Nursing doesn’t have to be a pain in the back!

By Dr Kevin Lau
Featured in Singapore Nursing Journal

As a nurse, you probably bend and lift patients and equipment many times a day. This repetitious activity makes you vulnerable to a common occupational hazard: back, neck, or joint injury. Of the most common problems I see in practice is low back pain due to degeneration of the spine. Any of the spinal discs can be injured or undergo degeneration; but because of their location, discs in the lower spine are subjected to the greatest weight-bearing stress and are most likely to slip or be compressed.
What is Disc Degeneration?

As we grow older and less active the tough elastic tissue of the disc begins to lose its fluid. The loss of fluid thins and weakens the disc making its function as a shock absorber for the spine ineffective.

Although the discs BEGIN to degenerate after about 25 years of age, everyone SHOULD be able to complete his entire life span with no discomfort from this aging process. It is when the degeneration speeds up beyond normal that a person is likely to have trouble. The fast-weakening disc begins to bulge like a weak wall on an automobile tire and gradually protrudes into the spinal canal to press against nerves and cause pain.
What Causes Speed-Up of Degeneration?

Even young persons may suffer from disc degeneration due to poor nutrition. This is not malnutrition in the sense of what we eat. It has to do with starved disc tissue. Every cell of the body must be fed correctly in order to maintain its proper function...and the disc is no exception. The disc must absorb its nutrition from the fluids which surround it.

The disc may get some of its food through osmosis, but adequate absorption of nutrients takes place when the disc is in a state of accordion-like motion. When in motion it squeezes the surrounding fluid in and out, much like the action of a sponge. Some of the factors affecting disc nutrition are in-activity, poor posture, stress, weak muscles, injuries, muscle spasms, and fixation (two adjoining vertebrae moving as one).
What Can Be Done?

Fortunately, 95% of all disc cases can be managed through modern chiropractic methods. Years of research and experience in disc cases qualifies the doctor of chiropractic as the doctor of choice in acute and chronic disc problems. In my practice I truly believe in teaching patients how to become independently healthy and strong. The key to preventing the low back is to strengthen core stability muscles, such as you abdominals. While the abdominals conjures up images of a six pack, the most important core stability muscle is the transverse abdominus, which acts as a natural weight belt, keeping your insides in. This muscle is essential for trunk stability. Here are a few core stability exercises to help strengthen the low back.

Exercises for Developing Torso Stabilization


1. Training the Core: This exercise involves recruiting the transversus abdominis, pelvic floor and deep muscles of the lower back. Breathe deeply while sitting in a chair or lying down with the knees comfortably bent. When exhaling, visualize pulling your navel toward your spine and contracting your pelvic floor. Activation of the pelvic floor helps co-contract abdominal stabilizers. If you put your fingers on the inside of your hip bones, you should feel this contraction. Be aware that you want to keep the rectus abdominis and glutes relaxed. Once you feel comfortable with this exercise, work on intervals of holding the pelvic floor/transversus contraction while breathing normally. Begin with three sets of 10-second holds and progress from there. Activate these muscles as you carry out other exercises.

2. Press and Reach: Lie on a mat face up, placing your hands at your sides. Bend your legs and lift them off the floor so your knees are aligned directly over your hips. Slowly lower your feet toward the floor in an alternating fashion. You can increase intensity by straightening your legs as you lower them and/or lifting your arms off the floor (try reaching one or both arms above your head). Perform 12 to 15 slow repetitions. Note: The goal is to control your low back from arching toward the ceiling; focus on keeping your navel parallel to your spine.

3. Side Bridges: With knees bent, lie sideways on a mat, making sure your shoulders, hips and knees are aligned. Lift your hip off the floor, propping yourself onto your elbow and the side of one knee. Your elbow should be directly under your shoulder. Make sure you are not allowing yourself to sink into your supporting shoulder. Hold this position for up to one minute while breathing normally. Try two to three sets and repeat on the opposite side. To progress, straighten your legs, propping yourself onto your feet. Note: A common postural mistake is to gain stability by pushing your hips behind you. Concentrate on maintaining proper alignment.

4. Body Ball Crunches: If torso curls are your true passion, try them on a body ball. Using a ball is much more unstable than using the floor. Therefore, stabilizers will come into play as you try to control your movement. Sit on the ball, then walk your feet out until the ball is under your low-to-mid-back. Move through the torso curls in a slow, continuous motion, lifting your shoulder blades off the ball while your lower back remains on the ball. Guard against pulling on your head and neck. Perform one to three sets of 12 to 15 curls.
Prevention key to a healthy spine

The greatest tip I can offer to anyone suffering from low back pain is to not ignore it! Pain is necessary to prevent further damage into joints and alerts us that something is not right. As in most cases, prevention is to key to having a healthy spine as you head into your older years. Timing is critical in muscle, ligament, and joint injury because healing begins immediately after the damage. If activity is not started soon, usually between two and six weeks, then injured tissues may not recover their flexibility, strength, and ability to function (i.e., to do what they are designed to do). After losing flexibility and function, the healed tissues become weak. Even small movements can then lead to re-injury and to a chronic back problem and eventually degeneration. Just as your teeth need to be brushed daily to keep it in top notch, your spine also requires its maintenance. A large number of spinal problems I see in practice could have been prevented with proper treatment immediately after the initial injury.

Protect yourself from strain and disability by following the simple tips.
LISTEN TO YOUR BACK
Pain is a warning sign. Your body is telling you that you have already or are about to cause damage. If what you are doing hurts then STOP. Do not try to push through the pain.

EXERCISE
Regular exercise is important to help maintain mobility and strength. It should be done without pain and it should be done regularly. Brisk walking, swimming and cycling are all excellent exercises, but you should do what is suitable for you and what you enjoy.

WARM UP
You should warm up your body before any form of physical activity, whether it is nursing, sports or gardening. This prepares the body for action and helps to prevent injuries.

COOL DOWN
Cooling down and stretching after exercise or physical activity is just as important as a warm up. Never "bounce" your stretches and do it gently without pain.

LIFT CORRECTLY
You don't have to lift something heavy in order to hurt your back. Picking up something light incorrectly is far more likely to hurt your back than picking up heavy objects correctly. Lifting things away from your body is also likely to cause damage. When you pick up anything, no matter how heavy, get it as close to your body as you can and keep your back as straight as you can and don't twist with it.

MOVE NOW AND THEN
Whether you are at home, at work or in the car, prolonged sitting causes load on the discs and weakness of the muscles. Get up and move every now and then, even if it is only for a minute. The body is designed for movement not for slouching in front of the TV or driving for hours on end.

GET THE RIGHT FURNITURE
So called "comfortable chairs" do not do your back any good. They are usually too low, too soft and the seat is too long with a rounded back. They force you to slouch and sit awkwardly which puts stress on your back. Choose a chair that is supportive, allows you to sit up correctly with your feet flat on the floor. The right bed is also important. Beds can be too hard. The base of the bed should be firm and the mattress should be soft enough to mould to the contours of your body but be firm enough to give you support in the right places. Futons are not good for most backs and the word "Orthopaedic" when applied to beds means absolutely nothing.

SLEEP PROPERLY
Sleep in a comfortable position. On your side in the "foetal" position is usually the least stressful on your back. Sleeping on your front puts most stress on your back and neck and can lead to trouble. Using a pillow of the right height which supports the neck is also important.

USE MEDICATION WISELY
All drugs have side effects so they should be used wisely. The use of pain killers (paracetamol, cocodomol etc.) and non steroidal anti-inflammatory drugs (nurofen, brufen, diclofenac etc.) only helps to mask the symptoms and not to sort out the problem.

CONSULT YOUR CHIROPRACTOR
If you have a long term problem, whether it is just "niggly" or disabling, or if you have a recurring problem, then chiropractic treatment can probably help. Chiropractors can usually give you marked relief from pain and discomfort and improved quality of life as well as decreasing the likelihood of a recurrence.

Being a nurse is a rewarding and life changing role, but it also has its physical stresses. For a nurse to be successful in being a caregiver it is essential that you take care to the most important person in the world… YOU! For it is only when we are healthy, happy and pain free are we as health professionals able to better serve our patients.

Vitamin D May Improve Survival in Colon Cancer Patients

In this study involving 304 subjects diagnosed with colon cancer, those whose blood levels of vitamin D were in the top 25% were twice as likely to survive as those in the lowest 25%.

The authors conclude, "Among patients with colorectal cancer, higher prediagnosis plasma 25(OH)D levels were associated with a significant improvement in overall survival. Further study of the vitamin D pathway and its influence on colorectal carcinogenesis and cancer progression is warranted."

With cancer treatments being toxic and costing hundreds of thousands of dollars, and vitamin D being safe and cheap, I recommend people with cancer take 4,000 units of vitamin D a day now, instead of waiting 20 years for these studies to be done!

References

"Circulating 25-hydroxyvitamin d levels and survival in patients with colorectal cancer," Ng K, Meyerhardt JA, et al, J Clin Oncol, 2008; 26(18): 2984-91

Colon Cancer Recurrence Reduced with Flavonoids

In this study of 87 patients (36 with resected colon cancer and 51 after polypectomy), 31 were supplemented with flavonoids and the other 56 were not treated. The flavonoid mixture consisted of 20 mg/d apigenin and 20 mg/d epigallocatechin-gallat. Subjects were observed for 3-4 years. Among the patients with resected colon cancer, those treated with flavonoids (n=14) had zero cases of recurrence of cancer and only one adenoma, compared with a 20% recurrence rate of cancer and a 27% adenoma development rate among controls. These results suggest that long term supplementation with flavonoids may dramatically reduce the rate of colon cancer recurrence—even in those with resected colon cancer.

References

"Prospective cohort comparison of flavonoid treatment in patients with resected colorectal cancer to prevent recurrence," Hoensch H, Kirch W, et al, World J Gastroenterol, 2008; 14(14): 2187-93.

Vitamin B6 May Decrease Colon Cancer Risk

A Scottish study of almost 5,000 people suggests that an increased intake of vitamin B6 from diet and supplements may reduce the risk of colorectal cancer by 19%.

There are ~ 945,000 new cases of colorectal cancer every year. The new case-control study involved 2,028 hospital-based colorectal cancer (CRC) patients and 2,722 population-based controls. The lead author, Evropi Theodoratou, noted that "Moderately strong inverse and dose-dependent associations in the whole sample were found between CRC risk and the intake of dietary and total vitamin B6." He also noted that this result has been supported by other studies as well.

Other nutrients are also important. Writing in the Journal of Nutrition (Vol. 137, pp. 2701-2708), Tufts researchers found that moderate deficiency of folate, riboflavin, and vitamins B6 and B12 together may also promote the risk of DNA damage and increase the risk of colorectal cancers. In addition, other studies have suggested that folate deficiency alone may promote the risk of colorectal cancer.

I find that the best effect is obtained by getting all of the B vitamins in a balanced formula (such as the Energy Revitalization System vitamin powder), as this supplies them to the body in a balanced manner. High doses of the individual nutrients alone may cause more harm than good.

Source:

E. Theodoratou, S.M. Farrington, A. Tenesa, G. McNeill, R. Cetnarskyj, R.A. Barnetson, M.E. Porteous, M.G. Dunlop, H. Campbell. Dietary Vitamin B6 Intake and the Risk of Colorectal Cancer. Cancer Epidemiology Biomarkers & Prevention. 1st January 2008, Volume 17, Pages 171-182, doi: 10.1158/1055-9965.EPI-07-0621

Antioxidant Supplementation May Reduce the Side Effects of Chemotherapy

In a thorough review of randomized studies evaluating the effects of taking antioxidants with chemotherapy, antioxidant supplementation was found to reduce the toxic effects of chemotherapy. The researchers reviewed 33 studies (which included 2,446 subjects). Twenty-four showed that taking the antioxidants decreased the toxic side effects of chemotherapy.

Antioxidants used in the studies included: glutathione, melatonin, vitamin A, N-acetylcysteine, vitamin E, selenium, L-carnitine, coenzyme Q10, and ellagic acid. Five of the studies found that subjects taking antioxidants were able to complete more full doses of chemotherapy, The authors conclude, "This review provides the first systematically reviewed evidence that antioxidant supplementation during chemotherapy holds potential for reducing dose-limiting toxicities. However, well-designed studies evaluating larger populations of patients given specific antioxidants defined by dose and schedule relative to chemotherapy are warranted."

While these studies are being done, I encourage my cancer patients to get solid overall nutritional support with the Energy Revitalization System vitamin powder. I also like to augment immune function and recommend the immune boosting supplement ProBoost 1 packet 3x day for 3 months (and then may decrease to once daily) for those with cancer. I then add other nutrients based on the specific cancer type.

As part of the ongoing attempt to discourage natural supplements, some physicians have been told that anti-oxidants may decrease the effectiveness of some chemo and radiation therapies (that kill cancer through oxidation). My reading of the science over the years suggests that people who supplement live longer. A simple compromise. I leave off the supplements for a week before and after treatments if the oncologist voices a concern. I have found that trying to starve you to starve and kill the cancer cells is a losing proposition in the long term. People do best when their own defenses are kept strong, so they can remove the cancer while working along side with the prescription medical treatments.

References

"Impact of antioxidant supplementation on chemotherapeutic toxicity: A systematic review of the evidence from randomized controlled trials," Block KI, Koch AC, et al, Int J Cancer, 2008; 123(6): 1227-1239.

Testosterone Blocking Medication NOT Helpful for Early Prostate Cancer

Prostate cancer therapy that lowers testosterone levels does not improve survival in elderly men with early-stage prostate cancer, compared with conservative management, US researchers have found.

"For the majority of men with incident prostate cancer, disease is diagnosed at localized (T1-T2) stages, and standard treatment options include surgery, radiation, or conservative management (i.e., deferral of treatment until necessitated by disease signs or symptoms)," explain Dr. Siu-Long Yao, from Robert Wood Johnson Medical School in New Brunswick, New Jersey, and colleagues.

However, they add: "Despite a lack of data, increasing numbers of patients are receiving primary androgen deprivation therapy as an alternative to surgery, radiation, or conservative management for the treatment of localised prostate cancer."

The researchers studied data on 19,271 men over 66 years old who were diagnosed with localized prostate cancer between 1992 and 2002 and who received either androgen deprivation therapy (7,867) or conservative management (11,404). By December 2006, 1,560 of the men had died from prostate cancer.

Men who received androgen deprivation therapy were 17% more likely to die of prostate cancer during the monitoring period than those who received conservative management.

Men who received androgen deprivation therapy were also just as likely to die of other causes as those who received conservative management.

"Primary androgen deprivation therapy is not associated with improved survival among the majority of elderly men with localized prostate cancer when compared with conservative management," Dr. Yao and team conclude.

They add: "The significant adverse effects and costs associated with primary androgen deprivation therapy, along with our finding of a lack of overall survival benefit, suggest that clinicians should carefully consider the rationale for initiating primary androgen deprivation therapy in elderly patients with T1-T2 prostate cancer."

References

JAMA 2008; 300: 173-181. Click here to read full article.

Curcumin (Turmeric) May Slow Advanced Pancreatic Cancer

In a phase II study involving 21 patients with advanced pancreatic cancer, patients were given 8 gm/day of curcumin (turmeric). The Curcumin showed significant benefit in 2/21 patients with one patient maintaining a stable disease state for more than 18 months, and another patient had a brief, but marked, significant regression of the tumor (73%), along with significant increases in (from 4 to 35-fold increases) serum cytokine (immune function) levels. Many other blood test markers also improved.

Currently, there are currently only 2 FDA approved drugs for the treatment of patients with advanced pancreatic cancer, and both of those drugs (gemcitabine and erlotinib) are only effective in less than 10% of patients, making the Curcumin's effectiveness similar to the chemo agents. A critical point to know about curcumin is that it is very poorly absorbed (blood levels were very low, peaking at 22 to 41 ng/mL). The good news is that the absorption of Curcumin can be markedly increased by taking black pepper with it (the piperine in pepper enhances the absorption). Alternatively, curcumin products are available that have been shown to be better absorbed. For example, Curcugel (available online at many shops) was found in 1 study to be absorbed 8 times as well as plain curcumin. I would take 4-8 capsules of the Curcugel or 2 teaspoons of curcumin daily with ~ 1/8 teaspoon of black pepper added (for recipe ideas on how to take the curcumin, see Ideas For Dissolving Curcumin).

Although the curcumin may help, if I had pancreatic cancer I would use the protocol developed by Dr. Nick Gonzalez, and fly to New York to see him for an appointment. Click here to visit his website.

References

"Phase II Trial of Curcumin in Patients with Advanced Pancreatic Cancer," Dhillon N, Aggarwal BB, et al, Clin Cancer Res, 2008; 14(14): 4491-4499

Breast Cancer and Iodine Deficiency

Iodine is critical for breast tissue function and has been shown to be lower in cancerous breast tissue of women with breast cancer.1 I suspect that iodine deficiency is a significant contributor to breast cancer, and after we complete our study of Natural Treatments for Infertility the next study planned by our foundation is to add high dose Iodine (Iodoral—a mix of Iodide and Iodine with 12,500 mcg/tablet) to the treatment of women with breast cancer. In the interim, I strongly encourage the use of Iodoral 1 tablet a day (or more if under a physician's supervision) for all women with breast cancer (along with CoEnzyme Q10 at 200-400 mg a day).

I also strongly encourage those with breast cancer or breast cysts to read an excellent book called, simply, "Iodine" by Dr. David Brownstein (available at Dr. Brownstein's website).

References

Kilbane MT , et al. Tissue iodine Content and serum mediated Iodine uptake blocking activity in Breast cancer. J Clin Endo and Metab 85: 1245-1250, 2000.