Wellness Report

You’ve been talking about getting in shape for a long time, but problems with pain have slowed you down and put on extra weight. But did you know that all pain is not bad? There is such thing as “good pain.” Here’s how to tell the difference and how to get started.

“It radiated down my leg and across my ankle,” says 63-year-old Sara Stewart. She spent agonizing years dealing with pain in her hip. It got so bad; she ended up changing her life to fit the pain.

“It got to a point where I finally was in so much pain that I couldn't sleep, it was keeping me from doing things.”

“Our goal is really to keep people active,” says Dr. Mark Mariani, a sports medicine specialist at the Multicare Sports Medicine Center in Tacoma. He says people starting exercise programs also risk injuring weak muscles or aggravating a more serious medical problem.

“I didn't know what to do,” says Stewart, “because if I did something and it hurt I felt like I had to stop.”

Mariani says one of the first steps is recognizing what kind of pain you have. Here’s what’s called “bad pain:”

• Pain after 72 hours--even with icing
• Sharp pain
• Pain centered around a joint--not the muscles
• Pain accompanied by numbness, weakness or swelling
• Pain that wakes you up at night
• Pain with fever, chills or severe sweating

These are all reasons to see a doctor. For Stewart, not exercising made her pain worse. Exercises increases blood flow--which is how the body heals itself.

“And I slowly got stiff, and the stiffer I got the more painful it got. And then I found I was spending a lot of time sitting in a chair.”

“Clearly you become de-conditioned,” says Mariani, “and that basically means your tendons your ligaments are no longer able to tolerate what they were able to tolerate before.”

Dr. Mariani suggests:
Regular doses of Tylenol or Ibuprofen for a few days
Start simple, and start slow. Most people initially over-do-it
Try something you like to do-or every day activities such as housework or playing with the kids.
It all helps says Mariani, just get moving.
Stewart says the combination of a cortisone shot and low-impact exercises—including water aerobics--worked wonders for her.

“I'm to the point where I don't remember a lot of the pain.”
Finally, Mariani says don’t get discouraged. Your time and effort could change your life for the better.

“I have so much more energy,” says Stewart, “and I'm looking forward to spring.”

Web Extra:

“Good Pain vs. Bad Pain”
There are two kinds of pain: Good Pain and Bad Pain.
How can you tell the difference, and what do you do about it? Read all about the latest tips, how to ice an injury and how to get finally get moving!

Good Pain:

When muscles that have not been exercised for long periods of time see a lot of stress and they respond by getting "sore." Muscle soreness typically occurs if you do a new exercise you’re not accustomed or if you do a familiar exercise too hard. This soreness typically starts within a few hours, but peaks around two days after exercise. This soreness is called "delayed onset muscle soreness," and it actually means you did some damage to your muscles. It shouldn’t stop you from exercising, but you do need to pay attention to how your body feels—and proceed appropriately.

When you workout, it takes your body about 10 minutes to start to perform well—to adjust to the exercise you’re doing. Expect stiff, sore muscles for 4 to 48 hours after exercise—especially when you are increasing your activity.

On the second day, it’s a good idea to change from heavy workout, to a good warm-up, lots of slow stretching and a lighter workout. If the pain doesn’t start to fade after about 10 minutes, ease up a bit more or stop and put an ice compress on any area that feels particularly stressed.

Within 48 hours: muscles can usually repair and rebuild themselves and typically come back bigger and stronger. Of course, the opposite happens if you damage your muscles too much. So it’s equally important to be consistent with exercise, and give your body some down time. Most studies show cool-downs and stretching are crucial to a proper workout.
In severe cases, the muscle may be damaged to the point that the muscle starts to die. In individuals who are extremely out of shape, if multiple muscles are exercised too hard and too fast, then as the muscles die they release proteins into the blood stream, which can shut down the kidneys. While it is rare, there have been cases of death due to this extreme over-exercising of the muscles, so it is generally recommended that if you start an exercise program, you begin very slowly and build up gradually. We usually recommend that whatever amount of exercise you think that you can do, cut it by one-third the first few times to prevent this problem with your muscles.
Bad Pain:

The muscles, tendons, ligaments, cartilage and bones of the body are living structures that react to the stress of exercise very slowly.

Your muscles join tendons, which then anchors muscles to bone. Sore muscles with exercise are to be expected, but watch out for Tendinitis-that’s inflammation of the tendon. It can be a fine line between these two types of pain, but Tendinitis usually develops closer to the joints. It is often a sharp, or burning pain close to the joint. Common tendons that get Tendinitis are: the Achilles tendon (at the heel), Patellar Tendon (above and below the kneecap), Ilotibial Band (the side of the knee to the side of the hip), Rotator Cuff (shoulder), and the Lateral Epicondyle (elbow).

When these tendons tear, it can mean surgery and the results are rarely as good as the original structure. Treat tendinitis with ice—15 minutes, 2-3 times a day. Be careful. More than that can damage the tissue. Do rest, gentle stretching and anti-inflammatory drugs like aspirin or ibuprofen. If you notice you tendonitis is not improving, change your workouts so they don’t stress the painful area. You probably want to see a sports medicine doctor to make an accurate diagnosis.

There are other types of Bad Pain. If you feel sharp pain, it could also mean cartilage damage. Cartilage is the white tissue or “cushion” on the ends of the bones at the joint that allows the bones to glide and move smoothly over one another. As a person matures, it is common for the cartilage to see some wear and tear. When the cartilage sees too much stress too rapidly, it first causes pain in the joint and secondarily fluid in the joint. Swelling in a joint is a bad sign and means that the cartilage is not happy. If the joint is not rested, the pain and swelling can increase and cause an inability to use the joint for not only exercise but for activities of daily life.
Stress fractures are mini-fractures of the bone from overuse. They can grow into a complete fracture and can develop in many different areas, including the foot, leg, hip and spine.

Warning Signs:

• Pain that does not go away within 48 hours after using ice, rest and gentle stretching-or within 72 hours of the initial pain.
• Pain that begins to affect your normal function outside of sports, such as walking or every day movements.
• Sharp pain
• Pain centered around a joint—not the muscles around the joint.
• Pain that is accompanied by numbness, weakness or swelling in the joint. The development of tingling or numbness, which is the feeling you get when your hand goes to sleep or when you hit your "funny bone" at the elbow, is also not normal and may indicate nerve problems.
• Pain that requires increasing amounts of medication.
• Pain that affects your sleep. Pay special attention to pain that wakes you from your sleep--especially if it does it every night and increases over time.
• Fevers, chills or severe sweating at night are not normal and you should consider seeking evaluation right away.
• Injured areas that turn black and blue over time indicate that blood vessels have been broken and that there is the possibility of an injury to the bones, ligaments, tendons or cartilage. In most cases where a joint becomes swollen, painful and incapable of movement after an injury, it is impossible to tell if there is a fracture without an X-ray.

Treatment:

First: cutback on exercise for at least a short period of time, but try to resume some form of exercise that doesn’t stress that area. If you hurt something on your lower body, try exercising your upper body for the next day or two or vice-versa.

Second: treat painful areas by icing.
You may have heard of RICE. It’s the acronym for Rest, Ice, Compression and Elevation. It’s the standard initial treatment for many injuries. Here’s how it works:

• Rest: Just stop what you're doing. Without a little TLC you will only aggravate the situation.
• Ice: As soon as you can, apply ice -- it is the most important during the first 24 hours. Icing constricts blood vessels, which minimizes swelling. Here's your time cycle: Ice for 20 minutes take it off for 10 minutes. Repeat that cycle 2-4 times. Make sure to wrap the ice compress in a towel or cloth to avoid frostbite.
• Compression: Think about squeezing a sponge. Compression pushes fluid out of the area and reduces swelling.
• Elevate: If you hurt your foot or leg, raise it above the heart to restrict blood flow. If it's your arm put it in a sling. Some swelling is OK. In fact, it can aid in the healing process. Extra blood to the area can help tissue repair itself.
• Use heat--usually within 48-72 hours after you got hurt. Like a heating pad or soaking in warm water. Not all experts agree with this step, but some agree it can ease the pain and promote blood circulation around injuries.
Third: make sure you continue to move the joint or extremity. You don’t want the area to get stiff. Stiffness will affect the ability for the joint to function normally and could lead to long-term problems. It’s not a good idea to return to normal exercise, but try “range of motion” where you are not adding a lot of weight to the joint or doing fast or hard movements.
Fourth: use over-the-counter pain relievers or anti-inflammatory agents. Try acetaminophen, ibuprofen, naproxen or aspirin. They call all reduce pain and swelling. An important note: make sure you take the right amount. (A/I every 3-6 hours, N/K every 6-12 hours) If these medicines do not take care of the pain over a few days then it is time to see your physician.

Exercising:

• Choose an activity that's fun.
• Change your activities, so you don't get bored.
• Doing housework may not be fun, but it does get you moving! So do gardening, yard work, and walking the dog.
• If you can't set aside one block of time, do short activities during the day, such as three, 10-minute walks.
• Create opportunities for activity, such as parking your car farther away, taking the stairs instead of the elevator, or walking down the hall to talk to a coworker instead of using e-mail.
• Don't let the cold weather keep you on the couch! You can still find activities to do in the winter like exercising to a workout video or joining a sports league. Or get a head start on your spring-cleaning by choosing active indoor chores like window washing or reorganizing closets.
• Use different jogging, walking, or biking paths to vary your routine.
• Exercise with a friend or family member.
• If you have children, make time to play with them outside. Set a positive example!
• Make activities into social occasions-have dinner after you and a friend work out.
• Read books or magazines to inspire you.
• Set specific, short-term goals, and reward yourself when you achieve them.
• Don't feel badly if you don't notice body changes right away.
• Make your activity a regular part of your day, so it becomes a habit.
• Build a community group to form walking clubs, build walking trails, start exercise classes, and organize special events to promote physical activity.

If you're not active at all or have a medical problem, start your program with short sessions (5 to 10 minutes) of physical activity and build up to your goal. Before you start your activity, be sure to warm up for 5 to 10 minutes. Use the right equipment-whether it's walking shoes, running shoes, or knee pads-make sure it's in good condition and right for your skill level. Drink water before, during, and after exercise. At the end of your physical activity, cool down by decreasing the intensity of your activity so your heartbeat is normal. Be sure to stretch. If your chest feels tight or painful, or you feel faint or have trouble breathing at any time, stop the activity right away and talk to your health care provider.

Source: “Good Pain, Bad Pain” (The Athletic Women’s Survival Guide)
Carol L. Otis, M.D./Chief Medical Advisor to the Sanex WTA and UCLA student health physician. Roger Goldingay /Former professional soccer player).
Source: John Hopkins Sports Medicine (Edward G. McFarland, M.D/Vice Chairman, Adult Orthopaedics), Andrew Cosgarea, M.D., Brian J. Krabak, M.D.
Source: Michael Castleman (Medical Journalist/Novelist). “Blended Medicine,” “The New Healing Herbs,” “Complete Guide to Preventing, Treating and Coping with Alzheimer’s Disease.”

Additional Links:

The National Women’s Health Information Center (U.S. Dept. of Health & Human Services)

The Body Mass Index (The Centers For Disease Control & Prevention)

The “Exercise Is Medicine” Program (American College of Sports Medicine)

You’ve got a little crick in your neck or a constant twinge in your back. It could be that where you sit and work is set up wrong! Occupational Therapist Laura Griffin from Virginia Mason Medical Center explains how to work "comfortably."

Think about what you do when you get in your car. You adjust your mirrors; your seat and you try to get comfortable. So why wouldn't you do the same at work?
“So my handy dandy measuring tapes is one of my tools!” says Laura Griffin. She is an occupational therapist at Virginia Mason Medical Center in Seattle. She says bad positioning where you sit at work can lead to bigger problems.

“They don't think about it. They just know they have a little crick in their neck and maybe their exhausted at home and can’t sleep well.”

She says start with your chair first. “You want to be more or less up right or slightly reclined,” says Griffin. “Your feet should be firmly on the floor.” And use each lever to mold the chair to your body in a comfortable sitting position.

“So you want that curve, which is called a ‘lumbar curve’ in the small of your back,” she says. Also, you may want to remove the arm rests or drop them because arm rests that are up too high, push your shoulders up and that creates tension in your shoulders and your neck.”
Next, get everything lined up. “You want to be able to look up and down at the keyboard, your document, and your monitor from the same position,” says Griffin.

Griffin points out: a badly positioned keyboard can cause tendonitis. Most people have their wrists cocked too far back. Griffin says drop your keyboard low enough-maybe on a tray under your desk--so your shoulders are relaxed, your forearms are about parallel to the floor, and your wrists are straight.

“Fold those little legs on the keyboard down. They are actually built incorrectly. We actually want the keyboard tilted slightly away from our body not up and towards us.”

Next, take a look at your where your mouse is positioned. Constant reaching can lead to shoulder pain, says Griffin.

Also, use a document holder. It will minimize twisting and turning your body.

A monitor in the wrong place can cause all kinds of problems. She says tilting it maybe a half-inch is OK, but tilting it up too much you're going to start catching glare from overhead lighting.
"Start by putting your monitor at about arms length-to 30 inches away. The top of the screen should be at, or slightly below eye level and your eyes should look slightly downward when you look at the middle of the screen.”

Last: Griffin highly recommends an earpiece for your phone. In fact, your workplace may pick up the cost--you just need to ask.

It takes about 5 minutes to set up and it can mean a much more comfortable day at work.

WEB EXTRA
Here is a full report that professionals use to assess Work Station Ergonomics, courtesy of Occupational Therapist Laura Griffin and Virginia Mason Medical Center. It is your free guide to get you more comfortable at work!

Work Station Ergonomics
These guidelines have been prepared to assist Virginia Mason managers in dealing with workstation ergonomics. They are not a substitute for a complete ergonomic assessment. They should help you determine whether a full assessment of a particular workstation and employee are necessary.

As our society becomes more and more reliant on computers for work and play, the amount of time each of us spends in front of a computer will undoubtedly continue to rise. Long hours on the computer can be rewarding, even fun, but they can also lead to aches and pains in your neck, shoulders, arms, and hands. If you ignore these aches and continue working with improper work habits, you may develop painful and disabling injuries. Please use the following information to set up your workstation and work as safely as you can.

What is ergonomics?
Ergonomics is an applied science concerned with designing and arranging things people use so that the people and things interact most efficiently and safely. So simply stated, it fits the workplace to the worker.

Ergonomic problems with computers can include eyestrain, visual impairments, muscluoskeletal discomforts, and stress symptoms. Using the computer can place strain on your eyes, fingers, wrists, arms, neck, back and feet. There is also evidence that computers can cause mental and emotional stress. If you experience any discomfort while using your computer, it is most likely due to an inappropriate workstation design. By working in a station that is not correctly set up for you and not following preventative habits, you may experience eyestrain, headaches, tendinitis or back pain, to name a few side effects. The U.S. Department of Health and Human Services says that most ergonomically related problems can be corrected through a combination of better workstation design and operator training.

The information presented here is intended to be a brief useful summary for individuals to begin having an active focus on ergonomics. By doing so you can greatly increase your productivity and general satisfaction in a work situation requiring computer use.

Three points to healthy computer use

1. Position Your Equipment Properly
Arrange your equipment so that you can work in a natural/comfortable and relaxed posture. Place items that you use frequently (e.g., phone, document holder, mouse, calculator, etc.) within easy reach. Adjust your input device and monitor to the proper height by lowering the table or tray or by raising the seat of your chair. To create desk space, you can put your computer base on the floor.

Think about adjusting everything to find your most effective body postures for your most common tasks.

In general you should adjust your chair first, your keyboard and mouse second, and your monitor and written material third.

Adjust Your Chair
Your chair should be adjustable and stable. Vary your posture in the chair throughout the day.
-Adjust the height of the chair so that your feet are firmly on the floor but not so low that your weight is not evenly distributed over the full seat surface.
-Only use a footrest when attempts to adjust your chair and the rest of the workstation fail to keep your feet on the ground.
-Be sure that you have some space between the top of your thighs and the underside of your workstation.
-Move your feet slightly forward so that the angle at your knee is 90 degrees or more.
-Keep your body in a relaxed yet upright position. The backrest should support the inward curve of your lower back.
-Use the entire seat and backrest to support your body. Adjust the backrest slightly backwards. The angle formed by your thighs and back (hip) should be 90 degrees or more.
-The arm supports should support the forearms comfortably while typing. Adjust the height of the armrests or forearm supports so that when your arms are resting on them, your shoulders can relax.

Adjust Your Keyboard and Mouse
-To prevent having to reach to the front or side, position the keyboard and pointing device (e.g., mouse trackball, etc.) directly in front and close to you.
-If you use a mouse, position it at the same height as the keyboard and right next to it. Grasp the mouse lightly and loosely and keep your wrists straight.
-Adjust the keyboard as low as possible without resting it on your legs. Your shoulders should be relaxed and not elevated during keyboard use. To do this, the keyboard and mouse should be on a thin (1 to 2 inches) surface, not on a desk with a drawer underneath.
-In general, your elbows are near your body and your forearms approximately parallel to the floor, with your forearms resting on either armrests or forearm supports. If you do not have armrests or forearm supports, your upper arms should hang comfortably at your sides.
-The slope of the keyboard may need to be adjusted so that it is flat or tilting away from you slightly in order that your wrists are straight, and not bent back while you are typing.
-Type with your hands and wrists floating above the keyboard. Use a wrist pad only to rest your wrists between typing. Avoid resting your wrists on sharp edges.
-Avoid twisting your wrists sideways to press hard or to reach keys. Instead, move your whole arm. Keep from bending your wrists, hands, or fingers sideways.
-Press the keys gently; do not bang them or hold them down for long periods. Keep your shoulders, arms, hands, and fingers relaxed.


Adjust your monitor
-Correct placement and adjustment of the monitor can reduce eye, shoulder, neck, and upper back fatigue.
-Position the monitor at a 90 degree angle to windows or other bright light sources to minimize glare and reflections. Adjust the monitor tilt so that ceiling lights do not reflect on your screen.
-Position whatever you are looking at most of the time (either the monitor or paper material) directly in front of you so that you do not have to turn your head to the side while you are typing.
-If you use specific papers a lot, put them in a document folder that is placed next to the monitor. There are document holders that will handle all sizes and weights of documents.
-Adjust the monitor height so that the top of the screen is at or slightly below eye level. Your eyes should look slightly downward when viewing the middle of the screen.
-Position your monitor so that it is approximately an arm length away. If you have trouble seeing the monitor check for glare, check the monitor, or have your eyes checked by an optometrist.
-Rest your eyes periodically by focusing on an object at least 20 feet away. Blink often.
-Clean your monitor regularly. Use a lint-free, nonabrasive cloth and a non-alcohol, neutral nonabrasive cleaning solution or glass cleaner to minimize dust.
-Adjust your monitor's brightness and contrast controls to enhance readability.
-If reflected light makes it hard for you to see your screen, consider parabolic lenses on over head lighting, a desk light instead of overhead light or as a last resort use an antiglare filter.
-Get regular eye check-ups.

2. Relax your shoulders and hands while working
-Your arms should be vertical at your sides. Elbows should be at comfortable 90 degree angle. You should not have to hold your arms up at the shoulders.
-Work surfaces should be height adjustable and have rounded edges (thus avoid cutting off circulation when limbs rest against them).
-In order to avoid muscle tension due to your body trying to maintain it's favorite temperature, keep the temperature in the office the recommended 73°-79° F in the summer and 68°-74.5° in the winter (This is a tough one to implement, but you can be creative and bring in a portable heater or fan.)
-Take breaks frequently and perform shoulder, forearm and wrist stretches to relieve tension from repetitive movements.

3. Vary Your Workday
Now that you have seen to the proper positioning of your equipment, make sure you do not stay stuck in one position. Our bodies were designed to move; they were not designed to stay in the same posture all day.
-Vary your tasks throughout your day.
-Build in short tasks that force you to stand up and walk away from the computer. These tasks should involve walking, standing, and stretching.
-Take these brief breaks every 20 to 30 minutes.
-Frequent short breaks may be of greater value that fewer, longer breaks.
-During these breaks, stretch muscles and joints that were in one position for an extended period of time.
-Relax muscles and joints that were active.
-Use a timer or reminder software to remind you to take breaks.
-Alter your sitting posture periodically and keep your hands and wrists warm.
-Some people like to stand when they use the computer or change from sitting to standing during the day.
Remember, it is not one size fits all. When you get into a car, you adjust mirrors and seats for your body, so treat your workplace the same way. An ergonomically proper workstation should do the work for you.

WORKSTATION MYTHS
Many generally accepted guidelines for good posture and proper furniture at computer workstations are, in reality, myths. If rigidly followed, these misconceptions can lead to uncomfortable and costly mistakes. Some of these myths include:

-Good posture at the computer eliminates discomfort and possible injury. "Picture-perfect" posture can be extremely fatiguing. If you commute to work and sit most of the day, you can be sitting for 10 to 12 hours a day. When sitting, the full force of gravity is carried by the upper body and can lead to excessive fatigue resulting in muscle strain and joint pain. This strain is increased when you sit upright and do not use the back of your chair for support.
-Computer operators should sit upright at the computer. If given a choice, four out of five computer operators prefer a slightly reclined position when working, because it reduces the amount of muscle activity required to maintained an erect posture.
-Height adjustable chairs enable you to work at any height table. In many situations, chair height adjustments won't result in safe work postures at a desk or table. If the table top is low, lowering the chair may reduce knee clearance and leg space. This can result in an awkward position that places extra pressure on your back. A better alternative would be to raise the desk on blocks. Petite workers often have difficulty working at a standard or high desk-top. If the chair is elevated to work comfortably, feet end up dangling above the floor. Footrests can sometimes provide foot support in this situation but they still do not accommodate all positions a worker might need to reach equipment or complete all work tasks. The best solution is to lower the desk or change the work task to eliminate the need for forward reaching.
-Ergonomic chairs are designed to fit all users. Everyone is shaped differently. Women generally have larger hips than men and need a chair with a higher lumbar back support and a wider seat area. Men frequently have longer legs and need a deeper seat area. When selecting a chair, consider your individual needs.
-Adjustable work stations are the best office furniture. Most work stations require adjusting work surfaces manually which is often inconvenient and time-consuming. A better solution is to place key boards and monitors on flexible, counter-balanced arms that can be easily adjusted to accommodate a variety of workers and work postures.
Don't be maimed by workstation myths. Find your most comfortable position. Make sure your furniture and chair are adequate for your needs and use good work habits. Change postures and take frequent short breaks throughout the day. Good common sense can go a long way in making your work environment safe.

The following computer workstation checklist will help you to identify some important risk factors that can contribute to work-related discomfort or problems.

-Is your head in an upright position when you view documents or your computer screen?
-Are your arms close by your sides in a relaxed and comfortable position when you use the keyboard or pointer?
-Are your shoulders in a relaxed position when you place your hands on the keyboard?
-Are your elbows bent at a 100-110 degree angle when you use the keyboard or pointer?
-Are the home row keys on your keyboard positioned directly in center front of your trunk?
-Are the keyboard height and slope both easily adjusted?
-Is your pointing device within close reach and at the same level as your keyboard?
-Is the keyboard and pointing device within close reach?
-Is the height of your chair adjusted so that your feet are positioned flat on the floor or on a footrest?
-Are your hips as far back in the chair as possible so that your back is touching the chair back?
-Is your lower back supported by the back of your chair?
-Is the chair backrest height adjusted to provide maximum support for your back?
-Is the size of your seat long and wide enough to support your hips and thighs?
-If you have armrests, do they allow you to rest your arms comfortably?
-Is the top of the screen slightly below eye level?
-Is your computer screen at proper tilt and height to allow you to view it without raising or lowering your chin?
-Are you sitting directly in front of your computer screen?
-Is the computer screen approximately an arm’s length away from you( 18-30inches)?
-Are your source documents positioned on a stand between the monitor and the keyboard?
-Is there sufficient light for you to complete reading tasks without straining your eyes?
-Is there sufficient lighting without glare on the screen from windows, lights, and surfaces?
-Are your shoulders relaxed when keying and using the mouse?
-Are your elbows positioned close to your side when keying or pointing?
-Are fingers and wrists in a neutral (straight) alignment when typing?
-Are you striking the keys with as light a force as possible?
-Are you holding the mouse loosely with your hand and fingers in a relaxed position when moving the pointer around the screen?
-Are you trying to keep your fingers relaxed when keying or using the mouse, i.e. not positioning or hovering your fingers above the keys?
-Are you avoiding awkward postures such as an extended finger or thumb when keying or using the pointing device?
-Do you take a 1-2 min. break from keying or mousing every 30-45 mins.?
-Do you take stretch breaks intermittently throughout the day?
-Do you avoid cradling the phone between your head and shoulder?
-Do you know how to adjust your chair, keyboard tray and other workstation accessories?

Countering Work Station Discomfort
Occupational Therapist Laura Griffin shows us how to do some simple exercises to counter pain and stress in the body from sitting and working.

“ I'm guessing if you've been sitting for a long period of time you probably want to be careful. You want to just ease into things. You want to just do a little body adjustment by putting things into the opposite position they've been in for a long period of time.”
“ When you do get up, to do a couple of stretches or think about doing a couple of stretches about every half hour to one hour.”
“First: with your arm extended all the way, bend your wrist or hand forward and hold it for 10 seconds, then backward for 10 seconds.
Next: pull your shoulders back and pull your shoulder blades together. Stand up in a standing back extension. Put your hands on the back of your hips for support and arch back.”
“You want to be a little careful with the neck, and move slowly. Tip the head gently to the side, keeping your face forward, then tip it gently to the other side.”
“For your leg position want to make sure your knees are below your hips.”
“You should have at least 2 fingers of room between the back of knees and chair. You don't want to have the chair bumping up against your leg and cutting off circulation.”
“And for women the tendency is to cross the legs in some way or another. All of a sudden you have unequal pressure on your leg. That's fine for 2 seconds or 2 minutes, but end up with uneven pressure at several points on the leg.”

Cancer and Supplements

One could affect radiation treatment and another could make tumors grow. In this week's Wellness Report: Cancer and supplements and what to watch out for.

“My mother lived to be 99 1/2! Yeah!” At 77 Anita Stein is funny, spunky and young at heart. She was also diagnosed 10 years ago with breast cancer.

“My husband died of cancer that year in May and I was diagnosed in September, ”and it looked bad. The right side looked really bad. Not just one lump but little funny things marching over toward the underarm.”

“I was just drained. I had no energy. I just felt like blah, but I didn't want to feel like that. So I went to the health food store and I said listen I need something to perk me up and get my immunity redone and everything.”

First a nutritionist recommended soy powder.

“But it turns out soy is bad for people with breast cancer because of all the hormones!” Stein found out.

“Soy is faboten!” says Stein, which means forbidden in German. “Totally no good for breast cancer!”

“It's very difficult for them to understand that something like a vitamin or a mineral can actually be harmful,” Says Dr. Neli Ulrich. She is a researcher at the Fred Hutchinson Cancer Research Center and she and her colleagues have compiled more than 30 studies on cancer patients.

She found: ¾ of them take supplements, but some studies show some supplements could be harmful. Take Saint John's Wort for example, which is a popular herbal anti-depressant:

“So there's a drug called Irinotican which can be used for colon cancer patients and it can alter the efficacy of that drug,” says Ulrich.

She also is considering a study into Folic Acid. Typically it helps to produce new cells, but so do tumors.

“Folic Acid is a nutrient that is important for the healthy growth of cells, but once people have a tumor, there is now data that suggests that it can foster the growth of a tumor.”

There is also growing research that grapefruit juice can be dangerous for cancer patients. It can block enzymes in the body that regulate how well the body absorbs cancer medication.

“We want to avoid a case of extreme toxicity,” warns Ulrich, “but we also want to give the highest maximum dose to kill the cancer.”

“I don’t take a multi-vitamin anymore,” says Stein, “but I take cod liver oil—but it has to be the one with the lemon it, vitamin E, D, C and I also drink green tea and then put a big, heaping spoonful of ground flax on my oatmeal.”

Stein has a pretty good idea *now* what's safe for her, but Ulrich says that's because stein does what most patients don't do: talk to their doctor--and ask questions.

“I always ask! I'm a curious person!” she laughs.

“Doctors need to do ask too--especially since more research needs to be done says Ulrich.

“Many times it's also not recorded in the person's charts. We really do not know if this is harmful or beneficial to patients.”

Today Stein is feeling good, and ready to spend a lot more time with her family.

“I’m OK. I have a wonderful life.”

Web Extra
Dr. Neli Ulrich, at The Fred Hutchinson Cancer research center, compiled more than 30 studies on cancer patients. She shares some important information on vitamin D, antioxidants, and what you should ask your doctor.

“Vitamin D can increase the absorption of calcium in the body, to the degree that people get kidney stones and calcification in the heart.”

“ So radiation is a case where we really want to have the damage done to the tissue, because that's what kills the cancer. Usually doctors recommend not taking any anti-oxidants prior to radiation therapy.”

“Now anti-oxidants everybody thinks are a good thing, but if you have radiation therapy, taking anti-oxidants may actually aggregate the effects of radiation therapy. What happens with radiation therapy is we actually induce oxidative damage to the DNA so we increase the oxidation and cause damage specifically to the cancer cells, or more specifically to the cancer cells, and if we take anti-oxidants it may reduce the efficacy of the radiation treatment.”

RECOMMENDATIONS FROM DR. NELI ULRICH FOR CANCER PATIENTS:
1. Ask your doctor for a list of the drugs you are taking.
2. Ask your doctor if there is a reason to believe that some of these drugs could interact with some of the supplements you are taking.
3. Make sure every doctor that treats you knows of the supplements that you are taking and it is written in your records.
4. Dr. Ulrich recommends *not* taking supplements *during* treatment.
5. Also, avoid multi-vitamins or "mega-doses" of vitamins. You can usually get most of what you need in a balanced meal.
6. Get on an exercise plan. The research is strong, that exercise helps in reduction and recovery.
7. Have a good social system around you to help you ask questions and support you when you need help.

4 GOOD SOURCES:
1. Your Physician
2. National Cancer Institute www.cancer.gov
3. American Cancer Society www.cancer.org
4. Fred Hutchinson www.fhcrc.org

Dana Rivkind was 18 when she got her first tattoo. A rose ... on her chest. "It was a stupid kid decision. I didn't really have any good reason for getting a tattoo." Rivkind says. And it wasn't long before Dana looked at that rose with regret.

"Probably a couple years. It was in a terrible location. it wasn't sexy. it wasn't pretty."

Now in her 30's, and with a big job at Microsoft, Dana decided the rose had to go. She started removing it with laser treatments in 2003.
That was five years ago. And it's still not completely gone. But it's better. "Now it just looks like a bruise and could easily be covered up with make-up." Rivkind says.

According to plastic surgery nurse Michelle Boone they usually see people in their late 20's and mid 30's starting families. They have kids. They are in the job market. It's affecting their careers. She adds getting the tat removed is a long, expensive and often painful process. "You really have to hate that tattoo. You don't want to do this frivolousyl. It's expensive. There's healing involved. The skin gets real blistered. It's ugly for about two weeks."

Web Extra:
Green is the hardest color to remove And also -- one of the most common. Red and black are the easiest to come off. There are new inks being formulated for tattoos that are supposed to come off with "one" laser treatment. But some are skeptical that they'll catch on. " It's going to be more expensive. It's just now coming out onto the market. I wonder how successful that's going to be. Because people do tattoos on an impulse and rarely do they stop to think that in 6 months I'm getting married or getting a new job...." says plastic surgeon Dr. Richard Gegory.

How much is it worth to Rivkind to remove her rose tattoo? "I've paid 175 dollars a treatment. The last one was my 9th treatment." Do the math..that's nearly 16-hundred dollars..and she's not done yet.

For more information from the National Institutes of Health on tattoos and tattoo removal:
http://www.nlm.nih.gov/medlineplus/piercingandtattoos.html

The FDA
http://www.cfsan.fda.gov/~dms/cos-204.html