Recover from these hot summer days with this refreshing spinach and strawberry salad. Flavors of sweet and citrus are deliciously juxtaposed in this incredibly easy-to-make recipe. You’ll love it!

Ingredients

• 1/2 small, red onion (thinly sliced)
• 1 1/2 tsp kosher salt, divided into 1/2 tsp portions
• 2 tbsp unsalted butter
• 1 tbsp high quality strawberry preserves (more fruit than sugar)
• 2 tbsp grape seed oil or canola oil
• 1/2 tsp fresh ground black pepper
• 1 lime, halved
• 6 cups baby spinach, washed and dried

Directions

1. In a fine mesh sieve mix the onion with 1/2 tsp of the kosher salt.
2. Set aside for 5 minutes, then rinse under cold water.
3. Transfer onion to a paper towel and set aside.
4. In a large skillet set over medium heat, melt the butter and add the pistachios and cook, shaking the pan often, until the pistachios are golden brown – 3–4 minutes.
5. Stir in 1/2 tsp of the kosher salt and turn the pistachios out onto a large plate to cool.
6. In a salad bowl whisk together the strawberry preserves, remaining 1/2 tsp of kosher salt, black pepper, and the juice of 1/2 lime.
7. Add the spinach, onion and pistachios to coat.
8. Squeeze the remaining lime half over salad and toss gently to serve.

More than 450,000 hip replacement procedures are done every year in the United States, to restore mobility and resolve chronic pain in patients with debilitating hip problems. While these procedures are generally very safe and effective, problems with hip replacement implants have caused quite a stir lately. Recalls and high rates of complications have drawn the attention of regulatory agencies in both the United States and the UK, as concerns about the safety of an entire category of hip implants have been raised. If you are planning to have a hip replacement or have already had a procedure, there are some things you need to know about the dangers associated with hip implants.

Hip Replacement

Hip replacement removes a damaged hip joint and replaces it with an artificial joint. Total replacement removes the natural femoral head, or ball, and the acetabulum, or socket, of the hip joint. Partial replacement replaces just the femoral head. Joint resurfacing generally replaces the acetabulum with an artificial cup,

General Hip Implant Issues

Hip replacement implants are made with materials that include plastics, metals and ceramics. The most commonly used implants are composed of a metal ball and a socket that is made of plastic or lined with it. Implants are also made with ceramic femoral heads, paired with plastic, metal or ceramic sockets. In metal-on-metal implants, both the ball and socket have metal surfaces.

All implants have some risk of complications. Most common is implant dislocation, an issue that most often occurs during the weeks following surgery as the hip is healing. Bone fractures can occur, due to pressure from the implant, as can infection. Osteolysis, or bone loss, can happen as the body’s immune system attempts to clear away implant debris, destroying bone cells in the process. Nerve damage, hardening of soft tissues around the hip, implant loosening or breakage, and uneven leg lengths are other possible complications.

Metal-on-Metal Complications

Metal-on-metal hip replacement systems have been more problematic than other types of hip implants, due to minute particles of metallic debris that wear off of their components over time. These particles collect in the soft tissues around the hip and can cause a condition called metallosis. Metallosis happens when those particles cause the tissues to become inflamed, leading to intense pain and swelling in the hip and in some cases, tissue death and bone loss at the implant site.

Metal ions can also be absorbed into the bloodstream, circulating throughout the body. Although the long-term consequences of elevated levels of these ions in the blood are largely unknown, medical experts have expressed concern that they may affect immune function and increase cancer risk.

Implant Recalls

Several metal-on-metal products have been recalled by manufacturers. There have been several DePuy hip replacement recalls, including their ASR XL Acetabular System and ASR Hip Resurfacing SystemStryker. Products made by Zimmer Holdings and Smith & Nephew have also been recalled. Thousands of patients have been affected by these faulty implants, leading to thousands of revision surgeries and hundreds of lawsuits.

This article was written by Elizabeth Carrollton who writes to inform the general public about defective medical devices and dangerous drugs for Drugwatch.com.

I love sharing what I know with others and discussing my patient care philosophy. I recently had such an opportunity with Jennylyn Gleave on The Jennylyn Show. We sat down together and discussed everything from the humble beginnings of my career as a 14-year-old hospital volunteer, to how the lifestyle of a professional athlete can impact overall health. I describe how the prescription drug abuse epidemic affects the doctor-patient relationship, and we discuss the issue of “biofeedback” and how emotional barriers can prevent effective treatment. Join us for an in-depth one-on-one.

Watch the video on YouTube.Or, you can view the interview on Vimeo. If you’d like to know more about Jennylyn, visit JennylynShow.com.

Your health is important, and after a long winter of reduced activity or inactivity you might be tempted to ditch those old winter habits, go outside, and train as soon as the weather improves.

According to Moshe Lewis, MD, chief of physical medicine and rehabilitation at California Pacific Center, St. Luke’s Campus in the Department of Orthopedics, although you may be tempted to exercise at the same level you did at the end of the last season, such enthusiasm often leads to early season injuries.

If you changed your routine for the winter, you need to get back into shape slowly. The following are some tips from Dr. Lewis for avoiding injuries as you increase your exercise this summer.

1. Slow and steady — don’t overdo it

Try to exercise three to four times per week on alternate days. One of the best ways to get injured or sore is to go hard all weekend and do nothing during the week. Don’t succumb to the weekend warrior syndrome. You will also have higher risk of damage to your ligaments if you overexert yourself. Remember to pace yourself and increase your training gradually over the weeks. Adding one hundred steps to your daily routine will add a tiny bit to your fitness level, if you keep it up. Your body will adapt.

2. Cross train

Alternating your workouts can improve your performance and reduce the risk of injuries. By participating in a variety of different activities such as running, weight training, hiking, or biking, you limit the stress on one specific muscle group because different activities use muscles in slightly different ways. Muscles are easy. They adapt and get stronger fast. And that is why you get injured.

3. Avoid exercising in pain

As you ease back into training you may experience some minor muscle aches and soreness. But if you have any sharp, unusual pain, or soreness that doesn’t go away, pay close attention. You may be on the way to an injury. Listen to the early warning signs of an injury, otherwise you increase your chances of tissue and muscle tear, which can often lead to permanent long-term damage.

5. Train with others who share the same enthusiasm as you

If you can find a few people with the same fitness level and goals as you it can help keep you progressing at a good pace. Working out in a group provides support, accountability, and structure. You are more likely to complete a well-rounded exercise routine and stay on track with your fitness regimen.

6. Don’t be so hard on yourself

Getting back into shape is often slow and difficult, and you have to ramp up your intensity level and exercise routines gradually. Remember you have to pace yourself, and if you took the winter off don’t expect to be back at your peak fitness in a week or two.

Take your time and keep in mind that summer training is a time for fun, light-hearted exercise. You aren’t competing so just relax, enjoy your activity, and enjoy the summer.

Doctor visits typically increase as the year comes to an end. How many times have you been to the doctor’s office, been poked and prodded, leaving with a prescription, only to recall all of the  things you didn’t ask? Or maybe there was something the doctor said you didn’t quite understand? Since many people are going to the doctor’s office to improve their overall health, the next time you go, make the most of the visit with a few strategic tips.

1. Take an active role in your medical care and treatment.

• Listen intentionally to what the doctor says during all doctor visits, and be proactive with taking notes.
• Do some research on your own and consider that you may just need to talk to more than one healthcare professional.
• COMMUNICATE! Share important information with your doctor — such as other medications and supplements you take, whether you have claustrophobia, and how you handle your symptoms.
• Learn your treatment options and work with your healthcare professional to customize your treatment plan.

2. Take proper care of your body and mind.

• Incorporate stress reduction techniques such as medication, exercise, and stretching into your day.
• Eat well! Proper nutrition goes a long way toward helping heal the body.
• Get counseling or join a support group.

3. Effectively utilize healthcare resources.

• Make a plan and stick to it, such as walking more or eating less carbohydrates.
• Know what triggers your pain/condition and AVOID those triggers.
• Develop effective responses to deal with flare-ups.
• BE PREPARED with extra medications, equipment for long trips, or other necessary preparations.

4. Know your health plan coverage.

• Does your plan put a cap on the services that your doctor is requesting?
• Does your insurance company cover alternative treatments such as acupuncture or chiropractic care?
• Can you receive reimbursements for treatments that may be considered complementary such as nutrition, biofeedback, yoga, or medical equipment? Check to see if your flexible savings account will cover any of these.

5. Ask, ask, ask, and ask again.

• Don’t be afraid to ask questions or about what a medical term means. You did not go to medical school.
• Ask the doctor to clarify or elaborate on any medical jargon used.
• Ask about medication samples. Your doctor may have drug samples that could work for you.
• Ask if any of the special services you need, such as physical therapy or assistance taking care of basic needs, can be done in your home especially if you have limited mobility.

In this interview with Dr. Michael A. Lenoir on KPFA Radio's About Health, we touched on acute vs. chronic pain, Michael Jackson and dietary considerations. We answered many listener questions regarding increased sensitivity to pain, acupuncture, avoiding surgery, chiropractors, arthritis, the stress caused by pain, and more.

Listen to this interview on KPFA Radio's website

In light of the following article, I have always strongly encouraged my patients to actively involve their family by bringing them to visits. In addition, I strongly recommend participation in the California Neuropathy Support Group and to openly discuss their feelings with our healthcare team:

Abuse of narcotic pain relievers, insomnia drugs and anxiety drugs by women is landing a growing number of them in emergency rooms for drug-related suicide attempts.

A recent report by the federal Substance Abuse and Mental Health Services Administration shows a 49 percent rise in emergency department visits for drug-related suicide attempts by women aged 50 and older between 2005 and 2009.

While some of the increase can be attributed to population growth of women in this age group, the study found stark increases in emergency department visits for drug-related suicide attempts involving drugs that treat anxiety, insomnia and pain, such as hydrocodone and oxycodone products.

Michael Dulle, clinical director of the Salt Lake substance abuse treatment center Odyssey House, said he is personally aware of five to eight female patients, ages 50 and up, who have been hospitalized for accidental overdoses or suicide attempts from prescription drugs in the past 18 months.

Read the rest of this article on Deseret News

Ken McCoy recently interviewed me on his radio show. We had a great time discussing what pain management is, what pain management specialists do, and my philosophy regarding pain management in general. Click the play button on the audio player above to listen to our segment. Here’s an overview of what we talked about:

• Blending the best of eastern and western philosophies to treat pain in the most effective way.
• The holistic approach to treating pain: Diagnosing should never be done with a cookie-cutter. I get the story behind the pain, look at the patients lifestyle, how chronic is the pain, etc.
• Avoiding drugs when possible: Many chronic pain disorders can be treated with topical treatments such as gel patches, ultrasound, electricity, acupuncture, etc. This greatly reduces the chance of organ damage and side-effects.

• Trying to get patients to understand their medication: Medication is extremely important to many, but some forget what their medicine is supposed to be doing for them. Sometimes they no longer need to be taking it.

• Ken McCoy and I also discuss how I got started as a pain management, physical medicine, and rehabilitation specialist. * We discuss how the holistic approach to treating patients and the future of medicine/health.

• Why I find it important to raise public awareness of pain management.
• Why your chronic pain doctor will be your most visited doctor; pain “management” requires specialists who can dedicate themselves to their patients.
• Why pain management specialists are in high demand right now: We are living older, we are doing more than ever, everyone is personally effected by pain, celebrities find their expertise useful, and they often utilize a holistic approach to treating patients.
• McCoy and I talk about my latest media appearances. We talk about my latest public service announcement regarding the dangers of RSI and arthritis and how to treat these painful disorders.
• Insurance companies and their positive relationships with pain management specialists.
• What some of my everyday patients look like (age, physical activity, etc.)

Listen to the entire episode of Ken McCoy's show

Alice Francis and her husband Alan had always been a dynamic and evenly-matched couple. They both worked in high-energy careers that they loved; they traveled the world together; they exercised together regularly, and led extremely active lives. When Alan’s first flares of chronic back pain prevented him from keeping up with their fast-paced lifestyle, Alice quickly realized that their relationship was about to undergo some drastic adjustments.

“This transition has been life-changing,” she admitted, “and although I wouldn’t want anyone to have chronic pain, I have learned a lot of lessons regarding pain care and advocating for my spouse in this ‘adventure’ ”.

Alice does not like referring to herself as her husband’s “caregiver”, but it is an apt description of the role she has had to fill in Alan’s health care management. As her husband’s treatment progressed through office visits, complex pain regimens, and four corrective surgeries, Alice has taken on an active role in helping her Alan to manage his chronic pain. In the six years since Alan’s degenerative disc disease was first diagnosed, Alice has learned to be an effective champion of her husband’s medical care while maintaining her own positive outlook on life.

Thousands of spouses and children of pain sufferers find themselves in Alice’s position every year. Becoming involved in the care and treatment of a suffering loved one is a natural and loving gesture, but it can easily take its toll on even the most patient caregiver. Here are some of Alice’s tips for others who are caring for loved ones suffering from chronic pain.

Selecting doctors

• After you or your partner have researched several doctors, set up “appointments/interviews’ with your top 3 choices.
• It’s a good idea for you as the partner/caretaker to attend these appointments so that you have two sets of ears. It’s amazing how things can be interpreted differently between the person who is in pain and the person who is there to support!
• This sounds crazy, but I suggest you and the pain patient dress nicely for the appointment. We have found we are definitely treated with a higher level of credibility and respect.
• Let the doctor know that you are deciding what will be the best match in terms of a relationship with a new doctor and you have some questions as well. Sometimes I asked the questions and sometimes my husband did. It really depended on his pain and anxiety level that day. If a doctor is reluctant to be “interviewed”, that should tell you something.
• Take notes! It is very important in all appointments, quite frankly.
• Here are some good questions to ask at an initial interview:

1. How long has the doctor provided pain management?
2. Does the doctor give injections, and if so, where were they trained and what is their general outlook on patient injection needs? (In our experience, doctors who were trained via Mayo Clinic will give only 3 injections per year. Doctors trained in other programs are sometime more open to assessing the number of injections based on the need of the patient.)
3. What is the doctor’s general philosophy on pain management? If they don’t have one, that’s a red flag.
4. How many doctors are in the practice? Will patients generally see the doctor or the physician’s assistant?
5. How far in advance do you need to make an appointment?
6. Who is the contact when you are unable to reach the doctor?
7. Will you be able to get copies of all medical records and appointment notes? (I always request this on a monthly or quarterly basis. It’s important to see what the doctor’s interpretation of the appointment was, which can be quite different than yours or the patient’s.)
8. Has the doctor ever experienced long-term or chronic pain? Although this isn’t a deal-breaker, the doctor’s firsthand experience is a plus. They will most certainly have a high level of compassion and understanding for what the patient is going through.

Alice stresses that finding the right rapport between a doctor and the patient is extremely important, since this doctor-patient relationship could potentially last for years. She found that helping Alan to be proactive about his own emotional needs made it easier to find doctors who were a good match for Alan. “At the beginning of our pain journey, it was very important for my husband to explain to a doctor who he was before pain. He wanted them to have a glimpse of what his life was like before this happened. He was struggling to deal with all the changes going on, and needed people to know that he hadn’t always been the ‘patient’.

“Some doctors were very attentive during this dialogue. Others were very dismissive and condescending. Their reaction was almost always a sign of the care and compassion to come. I suggest the patient or caretaker come up with some brief summary of activities and interests prior to the pain and see what kind of reaction you elicit.”

Providing care for your loved one

• Carry a list of all medications and amounts the patient is taking. If there is an emergency situation, it will be necessary to provide the EMT’s or other medical help with that information
• If you live with the patient you care for, be observant as to what time of day they take their meds. Make it clear that this isn’t policing, but rather just another set of eyes. When someone is in chronic pain, memory can be affected, and it’s just good to have a general idea of your patient’s pattern of medication use.
• Get to know your pharmacist. I know our pharmacist very well. In fact, I can call the pharmacy and say, “It’s Alice”, and they know who I am! It’s important to build a rapport so that you can ask questions and receive the best customer service possible.
• LISTEN to your loved one! This was VERY difficult for me to learn. When he would complain about the pain or express frustration, I wanted to ‘fix it”. Listening was not part of my plan. Many times, he didn’t want me to fix anything. He just needed me to say, “That must be really hard”, or “ I’m so sorry you are having to go through this”. Understanding and improving our communication has helped both of us a great deal.

Alice offers further perspective on the changing relationship of chronic pain patients and their caregiver companions. “My husband went through not only a huge physical adjustment to dealing with chronic pain, but an equally large psychological adjustment. Without work or exercise or the ability to live an active lifestyle, he just didn’t know who he was anymore. I went through a similar adjustment, I’m sure.

“Acknowledging this transition, and how hard it must be, was very important for both of us. Be patient during this time, because your loved one really needs to feel vital and normal. Strongly suggest to your loved one they go see a therapist or psychologist to work through these issues. It can be a huge help to you both.”

Take care of yourself

“Of all the things I have done in my life,” says Alice, “taking care of or being in a relationship with someone you love who is in chronic pain is by far the most difficult. In the beginning I felt like my good days were completely dependent on his good days. That’s no way to live.

“You do need to provide love, compassion, sometimes some physical and mental support. But you also have to realize that you CANNOT fix or change the situation. You can’t make the person take meds or not take meds. You can’t do physical therapy for them. You can’t take the pain away so you just have to let it go. “I developed a sense of normalcy around all of this. I have a career that I love-- it keeps me very busy. I go shopping and traveling some with girlfriends. I exercise on my own, and do things just for me. This new ‘normal’ life really helps provide Alan with a sense of ‘normal’ as well. I strongly encourage you not to forget about you in this process.”

This article is summary and companion article to Taboo Talk's April 6th (2011) radio show/podcast.

New Treatments in Neuropathic Pain

• Tuesday April 12th, Seton Medical Center, Daly City

New Treatments for Osteoarthritis

• Wednesday April 13th, Rancho Cucamonga, LA
• Thursday April 14th, Las Vegas, NV
• Monday April 18th, Support Group, Fort Lauderdale, FL
• Wednesday April 27th, LA, CA

New Treatments in Chronic Pain

• Tuesday April 26th, Yountville, CA
• Thursday April 28th, 2011 Santa Cruz, CA

Written by Dr. Moshe Lewis M.D.
In collaboration with Raymond Chou

1. Darken the room so your brain releases more of its own melatonin for better sleep.
2. Try not to eat or drink much just before bed, and try not to take medications with stimulants—for example, avoid antidepressants, caffeine, Ritalin, and Straterra. Food and stimulants shorten the REM stage in unhealthy ways.
3. Turn off the television and radio an hour before bedtime. Decreasing stimulation will help to ease your brain into a state of restfulness.
4. Incorporate restful practices into your waking life. For example, try yoga, or take time to pamper yourself at a spa or with a massage.
5. Take vacation time and use your paid time off, especially when it does not accrue year to year. Fatigue builds over time, so be kind to yourself.
6. Take naps, especially on the weekend when there is some extra time.

The San Francisco Chronicle recently interviewed one of my patients and myself to gain a perspective on how many doctors are "scared to death to prescribe [medicine] stronger than ibuprofen 800mg", given concerns about drug misuse. The article discusses the balancing act between the lack of access to pain physicians and the way most patients can be functional despite pain medication. Here is an excerpt of one of my quotes:

"I have colleagues who are board certified in pain who will not write significant pain medication for treatment. Many of them are feeling overwhelmed and scared," said Dr. Moshe Lewis, a pain management specialist with California Pacific Medical Center who has treated Reia. "Most of the patients I see, probably 90 percent, have legitimate pain. The challenge is figuring out who's who."

Read the entire article on SFGate.com

Do you have a muscle, tendon or part of your body that is recurrently tight or painful and does not respond well to stretching? You may be a candidate for Active Release Techniques® (ART). ART is a fast-acting, highly effective soft tissue technique that breaks up adhesions or scar tissue, whether from trauma or repetitive strain, and helps return tissue to its normal flexibility and function.

Scar tissue can form with any type of repetitive motion that limits relaxation of the tissue thus restricting sufficient blood flow and oxygen to the area. An injured area where there is a chronic inflammation and insufficient flow of oxygen may trigger a series of chemical reactions called chemotaxis that increases the recruitment of macrophages and fibroblasts that eventually build fibrosis or scar formation. As an area becomes tighter and more fibrotic, the cycle is perpetuated and more scar formation occurs.

Acutely injured tissue tends to feel boggy and swollen, such as experienced with a sprain, strain or spasm. After a couple of weeks, tissue under the stress of sustained tightness or decreased mobility begins to change, becoming stringy, then lumpy, and eventually fibrotic. Fibrosis is what causes tendonitis to become chronic tendinosis. It is what can entrap nerves and cause someone to experience nerve pain with movement.

Whether scar tissue formed by repetitive motions working at the computer or by repetitive training for an elite musical or athletic performance or somewhere in between, an ART practitioner can identify where the adhesions are and then release them. Fibrotic tissue can be broken down, reabsorbed by the body, and with correct exercise and movement re-education, the tissue will remodel to do what it was designed to do, without recurrent pain or tightness.

Prior to the Vancouver Winter Olympics, I was working with Chuck Berkeley, a member of the USA Bobsled Team. He was experiencing recurrent calf pain and tightness that was keeping him from sprinting and jumping, two must-dos for his sport. Through specific palpation, adhesions were identified deep in his lateral calf, between the soleus and the peroneus longus. With significant tension placed on the adhesions and Chuck moving his ankle through motion first to stretch soleus and then peroneus longus, tension increased where my hand was and the adhesions were released. Within 3 treatments, his calf was no longer painful or tight. To restore the tissue to its normal function, Chuck was given specific exercises to strengthen his gluteal muscles, and avoid overuse of his calf muscles for stabilizing and push-off through his running stride and with jumping. His symptoms did not return, and Chuck was able to continue his training and compete in the Olympics.

P.R. “Nina” Patterson, PT, OCS, ART
Sports + Orthopedic Leaders Physical Therapy, Inc
www.solpt.com