Most people know what orthopedic surgeons and physical therapists are, but few of us have ever heard of or are familiar with physiatrists.  This highly underutilized medical specialty focuses on muscles, nerves and joints but in a more non-surgical approach that sees problems as being part of a larger process.  Physiatrists are called by many different names:  physical medicine and rehabilitation specialists, PM&R, sports medicine, and physiatry,

Physiatrists often work in close coordination with physical therapists, orthopedic surgeons, pain management specialists, neurologists and primary care physicians.  All physiatrists have a MD or DO designation which means they are able to prescribe medications and can do procedures such as injection of joints, EMG (electromyography), trigger point injections for muscle pain, or removal of excess fluid.  What makes them different from orthopedic surgeons is that their approach is mainly non-surgical and try to prevent the problem from progressing to the point of needing surgery.

For most minor musculoskeletal issues, a 2 week trial of anti-inflammatory medications, rest, and stretching should improve symptoms.  However, if there is no improvement an evaluation with your primary care physician can determine whether you need physical therapy, orthopedics, or a physiatrist.

For more information about physiatry, please visit the American Academy of Physical Medicine and Rehabilitation website.

This week, the CDC issued a guideline urging medical providers to use extreme caution when prescribing narcotics for pain.  Many people think that just because a medication can prescribed legally that it is different from “street” drugs such as cocaine and crystal methamphetamine (“crystal meth”).  This couldn’t be further from the truth.  Prescribed narcotics can cause overdose-related deaths and be just as addictive as their illegal counterparts.  The CDC statistics show that from 1999 to 2014, over 165,000 deaths can directly be attributed to prescription medications!

Don’t get me wrong, in the right context pain medications can be helpful but everyone should always try medications such as NSAID’s (non steroidal anti-inflammatory medications), which can actually be more helpful when inflammation is involved, or acetaminophen (Tylenol).  NSAID’s should not be used in certain groups including people with kidney disease or history of stomach ulcers, and if you think you may need doses higher than what is recommended on the packaging, you should consult your healthcare provider.  A misconception I see often in my practice is that people assume that just because they hit the maximum dose on their bottle of Advil (ibuprofen) or Aleve (naprosyn) that the medications aren’t effective.  What they don’t understand is that the over the counter label instructions have lower maximum dosages with the assumption that it is not directed by a healthcare provider.  In fact, there are much higher dosages and more potent forms of NSAIDs available by prescription only which are very effective at treating pain.

Acetaminophen should be taken at doses lower than 4000 mg in 24 hours, or 2000 mg in 24 hours for people with liver disease.  I also find that topical medications such as capsaicin cream and Biofreeze gel are greatly underutilized for minor musculoskeletal injuries.  If you are seeing your healthcare provider for pain and they want to prescribe you a narcotic pain medication, ask them if there are any alternatives or if you can take a stepwise approach to pain relief.  Maybe for the first day you could try NSAIDs and tylenol and see if that suffices.  If the pain persists, you can follow up with your provider to reassess and see if a low dose narcotic may be right for you in conjunction with continuation of NSAIDs/tylenol.

We often don’t hear about the severe side effects of narcotics.  They can cause everything from hallucinations, impaired driving leading to accidents, non-stop vomiting, falls, and even severe constipation requiring a trip to the ER.  Many times, the risks of these and overdose far outweigh the benefits.

Narcotic medications also have another negative side effect.  Take a look in your medicine cabinet right now.  Almost all of us have at least one orange bottle of pills with a white safety cap prescribed for a medical illness.  Maybe it is something you are currently taking on a daily basis, but more likely than not it is for some issue in the past.  You just didn’t get around to throwing it out or figured you may need in the future.  Now imagine if your teenage child got a hold of it.  He/she could abuse it.  Think that won’t happen to your child?  Think again, this is becoming more commonplace.  In fact, many studies have shown that a significant proportion of current illegal drug users started off by stealing old prescribed medications from others.  I recommend that if you have any unused medications, particularly narcotics, you should bring them to your local pharmacy for safe disposal.  Do NOT throw them down the toilet or in the garbage as they can enter the drinking water supply.  Don’t save up prescription medications thinking you will use them later, the risk of your child becoming addicted/poisoned is not worth it!

Many diseases such as Zika, Malaria, Yellow Fever, West Nile Virus, and Dengue Fever are spread by mosquitos.  The biting insects are found almost everywhere, but there are steps you can take to reduce your risk of being bitten.  Here are some tips I recommend that you follow at home and traveling abroad.

• Remove standing water from your yard.  Mosquito larvae can grow in small amounts of water, even as little as a bottle cap!  Do a thorough cleaning of your yard and remove any standing water, such as bird baths, catch basins, or clogged gutters.
• Make sure your window and sliding door screens are intact.  If there are holes, you should replace them immediately.
• Keep your skin covered when walking into wooded areas.  My favorite fabric is linen because it covers your skin yet allows for good air circulation and keeps you cool.  I also recommend tucking your pants into your socks to prevent the insects from crawling or flying into your pant legs.
• Mosquitos generally do not like air conditioning.  Keeping your bedroom and house cool can prevent them from coming in.
• Avoid applying personal care products with fragrance.  Mosquitos are attracted to scents such as perfumes.  Even a strongly scented deodorant will attract them.
• If you will be outdoors, you can burn mosquito coils (a type of incense) or light citronella candles.  Mosquitos do not like to be near smoke as it reminds them of a forest fire.
• Generally, most people get bitten at dawn and dusk periods, so be particularly careful if you are outdoors during these times.  However, there are mosquitos that feed during the daytime as well.
• Use a repellant with at least 20% DEET on your skin.  Avoid products containing 100% DEET on your skin as they can be quite irritating.  I recommend using a spray called Deep Woods Off!  Another handy DEET-containing product is REPEL wipes.  These are great if you want to be discrete about your mosquito avoidance and not create a plume of chemicals which could be irritating to people nearby.  They are also very convenient for travel because, unlike the spray bottles, they are TSA compliant for carrying onboard airplanes.
• If you will be outdoor extensively (hiking outdoors, outdoor picnic, etc.) you can should use Permethrin Spray on your clothing in addition to DEET on your skin.  You can even spray the clothing the day before.  Be sure to do this in a well ventilated area, preferably outdoors, and allow to dry. Do not spray permethrin on skin as this can cause irritation.  A great idea is to spray a lightweight scarf or old T-shirt with permethrin and put it in a plastic bag so that if you do note that the mosquitos are biting, you can wrap up with it and be protected.
• If you are applying sunscreen and mosquito repellant spray, you should always apply the sunscreen first and then the mosquito repellant.  Doing it in reverse can cause the sunscreen to slide off and become ineffective.

Protection is key to prevention of mosquito-borne diseases.  Be prepared and you will not need to worry!

Fall and winter months are typically cold and dry months.  The air in our homes usually gets very dry during these times.  As a result, our skin loses a lot of moisture causing itchy skin, dandruff, worsening eczema (a skin condition that is related to allergies), dry noses, sore throats and chapped lips.

Here are some great ways to increase the humidity of your home so you can feel better:

• Grow indoor houseplants.  Plants release oxygen and moisture into the air.  They can also purify your home environment of toxins.  If you don’t have a green thumb, even having a “lucky bamboo” plant sitting in a vase with water can be helpful.  These just require you to remember to fill the vase with water every few weeks and do not require much sunlight.
• Fill a stainless steel bowl or cookie sheet with water and place it on top of a radiator.  The heat from the radiator will evaporate the water.  Be sure to change to water in the bowl every day to avoid mold growth.  Also, make sure it is out of reach or any children.
• Purchase a humidifier.  I recommend avoiding the humidifiers with the “blue plastic tanks” because they are difficult to clean and can be a breeding ground for mold.  The humidifier can then disperse the mold spores into your home and cause terrible allergies, nasal congestion, and even fungal pneumonias!  I highly recommend a humidifier with an easily cleanable tank which is called the Venta humidifier.
• Turn on your shower.  If you don’t pay for hot water, this is a great way to humidify your home quickly and cheaply.   Turn your shower on with warm water and leave the door open to the bathroom for about 20-30 minutes.  You can even put a fan at the doorway to your bathroom blowing the steam out into the rest of the apartment/house.
• Take a bath and leave the bath water in the tub afterwards.  If your home is warm and dry, the evaporation will increase.
• Avoid turning up the heat too much in your home.  Sure, 80 degrees feels great but forced heat is dry air.  Keep it in the low 70 degrees Fahrenheit and your skin will remain more moist.
• Open the windows on days when it is humid outside to let in moisture.  Check your local forecast and see if the humidity outside is high.  Generally morning hours are the most humid and mid afternoon are the least humid times of day.

Most of us know our height and weight, but do you know your blood pressure numbers?  I believe we should all know these two important numbers.  You should be concerned about high blood pressure.  It runs in families and can cause early heart disease (heart attacks), strokes, kidney failure, and blindness.  As devastating as these conditions are, we often don’t feel when our blood pressure is high.  That is why high blood pressure has the nickname, the “Silent Killer”.

I recommend starting with an annual physical with your primary care provider.  He/she can take an accurate measurement of your blood pressure in both arms.  The top number is called the “systolic blood pressure” which measures the pressure in your blood vessels during contraction (pumping) of the heart, while the bottom number is called the “diastolic blood pressure” which is the pressure when the heart has relaxed.  I recommend that you write these numbers down or record them on your smartphone.  Then, purchase a blood pressure monitor.  I personally recommend the Omron blood pressure monitor with an upper arm (bicep) cuff as they are more accurate and generally not too expensive.  These are automatic cuffs and do not require any more skill than pushing a button.

Here’s how to get an accurate measurement:

• Set up the blood pressure monitor on a kitchen table, with the cuff snugly around your upper arm.
• Sit quietly for 2 full minutes with both feet flat on the floor.
• Push the button with your other arm.  Sit still and try not to move until the reading is done.
• The cuff should inflate and then deflate.
• Do not be tempted to recheck the blood pressure until 10 minutes later.  Rechecking the blood pressure too soon can result in inaccurate measurements.
• Try to take your blood pressure in the same arm each time.  Generally speaking, the blood pressure in the left arm will be slightly higher on average than the left since the heart sits closer to the left arm.

Here are some numbers and what they can mean.  Generally, we look at blood pressure trends and not individual numbers.

Top number <100 or bottom number <60:  Your blood pressure can be normal for you or too low.  check with your medical provider to see if this could have an impact on your health or needs further workup.  People with very low blood pressure can have fainting spells or light-headedness when they stand.

Top number 100-130 or bottom number 60-80:  This is the ideal range for blood pressure.  Make sure you maintain proper diet and exercise regularly to keep these numbers in range.

Top number 130-140 or bottom number 80-90:  This is called “pre-hypertension” and you are at risk for developing full blown hypertension in the coming years.  Medications are not usually indicated for this blood pressure range if you are otherwise healthy, but if you have a history of heart disease or diabetes your healthcare provider may start you on medications.  Diet and exercise are extremely important to reverse pre-hypertension.

Top number 140-160 or bottom number 90-100:  These are numbers consistent with true hypertension.  You should make an appointment to see your healthcare provider to find out what medication you need to be on.  Lifestyle changes such as daily exercise and low fat diet are also important.  In fact, if you are able to lose weight, and truly live a healthy lifestyle, you may be able to maintain a good blood pressure and can stop the medications.

Top number >160 or bottom number >100:  These are dangerously high blood pressures that need immediate attention.  If you have these numbers and have any symptoms of chest pain, blurry vision or loss of vision, decreased urination, leg swelling, or headaches, you need to go to your nearest emergency room.  Blood pressures that are in this range can result in serious life threatening problems.  If you forgot to take your blood pressure medication, take them immediately.  You will likely need to be given blood pressure medications through an IV at the hospital with close monitoring of your blood pressure and need some blood tests and an EKG to be done to make sure there is no damage to your heart.