Text Neck: The Hidden Epidemic We Shouldn’t Ignore
Everyone’s heard the mantra of the “core,” defined as the lower back, hips, pelvis, and stomach. We all know the core is essential for movement and athletic performance.
But what about the north core?
Never heard of it? I’m not surprised.
What I define as the “north core” is the group of muscles surrounding your neck. Unfortunately, the neck is the forgotten part of the spine.
In my opinion, we focus too much on the main core — that anatomy is extremely solid. We really haven’t focused on the ergonomics and protection of the north core, even though those muscles give the neck strength and flexibility.
The seven cervical vertebrae are tiny, and we aren’t conscious of the surrounding muscles... that is, until the pain of text neck starts.
The Neglect of the North Core
Neglecting the neck can lead to a domino effect of symptoms in our musculoskeletal system.
When we ask our muscles to perform tasks they simply can’t do, they become stretched and inflamed. They spasm. As they spasm and contract, they create tension in adjacent muscle groups.
What starts as overuse of a small group of paraspinal cervical muscles turns into trapezius spasms, shoulder pain, and headaches. And it’s all driven by overuse of these little muscles.
To prevent a pain syndrome cascade, we need to better protect and be conscious of our cervical muscles.
Let’s Talk About Text Neck
There’s an epidemic of neck pain, and the driver is poor ergonomics and how we interact with screens — particularly handheld devices like phones. The condition is called text neck, and recent studies show astounding results.
The average human head weighs 10–12 pounds. As you tilt your head forward, you increase the force applied to the base of your neck.
As you can see in the graphic, even slight increases in tilt angle drastically increase the amount of force transmitted to your neck. By the time your head is tilted to a 45-degree angle, the force on your neck has increased fivefold!
Heavy is the head that stares at the phone.
Imagine the effect of this amount of sustained pressure over hours every day. Voilà — text neck!
What if We Ignore Text Neck?
Who doesn’t have neck pain?
My best friend once asked me to refer him to a good acupuncturist because his neck was killing him. I told him I’d refer him to a good acupuncturist if he promised to stop resting his laptop on his chest while he used it in bed.
Don’t put a Band-Aid on a bullet hole. There’s no reason to provide a small, momentarily effective treatment if you don’t do anything to address the root cause of the problem.
As I mentioned earlier, the issue with neglecting your north core is the domino effect it can cause throughout your musculoskeletal system. Overuse leads to stretching and inflammation, which leads to spasms, which leads to pain in the neck, which migrates to the shoulders and back and causes headaches.
Simply put, it’s not just about neck pain.
Stop Blaming Your Pillow for Text Neck
Often, patients ask me what the best pillow is for neck pain. When I ask why, they tell me they wake up every morning with terrible neck pain and insist it must be their pillow.
Let me assure you — it’s not your pillow’s fault.
The mechanism for generating the pain you woke up with is the muscle you overused the day before, the inflammatory process that set up overnight, and the spasm you woke up with. Just because you woke up in pain on your pillow doesn’t make it your pillow’s fault.
What We Can Do About Text Neck
First, we must be aware that text neck syndrome is real and common. The signs are frequent neck pain, headaches, shoulder pain, and pain anywhere from the top of your head to your armpit. The problem is widespread, and we need to address it.
Amazingly, there’s an app for that!
Some brilliant people have found a way to use a smartphone’s motion sensor to determine the angle at which the phone is being held. The app alerts the user with a red light when the angle of view is too severe.
Using tools like this can significantly improve your posture during device use and reduce your risk of developing text neck. Taking advantage of voice-to-text functions and voice assistants like Siri and Alexa more often can also help.
Finally, you can improve your range of motion and alleviate pain by stretching regularly. Since pain is caused by muscle spasms and tightness, stretching those muscles can help reduce pain and prevent further damage.
Today’s Takeaways
- Your “north core” deserves just as much attention as your main core.
- Text neck is real and incredibly common.
- A new pillow won’t solve the problem. Instead, try posture-improvement apps, voice-to-text assistance, and stretching exercises to improve your north core strength and prevent text neck.
COVID 2023: Are We There Yet?
For over three years, we’ve waited for the COVID pandemic to be over. An analogy to intensive care medicine seems appropriate.
I was taught that “a patient enters an intensive care unit with dramatic catastrophes and leaves with incremental, slow, methodical improvements.” That is, the beginning is more obvious than the end.
We’ve made tremendous strides in reducing the number of infections, hospitalizations, and deaths attributed to COVID. With these gains, our societal focus has shifted elsewhere. Emergent government policies to address the economic and health effects of the pandemic are being scaled back. But is the pandemic over?
On one hand, the data in Contra Costa County and at the national level demonstrate markedly reduced levels of COVID viral particles in the sewer systems, fewer people in the hospital due to COVID, and fewer people dying.
On the other hand, based on the national data from April, we’re still losing 1,300 people per week to COVID. This yields an annual death rate of 68,000 more people than the number lost to influenza in any year for the last decade. Unfortunately, the risk of COVID is still with us.
Fight On
Vaccination has been our best weapon against COVID. After three years, most of us have had multiple vaccinations and, often, a COVID infection or two. We’re beating back the pandemic because of the level of immunity generated by this process. The obvious question becomes: What is the incremental benefit of yet another vaccination?
The answer depends on your level of risk for a bad outcome from COVID.
Almost everyone currently hospitalized with COVID falls into four broad and potentially overlapping categories:
- Over 50
- Multiple comorbidities (such as obesity, diabetes, heart disease)
- Immunocompromised
- Unvaccinated or under-vaccinated
In fact, 90% of those currently hospitalized have not received the most current bivalent COVID vaccine. This version contains two strains, one against the original Wuhan variant and another against a new omicron variant. Since this vaccine’s release in fall 2022, numerous studies have demonstrated its greater efficacy than the original single-variant vaccine, which will be phased out.
Most of you have already received a bivalent COVID vaccine booster. If you haven’t, please consider getting your first dose of the bivalent COVID vaccine now.
Who Needs a Booster?
What if you’ve already received the bivalent COVID vaccine? On April 19, 2023, the CDC updated its recommendations for booster vaccinations this spring. They identified risk groups who should receive an additional bivalent COVID vaccine, and they’ve included timing recommendations:
- If you’re over 65 years old, you should wait four months from your last vaccination or COVID infection to receive this booster.
- If you’re immunocompromised, you should wait at least two months from your last vaccination or COVID infection to receive this booster.
I sense a growing frustration with being asked to get a COVID vaccination again and again. We remember getting childhood vaccinations that lasted decades, and we can tolerate getting a tetanus booster every 10 years or so. However, the biology of the COVID virus and the vast numbers of infected individuals have allowed rapid evolution to occur, which continues to select for variants that can partially evade our vaccines.
We’ve been able to develop vaccines that work against these newer variants, such as the current bivalent COVID vaccine. Researchers are working to develop vaccines that target parts of the virus that don’t mutate as rapidly as the spike protein, the target of current vaccines.
Also, to compensate for the decline in efficacy over time, we increase the frequency of vaccination to get a recurring boost in our antibody levels, which are at their peak for one to six months after vaccination. Thus, recommendation for frequent vaccination allows us to extract maximum performance from our current vaccination technology, which is needed to maximally protect those at the highest risk.
Who Doesn’t Need a Booster?
It also makes sense to discuss who does NOT currently need a booster vaccination.
The incremental benefit of each additional vaccination has become ever smaller. Thus, for populations whose overall risk of a bad outcome is already very low, such as children and younger adults, a further tiny reduction isn’t worth the discomfort and rare (but not zero) risk of a serious vaccine complication.
Today’s Takeaway
Please get a COVID bivalent vaccine now if you fall into any of these categories:
- If you’re over 50 and haven’t yet had a bivalent COVID vaccine
- If you’re over 65 and haven’t had a COVID vaccine or infection in the last 4 months (or wait until 4 months have elapsed)
- If you’re immunocompromised and haven’t had a COVID vaccine or infection in the last 2 months (or wait until 2 months have elapsed)
Please reach out if you have any questions or concerns.
Circadian Rhythm Manipulation for Insomnia and Sleep Habits
Complicated problems often require complicated solutions. Problems with sleep are no exception, and they frequently require what’s called a differential diagnosis.
A differential diagnosis encourages doctors to think comprehensively across a range of possibilities to identify what factor(s) may be causing a patient’s problem. That’s how we arrive at a specific, patient-focused solution.
This is in marked opposition to what often happens in a time-pressured healthcare environment where “if-then” statements dominate. This reductionist logic boils complex problems down to linear, one-size-fits-all solutions: “If X is the problem, then Y is always the solution.”
Such reductive thinking may be fast, but it isn’t effective.
I want to clearly distinguish from this linear logic a more expansive, inclusive thought process. Doctors often translate the sentence “I can’t sleep” into the medical term “insomnia,” but what is the differential diagnosis for insomnia?
Many factors can contribute to not being able to sleep. Circadian rhythm problems are one of them.
The Circadian Rhythm
The circadian rhythm is a biological rhythm unique to each individual, lasting about 24 hours. We’re most aware of it in the context of sleep, but actually, every biological function is timed with a daily clock — digestion, reproduction, cognition, etc.
The word “circadian” comes from the Latin circa, which means “approximately,” and diem, which means “day.” Together they mean “about a day.”
Let’s focus on the word “approximately.” Reflected in this word is the fact that not everyone follows the 24-hour sleep cycle exactly.
There are some individuals for whom the sleep cycle is less than 24 hours. We refer to these people as morning sparrows. They do their best thinking in the morning, have the most energy early in the day, and follow the “early to bed, early to rise” adage.
Then there are those whose circadian rhythms run longer than 24 hours — night owls. These are the individuals who don’t want the night to end. They’re most focused and animated late in the evening and have difficulty settling down and sleeping. They’re also the ones slamming the “snooze” button come morning.
Understanding and observing an individual’s circadian rhythm can yield valuable insights into potential causes of their insomnia. Let’s look at a few examples.
The Circadian Rhythm and Insomnia
Example A: Teenagers
If you have a teenager in your life, he or she likely falls into the night owl category, unable to fall asleep at an appropriate time to wake up for school the following day.
Don’t be so quick to attribute this to laziness. Not only is there individual variation in a person’s circadian rhythm, there are also age-related variations affected by hormones. As children approach and go through adolescence, their circadian rhythms lengthen, and they’re biologically programmed to stay up later and wake up later.
This understanding provides insight into how we can help young people function better.
For example, the first thing I as a physician would suggest is that this teenager limit his or her screen time in the evening. When we look at screens, we absorb a specific blue light wavelength directly into our eyeballs. Our retinas have receptors that detect this wavelength and send our brain a signal that the sun hasn’t set yet. Our brain then knows not to initiate the hormone cascade that helps us sleep.
In short, screen time right before bed sends our bodies the opposite signal we need.
To combat this and help teenagers sleep, I recommend limiting any white/blue light that would hit the eyes.
I would also suggest using melatonin supplements, if necessary. Melatonin is a hormone released in the brain, increasing when it’s dark and decreasing when it’s light. It’s basically the hormone of darkness that enables us to sleep.
A Personal Example
When my daughter was 17, her summer break was like that of most teenagers. Left to her own biological rhythms, she was going to bed progressively later, 1 a.m. or 2 a.m. Without the confines of school, she followed her natural sleep cycle.
Well, one day, much to her horror, she realized she had to wake up and take an SAT in just three days. She didn’t have a ton of time to change her sleep pattern.
We got to work right away. First, I had her wear blue light-blocking glasses, which would mute the neurological signals from any lights she’d be exposed to. She’d wear these for two hours before bedtime. I also gave her a very low dosage, six-hour sustained-release melatonin to help shift her circadian rhythm earlier.
With these tools, she went to bed several hours earlier each night. She woke up on time by her deadline and did fine on her SAT.
The tools we have at our disposal are deceptively simple and safe, yet powerful — as is our ability to modify circadian rhythms.
Example B: Aging
A common sleeping problem in older folks is called pre-terminal insomnia. Pre means “before,” terminal means “the end” (in this case, the end of the night), and insomnia means you can’t sleep.
You’ve likely deduced that this is when people wake up in the middle of the night — 2 a.m., 3 a.m., etc. — and can’t fall back asleep. This can be caused by many factors, including depression, anxiety, and advanced sleep phase disorder, a form of circadian rhythm disorder.
Just as teenagers see their circadian rhythms lengthen as part of the hormonal changes of adolescence, as we get older, our circadian rhythms often become shorter. For example, the older a person gets, the earlier they typically prefer to hit the hay.
Sometimes, the circadian rhythm gets too short. Those poor morning sparrows’ hormones are being activated too early, and they end up waking at 2 or 3 a.m. because they’re experiencing circadian rhythm activation before dawn.
When your hormones activate before the sun rises, it’s time for intervention. In this instance, I’d recommend small quantities of rapid-acting melatonin that dissolve in the mouth, as opposed to something longer-acting, which we’d use for teenagers. Morning sparrows would take this when they wake up in the middle of the night to tell their hormones, “It’s too soon to activate!”
These older individuals also have to be careful to remain in darkness. Any light stimulus that reaches the eyes in the early morning further confuses the body by signaling that the sun is rising.
How to Tell if You’re Experiencing a Circadian Rhythm Issue
If you’re experiencing sleep problems, it could be due to issues with your circadian rhythm — but often, it’s a combination of factors.
Sleep can be very complicated. The best advice I can give is to seek out the appropriate medical care.
This isn’t a DIY fix or diagnosis. Please don’t try this at home. Sleep treatment often requires a professional.
Today’s Takeaways
- Complex problems require complex solutions. When it comes to sleep problems, differential diagnoses are important.
- Circadian rhythms are individual and change over time.
- Using appropriate medical intervention, we can shift circadian rhythms when necessary.
Sleep is complicated. If you’re having trouble sleeping, please consult your doctor or contact Banner Peak Health.
Overlooked Screenings That Belong on Your Preventative Care Checklist
As a doctor with over 30 years of experience, I’m always seeking to better understand the overall context of my patients’ lives. This helps me better customize my care to address their health needs.
Our bodies are the vehicles, the cars, with which we transport ourselves through our lives. As a physician, I don’t just want to kick the tires and perform some maintenance; I want to know where each vehicle is headed.
For example, if I’m asked to do a preoperative evaluation on a patient for a hip surgery, I’m not just looking at their physical readiness. I also want to know whether their circumstances are conducive to a successful surgery.
Will they have adequate care at home, or are they the sole caregiver for an ailing spouse? Or, perhaps they have hidden depression that the pain and immobility of a major orthopedic surgery will exacerbate. Or, maybe they’re an athlete who’ll tell me, “You can’t take my joint; golf season’s coming up!”
The same medical question can have very different answers depending on the overall context of an individual’s life. For truly high-quality, responsive healthcare, the full picture is necessary.
The same is true in determining how to maximally leverage preventative healthcare for each patient. At its core, prevention is really about individual lifestyle. Anyone can recommend a mammogram to a woman over 40, but to really address the deeper fundamentals of prevention, you have to understand how a person lives. Then you can work with them to modify their lifestyle.
True prevention isn’t checking off boxes on a preventative care checklist in a cookie-cutter fashion. It’s a much more personalized, intimate process.
The Typical Preventative Care Checklist
You’re likely familiar with many of the items on the typical preventative care checklist in conventional medicine. You’ve heard about them your entire adult life. They include studies such as:
- Mammograms
- Pap smears
- Colonoscopies
- Prostate exams
- Lung CTs
As practitioners of concierge medicine, we don’t believe your health is adequately protected with a simple checklist. You need something much more comprehensive for true prevention.
Of course, at Banner Peak Health, we still recommend all the above tests — but we go much deeper. And there’s no one-size-fits-all checklist for the amount of customization we do.
In addition to the tests and screenings on the standard preventative care checklist, we also take advantage of state-of-the-art screenings and equipment. Here are just a few of the ways we help our patients stay proactive about prevention:
- Coronary artery calcium score — early detection test for cardiovascular disease risk
- GRAIL Galleri test — early cancer detection test administered through a simple blood draw
- InBody — body composition screening that goes beyond BMI to consider what percentage of your body weight is fat versus muscle
- Emotional health screening tools — means of diagnosing hidden depression and anxiety. These are very intimate, and vital in understanding how to best treat other physical needs.
The unique model concierge medicine provides allows us to offer this more in-depth, customized care. We aren’t beholden to insurance companies, who would dictate what tests we can run and what equipment we can use. We’re free to prioritize your health, rather than commoditize it.
Banner Peak’s Priority
Your body is your vehicle, and it needs to stay in proper working order. To make that happen, we need to know your destination. That way, we can help provide the right maintenance along the way and get you there in the best condition.
We’re proud to offer a robust preventative care checklist — but one that’s customized to every patient. By connecting with each of our patients and taking the time to learn about their lifestyles, priorities, and health goals, we’re able to offer the individualized care they need and deserve.
If our approach sounds like it would be a good fit for you, contact us today. We’d love to help!
What Is Sleep’s Effect on Athletic Performance?
We know sleep is vital for all our emotional and physical endeavors — but it’s not enough to just get sleep. We need the appropriate quality and quantity of sleep.
Obstructive sleep apnea — a common form of sleep deprivation which affects 15–30% of men and 10–15% of women in North America — manifests by closing off the airway during the deeper phases of sleep, preventing air from reaching the lungs and oxygen from reaching the brain. This creates an adrenaline/stress hormone surge that prevents us from reaching the more restful stages of sleep.
I spend a good amount of time in the clinic identifying which of my patients are at risk for obstructive sleep apnea and convincing them to undergo testing and receive appropriate treatment.
To help my patients understand the importance and value of treatment — and to aid in my sales pitch — I direct them to literature that demonstrates sleep’s effect on athletic performance.
Sleep’s Effect on Athletic Performance
The following are three ways sleep — or a lack thereof — can affect athletic performance.
Cognitive Ability and Physical Endurance
Golfers will do anything for an edge up.
Golf relies on cognitive abilities to strategize and calculate risk/return, physical endurance for strength and accuracy, and emotional control to manage pressure.
All these abilities can improve with adequate sleep. Data shows a statistically significant improvement in a golfer’s handicap after treatment of obstructive sleep apnea.
Training and Recovery
Let’s look at the fundamental core of fitness and working out. How do we get in shape?
When we exercise, we stress our body — by weightlifting, running, etc. That stress manifests as low-level cellular damage to our muscles. It’s the response to this stimulus, this damage, that allows our body to recover and come back stronger. This is how we build ourselves through training.
As I’ve said before, recovery is the process that makes us physically stronger, not the stimulus.
Sleep is absolutely vital to this recovery. The hormones we need to build back better — such as testosterone and growth hormone — occur in adequate quantities during sleep. That’s when our bodies recover and grow stronger.
Jet Lag and Circadian Rhythm
One potential threat to obtaining the adequate quantity and quality of sleep is jet lag.
Almost every bodily function is regulated by our own internal clock, our circadian rhythm, which is synchronized to our local time zone. With travel, there’s a risk of jet lag and impaired sleep.
In 2013, researchers analyzed over 40 years of NFL games, specifically questioning whether circadian rhythm-induced jet lag influences a team’s performance. They found that for night games played on the West Coast, the home team beat the predicted point spread twice as often.
It’s fascinating evidence linking sleep with the peak performance of professional athletes. It’s also something to keep in mind during your next trip to Vegas: Give yourself an extra day to recover before hitting the casino. You’re welcome.
Today’s Takeaways
- When you’re traveling to compete in an athletic event, be cognizant of sleep’s effect on athletic performance. Do your best to compensate for your circadian rhythm by giving yourself a few extra days to recover before you compete. In other words, you shouldn’t fly to Paris and ride in the Tour de France the next morning.
- Be cautious when you get up early to work out. Patients often ask me whether it’s better to get up early to work out or to sleep for an extra hour. I tell them, “Do both.” If you can get up early to work out and still get enough sleep, that’s fine, but to lose an hour of sleep for an hour of workout isn’t maximizing your potential athletic gain.
- Be open to discussing obstructive sleep apnea with your physician. Diagnosing this disorder and treating it effectively can yield many health benefits, including better athletic performance.
The Sad Triad: Depression, Poor Sleep, and Chronic Pain
For about 15 years, I studied Chinese medicine and practiced acupuncture. As such, I have a deep appreciation for the Eastern perspective on medicine, health, and wellness.
In Western medicine, we tend to sort everything into conceptual silos: “This is a neurological disease, so you have to see a neurologist.” “This is an endocrine disease, so you have to see an endocrinologist.” Cognitively, we’re splitters.
But in Eastern medicine, everything is inextricably linked, which leads to a lot of powerful explanation.
With that in mind, I’d like to introduce “the sad triad” — the link between depression, sleep deprivation, and chronic pain.
The Sad Triad
1. Chronic Pain
One of the most challenging aspects of any medical system is treating pain, especially chronic pain.
At first glance, many perceive the transmission of pain as linear, like the child’s game of tying two cans together with a string to transmit a signal between them.
However, the transmission and sensation of pain are much more complex. A more apt metaphor would be that of a spiderweb: a myriad of interlocking nodes in which modulating any one node changes what happens to all the other ones.
This is why I believe the Eastern view of interconnectedness is a more useful, more explanatory way to address chronic pain.
Pain’s impact on the body isn’t linear. It’s influenced by many other factors — especially the quality and quantity of sleep we get.
2. Sleep Deprivation
Being an adult often means masking our true selves for the sake of social acceptance. We sometimes get a clearer view of human nature by observing children.
For example, a toddler who’s well-rested and enjoying herself at the playground may trip and face-plant while running across the turf. While this will probably draw a shriek from the parents watching, she’ll cheerfully get back up, brush herself off, and keep running toward the next play structure.
However, anyone who’s tried to put an exhausted toddler to bed knows a barely-pinched toe can lead to a hysterical tantrum.
That’s a great illustration of how sleep influences the perception and impact of our pain. Ultimately, poor sleep is a pain multiplier.
3. Depression
The emotional context around pain also influences the pain’s impact.
Although there are no perfect analogies, the example I’ll use here is of two very similar anatomical injuries I’ve treated in two very different contexts.
The first injury occurred when a snowboarder was going for big air and blew it. He jammed his neck and weathered chronic neck pain as a result.
The other injury was the result of a car accident. A woman was rear-ended driving home from work. Because of her injuries, she also suffered chronic neck pain.
Although the two injuries aren’t anatomically very different, the perceived pain is. The snowboarder has much less perceived pain because he had agency over his situation. He himself made the decisions that led to the injury. The woman in the car accident, meanwhile, has much more perceived pain because she felt victimized by her circumstances.
Our emotions interpret pain — they influence how we experience our pain and how it impacts our lives.
A Vicious Cycle
These three realities — chronic pain, sleep deprivation, and depression — feed into each other in a tragic, debilitating way.
If pain is unrelenting and interferes with sleep, the pain becomes more perceived and more impactful. If you’re exhausted and not sleeping, you’re at risk of depression. The cycle continues.
If you’re caught in that cycle, a Western physician will likely diagnose you with chronic pain, then with sleep deprivation, then with depression. Each condition will be treated separately rather than as a whole.
Holistic Treatment
Now that we understand how these conditions are related, we can use this interrelatedness to our advantage. We can turn the vicious cycle of the sad triad into a virtuous cycle.
For example, some of our most potent chronic pain medications are also used as antidepressants. We believe these medications manipulate anti-pain properties through the same neural pathways an antidepressant would use.
I’m a minimalist when it comes to medication, but when a patient tells me their pain is affecting their sleep, I become pharmacologically aggressive. In that case, the benefits of medication far outweigh the risks.
On that note, if you yourself are caught by the sad triad and need help turning that vicious cycle into a virtuous cycle, Banner Peak Health is just a call or click away.
Today’s Takeaways
- Pain severe enough to disturb sleep warrants treatment.
- Hidden depression can present as chronic pain.
- People with chronic pain often categorize good days and bad days based on their symptoms. I posit that a bad day often correlates with not having gotten enough sleep the night before. Paying more attention to sleep may lead to more good days.
- Taking an antidepressant to address chronic pain does not dismiss the physical reality of the pain. In no way am I trying to tell you your pain is “just in your head.”
- Mindfulness/stress reduction classes are an effective means of pain relief. If you can achieve control through mindfulness, you can control your pain relief.
- Physical exercise can also be a wonderful treatment option for the entire sad triad.
How to Stop Jaw-Clenching From Stress
Some people experience a wide range of physical symptoms as a result of unmanaged stress. A clenching jaw is one of them.
Clenching your jaw can lead to unpleasant side effects such as headaches, dental issues, soreness, and disturbed sleep. We’ll explore those later.
While there are many “lists” online that explain, on a superficial level, how to stop jaw-clenching from stress, I believe we need to look deeper. We need to look at the stress itself.
What Is Stress?
I often ask new patients to complete a form titled “Perceived Stress Scale.” The term “perceived stress” encompasses two aspects of stress:
- External stress. These are the more obvious contributing factors. For example, it’s stressful if someone cuts you off in traffic or if you have financial difficulties.
- Internal stress. This is the aspect of stress we often overlook. The term “perceived” incorporates the concept of how your internal self can evaluate, cope with, and handle stress.
I look at both a patient’s external and internal stress to best understand where their symptoms, such as a clenching jaw, are stemming from.
Two Phases of Coping
Not only are there two aspects of stress, but there are also two methods of coping with stress. I often explain these methods as “young adult stress coping” and “mature adult stress coping.”
These don’t relate to our chronologic age; rather, they refer to the mechanisms we use to manage the two aspects of stress.
Young adult stress coping is based on the stress we perceive externally around us. For instance, if a college student is taking too many courses, her solution may be to drop her economics class before the midterm. By modifying her external world, she’s brought her stress to a manageable level.
Mature adult stress coping is the opposite. If we live long enough, we will eventually confront major stressors beyond our control: serious health problems in ourselves and others, losing loved ones, etc.
The question becomes how we cope with and adapt to stress that we cannot modify externally.
Stress Inbox and Outbox
When I instruct patients on how to stop clenching their jaw from stress, I encourage them to imagine that their stress has an inbox and an outbox.
I like this metaphor because it resonates. We’re all acutely aware of what comes into our email inboxes. What is more difficult for people to understand, and where I focus, is the stress outbox — or, how we cope with stress.
When working on identifying, developing, and building a stress outbox, I look at two categories: lifestyle factors, and social connection and structure.
Lifestyle factors include things like exercise, sleep, diet, and substance use. I also like to look at social connection and structure: the presence of a religious community, clubs, groups of friends, and a supportive family. These networks have a huge impact on our emotional health as well.
I’ve been surprised by the number of people who can’t come up with an answer when I ask, “What’s in your stress outbox?”
To their silence, I reply, “We have work to do.”
Biology of Emotions
Catchphrases like “mind over matter” have convinced us that our minds and bodies are connected but disparate. Nothing could be further from the truth.
To even ask “are the mind and body connected?” is to misunderstand that they are one and the same. They’re not even two separate things that are “bridged.” They are inextricably linked.
In order to effectively treat the symptoms that manifest as a result of a stress inbox/outbox imbalance, we must begin with this understanding.
The Canary in the Coal Mine
Many of us, even some doctors, aren’t aware that our overall stress — or, having more stress coming into the inbox than going out through the outbox — can create real, biological problems.
A physical symptom of stress, such as a clenching jaw, is the canary in the coal mine. It’s a way your body warns you of an imbalance in your stress inbox/outbox.
If you ignore that warning and simply treat the symptom, it’s likely additional symptoms will manifest as your stress imbalance worsens. These symptoms include temporomandibular joint pain (TMJ), headaches, insomnia, heart palpitations, impaired concentration, irritability, nausea, and diarrhea.
Yes, the most common cause of a clenching jaw and jaw stress is the temporomandibular joint weakening from bruxism (teeth grinding). Statistically, wearing a mouth guard to bed may help the symptoms of a clenching jaw, but we can’t stop at the biology. We have to look deeper.
We have to learn how to listen to our bodies.
Today’s Takeaways
- How to stop clenching your jaw from stress: Statistically, plastic mouth guards offer significant relief from symptoms like teeth grinding, TMJ pain, and soreness. However, jaw-clenching is a symptom of a greater issue — unmanaged stress.
- There are two phases of coping: Young adult stress coping and mature adult stress coping. YA stress coping means modifying the external world to manage stress. MA stress coping means adapting to stress we cannot control externally.
- Your body has a stress inbox and outbox: Your outbox is influenced by two categories: lifestyle factors (diet, exercise, sleep) and social connections and structure (family, friends, religious community). Your physical health relies on your ability to manage and balance your stress outbox.
Your mind and body are one and the same. When your mind is out of balance, your biological health suffers.
The physical manifestations of stress comes in the form of symptoms such as headaches, insomnia, trouble concentrating, and more. These are the canaries in the coal mine, warnings that your body is out of balance.
To stop clenching your jaw, practice listening to your body. Pay attention to what it’s trying to tell you, and rather than just treating the symptom, get all the way to the root of the problem.
Significant Drug Side Effects Are More Common Than You Think
The power of modern medical pharmacologic treatment is miraculous. During my time as a physician, I’ve witnessed remarkable strides in our ability to prevent and treat horrible illnesses, such as multiple sclerosis, malignant melanoma, and myocardial infarction.
However, medication therapy is a double-edged sword. I’ve detected many instances of illness caused by side effects of medication.
- A young woman forced to drop out of college due to chronic abdominal pain from a medication designed to prevent migraines.
- A middle-aged businessman unable to sleep because of his asthma inhaler.
- An elderly man who became more confused and agitated due to a medicine designed to ease symptoms of depression.
These are just a few of the countless cases I’ve encountered.
Each drug represents the potential for benefit or harm — and that’s a single drug. Commonly, people take multiple medications simultaneously.
This creates the opportunity for drug interactions — that is, the body reacting differently based on the sum total of the drugs — markedly increasing the possibility of side effects.
So, especially when an individual has enough medical problems to warrant multiple medications, the challenge becomes how to discern what’s caused by the underlying medical illnesses, and what’s caused by the medications used to treat those illnesses.
Work With Your Doctor to Avoid Significant Reactions
The first step in detecting a drug reaction is having the active consciousness that drug reactions exist and are common. Be aware that medications can and do interact with each other — and not often in a positive way.
The second step is discerning when a particular drug was initiated and when a particular symptom began, and it requires meticulous record-keeping. This often provides the strongest hints toward a drug reaction.
Keeping notes in a notebook or on your phone, as long as they’re accurate, is a great way to pass information to your doctor. Digital files are easy to organize and send via email.
The third step involves trial and error. You may be able to work with your doctor to stop taking a single drug, monitor your symptoms, note any improvements, resume taking the drug, and document any symptoms that recur. Keep meticulous records and always update your doctor accordingly.
Please note: There’s no textbook or website that can definitively diagnose a drug reaction in any individual. Trial and error is the gold standard for diagnosing a drug reaction.
Stopping a Drug
While starting a drug is relatively easy, stopping a drug is very, very hard.
From the vantage point of a primary care provider, specialists initiate many drugs. Stopping one of these drugs involves close and careful communication with the original prescribing specialist — and that isn’t always easy.
Diagnosing and treating drug side effects can be extremely difficult in an environment of:
- Time-pressured physicians
- Fractured care among many doctors
- Insufficient time to carefully communicate with patients
Unfortunately, this is the type of environment plaguing traditional healthcare systems.
Concierge Medicine Creates the Right Environment
Here at Banner Peak Health, we have the experience and time to delve deeply and work through the laborious process of diagnosing and correcting drug side effects.
We can spend as much time as we need to diagnose each patient’s drug side effects, both in person and over the phone. We’ll always get the job done right; it’s what our practice was created for.
Today’s Takeaways
Think you’re experiencing a bad reaction from a drug? Follow these tips:
- If a new symptom occurs shortly after starting a new medication, alert your physician.
- Don’t be afraid to ask your physician, “Can one of my medications cause this symptom?”
- Your pharmacist has access to a drug database with drug interaction detection software. Ask them to search for any drug interactions among medications you’ve been prescribed, especially by different physicians.
- Be a critical consumer of medications. Ask your physician, “Do I really need all these drugs?”
At the end of the day, you are in control of your own healthcare experience. Speak up and advocate for yourself — and don’t get comfortable with being uncomfortable!
A Doctor’s 5-Step Guide to Athletic Performance After 50
Most people believe it’s all downhill after 70, 60, or even 50. Our days of athleticism are over, and we should throw in the towel.
I’m here to tell you that’s not the case. Those three or more decades could be filled with personal bests and new challenges.
Our bodies are vehicles — they’re our modes of transportation to our goals. Yes, our bodies change over time, but just because aging is inevitable doesn’t mean we have to abandon our aspirations.
Goals are vital. You can’t get to where you want to go unless you know where you want to go. As we age, the route and the vehicle we use to achieve our goals may change, but the goals themselves shouldn’t.
For example, many people look to athletics for a personal challenge. Let’s say you’re a runner. You may train for a marathon in your 20s or 30s, and you may train for a 10k or 5k in your 60s and 70s. The goal of a personal challenge is still there to be achieved, but you’ve changed the means.
Others look to athletics to socialize. If your goal is to find community through athleticism, you might play five-on-five basketball in college, then tennis or pickleball later in life.
Others, myself included, use athletic endeavors to get outside. For me, nature and athleticism are inextricably linked. I love bicycle riding after work — I do it to relax, stay fit, and connect with nature.
In summary, pursuing athletic performance and getting into shape after 50 is absolutely possible. Don’t abandon your goals just yet.
The Challenges and Implications of Aging
Getting into shape after 50 isn’t the same as getting into shape at 25.
As we age, so do our bodies. Our VO₂ max (the maximum amount of oxygen our bodies can utilize during exercise — our horsepower, in other words) declines, and our post-workout recovery time increases. Preserving muscle mass becomes more challenging, and overall body fat increases.
These challenges are part of aging. The good news is modern physiology and training tactics have given us hacks we can use to compensate for the inevitable.
In the past, we thought aging athletes needed to slow down, to scale back on their performance. However, modern research shows the exact opposite. Us aging athletes need to lean in and, in important ways, be more deliberate about our training.
Previously, we were told to wind down as we age. Actually, we need to double down.
Doubling Down: 5 Vital Steps
Implement HIIT (High-Intensity Interval Training)
One of the most important tools for preserving cardiovascular conditioning and getting into shape after 50 is high-intensity interval training, or HIIT — that is, spending short but repeated episodes in the “red zone,” pushing ourselves to the limit.
To compensate for age-related muscle loss, we need specific weightlifting regimens to provide what’s called a super physiologic stimulus — a stimulus more powerful than you would get from activity alone, using weights. This is vital in preserving the muscles we want to use for sports and performance.
Consider Timing and Tempo
Pop quiz: Does pumping iron make you stronger?
If you answered “yes,” you’re wrong. The recovery is what makes you stronger.
Let’s discuss the physiology of working out. Most of us focus on stress induction — how far we run, how much we lift, etc. We usually aren’t as focused on the stress response — our vital response mechanism to the stimulus, or how our body responds physiologically to stress. This is how we become stronger.
As we age, the stress response process becomes longer. We have to be more strategic in dosing how much stress stimulus we receive and how much time we spend responding to it.
I can’t tell you how many lifelong weightlifters I’ve had as patients. They tell me that the same workout regimen they’ve followed for years now makes them feel weak.
They say, “I’ve always done X, Y, and Z every other day!”
I say, “Yes, but because you haven’t increased your response time, your stress waves are piling on top of each other. You need to change the timing and tempo of your workout to make room for recovery.”
These patients are overjoyed! They thought they were “too old for weightlifting,” but now they know that with the right modification, exercise can still make them stronger. They just have to be strategic.
Maximize Recovery
When I use the term “maximum recovery,” I’m referring to sleep.
Here’s a secret: You’ve heard of athletes abusing human growth hormone or testosterone to improve their performance — cheating, in simple terms. We produce these performance-enhancing hormones naturally when we sleep.
You can enhance your athletic performance just by getting enough quality sleep.
Stay Hydrated
Be conscious of your hydration not only during exercise, but also as you recover. Adequate hydration both inside and outside the gym is essential to getting into shape after 50 and maintaining athletic performance into your golden years.
Be Conscious About Your Diet
We all know diet is important, and it needs to change as we age.
Sarcopenia is the medical term for age-related involuntary loss of muscle mass, a real concern if you plan on getting in shape after 50. So far, our focus has been on maintaining adequate training stimulus and using weightlifting to give the body a physiologic stimulus. Now, research reflects that adequate protein in the diet could save the day.
Studies suggest that to reduce the impact of sarcopenia, you should consume between 1.5–2 grams (g) protein per kilogram (kg) of your weight a day. For a 70kg man getting into shape after 50, that means taking in about 150g of protein in a day. That’s a lot. A common concern is that if you eat that much protein, you may be replacing other nutritionally rich foods.
The bottom line is that much more research needs to be done, but we do know protein plays a leading role in preserving muscle mass. Be conscious of it.
Safety First
An injured athlete is not a training athlete. Prioritize your safety, always.
If your normal exercise regimen hasn’t included HIIT up to this point, discuss this option with your physician first. Certain individuals will need cardiac evaluation and clearance.
Observing a meticulous technique when weightlifting is also crucial. The injury-to-benefit ratio with free weights is challenging, and unless your technique is meticulous, the risk is higher.
If you’re using free weights, make sure you have adequate training and observation. Weight machines are much safer.
All sports require good core strength and flexibility. This is vital to preventing injury. Consider Pilates, yoga, or specialized fitness classes. If you want to get into shape after 50, flexibility and core strength are key.
What Athletic Performance Means to You
Athleticism doesn’t have an age limit.
Your age and body will change, meaning you’ll need to adjust your approach to some sports and activities. But that doesn’t mean you should throw in the towel. Whether you’re interested in climbing a mountain or simply getting into shape after 50, any goal is a great goal!
You just need to change the way you think about exercise. It’s not simply about how much iron you pump or how far you can run. It’s just as much about the quality of your recovery.
Rethink what your goals mean to you in the context of your stage of life, and go for them at your own tempo. The best is yet to come.
Why Banner Peak Health Is Committed to Delivering Versatile Healthcare
In medicine, one size does not fit all.
There’s an inherent biological reality for all of us as individuals. We respond differently to medications, have different burdens of illness, different learning styles, and different emotional resilience.
A single approach simply doesn’t work. Maximum versatility is paramount.
For a clinical approach to be successful, it must accommodate the tremendous variation that is the human experience. Unfortunately, traditional healthcare systems often fall short in their ability to accommodate that inherent variety.
At Banner Peak Health, two vital tools allow us to provide personalized, customized, and individualized care for our patients.
The first is our relationships with our patients. We have greater in-depth knowledge of our patients based on deep, long-term connections. We slow down and take the time to get to know each one personally.
Our second tool is our practice’s structure. By removing the time constraints imposed in traditional healthcare practices, we can spend more time with each patient. We use that time to uncover what they need and develop treatment plans for them as individuals.
With these two vital tools, we’re able to explore the differences each of our patients bring to their healthcare interactions.
How Is Banner Peak Health Different?
How We Deliver Care
In traditional healthcare, insurance dictates what care patients can receive and how doctors can deliver that care. They refer to clinical visits as being “seen by the doctor,” because the structure of most insurance plans requires patients to physically be seen in order to receive reimbursement.
Banner Peak Health is free from this constraint. We enjoy more flexibility and can provide whatever care best fits the individual: in person, telehealth, texting, etc. You don’t have to be seen to be seen.
Patients Get Homework
Healthcare is not a single event. It’s how you live your life every day.
Thus, we provide our patients with written homework for almost all encounters, because healthcare is not what occurs under our roof — it’s what you take with you and implement in your daily life. Banner Peak Health is organized to facilitate and systematize that level of communication.
State-of-the-Art Testing
Since we’re freed from the constraints of insurance, we can explore a wider range of medical technologies we feel are vital to patient care.
We’ve been early adopters of state-of-the-art cancer detection technology such as Galleri by GRAIL, which can detect multiple forms of cancer using only a blood draw.
Other excellent detection tests we use include coronary artery calcium (CAC) scans to detect early coronary artery disease and body composition tests instead of BMI. One such test is InBody, which utilizes bioelectrical impedance analysis (BIA) to measure full body composition in under two minutes.
We take a wide array of metrics into account because we care about getting a full picture of each individual.
Today’s Takeaways
At Banner Peak Health, we want to introduce people to options and opportunities they aren’t aware of, usually because they’ve only ever known the constraints of the traditional healthcare system.
We see this in so many patients who come to us from traditional healthcare. They’re used to shoddy service and insurance constraints, and they accept this as the norm.
But you have options. You can enter a world where doctors won’t tell you “no,” physicians won’t short-shrift your time, and a human being will answer the phone when you call.
We’re all individuals, and we deserve better than that. You deserve better than that.
Which is why we exist.