluctant to see a counselor because of the perception that the pain is not physical
06:58But all in their head
07:00I asked her how she deals with that perception
07:03We understand where that's coming from and often times people have come from more adversarial situations where they're not believed
07:13Oh, that's just in your head. You're just making it up
07:16And so one of the first things we do in our pain classes and then we reinforce individually is
07:23We believe you. You don't have to justify your pain. You don't have to justify your life to us
07:30We understand
07:32You wouldn't have been referred to us if there was not an issue around chronic pain
07:38But the beauty and the blessing of what we do is we have the time and the patience and the understanding to accompany something
07:52To accompany somebody on this journey
07:54And so my role while I'm a counselor
07:59I'm also a witness to someone's own journey
08:04How they're dealing with their pain
08:06And I'm that person that's available outside their family, outside their friends
08:12Who are invested in a totally different way with that patient
08:17To bounce ideas off of
08:19To say have you ever thought about this?
08:22And maybe we could discuss this aspect of your life
08:27As a lot of our folks have lost their dreams
08:30They've lost their vision
08:32They've lost goals
08:34Because they believe pain has consumed them
08:37And I'm that outside voice saying
08:40Wait a minute
08:41There's another way
08:42To look at your pain
08:44There's another way to live life
08:46That's fulfilling and meaningful
08:49And so
08:51Sure you can call that counseling
08:54But that is a turn off occasionally
08:57And better to say we're accompanying you on this journey
09:01And I have a very specific aspect of what I look at
09:06So what is that goal that you have for each client that you deal with?
09:12One of the goals that I have is to help them develop their own goals
09:16Because what I see would be most beneficial might have never entered their mind
09:23So many times folks are unable to work
09:29Or their work has helped create the pain condition they're in
09:35And so one of the things I can do is to say
09:39You don't necessarily have to apply for disability
09:42There's many different ways to lead your meaningful life
09:47There's many different occupations that may be open to you
09:51And I have resources to make that happen
09:55A lot of folks come to us already on disability
09:58But they have defined their lives as
10:04I'm a pain patient
10:06My role in that situation
10:08My goal is to help them reframe, redefine their life
10:13As I am Treva, I'm Sally, I'm Joseph
10:18And I have a painful aspect in my body that I must deal with
10:24But I'm Grandpa, I'm Mom, I'm this, I'm that
10:30I sing in my choir at church
10:33So many different aspects of their lives tend to
10:38Do not come to the fore
10:40Especially in a medical setting
10:42I'm here because of the pain in my hip
10:45Oh well, tell me about the pain in your wallet
10:48Tell me about the pain in your relationships
10:52Because pain invades every aspect of one's life
10:57And that can create depression, create anxiety
11:00And it can be a plethora of other co-occurring disorders
11:07Disorders that make it hard to break free
11:10More in the next segment, so stay with us
11:12Though on a lighter note before the break, there's this
11:15I'm afraid you've got diabetes
11:17Well, I guess that's normal
11:19Normal?
11:20Yeah, my mother had it, my grandmother had it
11:22So it's normal for my family
11:24It needn't be normal, you can break the cycle
11:26What do you mean?
11:27You can't change your genes
11:29I know that and I'm not even a doctor
11:32Ah, but your genes have on and off switches
11:35And you can turn them off
11:37Yeah, but my mother got her genes from her grandmother
11:40And they were switched on when she got them
11:42True
11:43So do you do as much exercise as your mother and your grandmother?
11:47Well, no, my grandmother worked hard because she didn't have conveniences
11:51But my mother didn't exercise
11:53And for me, that sounds too much like hard work
11:56I'm not going to do it and I don't do it
11:58Well, that's one gene switch on
12:00How about food?
12:02Does your mom cook like your grandma?
12:04Oh yeah, she cooks this beautiful apple pie
12:06She takes white pastry and puts a sugary filling in
12:10Whipped cream on top
12:12Hey, would you like the recipe?
12:14Not if it comes with diabetes
12:16What do you mean?
12:17You haven't just got your parents' genes
12:19You've also adopted their lifestyle
12:21And it's the lifestyle that turns these bad genes on
12:25Oh, so I can continue to blame my parents and my grandparents for my bad health?
12:30Not exactly
12:31Genes load the gun, but lifestyle pulls the trigger
12:35So take your finger off the trigger
12:37Doctor's orders
12:46Roll up those sleeves
12:47Because we're in the kitchen
12:48And it's time to cook with Chef Marc Anthony
12:50It's such an honor and a privilege to have him in our kitchen
12:53What are we doing today?
12:55Today we're going to be doing some smashing
12:57Some smashing
12:58Chickpea
12:59Chickpea salad
13:00Smashing
13:01And I came up with the name Smashing
13:03Because I wanted something that was not completely blended
13:05And you'll see by the texture that it has that smashing type of effect
13:10Even though we're using a food processor
13:12Alright, well my mom would be proud
13:13She says I break everything
13:14So yep, I can break these chickpeas for you
13:16Perfect
13:17Yep
13:18Okay, here's our ingredient list right here
13:20For our Smashing Chickpea Avocado Salad
13:22It's got one 15-ounce can of chickpeas
13:25One avocado
13:27Couple stalks of celery
13:29Two scallions
13:30One cup of parsley
13:32I've got a tablespoon of nutritional yeast flakes
13:35And then I've got the juice of a lemon
13:37And with a little bit of salt
13:39So it's a really easy ingredient
13:41Okay
13:42And everything just goes right in the food processor
13:44Alright, shall I start loading that?
13:45So let me get the avocado going here
13:48And I like the way you do that, right?
13:52Yes
13:53Except I had a friend smash it into her hand somehow
13:56Oh no
13:57You've seen a lot of these people
13:58They might go like this
14:00Yes
14:01I'm always scared to do that
14:02Because you know
14:03The knife is kind of pointed right down at your
14:05Yeah
14:06At my house I have one of those scoops
14:08And it just goes right through
14:09All the salt?
14:11Yeah, start with half
14:13Half?
14:14Yeah, I'm not sure
14:15That looks like a lot to me right here
14:16Yeah
14:17And even the parsley
14:19You know, you can just put in however much you want
14:21Right
14:22It's one of those recipes you really can't go wrong with
14:24But parsley is such
14:26So rich in antioxidants
14:27It also acts as a diuretic
14:28So you've got a bit of blood pressure
14:30Or you want to get rid of a bit of extra fluid
14:33Have some extra parsley, you know
14:34It's really good little medicine
14:36Let food be thy medicine
14:38Yes
14:39There's our avocado
14:41And what else do we need?
14:46Some lemon juice
14:47I love your little lemon squeezer here
14:50I have never seen one like this before
14:52Really?
14:53It's got the lemon and the lime all in one piece
14:55Yes
14:56Save space in your cupboard, right?
14:58So like this?
14:59Yes
15:00I do it right, don't I?
15:01Yeah, you do, yeah
15:02Upside down
15:03Someone had to teach me too
15:04Yeah, that's the way I do it
15:05Okay
15:06I've seen people do it the other way
15:07But it doesn't get the juice out of it
15:09No it doesn't
15:10If you have that turned around that way
15:11Yeah
15:12So that gets it all
15:13Okay
15:14I tell you it smells so good with that lemon
15:16That is everything
15:17Alright, so time for me to go smashing?
15:19All we're going to do is pulse it
15:21So we're just going to give it pulse pulse pulse
15:23Alright, you tell me
15:24Keep going, you're going to give a
15:27In fact we're going to give it a little
15:30Do I need to wipe it down?
15:32Yeah, exactly
15:33Okay
15:34I'm pretty good at doing that
15:36Um, just by habit
15:37Yep
15:38Yep
15:39About double what you just did
15:40Alright
15:41And you'll be there
15:42I'm going to get some tomatoes going here
15:45There you go, that's it
15:48That's it?
15:49Yeah
15:50Ah, I had a smashing time
15:51Smashing
15:52And there you go
15:53That one can go right in the bowl there
15:55Oh, it's smashing, it's not smashing
15:57In fact if you want to grab me one of those buns over there too
16:00That'd be great
16:01Alright
16:02I've got a whole bunch of things going on here
16:06So you're going to show us how to actually use this
16:09Yeah, there's a number of things
16:10We don't have to eat it just like this
16:12No
16:13You know what, I'd want to put this with pasta
16:14Have you ever done that?
16:15Um
16:16No?
16:17No, not like a cold pasta?
16:18Yeah, well, yeah like pasta salad
16:21No?
16:22I have all these secret recipes
16:24But then I give them to you
16:25And then it's no longer a secret
16:26They're no longer a secret
16:27And then you have to rush off and create another secret, right?
16:29We like that
16:30Keep doing it
16:31I tell people
16:32I say share these recipes with other people
16:33Yeah
16:34You know as you share
16:35Back it comes
16:36It just reinforces it
16:37And that's really helpful
16:38So I'm getting in your way
16:39You can see how much texture this has
16:41It has body to it
16:43So it's not creamed into a mush
16:45It still has body to it
16:47And that's what I'm looking for
16:49And the nice part about this is
16:51You're basically making a recipe without all the fat from the mayonnaise
16:56All these people blasted with mayonnaise
16:58Wow
16:59And I wanted something where I've got a good fat in there
17:01Yeah
17:02So just like that
17:03Boom
17:04You've got a gorgeous
17:05That's beautiful
17:06Chickpea salad
17:07That's healthy
17:09And tastes fantastic
17:11You're right
17:12Fantastic
17:13Thanks Mark
17:14Such a masterful chef
17:17And if you want to catch that recipe
17:18Go to the website
17:19HopeTV.org
17:21GoHealthy
17:22Where you'll find all our recipes
17:25Today's story is about Antoinette
17:27She was diagnosed with lupus when she was a young mom
17:30And she had some very serious sequelae to her lupus
17:33Watch
17:34At one point I had a stroke and a heart attack in the same week
17:38And that stroke left me
17:42It took out my short term memory
17:45And my speech
17:48I had to go to speech therapy to help my speech
17:52And it was a horrible experience
17:57As far as communicating with people
18:00I became introverted
18:02And that's the way I was when I came into the integrative pain program
18:06Very introverted and insecure
18:10Because of the things that I used to do
18:13And I wasn't able to do
18:14So once I became a patient in the integrative pain program
18:19They introduced me to diet
18:23A different diet
18:25Nutritional change
18:31Definitely exercise
18:34A way to exercise
18:36So that I wouldn't over-exert myself
18:41Even I started out with chair exercising
18:44And then I advanced to standing up and exercising
18:49I was also taught breathing exercising
18:53Because I had a problem with sleeping at night
18:57I would always stay
18:58I had bad sleeping habits
19:01Because of the medication
19:03And different things that happen with lupus
19:06Having an issue with anxiety
19:09Because of the strokes
19:11And it was really intense
19:17Now it's more calm
19:19It's not as bad as it was
19:21I will have some issues with it
19:24But even when it arises or it appears
19:28Sometimes I have breathing exercises to look forward to
19:32Or, you know what I mean?
19:33I just, I breathe my way through it
19:35And I calm down
19:37I know to relax my body
19:39Close my eyes
19:41Think of a different place
19:43And I do that sometimes with pain
19:45Sometimes I don't always go to the medication
19:49Or relax
19:51Think of something else
19:53Or start doing something else
19:55Unless it's extreme pain
19:57After going through the courses
20:00Yeah, the courses of nutrition
20:03And exercise
20:04And relaxation
20:06I just continued to do that
20:08After I finished the classes
20:10And it motivated me to want to exercise
20:16I started doing hip-hop step aerobics
20:20I wasn't able to use the step part of it
20:23But I did it from the floor
20:24And I continued to do that
20:27And I kept working out
20:28And working out
20:29And when I couldn't go outside
20:30In the wintertime
20:31And actually do it
20:32I started doing the videos
20:34From YouTube
20:35And doing it from home
20:36And I bought the ball to exercise
20:38I would always ask them
20:40When I go into
20:41For my monthly appointments
20:43What else can I buy from home
20:45To buy at home
20:46That you have here
20:47That I could use at home
20:49And work out with
20:50Her spirit of inquiry and teachability
20:53Gave her a huge advantage
20:55We're talking today
20:56With the behavioural health counsellor
20:58Who coached Antoinette
20:59Along her journey
21:00Kathy Scott
21:01I asked her about the consequences
21:03Of being labelled
21:04A chronic pain patient
21:06Is that life suddenly narrows down
21:10To my doctor appointments
21:12My physical therapy appointments
21:14I have to go to the pharmacy
21:16I have to call in
21:17To get a pre-authorization
21:18For this and that
21:19So I can get my medication
21:21And so the career
21:23We have career patients coming to us
21:27And as I explained
21:31It's widening that world again
21:36It's helping them break out
21:38Of very narrow concepts
21:42Of themselves
21:44So that's incredibly important
21:47To move forward
21:48Because we say in the very beginning
21:50We will never call you a pain patient
21:53Never
21:54Never
21:55Because you are much more
21:57Than your chronic pain
21:59When you see a new patient
22:03What's relevant in terms of
22:05Their sort of biological assessment
22:07If we think of the
22:08Biopsychosocial
22:09Spiritual
22:10Pain
22:11Picture
22:12I rely on
22:14The providers
22:16To give me a sense of
22:19How severe is the
22:21Degenerative disease
22:22You know
22:23There are her failed back surgeries
22:26So I can appreciate that history
22:30It really is determined
22:33By how the patient appreciates that history
22:36You know
22:37Well I've had a couple of failed back surgeries
22:39But that's not going to stop me
22:41You know
22:42And you see this dogged determination
22:46And I often see it in my elderly women
22:49Who are
22:50I can get over that
22:52You know
22:53Sometimes I see
22:56The reverse in some of my younger folks
22:59Who say
23:00I had this car accident
23:03Ten years ago
23:04And I've just never gotten over it
23:07They relate it all to their pain
23:10The physical manifestations
23:14But it's actually such a jar to their psychological well-being
23:19So this is where the psychological aspect comes in
23:22Yeah
23:23And looking at prior history
23:26Was there any abuse as a child?
23:29Any neglect as a child?
23:31Did you feel loved?
23:32You know
23:33We incorporate very early memories
23:36Those are woven into the fabric of our being
23:39And will help determine how we perceive pain
23:44And how we manage pain
23:46So that's incredibly important
23:48I ask about educational levels
23:51Because if someone has only made it to the third grade
23:55Or if someone has a graduate degree
23:59Sometimes their understanding is a little bit different
24:03And so I need to be flexible in the language I use
24:09And in my approach
24:12So all of the past is important
24:15Because it weaves into how we cope right now
24:20And I tell folks up front
24:25If you come into this program with the mindset
24:29I want to be like I was 20 years ago
24:32I want to be like I was before the accident
24:35The injury
24:36Whatever the precipitating factor was
24:39I want to say
24:40You need to work on that
24:42Because we all want to be like we were 20 years ago
24:45That's true
24:46That is not reality
24:47Right
24:48And I say I'm not asking you to have a queen of denial reality
24:55That says there's nothing wrong with me
24:57La la la
24:58I can get on with life
24:59I want that reality that says I can do it
25:02I can cope
25:03I can manage today
25:05And we reinforce that in the pain classes
25:09I said look at all of you
25:11You made a decision to roll out of bed this morning
25:15To get dressed
25:17To take care of whatever business you had to
25:19And to arrange transportation
25:22To come into a 90 minute pain class
25:25That's the attitude I can work with
25:28You know
25:29The incredibly negative attitude
25:32I can't do this
25:33This won't work
25:34I can't manage my life
25:36That will then become your reality
25:39So you have patients coming into the program
25:41With that kind of attitude
25:43I can't
25:44I won't
25:45I
25:46Probably 80%
25:47Wow
25:48Yeah
25:49And how many leave the program at the end of five weeks
25:51With that same attitude?
25:52How many hang on to it?
25:54If 80% come in with it
25:56Probably 50% come into the initial assessment after the pain class is going
26:03Okay
26:04Now what?
26:06And they have that modicum of openness
26:11Because the providers are all in the class
26:15We make the investment to be with them
26:19To exercise with them
26:21To do the relaxation with them
26:23To do the plant-based eating with them
26:26All of our team are plant-based eaters
26:31And so we kind of model that
26:35And so we start that relationship building
26:38And our providers will sit like this
26:45In an initial session and say
26:48Tell me your story
26:50What really brought you to this point?
26:55Well you don't get that in a 15 minute primary care setting
26:58No
26:59That's
27:00No you can't
27:01The system does not allow that
27:02No it doesn't
27:03That's right
27:04That's the beginning of healing
27:08So they see that initially in the pain class of
27:11My doctor is teaching me Tai Chi
27:14My nurse practitioner is doing the exercises
27:17My counselors doing the meditation and the relaxation
27:22There must be some value to this other than
27:25You know just a bunch of talking heads
27:28So we start that engagement early on
27:33And it's a tough pull for folks to get over the mindset of
27:39I can't
27:41I won't
27:42And speaking of meditation
27:45Consider this
27:46Ephesians 4.26 says
27:50When you're angry do not sin and don't go to bed angry
27:54The limbic system in the brain is where emotions are processed
27:58If we don't deal with our emotions consciously before going to sleep
28:02Then the limbic system will do that while we're asleep
28:07It does that emotional clearing while we're having dream sleep
28:12It's probably not the best way to generate great dreams
28:15If we've had a lot of emotional turmoil during the day
28:18It's far better to pray before going to sleep
28:21Talk to God about the emotional hurts and the emotional distress
28:25That you may have had during the day
28:27And turn it over to Him
28:29Then think about all the good things that have happened
28:31And thank Him for those things
28:33It's a great way to clear our emotions
28:37And ensure that our dreams are sweet
28:39While we're in prayer we should release our worries to Him
28:42Because He longs for us to rest in Him
28:45To place ourselves in His hands
28:48So that He can take care of us
28:50And give us sweet dreams
29:00You'll notice we always stretch before and after exercises
29:03And that's because flexibility is an essential part of fitness
29:07So if you can't touch your toes
29:09You need to join us right now
29:10And if you can, join us anyway
29:12So Sean, what's our limbering activity today?
29:14Our limbering activity today
29:16Will be a cardio workout, okay?
29:19Now the goal really is for us to really elevate our heart rate
29:22To be able to recover as much as possible
29:24But push ourselves as hard as we can, alright?
29:26So in order for us to get started
29:28Let's start with some bringing up your knees one at a time
29:31Because we have an exercise where we're doing some marches
29:34Or some high knees
29:36And I'm gonna challenge you to really push yourself outside of your comfort zone today
29:41So this warm up is really to get you geared for your workout, okay?
29:45Alright
29:46So do that for about 30 seconds
29:47Taking your time and breathing
29:49Inhaling through your nose
29:50Exhaling through your mouth
29:51And preparing your mind and your body
29:53For what you're about to go through, okay?
29:55Alright
29:56I'm not trying to scare you
29:57No, I was just gonna say
29:58It sounds like I should probably run in the other direction
30:00It did, it did
30:01There you go
30:02Three exercises
30:03And I want you to do them for 30 seconds each, alright?
30:05After you've done the 30 seconds each
30:06You're gonna rest for 30 seconds
30:08After the 30 seconds of rest
30:10You go right back into it again
30:12Repeat this for about four times
30:14It is challenging
30:15The heart rate will be elevated
30:17But the most important part is
30:18You tried your best
30:19Your heart rate is elevated
30:21And you're burning some calories
30:22Right, because building that vigorous activity in is really important
30:25Absolutely
30:26So let's start with the mountain climbers
30:27Alright, hands down
30:28Core nice and tight
30:29And in order for us to do this right
30:31We're not gonna necessarily go really fast today
30:34But you're gonna see the core nice and tight
30:36You're in that elevated position
30:38And driving the knee toward the elbow
30:40The goal here is for you to be on your toes
30:43Get in a real athletic shape
30:45As if you're about to take off on the track
30:47Three, two, and one
30:49Slow it down
30:50And hold that plank position at the end
30:52This position right here is our starting position
30:55And our ending position
30:56It's a mountain climber
30:58But at the same time it is core-centric, okay?
31:00Right
31:01So hold on
31:02I'm not trying to torture you
31:03I want you to go again
31:04Three, two, one
31:05Go for it again
31:06One, two, three, four, five, six, seven, eight, nine, and ten
31:11Alright, thirty seconds
31:12Stand up tall
31:13Alright
31:14So that is your mountain climber
31:15But always remember that each exercise that we do
31:18Has some involvement of our core, okay?
31:21Right
31:22Number two will be our high knees
31:23Or our marching high knees, okay?
31:25Where you're picking up the knees as much as possible
31:27We did this in our warm up
31:29To get ourselves, you know, moving and going, alright?
31:32Right, yeah
31:33This is a high knee march
31:34But you can also do very dynamic
31:36Where you're on the tip of your toes
31:37And you're going up as high as possible
31:39Thirty seconds
31:40You're pushing it
31:41Heart rate is elevated
31:42And you're going to want to, you know
31:44Yeah, you're looking forward to that
31:45Thirty-second break, right?
31:46Yeah, when that timer goes off
31:47You're like, oh, I really worked it, okay?
31:49So this is your march
31:50Thirty seconds
31:51Give it your all
31:52Shake it off
31:53Shake it off
31:54And this one is called a skater
31:56The skater allows you to go from one side to the next, okay?
32:00As if you were jumping over like an object
32:03But I want you to pause, alright?
32:06Bend the knee a little bit
32:07Yup, there you go
32:08So this is called your skater hop, alright?
32:11What you're intentionally doing is jumping over an object
32:14Working on your balance, alright?
32:16And really feeling like an athlete every single time you perform this exercise
32:20So in combination, right?
32:22You have your mountain climber working the core
32:24You have your high knee march
32:26And then you have your skaters, alright?
32:27Different directions
32:28Heart rate is elevated
32:30And at the end of that 90 seconds in total
32:32You will feel like you have worked it
32:34Right, and this bouncing on your feet
32:38Is really good for your bones as well, isn't it?
32:40Yes, it is
32:41Strengthening your bones
32:42So remember, in that time that you're done
32:44The recovery is very important, alright?
32:46So taking that deep breath inside of our nose
32:48And blowing it out
32:50Is pivotal for you to recover
32:51And for you to give your all
32:53When you do the second, third, and fourth round, okay?
32:56Yeah, right
32:57Four rounds, work it
32:59Quick workout
33:00But you can maximize your time if you do your best, okay?
33:02Right, yes
33:03So you don't have to
33:04It doesn't have to take a whole lot of time
33:06That's true
33:07So that same exercise now that you're done
33:08That we did for the warm up
33:09We're gonna do that same exercise
33:11But we're now gonna hold it, okay?
33:13What we're doing here is
33:14It's a static hold
33:16Working on your balance
33:17Breathe
33:18In three, two, one
33:20Hands down
33:21And in the other side as well, okay?
33:23Three, two, one
33:25Feet nice and wide
33:26Take a nice deep breath
33:28Inhale through your nose
33:29Exhale through your mouth
33:30And I want you to just reach all the way down to the floor
33:33Getting a good stretch
33:34Of your hamstrings
33:35Because those might be tight
33:37Three, two, one
33:39Come up nice and slow
33:40One vertebrae at a time
33:42Roll your shoulders back
33:43And you are done
33:44Wow, thanks Shawn
33:45It feels good
33:46You are very welcome
33:47Raisins and dried apples are delicious additions to any breakfast cereal
33:54Not only do they add a sweet crunch
33:56They may also reduce your risk of pancreatic cancer
33:59According to the Adventist Health Study
34:01Individuals who ate dried fruits frequently had one-fifth the risk of pancreatic cancer
34:06Than those who rarely ate them at all
34:08Why not sprinkle some dried blueberries on your dinner zone?
34:11Or snack on dried apricots to satisfy that sweet tooth
34:15Enjoying dried fruits often is another ageless advantage
34:20It's question time
34:22And here's our first question
34:24Someone called in
34:25What is the recommended intake of vitamin K2 for osteoporosis?
34:30Well, everyone knows we need calcium and vitamin D for strong bones
34:34But you know for bone health we also need magnesium, vitamin K, potassium
34:40So a number of these other things
34:42And that's not all
34:43But in one Japanese study you're asking about vitamin K2
34:46So in one Japanese study they actually tested multiple doses of vitamin K2
34:51And found that 45 milligrams is sort of the minimum effective dose for improving bone mass
34:57So don't go below 45
34:59You can take a little more
35:00There is some leeway there
35:01But at least that much
35:03Just remember that if you take warfarin or Coumadin
35:05You should not take vitamin K
35:08Because they actually oppose each other
35:10Here's our next question
35:12Do you recommend a low FODMAP diet?
35:15Well, let me explain FODMAP diet
35:17Some people have a clear benefit with digestive symptoms on a low FODMAP diet
35:24And for them I would say yes
35:26It's something that they could try at least temporarily
35:29Now what FODMAP stands for is fermentable oligo, dye and monosaccharides
35:35Which are sugars
35:36And polyols
35:37So basically those are carbohydrates that some people are unable to digest
35:43Not everybody
35:44But the symptoms that they get are often labeled irritable bowel syndrome
35:49So symptoms like gas, bloating, pain, diarrhea and constipation
35:54And constipation
35:55You can go between the two or just have one or the other
35:58So now those carbohydrates I mentioned would include fructose
36:03Which is the sugars in fruit and vegetables
36:06Lactose, which is the sugar in milk
36:08Fructans, which come from the grains
36:11Like wheat and barley
36:14So some of the other grains don't have so much
36:17And then galactans, which we get from legumes
36:20And then the polyols, sort of the alcohols
36:24But things like their sweetness
36:26Xylitol, sorbitol, mannitol
36:29So if you notice that those are ingredients in your whatever it is you're eating
36:34And you get gas afterwards
36:35You're obviously someone who can't digest those kinds of things
36:40So it doesn't have to be all across the board
36:42You can experiment and see which FODMAPs actually are your triggers
36:47Now some of these are not supposed to be digested
36:50Nobody digests them
36:51But the gut bacteria actually break them down
36:54And use them for fuel
36:55The problem is friendly bacteria use them and create methane as a byproduct
37:01But the unfriendlies create hydrogen as the byproduct
37:04And that's what creates the symptoms
37:06You know, and FODMAPs too also draw water into the gut
37:10And so that extra water can be the trigger for the diarrhea
37:14So different ways that that happens
37:17Now a low FODMAP diet leaves out many healthy food groups
37:21So you need to pick your way around the offenders
37:24Don't just eliminate them all
37:26Have a selection of healthy foods that you still continue to eat
37:31Maybe best just to do an elimination diet
37:34Figure out which vegetables don't cause symptoms
37:36Which grains are suitable
37:38And hopefully not all the legumes will cause upset
37:41Because if you're vegetarian you really need to be having legumes everyday
37:45Here's our next question
37:47Mary asks, is it healthy to use soy lecithin granules?
37:50Well this was all the craze a little while ago
37:52Soy lecithin is a food additive
37:55And it's used, it'll sneak into many of your foods
37:58There's an emulsifier, a lubricant, antioxidant and flavour protector
38:01So it's often at the bottom of the long list of ingredients
38:04There's no evidence that it does any harm
38:07Though there's been many people that say it does
38:10There's no evidence that it does in the science
38:12It's found as I say in many foods
38:15A couple of studies have shown that it can reduce LDL cholesterol
38:19Without taking down your good cholesterol, the HDL
38:22And so some people have used it for that
38:25Just bear in mind a chemical solvent is used to extract the lecithin from the soy
38:30And also a lot of soy is genetically modified
38:33So you might want to avoid the genetically modified sources
38:37Now if you want to send in your question
38:39Just leave it on our phone, by text, website or Facebook
38:45And some of those I'll be able to just answer your questions directly back to you
38:50And now let's head down to the store and see what's down there today
38:54Modern beetroots are derived from wild sea beets
38:59That originated around the coasts of Europe, Middle East and Africa
39:04They're available all year round so it's easy to find them fresh
39:08Choose fresh, bright, firm textured roots
39:12The top greens should be used while they're fresh
39:15Chop them finely and steam them on their own or with your favourite greens
39:20The root can be kept in the fridge for weeks
39:23They're a wonderful source of iron and nitrate
39:26They boost the immune system and guard against cancer
39:29Beets can be grated and eaten raw
39:32Or you can boil, steam, roast or sauté them
39:35Raw they're great for juicing and recent research shows that the juice can bring down high blood pressure
39:41Bon appetit
39:43I've noticed that those with chronic pain have often developed high expectations
39:48Of what their health care providers can do for them
39:51On the other hand the integrative pain program at Eskenazi Health
39:55Has expectations of what patients will do for themselves
39:59I asked Kathy Scott, behavioral health counsellor on the program
40:02How she helps people make that huge transition
40:06Well we understand that they're having a big learning curve
40:12And they have that mountain to climb
40:14That's our mountain to climb with them on that
40:17To say we're not really empowering them
40:21We're helping them uncover their own power inside
40:25And we do that with engagement and we are very honest
40:29We're very honest in each pain class
40:33Very honest in the very first time we meet with folks
40:37We cannot cure your pain
40:40Now Dr. Mackay, who is our medical director, is a brilliant internist
40:45And has uncovered things in rush sessions that with primary care they might have missed
40:56That being the case, that's not usually what happens
41:02We have our patients who have dealt with this for 30, 40 years
41:08And are at the end of the line
41:11So that learning curve for them is what, you know you're not going to cure me
41:19You can't take my pain away 100%
41:23No we can't
41:25But by golly, we can help you re-engage with life
41:29And we have seen the success enough to keep us doing this
41:34And we have tools and education that we can provide you
41:39That you can take as a cafeteria
41:42I'll take a little of this, I'll take a little of that
41:44That what fits into your life can be life changing
41:48So tell us about cognitive behavioral therapy for chronic pain
41:53In CBT, I use it a lot with depression, anxiety, stress management
42:02And just looking at how do you perceive your pain
42:06Is it overwhelming?
42:08What are the words you use?
42:10You know, does it consume your life?
42:13And then we start with deconstructing that
42:18And it's like we have patients who are Humpty Dumpty
42:23And they are in hundreds of pieces
42:28And we help start building those pieces back
42:33But you have to deconstruct a lot of thinking that
42:38I'll always have this
42:40I'll be a pain patient forever
42:43I can't do anything
42:45I can't exercise
42:47I can't go back to work
42:49I'm worthless
42:51Nobody cares really about me anymore
42:55Because all I am are a set of problems to them
42:59So we have to do, I have to do a lot of
43:03Working with that deconstructing that model
43:07And saying there's another way to live
43:10And that takes time
43:12And to do that we build relationship first
43:15You have to be able to trust someone
43:17Who's going to give you a whole other pathway to look at
43:22Now you do this work over five weeks
43:24Or is it more extended?
43:26Does it go through months?
43:27It starts five weeks, twice a week
43:29Right
43:31But it is very much extended
43:34And we preach the same thing in pain class
43:40We preach it on an individual
43:42And I get to work with folks
43:44Not only with relaxation
43:46But with a lot of cognitive therapy
43:48Now we talked about opiates in the previous session
43:54How many of your patients will come in with addiction
43:59And how do you deal with that side of things?
44:03Probably 70% of our patients have relied on opiates as their main way to sleep
44:13Main way for energy
44:16Main way obviously for pain management
44:20But then that's not really managing their pain
44:23Because they're dissatisfied
44:25They still have pain
44:26And so that is a big learning curve for them to say
44:31I can manage my pain without opiates
44:36I can wake up
44:38And my thinking becomes a lot clearer
44:42But this has
44:44The proof is in the pudding
44:46And we have to first engage them in that
44:49And our providers decrease their opioids
44:54And get them off
44:56Or at least to a very minimal level
44:59But as they're decreasing
45:01I mean helping them increase their skills
45:04In managing that
45:06If things are just out of control
45:09I just want my pain pills
45:11You had just better give me my pain pills
45:14We will have that conversation
45:18To say maybe a referral to addictions
45:22Would be the best point
45:24We're happy to work with you on alternative ways
45:27To manage your pain
45:28But you need to be in
45:30With mental health addictions treatment
45:33As we're not going to be running addictions groups
45:37And I'd say a small percentage of folks
45:42They bite that
45:44And they say okay I'll do addictions
45:46Can I still see you?
45:48Absolutely
45:49So we'll work concurrently with the addictions folks
45:53And how many people who are addicted
45:57Actually realize that they are dependent on opiates
46:00Or are people sort of blissfully unaware of that often
46:03Because they're so focused on their pain?
46:05I wouldn't say they're blissfully unaware
46:07They are unaware
46:09But they come in because their providers
46:12Will not provide opioids
46:14And I have to come here
46:16My doctor won't give me any pills
46:18You guys are going to give me the pills
46:20So that is often the first thing
46:25That comes out of folks thinking
46:28Coming right up we'll hear the rest of Antoinette's story
46:31Don't miss it
46:38For the last 30 years
46:40Antoinette has had lupus
46:41Resulting in multiple strokes
46:43Heart attacks
46:44And chronic pain
46:45That made her introverted
46:47Insecure
46:48And anxious
46:49Steroids made her gain weight
46:51The oxygen kept her at home
46:53And pain made her sedentary
46:55Life was sad
46:57Then she became a patient
46:59In the integrative pain program
47:01At Eskenazi Health
47:02She learned how to deal with anxiety and pain
47:05She learned about nutrition, sleep
47:07And how to love herself again
47:09She started to move
47:11And now she loves doing aerobics classes
47:14Watch
47:15I was originally at 276 pounds
47:19By the time I got into the integrative pain program
47:23I believe I was at like 252 or 256
47:28When I came into the program
47:30I now weigh 135
47:33I am no longer on oxygen
47:35I thank God for that
47:36And I don't use my cane
47:40I love my weight loss
47:43I have to buy new clothes
47:44But it's awesome
47:46I feel a whole lot better
47:48My breathing has improved
47:50The pain has definitely improved
47:53In my back
47:54I really had back pain
47:56I had a lot of sciatic nerve pain
47:59And a lot of that has basically gone away
48:02I don't have that as much as I used to
48:06So life for me has changed
48:09I was just telling him on the way in here
48:11That I've begun to travel again
48:14At first I wasn't traveling
48:16I wasn't doing a whole lot of things
48:18That I was used to doing
48:20Because it's hard to travel with oxygen
48:23I tried it once
48:24And it's horrible
48:26To travel with oxygen
48:28And get all that kind of stuff set up
48:30And it was just a lot on me
48:33It was actually depressing being that size
48:37And that sadness
48:41It's not there anymore
48:43I'm just happy
48:45For the change
48:47I'm happy to be me
48:48I would encourage a person
48:50That's in the program
48:52To not give up
48:53Because I can see where you can get in the program
48:57And you can see this is not for me
49:00Yes it is
49:01Never give up on something
49:03That's going to give you a positive ending
49:09You know it may look bad
49:13Or look like it's too much for you to do
49:16For you to complete
49:17Or sometimes even comprehend
49:20But it's not
49:22They're not picking on you
49:24They're not taking things
49:26Because some of them
49:28When I was in the class
49:30Thought of it as a way of punishment
49:32It's not a punishment
49:34It's to help you
49:35It's to motivate you
49:37It's to help you love yourself
49:39And see that this is going to make you
49:42A healthier you
49:43A better you
49:45A more positive you
49:48So that's the way I would see it
49:51Love yourself
49:53And in the end
49:54You'll love
49:56You'll love
49:57Do this program
49:58And in the end
49:59You'll appreciate it
50:00And love yourself for it
50:02That's my take on it
50:05And we're talking today
50:07With one of the team
50:08That helped Antoinette
50:09Love herself again
50:10Kathy Scott
50:11Is a behavioralist
50:12On the integrative pain program
50:14Before the break
50:15We were discussing the problem
50:16Of using opiates long term
50:18Believing that you cannot do life
50:20Without them
50:21And demanding that you get
50:22Your next prescription now
50:24I asked Kathy how the team
50:26Have that difficult conversation
50:28Of weaning people off
50:30Dr. McKay certainly explains
50:33You know
50:34Pain medicine for acute pain
50:37Is definitely indicated
50:39You know
50:40You come in after surgery
50:41You need those opioids
50:43For a short time
50:45To get through that acute pain
50:48But with chronic pain
50:50Sometimes those opioids
50:52Will be causing part of your pain
50:54And that is a very difficult thing
50:58To get through
50:59So we all are on the same page
51:01On that
51:02Your food choices
51:05So hearing it
51:06Right
51:07So hearing it from different members
51:08Of the team
51:09That helps
51:10Is reinforcing
51:11And it
51:12And
51:13With folks who have
51:14Possibly have personality disorders
51:15Who try and split
51:17Can I get it from this person
51:19Instead of that person
51:20We're all singing the same song
51:22And
51:23You were mentioning the food choices
51:26Well we talked then about inflammation
51:29And some of the food choices
51:31That you make
51:32Are going to create more inflammation
51:34Which is going to create more pain
51:36Your depression
51:37Is impacting your pain
51:39Now what came first
51:40The pain or the depression
51:41In the end
51:43Both
51:44It's a house of cards
51:45So if
51:46You're complaining about your pain
51:49But you also say yes
51:50I have a lot of depression
51:52Let's impact that depression
51:54Let's reduce the depression
51:56Reduce the anxiety
51:57That will reduce your pain
51:59There are many ways
52:02Many factors involved with pain
52:05And many interventions that we can do
52:07That will help you lower your pain
52:09And you can rely on your own skills
52:12At that point
52:14So if those that come in
52:16Demanding
52:17Their opiate prescription be filled
52:19At the end of five weeks
52:21Are they
52:22Is their thinking completely changed
52:24About
52:25Their relationship with opiates
52:27Are they much more open
52:29To all the other options
52:31Or
52:32Surprisingly
52:33And
52:34They are
52:35Now they may still
52:36Ask for them
52:37The first thing out of their mouth
52:38Is
52:39Can I have my pain pills
52:40But with the
52:42Twice a week
52:43For five weeks
52:44With
52:45The chorus we sing
52:47And
52:48The different avenues
52:49That they've experienced
52:50Oh I can move my arm
52:52And
52:53I don't have that pain
52:55Or
52:56I've gotten stronger
52:57Or
52:58I'm doing some chair yoga
53:00Or some tai chi
53:01I'm practicing the relaxation
53:03I'm practicing the mindfulness
53:05I feel a bit better
53:07I've changed my eating a little bit
53:09So
53:11They start to see success
53:13And
53:15That makes a big difference
53:17So when they get to us
53:18For the initial assessment
53:19Then
53:20Oh
53:21So you've already changed this
53:22You've already changed that
53:24Excellent
53:25Let's move you a little bit forward
53:28And
53:29We'll
53:30Hear them say
53:32I feel a little bit better
53:34And
53:35That's just
53:36You know
53:37Cannons go off
53:38And
53:39The
53:40Stars
53:41Appear
53:42Because
53:43That is a victory
53:44What about spirituality?
53:46Because
53:47This model is
53:48Biopsychosocial
53:49Spiritual
53:50So what aspect of spirituality
53:52Is helpful for
53:53People with chronic pain?
53:55Well
53:56And that's sort of
53:57Another one of my professions
53:59Yes
54:00Ordained in the Episcopal Church
54:02I don't tell folks that
54:04Right off
54:05But what we have are folks
54:08When I'm talking with them
54:10As part of my assessment
54:13Do you have a faith community?
54:15I have Muslims
54:17I have a lot of different
54:20Protestant denominations
54:21Catholic
54:22And
54:23Haven't met any other Episcopalians
54:25But
54:26I have a wide variety
54:28And then I have agnostics and atheists
54:31But what I've found
54:33If you are grounded
54:35In a faith community
54:37That gets you through a lot
54:40Gets you through a lot
54:42Gets you through a lot
54:43Gets you through a lot of suffering
54:45Sometimes that suffering
54:47Is transformative
54:49Based on your faith
54:52It deepens faith
54:55Certainly deepens prayer
54:58And
55:00I'm very comfortable
55:02Talking on that level with folks
55:06And in reality
55:08With some of my patients
55:09of my patients that's where we meet is on that level on a depth level of what
55:18gets you through the day in reality it's not your pain meds no it's God it's Allah
55:28you know and so boy we can go from there and that has made the most significant
55:38difference for my folks as they reduce on on the opioid medicine and that's when we
55:45do a little bit of rejoicing about the grace of pain and grace being gift of pain
55:53people come into us not seeing pain as a gift and in working with them we can
56:00find the gift of pain the ultimate end game being thankful in every situation
56:09but only by God's grace and often there's a lot of processing and deconstructing
56:14that needs to happen before that becomes a possibility if you're suffering from
56:20chronic pain remember the alt brain is processing data from all over your body
56:24anxiety sadness depression and anger will change the perception of that pain
56:30having a can-do attitude really helps even if it's just a baby step believing
56:37that you can is half the battle practice relaxation breathing and gratitude God
56:44has promised to never leave you nor forsake you that's all for me today thanks
56:49for joining us on go healthy for good I'll see you next time
57:19you