My Plan For Health

From Shelly Dembe's Web site, A Healthier Balance

Happy Thanksgiving, everyone!

This blog has given me a lot to be thankful for. I’ve learned that I can make changes in my life at age 39 that make me feel better and help me enjoy life more. I’ve discovered that there are many resources at Ohio State to help me accomplish my goals.  I’ve had the chance to write about health and fitness for the first time in years. And I’ve enjoyed the support of so many people across campus — including those who notice when I don’t post updates for a while. For that I am thankful indeed!

But this year, the thing that I am most thankful for is dancing.

I’ve been studying belly dance at Habeeba’s in Grandview, and yoga dance at Ohio State through Lunch & Learn. The classes are very different — Habeeba’s technique is very controlled, while yoga dance is about moving however your spirit takes you.

Habeeba's dancers at the Upper Arlington Labor Day Arts Festival 2009

Yoga dance teacher Shelly Dembe, RN, tells us to “move like no one is watching.” There is just something about Shelly. She can get a roomful of self-conscious people to open up and dance as if we’ve been doing so all our lives. Her class is the most fun I’ve had since kindergarten.

“Think about how you felt when you got here,” she said to me after class, “and how you feel now. That’s what it’s all about.” She’s right — I always arrive tense from the office, and leave relaxed and buoyant.

Belly dancing has been a different experience. The class has been difficult, and I must have quit and unquit dozens of times early on. Now I love it and can’t imagine not doing it.

Me dancing on stage after the show. It's the shades that make the look.

I worked backstage at a Habeeba’s performance at the Upper Arlington Labor Day Arts Festival, and one of my teachers even pulled me onto the stage afterwards. More recently, after we’d just finished learning a new move in class, teacher Sharon Buhrts got me to think about how far I’ve come. “When you got here, you were afraid to move your arms,” she said, “and now look at you!”

I turned to Susan Van Pelt Petry, professor and chair of the Department of Dance at Ohio State, for an academic perspective on all this fun I’ve been having. The following text is from our email Q&A.

Enjoy, everyone, and have a healthy and happy Thanksgiving. Dance with those you love — to burn some holiday calories, and let your spirit soar.

PFG: Do you have any advice for people who are pursuing dance for fitness, such as myself?

Susan Van Pelt Petry

SVPP: Find a teacher who has some dance credentials - either a degree in dance, professional experience, membership in a professional dance organization, etc. Notice if the teacher communicates instruction about movement with clarity and anatomical awareness. They should be able to address things such as how to protect knee joints, how to develop core strength so the back is not at risk of injury, and how to pace a class for appropriate levels of muscle fatigue, stamina building, warmth, and flexibility.

A dance class should have an aesthetic component – it is an art form and one of the reasons it can be an attractive way to “exercise” is that it has that very quality of the mind that makes moving a pleasurable, engaging activity, and not just something to check off your list. Seek an experience where you feel the quality of your body and moving changes, where there are sensations of lightness, resistance, speed, etc. and not just the making of exterior “shape.”

PFG: I am taking two dance classes right now — belly dancing and yoga dance. The form of belly dance I’m studying is Habeeba’s, which is largely based on ballet, and thus very structured and controlled (and up on our toes!). The yoga dance is unstructured, freeform. I enjoy both very much! Can you tell me — what different benefits might I gain from the structured dance versus the unstructured?

SVPP: More structured classes teach dance “vocabulary” and instruct in the building blocks of a style. Often the style will have a cultural or historical context and that can be a very interesting and satisfying experience. In a more structured class one might be able to assess one’s progress quite clearly, as skills get added as you progress through movement sequences. In a less structured class, such as an improvisation group, or some forms of modern dance, or hybrid styles such as “yoga dance,” you have the advantage of learning more perhaps about yourself and you learn how to observe your movement from inside and not from outside instruction. In a less structured class there is often a higher degree of creativity, and that can be very fun. There might be less physical rigor as it is more self-driven.

PFG: Dancing is uplifting, psychologically. For instance, I’m more confident and I don’t mind wearing more revealing clothing (especially while I’m belly dancing — it helps me see my moves in the mirror, right?). The yoga dance is uplifting because it’s just wild and crazy and fun. Would you have any comment about how dance has been uplifting for you personally? Do you find that many people (dilettantes such as myself) get this kind of emotional boost from dancing?

SVPP: Absolutely! Very uplifting. Dancers even joke they get addicted to it…. And there are studies that show there is real brain chemistry that changes as exercise, music, and expression conjoin for powerful rise of seratonin levels. I am at my desk a lot more these days, and I do feel fundamentally somewhat diminished without dancing as much as I used to.

…And that’s not necessarily a bad thing.

Today’s TIME.com Wellness blog details a study on the placebo effect. Researchers may have pinpointed the parts of the brain that cause people who are sick or in pain to feel better, even when they are given a sham treatment.

Personally, I’m a big believer in what I call the “anti-placebo” effect: when I’m so certain that a treatment is a sham that it won’t work on me, no matter what! I refuse to get better!

The TIME story got me to thinking about alternative medicine, and why some people feel relief of symptoms such as pain when using alternative treatments which have proven to be no more effective than placebo in clinical trials.

I’ve been meaning to share a study on acupuncture that Noel Cressie forwarded to me, and this post gives me the perfect opportunity, since the acupuncture study says something about the placebo effect.

Here is the WebMD story he forwarded. A study found that real acupuncture (the study treatment) was no better than simulated acupuncture with a toothpick (the placebo) at treating back pain. The shocker: people who supplemented their normal back pain treatment with either kind of acupuncture (real or fake) were more likely to feel better.

That is, 40 percent of people who took pain medication and did physical therapy felt better, and 60 percent of people who supplemented their pain meds and physical therapy with real or fake acupuncture felt better.

An important point: Everybody in the study received the basic standard of care for back injury, which includes pain medication and physical therapy. The way the WebMD article is written — with the sub-headline “Acupuncture Trumps Standard Care for Back Pain Relief” — suggests that acupuncture alone caused 60 percent of people to feel better, when this is not the case. Rather, adding acupuncture to the standard level of care boosted the success of treatment by 20 percent.

You can find the researchers’ original journal article here, and a related paper which explains the treatment in detail here.

The researchers speculated that perhaps the acupuncture made people feel better because of the placebo effect. People seem to feel better just knowing that they’re doing something that might treat a symptom. And let’s face it, when the symptom is pain, people can be very flexible in what they are willing to do to make it go away — me included.

I have used meditation to control pain.

How can I tout an alternative treatment, you may ask, when I am a woman of science?

Well, yes, I am a very analytical person. And, yes, I’m always going on about “peer reviewed” this and “randomized clinical trial” that. But I am not opposed to some health practices that would normally be considered alternative, such as meditation, when they are used properly in addition to standard medical care.

I am not opposed to these alternative treatments because I am absolutely certain that in those cases where they have positive effects, medical science will someday reveal the reason, and there is nothing mystical about why they work.

For instance, I look at meditation as just another way to train my brain.

When I underwent surgery to repair a broken foot two years ago, I downloaded this CD from iTunes. I listened to it every night as I fell asleep in the weeks prior to surgery. The idea was to think positive thoughts that would put me in the right state of mind to let my body heal itself efficiently.

After the surgery, I wanted to avoid taking narcotics because they give me migraines. When I went home, I did not take my pain meds.

As you may imagine, I woke up the next morning in what was probably the worst pain of my life. You can bet I reached for my meds then! But I remembered what the surgeon had told me: once people start to feel pain, it takes a long time to shut the pain off, regardless of taking medication. He predicted that if I avoided taking my meds, they wouldn’t take effect for a couple of hours after I finally took them.

I needed a distraction — any distraction! — until those meds kicked in. So I played my CD. The familiar words and music drew me in, and by the time those 40-odd minutes were up, I realized that I was in a lot less pain.

Did the CD lessen my pain because it distracted me? Or because I desperately hoped that it would work?

You know what? I don’t care. But I know researchers are working on it.

After attending the Lunch & Learn program “Knowing Your Medicines: How to Be an Effective Consumer,” I am both amazed at the number of medications available on the OSU health plan, and glad that there are pharmacists on staff to help us understand them all.

Amanda Bain, a pharmacist with OSU Managed Healthcare Systems, talked us through the prescription benefit plan. She pointed to an online formulary which lists all the drugs that are covered.

Most importantly, she listed some questions every patient should ask his or her doctor when taking a new drug.  Obviously, we need to know how often to take a drug, but Bain said that we should also ask what time of day to take it, and then ask why.

She gave the example of a patient who was taking a drug that caused her to take frequent bathroom breaks at work. Her doctor had told her to take the drug every morning, because he assumed that she wouldn’t want to wake up at night to go to the bathroom, but the patient didn’t know that. By talking to her pharmacist, the patient discovered that she could choose to take the drug at night, in order to avoid interruptions at work.

I asked Bain something I’ve always wanted to know, which is what to do when I miss a dose of a daily medication. How many hours have to pass before I should just decide to wait until the next day to take my normal dose? She said that, in most cases, if you remember to take the drug within 12 hours, to go ahead and take it. But it’s best to call the pharmacy or Express Scripts if you have any doubts.

I also asked about pain medication. Since I exercise nearly every day, I also find myself taking over-the-counter pain meds nearly every day. Bain said that if I am taking meds that often I should probably talk to my doctor about it. She also wondered if I was overdoing my exercise routine, and I’m pretty sure I’m not — the good folks at the Faculty and Staff Fitness Program have me covered.

A belly dancing class. Photo by Meredith James, via Flickr

Some of you have been asking how belly dancing is going. I am four weeks into an eight-week program at Habeeba’s, and I have to say that belly dancing is really hard. Harder, even, than I thought it would be, and I tried to keep my expectations in check.

On the first night, I learned that the rest position for belly dancing is basically a squat. You stand there, knees slightly bent, and your pelvis tilted outward just a little, so that your back is straight. Standing like that for an hour is really tiring.

Just hours after my first class, my legs started to ache. The aching got worse the next day, when it felt like my legs were going to fall off. Just walking was hard!

Photo by Meredith James, via Flickr

It amazes me how, every time I start a new activity, my muscles find a new way to hurt. But I guess that’s the point of pursuing many different forms of exercise. Muscles that aren’t often used grow stronger.

The instructors gave us a hand-out with exercises to do in-between classes (we only meet once a week) and I think those exercises are helping — I am not so sore after class now.

I do, however, feel a great deal of frustration during class, when I can’t seem to get a particular move right. This is the first dance class that I’ve taken in my entire life, and I found that it’s just like what I’ve seen in the movies or on TV. The instructor shows you a move. Then you do the move. Then you do it again. And again. And again. And again and again and again and again. And then you do it again. And then the instructor says, “Hey, that last time was better!”

Last week, we started using finger cymbals, or zills. They are way cool and lots of fun to play with. Their purpose is to accent the moves you are doing, so that you strike them together in time with the dance. But I discovered that dancing and playing the zills at the same time is beyond me, at least for right now. Habeeba’s gave us some sheet music so we could practice at home.

My zills and sheet music

This week, New York Times science writer Tara Parker Pope announced that she is going to keep a decades-long promise to herself, and run the New York City Marathon. As a former runner who is trying to get back into the sport, she’s worried about injuries. The lessons that she’s learning along the way are valuable for anyone who’s starting an exercise routine.

Her Tuesday post offered some words of advice from Olympian and marathon trainer Jeff Galloway:

The key to injury prevention is to start slow and continue to take frequent walk breaks during the weeks of training and the marathon itself… The first step for any new runner, he says, is to just get out there two or three days a week for about 30 minutes. Don’t try to run the whole time — that’s how new runners get injured. Decide what run-walk combination works for you.

But for me, the words that resonated the most came from Olympian and marathoner Kara Goucher in yesterday’s post:

Q: What can someone planning to run a first marathon learn from an elite runner like you?
A: I’m going to train at a different level than an average runner because I have the time to and the resources to, and that’s my job. But I can relate to your average runner absolutely. You just have to scale everything and put it in perspective of what you’re trying to accomplish. You’re asking a lot of your body no matter how fast or far you’re going. Running is something that hurts. It’s a wonderful thing. It’s a gift in my life. But it’s painful, and it hurts and takes a lot of time. Have patience. Stick with it and don’t expect results overnight.

Since I broke a foot while jogging two years ago, I’ve been terrified of it happening again. I do not jog, and the hardest surface I will walk on for exercise is blacktop. I wear cushy shoes and cushy socks and tape up my feet and — for the most part — stick to the elliptical machine. But there are other things I can do to avoid injury, as Galloway suggests:

Q: One of the big worries of new runners is getting injured. How do you deal with injury concerns?
A: I’ve had lots of injuries, stress fractures, shin splints, compartment syndrome, I banged up my knee. I know what it’s like to be hurt. In my running I’ve incorporated a lot more weight lifting and drills that give my body overall more athleticism. I think that helps prevent injuries. If you only have 30 minutes to work out, sometimes it’s more important to run 20 minutes and take 10 minutes to stretch and do weights and build your overall athleticism. I think that will keep you healthy.

This is very similar to the advice that my trainers have been giving me in the Faculty and Staff Fitness Program. To balance out my fitness routine, I’ve scaled back some calorie-burning activities to make room for ones that build muscle, flexibility, and endurance.

Forgive me if my blog seems a little off today. I’m having trouble reading my computer screen. The text seems jagged and jumpy. I’m also groggy and feeling a lot of sinus pressure.

Yesterday, I had a migraine. Still feeling the after effects.

I could blame it on some absolutely delicious smoked turkey that I bought at the North Market on Saturday. But he culprit could also have been the red wine I drank with dinner, or the storm front that came in over the weekend.

More likely, it was a combination of all three. That’s what I learned at the Lunch & Learn program on Diet and Migraine offered by Michal Hogan, registered dietitian at Nutrition Results.

Researchers have studied diet and migraine for decades, but such studies are very difficult to do. There are many possible food triggers, and sometimes it’s not one food but the cumulative effects of several foods eaten within a certain time frame that triggers the migraine.

Hogan presented a detailed lecture on diet and migraine, including a survey of the scientific literature (email me if you’d like to see the references). Food is only one cause of migraines — other causes include weather changes and stress. In one study, eliminating trigger foods helped 2/3 of migraine sufferers.

Image from Nutritionresults.com

Migraines are caused by inflammation, which is the body’s  immune response to injury or invading pathogens. While scientists are still unsure how this happens in a migraine, some people’s immune systems appear to be irritated by certain foods, and the immune response causes inflammation of the blood vessels around the brain.

Hogan recommends mediator release testing (MRT) — a blood test that measures how a person’s white blood cells and platelets respond to 120 staple foods and chemicals. The patient then removes trigger foods from his or her diet, and gradually re-introduces foods one at a time to make the diet as inclusive as possible.

WebMD offers an extensive list of foods that are known to trigger migraines. Armed with this information, some people can try to remove foods from their diet without seeking medical help. But with so many foods on the list (and allowing for the possibility of interactions between them), it would be very hard for a person to guess the right combination of foods to remove from their diet. “Guessing right would be like winning the lottery,” Hogan said.

One snag: this therapy is not completely covered by the university medical plan. The office visit is covered, but the MRT test itself is only discounted. Hogan said the situation is similar to the university vision plan, where visits to the eye doctor are covered but glasses are not completely covered.

Maybe that situation will change, as researchers learn more about the link between diet and migraine. The costs to society are already substantial. Hogan cited a 2006 study that found that migraines cost U.S. employers $24 billion annually — $12 billion in direct costs such as medicines and emergency room visits, and another $12 billion in lost worker productivity.

I mentioned when I drew up my vision board that one of my health goals is to better understand what causes migraines, and learn how to prevent them.

The Faculty and Staff Wellness Program is offering a Lunch & Learn event on diet and migraines on May 14. I signed up, and I see from the Web site that spots are still available.

Nobody knows the exact cause of migraines, but certain foods appear to trigger migraines in some people. So I would like to learn more about the clinical research in this area and how I can prevent my own migraines.

Here’s the event description:

DIET AND MIGRAINE - Is Your Food Making You Sick? 12:00 Noon - 1:00 P.M.

Date: Thursday, May 14, 2009

Location: Research Foundation, 1960 Kenny Road, Room: 113

Details: Inflammation is part of the body’s defense against microbial invasion, but what if your body thinks food is the enemy? New advances in technology shed light on painful conditions previously thought to be merely functional or psychological. Explore new therapies pinpointing these enigmatic triggers of migraine symptoms.

Instructor: Michal Hogan, RD,LD,CLT, Nutrition Results

Here’s what I know from talking to my doctor: migraine pain is caused by inflammation of the tissues surrounding the brain. The inflammation is caused by blood vessels dilating. This is the opposite of a tension headache, in which the blood vessels constrict. Migraines also bring symptoms that tension headaches do not, such as nausea and sensitivity to light and sound. People often see little flashes of light, called auras, just before a migraine starts.

I’ve suffered migraines since I was a teenager. When one’s about to strike, I do see auras — they look like little flashes of lightning out of the corner of my eye — but I also smell a certain smell. It’s a very strong, sweet smell — sort of like a cross between burnt sugar and gasoline — and it comes in little bursts, like the lightning.

As much as I hate migraines, I think it’s sort of neat that my brain produces these sensory hallucinations in response to blood vessel behavior. And in a way, I’m lucky that I get these little warning signs — it’s my brain’s way of saying “Medicate — NOW.”

While I can often pre-empt migraines by taking an anti-inflammatory drug such as ibuprofen before the pain starts, that doesn’t always work. So my doctor gave me a prescription for a vasoconstrictor. This is a drug that forces my blood vessels to constrict, thus shutting off the migraine. At least, that’s what it feels like. I feel a flush, and then the throbbing in my head just stops.

Not everybody can take this kind of drug, though. People with high blood pressure, for example, can’t take a vasoconstrictor. There are other migraine drugs that work in different ways. So, as the commercials say, talk to your doctor.

I was actually afraid to ask my doctor for migraine medication. I thought she might suspect me of fishing for narcotics. But today’s migraine drugs aren’t painkillers — they work by other means, like my vasoconstrictor.

While I’m glad to have pharmaceutical science on my side, I would still like to prevent migraines from happening altogether. If I can make small dietary changes that help, well, I’m all for it.

Sign up for Lunch & Learn here.

WebMD also has an excellent Web site all about migraines.