Acupuncture and Weight Loss

Important Links

• Full Industrial Rehabilitation Program Description
• Medication Issues and Behavioral Treatment

Industrial Rehabilitation: Chronic Pain/Fibromyalgia Treatment Program

This is a multidisciplinary, biopsychosocial, wellness-based, functional restoration, pain-management program to treat central sensitization, which is the prime perpetuating factor in fibromyalgia and myofascial pain syndrome. This program is described as non-pharmacologic. Certain drugs prevent the patient from fully participating in or benefiting from a behavioral pain program. Behavioral therapy is impossible to teach to: (1) patients with pain if they are taking analgesics, (2) patients with sleep problems if they are taking sleeping pills or drugs that disturb sleep, (3) patients with fatigue issues if they are on drugs that cause fatigue or cause excess stimulation. Generally these are analgesics (opioid and non-opioid), hypnotics, tricyclic antidepressants (which increase daytime fatigue and impair cognition), neuroleptis, (often cause fatigue) and muscle relaxants (generally ineffective and cause fatigue). This program is evidence-based and documented with standardized outcome assessments and a system for symptom rating. It meets all of the standards for chronic pain management in the Medical Treatment Utilization Schedule (M-TUS) and ACOEM Practice Guidelines. It is also supported by the National Guidelines for Chronic non-malignant pain syndrome patients II: An evidence-based approach (www.guideline.gov). Click here for a detailed description of our Full Industrial Rehabilitation Program.

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Medication Management for a Biopsychosocial Pain/Fatigue Management Program

Almost all the patients referred to my program are on a drug-management plan that is appropriate for medical management of pain in the absence of a behavioral program.

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But behavioral pain-management is so effective that it adds a new dimension to the management of chronic pain. It requires a separate approach to medical management. This program provides the combination of behavioral sleep retraining with behavioral management of pain, mood, and fatigue. All of this is tailored specifically for patients with fibromyalgia syndrome or myofascial pain syndrome. Although this program is considered behavioral, it is not based on psychological theory; instead it is built upon principles of neurophysiology and behavioral-change theory. This program offers both: (1) behavioral management for pain and mood and (2) behavioral retraining for sleep. These are viable options for reducing symptoms and improving quality of life for people with sleep disorders, chronic pain, depression, and central sensitization. The average patient with severe problems experiences a 40-50% reduction in symptoms in about twelve weeks. But this outcome often requires the treating physicians and psychiatrists to reevaluate or redesign their medication plans so that drug management is not only supportive of a behavioral pain-and-sleep program but integrates this behavioral intervention into their overall approach with the patient. This program expands the options for the treating physician. The patient does not have to be off of all drugs to start this program. The program is designed to support the patient in the withdrawal process and eliminate the need for non-essential drugs or drugs that prevent wellness. Click here for a detailed description of Medication Issues and Behavioral Treatment.

Nutrition and Menopause

Women in midlife start to notice many changes to their bodies, most notably weight gain, loss of muscle mass,  bone loss and gastrointestinal discomfort.  Although these changes become more obvious in the 40’s, they start much earlier, so it is important for all women to pay attention to nutrition and exercise at all ages.  The main reason for these changes is the progressive loss of estrogen and progesterone. Not all women are candidates for hormonal replacement therapy, but there are natural  options available.  It is important to discuss these options with your physician. On average, women in menopause put on 1 pound per year, so it is very important to keep a healthy weight as we age.  There are many strategies women can use to reduce the symptoms of menopause.

• Eat those fruits and veggies. Variety is key.  Eat all the colors of the rainbow.  Most Americans are not getting their daily servings of fruits and vegetables.  Fruit should be limited to two servings a day and non starchy vegetables are unlimited, but you should consume at least 8 servings a day.
• For bone health, consume calcium. It is better to get your calcium from food sources.  You should have 1200mg of calcium daily. Good sources include dairy, canned fish w/ bones, broccoli, tofu and kale.
• Make sure you get your iron. You should be consuming 8 mg of iron daily (that equates to about three servings a day). Good sources of iron include red meat, poultry, fish, eggs, nuts, enriched whole grains, beans and spinach.
• Get enough protein. Try and consume protein at every meal (as it helps with feelings of satiety), as much as 90 grams a day, spread out evenly. Good sources of lean protein include, poultry, lean beef, fish, and soy.
• Stay away from packaged foods as much as possible. Packaged foods are loaded with sodium (not your friend) and sugar. Keep all your beverages calorie free and if you do consume alcohol, do so in moderation. Guidelines state women should never consume more than one drink per sitting.
• Stay away from white foods-avoid white flour, white sugar, white potatoes and white pasta.
• Move your body.  It is important to get 30-35 minutes of cardiovascular exercise daily and two to three days a week of weight bearing exercise (which helps build lean muscle and protects/strengthens bones).  Always consult your physician before you start a new exercise program.
• Take Vitamin D3. Unless you are very low (and you will need a prescription from your physician), I recommend 800-1000 IU daily.
• Consider a Probiotic for gastrointestinal health.  A general probiotic, such as Culturelle can assist with gut changes and gut health.  If you are noticing gas and bloating after dairy meals, consider switching to lactose free dairy.  If constipated, try increasing fiber and water.  We should all be drinking 8, 8 ounce glasses of water daily.

Dealing with the changes that menopause brings can be daunting and stressful. The above strategies can help reduce symptoms and improve your quality of life.  Getting support from your physician and dietitian can also help reduce the stress associated with managing these changes.   Grilled Fish Tacos

From EatingWell:  May/June 2010

Makes: 6 servings, 2 tacos each Active Time: 30 minutes Total Time: 50 minutes  

ADOBO-RUBBED FISH

• 4 teaspoons chili powder, preferably made with New Mexico or ancho chiles (see Note)
• 2 tablespoons lime juice
• 2 tablespoons extra-virgin olive oil
• 1 teaspoon ground cumin
• 1 teaspoon onion powder
• 1 teaspoon garlic powder
• 1 teaspoon salt
• 1/2 teaspoon freshly ground pepper
• 2 pounds mahi-mahi or Pacific halibut (see Note), 1/2-3/4 inch thick, skinned and cut into 4 portions
• 1/4 cup reduced-fat sour cream
• 1/4 cup low-fat mayonnaise
• 2 tablespoons chopped fresh cilantro
• 1 teaspoon lime zest
• 2 tablespoons lime juice
• 1 teaspoon sugar
• 1/8 teaspoon salt
• Freshly ground pepper to taste
• 3 cups finely shredded red or green cabbage
• 12 corn tortillas, warmed (see Tip)

COLESLAW

    PREPARATION

1. To prepare fish: Combine chili powder, lime juice, oil, cumin, onion powder, garlic power, salt and pepper in a small bowl. Rub adobo rub all over fish. Let stand 20 to 30 minutes for the fish to absorb the flavor.
2. To prepare coleslaw: Combine sour cream, mayonnaise, cilantro, lime zest, lime juice, sugar, salt and pepper in a medium bowl; mix until smooth and creamy. Add cabbage and toss to combine. Refrigerate until ready to use.
3. Preheat grill to medium-high.
4. Oil the grill rack (see Tip) or use a grilling basket. Grill the fish until it is cooked through and easily flakes with a fork, 3 to 5 minutes per side. Transfer the fish to a platter and separate into large chunks.
5. Serve the tacos family-style by passing the fish, tortillas, coleslaw and taco garnishes separately.

• Make Ahead Tip: Prepare coleslaw (Step 2) up to 4 hours ahead.
• Notes: Mahi-mahi (also called dorado) from the U.S. Atlantic and halibut from the Pacific are both sustainably fished and considered best choices for the environment. For more information, go to seafoodwatch.org.
• Mildly spicy dried chiles, such as ancho or New Mexico, add moderate heat and rich flavor to Mexican sauces like mole. Chili powder made from these chiles has more flavor than American-style blends. Look for whole dried chiles in the produce section of large supermarkets and New Mexico or ancho chili powder in the specialty-spice section of large supermarkets or online at penzeys.com.
• Tips: To oil a grill rack, oil a folded paper towel, hold it with tongs and rub it over the rack. (Do not use cooking spray on a hot grill.)
• 2 ways to warm corn tortillas: 1. Microwave: Wrap stacks of up to 12 tortillas in barely damp paper towels; microwave on High for 30 to 45 seconds. Wrap tortillas in a clean towel to keep warm. 2. Oven: Wrap stacks of 6 tortillas in foil; place in a 375°F oven for 10 to 15 minutes. Wrap tortillas in a clean towel to keep warm.

Per serving: 318 calories; 9 g fat (2 g sat, 5 g mono); 110 mg cholesterol; 29 g carbohydrates; 1 g added sugars; 31 g protein; 5 g fiber; 714 mg sodium; 829 mg potassium. Nutrition Bonus: Vitamin C (30% daily value), Potassium (24% dv), Magnesium (22% dv), Vitamin A (17% dv), Iron (16% dv)