BMI......BM "Why?"

Last night we had a couple of friends over for some pizza and beers.  At one point, one of them returned to the table after using the bathroom.

"You guys have a scale?  I haven't seen one of those in a while!"

It was a good point.  We've had a bathroom scale lying on the floor for as long as I can remember, but I'm not so sure why.  Sure, it provides us instant feedback about how much we weigh any time we step aboard.  But in terms of providing a good measure of health, does it really matter?

My neighbor's comment lead to a brief discussion about the current measure of healthy body weight as it relates to height, and that's Body Mass Index (BMI).  This number uses two measures, height and weight, to compute your number.  That's it.  However, there are plenty of people walking around who are "skinny" and unhealthy, and many who would "fail" the BMI test but who are pictures of good health by all other measures.

For 10 straight years, I was required to have an annual physical while I worked at the New York City Department of Education.  Each year, I was given a thorough work-up, followed by a brief 5 minutes chat in my doctor's office to discuss results.  Every year, I'd hear the same warning:

"You are borderline overweight.  Something you should keep your eye on."

Finally, after years of the same speech, I said, "Look, my weight has been the same every year I've come to you, within 3-4 pounds.  In fact, I've been the same weight since college.  I honestly don't feel like I have to worry about a weight problem."

His response was, "I know, but the insurance companies like to use this straight forward measure to help determine outcomes."

What's my point?  Get comfortable questioning your health care providers.  It was always funny to me to hear anti-universal health care coverage folks decry, "I don't want anyone coming between my doctor and me!"  Well, unless you pay your doctor in cash (meaning you don't have private insurance), there has always been a hidden third party involved.  And that third party has a major financial incentive at stake that may be influencing decisions made in the office or clinic.

If insurance companies like tidy numbers like BMI, it should make you question things.  By this standard of health, your average NFL running back (5"11 and 215 lbs.) would have a BMI of 30.0.  That puts these athletes in the "obese" category.  Does this make sense?

Piggybacking on my last post, the take-home message is this:  be your own biggest advocate.  Don't accept your health care interventions at face value.  I'm not suggesting that you should tie yourself into a knot by becoming an online MD.  Rather, don't be afraid to ask, "Why?"  You may be surprised at the answers.

When It Comes to Pain, Be Your Own Strongest Advocate

I've heard of several incidences recently whereby a patient was given either injections or medication for their pain.  I assume most folks are looking for a "quick fix" to their physical ailments, which is understandable.  And we know that modern medicine and the pharmacological industry are all too ready to accommodate them.  However, this might not be the best long-term approach to treatment.

Take a look at this article from the New York Times Magazine:

http://well.blogs.nytimes.com/2013/07/18/looking-for-alternatives-for-back-pain-relief/?smid=pl-share

I am not saying that all medicine should be shunned when it comes to pain.  I AM saying that you should not just accept that as the first and only solution without question.  The alarming thing to me is when I hear that people are receiving medicinal treatments without having been properly evaluated first!  At the end of the day, neither imaging (x-rays and MRIs) nor medicine should trump a good old-fashioned subjective and objective evaluation.

So, if you are planning on seeing your doctor for a consultation, be sure that he or she thoroughly reviews your history, habits, subjective complaints, etc.  Then, be sure that you are assessed by a comprehensive physical examination that involves movements (active and passive), palpation (hands-on), and even functional tasks.  This is a time-honored standard that should not take a back seat to the fancy "bells and whistles" that modern medicine has to offer.

Health care is not cheap.  Neither is your time and effort to make an appointment and be seen.  Make sure you are getting what you deserve.  Be informed and be your own strongest advocate.

Neck Pain? Check Your Shoulders and Breathing

While listening to a teleseminar with the great Shirley Sahrmann and Gray Cook on my run this morning, I hear this quote:

"Don't let your shoulders destroy your neck."

What does that mean, you may ask?  Remember the old song, "The hand bone's connected to the arm bone, the arm bone's connected to the shoulder bone, etc."?  Well, it turns out that this is true.  If you find yourself in pain somewhere in your body, don't jump to the conclusion that the site and source are one and the same.

Back to the neck and shoulder.  There are some important muscles that help move the shoulder blades (scapulae) called the levator scapulae and the upper trapezii.  One end of their attachments (origins) are on various parts of the cervical (upper) spine.  So, if you are having neck issues and find it painful to rotate your head into various positions, try these simple steps to see if you can find some relief.  First, rotate your head from side to side and forward and backward in standing to find your range of motion capacity.  Then, try sitting in a chair with armrests and prop your forearms on them.  You are essentially "unweighting" your shoulders in this position.  Now, retest your head movements to see if you notice any improvement.  You can also take the shoulders out of play by lying on your back and assessing your rotation.  Gravity won't be tugging at your shoulders in this supine position.

If you notice an improvement in your available pain-free range of motion with your shoulders "out of the way" so to speak, next check your breathing patterns.  One of the reasons that those aforementioned muscles may be contributing to your neck pain is if they are working overtime to assist with your breathing.  Healthy breathing patterns, as I've written about in the past, involve the diaphragm, and shouldn't rely on these accessory muscles of respiration.  If you find that you're someone who holds their stress and tension in your upper back and shoulders, there's a good chance your breathing is out of whack.

So, next time you experience a problem with your neck, look further away from the site of your discomfort.  You may be surprised to learn what's actually driving your pain in the first place.