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Pain Management as an Opportunity for Lifestyle Change

David Fernandez

Conference

Recorded

  • October 28, 2011
    3:00 PM
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but I just want to thank you for this opportunity for almost to be here Lord here is your army here is your team of people on the medical side to do your work we pray for the poor strength for wisdom we pray for guidance we pray for energy lowered the devil tries the business down the Lord give us strength it was energy and give us both openings that we can come in and in combination with our church members as well be part of the team that leads people to you because we know you're coming soon and this talk today Lord be with me I want them to hear me bother about the ledger you and be with us and think of this opportunity Jesus name amen why the Sony and happy that where we were able to come my wife is next-door think listen to another talk to write about twelve thirty this morning Opera Michigan but that's my first anger looks like a pretty nice for the world as in the don't have but I was so wet with out one of my favorite verses and that is found in Psalms one thirty nine fourteen I will praise you read it with me I will praise you for I am fearfully and wonderfully made marvelous idea words and that my soul knows very well we are here in one of the parks in Utah I think this one is maybe the design and/or one or the other ones but right behind us it drops down about a thousand feet and in all the different rock formations and as you look at it it is beautiful now when you read about how God created our world it didn't look like this it was even better but even then as soon affect the state we see the wonder of God in everything we look at would you agree and we are fearfully and wonderfully made law of when went back to RSS newspaper in pain management that's fine but when he threw well I want to talk about pain management has an opportunity to lifestyle changes how do you do that and that may lead even to the barbers and you can do it did was I appreciate his encouragement always wanting redrew the need for a man with no ignorance is mental and openly become a member here and appreciate that our objectives are I try to keep it simple what I did today is doing this to try to accomplish what he wanted to do with these objectives to review the major sources and treatment of pain in the neck and back on causes and prevention as it affects us and in the medical field outlets question is not amused as a motivation black lifestyle change what I ended up doing was I took pieces of different talks and and all from different lectures and combine them into this letter today so I hope your privacy out of radio which lays people want to talk at runtime meet with the same but that's what outwardly penetrated what hopefully will be amended to everything we have a lot of material to cover open of the little time left in all of the scientific talk to go put up your disclaimer some consultant Republicans find them resolved in a royalties has nothing to do with the day but there it is anyway built for every good thing that God has for us the devil as accompaniment it takes a beautiful thing and tries to inflict pain and punishment upon the individual can be physical it can be mental it can be spiritual financial and can do whatever and the justice usage it with his baby in the screen that was born with three legs think of the suffering not just of the child but the parents and of the staff they had to do with with with with the with the with this bigger child and what this Jonathan Goldman out to live what we would consider a normal life if there was possible oftentimes and you have multiple victims like this there is so my residual issues that reason that maintains and Scott so what and I don't know the bedrock of this but the group baby but the devil wears and and just changes things as much as it can for the worse for the workers and what do what what what what what you did it was where your Dominican God 's character a with way to vindicate his characters when we say things that does what you say howdy drink this kind of pain honey until the parents where I want to take everything out as as a parent I would be terrified that my babies I have a normal life what do you do what you do how do you tell them that this too all the building work Doug God tells us in third John one eleven I wish above all things above all things that you may as well prosper and be in health even as by what even as I saw presence God doesn't want just physical health when you hear the wind just mental health for you he doesn't want just spirituality was it all for you hiding was all three we heard earlier today that got sought a higher than ours his goals for us is hard and we can even imagine he wants us to have all held in all things in all circumstances now the devil comes along and throws on the monkey wrenches in it and tries to distorted and some of us for whatever reason made you were doomed to live a life of suffering a lycopene unlike the difficulty and we know we all know people that have the worst and often we are right and we would use a bee buzzing like everything that happens it had a patient who I saw the last a few months that had so many issues her husband left her she is now single mother her she was fun I have to agree different types of cancer she's being worked up for another one or two she has some math they didn't know what it was she had back pain which is a nightmare which is how I got rid she had this business-to-business and by the time he was dumbfounded about it she was crying and I was almost crying whether how can I handle all that far I quit I couldn't deal with it all I did it with my little parliament and in fact I couldn't do anything for her because she was putting all these other workouts is when we find out what else you got and what the treatment plan is then we can maybe deal with your bank but God does not want that for us for some people and I told her I said I don't know why this is seven to but I do know this I do know that God says that we can handle all things through Christ which one strengthens me I said I don't know why you are allowed to suffer but I do know that perhaps there is someone that will see you suffering and see the way that you handle it and therefore give the accident because she told me she just become Christian and I said and maybe your role run this are because there's somebody that needs to see any hand so your choices are you handle but I will say one thing Sentinel as for in one day soon you have a perfect body without all this pain and disease and whatever and that's only thing to do the giver Hopewell and fortunately were pregnant with her their my office window overlooking of anatomy to get a limited basis for some of the causes of back and neck pain and what were born are our spine assesses Chicot occurred this is kyphosis the other ways lordosis as we grew up with other transition phases until we get with all the and then we have lordosis in Iraq this is from the stack kyphosis in the thoracic area lordosis the lumbar area and thence kyphosis in the sake of not when you go from one zone to another we've opened up a exact occiput the neck neck and thoracic thoracic lumbar lumbosacral sake of the coccyx is a transitional zones and anatomy may be a different their people that I have none of the threads on the thirteenth normally as well as some people abnormal number five lumbar vertebrae some enforcement six but that is transitional nanny that they can occur the basic building block for a vertebral body property was that Mister got the vertebral body up front in the government the superior and inferior and place and this is when the distance it might appear the disc attaches to the coupon will see them the bodies connected to the elements in the back by a little while to provoke a particle which branches up to the transfers process is superior to another facet which makes one of the joints in Percocet which makes about joining each vertebrae is for joints to with one above it to with one of the blog the real choices like it's need for the time for the real and they can get arthritic thinking they can call something amended by the argument back on the land value problem had sort of laminectomy ectomy means removal whatever the word in front of his native Spanish process and the transverse processes of spinous process they also ran eleven slowdown service ligaments attachments for muscles and was whenever something something else as potential proclamation of that area and an neck that can be sources of pain there's a difference in anatomy and the spies you go from the neck all the way down to the sacrum is starting the cervical spine with a nice capacious canal affected Ruby is there is is right behind the second cervical vertebrae which has will recall the rule of threes after that is filled with you void which I was in a minute which is a portion seem to coming up behind the arc to see one up there to store the spinal cord a third space that that's why I went to people break their neck and the Greeks seek to matter but is paralyzed now Christopher Reeves who played Superman shattered CJ when he fell off his horse and landed on his head and what happened was that the fragments went back and struck the spinal cord and right at that area there and not doubters respirations I spoke to neurosurgeon that operated on him and also not been a nurse there they gave him my mouth to mouth he would die from sufficient to bring is awake alert penalize convey so while the lady that ended that saved his life and the prolonged and talk is best when the last year was to go down in the past flight as it is never and then the egg is low but deficient in the lumbar spine and ultimately provided figures to go down bigger loads placed on the lower areas of God abilities with foundation from bottom up right administrator was of course they can then adhere app of the sacroiliac joint the pelvis comes over and passes right here and of course is not very economical some neck pain but yet the changes and these changes are poor because of the thoracic spine with a narrower canal idiot anything that encroaches in that canal whether the enables Berwyn Libya distribution would be into them or whether the bleeding within the infection whatever it may be there's less room for comedy right so you can have more impressions find coordinates in one or logical issues the nurse come out come out right any register of attaching here that companies with a ribbon attached to the bone and is just never of course I will you feel when scoliosis where you have deformity of the vertebral bodies as well with rotation and everything disc is competent usual complicated so these are some of the things that we need to remember this is the one looking at it from the top down here's a thicker surface here's the of Bremen for the vertebral artery becomes of the vertebral artery this is front of this is the the joint right here where the C2 comes up and rotates but the Army comes out of there comes over and the top year into into the brain this is looking at it from side and hearsay to us he won the seats were different than all the other people bodies need to ask you about the way which comes up behind here and then only when her in on then there's the ligament was right behind and this is what Chris Farina shattered a memorable one back and and are compressed and damage the liberty will body there is no desk between C1 and C2 the dispute between C2 and C3 a lot of patients come to me because the range of motion and they notice is less and then they notice that now the cancer as well and they may be having some difficulty when the drive is looking with a blind spot maybe their workout about competitive attorney of the Mac or their advantage and one side of kitchen the other side so we assess the range of motion and waiver of that is really made us in such an awesome manner and that our next we can return and the more of our environment to better take at the careless have a question extension of middle side effects open the lab in your left and our rotation over here central planning and a conditions of the neck out from the skull down to the cervicothoracic junction can affect the ability to move in any one of these planes and there can call submissions also the back of people lose their range motion in the back and feel stiffer and a lot of different conditions that can cause a step back you've got ankles and spondylitis for example which eventually ends up in this some more people will ought up users find some may end up views like this I think people use all of you like this it happened gradually over the years but this is how they walk was a command and have chin and chest deformity and they cannot raise so they have to hyper extend for more of the back to be able to walk forward very debilitating that can be caused by a variety of things arthritis can cause by ankles and spondylitis and trauma on different things of that nature but it can affect your ability relative and just think of if you can't will gentleman was eighteen years old ankles and spotlight is on appeals from the skull coccyx and the set in I had to sit here but he developed arthritis of his hips Sonali couldn't than he could and couldn't set so we had to do hip replacement at the age of eighteen when you want to do that because you know they discriminate at least two revisions probably over the course of a slacker and revising is looking for both segments of the more the public scar tissue and so forth but that I remember when it does seem in a hospital in his lane and the bad and I'm staying in and at a point of talking to him and he's not looking at me now you can't turn his head 's I had one of bottom of the bed so he could see me from Wheelers Lane now assistant Roy said yet good attitude though really financing there he had different degrees of the range of motion spine for the neck thoracic and lumbar and the typically when I dictate I will say that was able to bend forward and reach the midlife speech the knees Proxima Pisces pickles on the floor of sin was able with mouth closed she was able to get with them to figure through the forefingers of just and in the rest of arteries in degrees now that this is a religious instruction when I was in medical school they taught us that the disc had no cells and it was a cellular but that's not sure anymore now we know that there are cells and that that secrete these different proteins in the different operative like as they make up the beyond the interim a little of the desk and some very interesting structures made of a several layers of they make up the engines which is the outer part of the visible slaves about thirty degrees to each other through the urgency the different regulations attached to the original body they overlap yes this you are right about here this is coming over and he worked couldn't see but you put your fingers in my chest here and ran your fingers up and down my spine you could tell which is the disk of which is the ball the ball is on the valleys the disc of Auburn Hills he can run up-and-down up-and-down and a slight incline and when her and this is not here's the new pulses which is has a lot of upload content that this has lower water content what happens is we get older dries out Minnesota's insurances as it dehydrates much like a tire when it is the linear bulges right so when the disc is low on water bill blogs in all directions in one of those wretches is into the canal I can put pressure on the nerves of pressure on the spinal sac respond accordingly and what level you're at a very interesting structure and a very very tough very very hard and then attaches greater than play here you haven't contemplate and when we go into somebody who has collapsed this he failed all nine of the management we will go with and will take this this now the largest in the case with the three cases of two weeks ago with one of my partners were we came in from the front and just hoping out and we put enough up the cage peak is a polyethylene to keep over polyether of the two thousand as the case is over the own graft substitute and that becomes now spacer and then with screws and the bones and in the nephews is we also have artificial this all that we can replace this with over one of them Cisco portal market because interest was in paperwork rate of interest is one pay for itself Thousand Oaks real shame as it was originally really nice but this has of the cells in it this has a lot of water in it and when business week then you have herniation of the material coming right through here and here's looking at from the top down so you can get one analyst Nintendo cracks will run this way or going out this way and or does weakness along with some business mantra that we would come up through the cracks which we will call it an extruded discrimination or just wanted out languages it would be contained not when the disc is generous or skin cracks one of the things that can happen is you can get some nerve fibers going into the into the desk which normally doesn't have got some nerve fibers on the outside always having been interfered that also can act as a pain generator and therefore can be a cause of all pain outwitted in an act of classic area and and that's when you meant to do a a a removal of the desert into a fusion if nothing else will work as a procedure called intravesical electoral thermal therapy ID e.g. I do for short they came out early to thousands couple of brothers invented it on California became the rage because he just under extra control with the patient awake insert a needle into the desk coil a electoral ground that plated machine step on the pedal and I keep the other the catheter in here and then an idealist who shrink-wrapped this is for my college and I need to go something about the saran wrap and cover shrinks and him avoid using major saran wrap it out for the winter and shrinkwrap and similar think that it would do that in a post event statement body lay down new college that you'll any of the pictures that you made in heaven because of pain also that he would feel any nerves coming in here at this but some of studies now the show doesn't work as well as it was thought and not too many people do it much nowadays that was one potential option for controlling pain you think me coming from a desk every topic structure will a more more about it one of the things of the trying to do is come up with a nuclear replacement where Senate taken the whole biscotti make the linear print this out and slip in a prosthesis that one begins the containers on annulus it will all swallow what different models one of models or so it would swamp water and then you would write on that endless and you save yourself fusion now their son 's prototype seven were done years and years ago I attended a lecture where Doctor Buddha really only looking spine and to metal balls in and the spaces and I forgot the name of that particular device but that was an artificial nucleus and that was his back and that was done decades ago so there's that the waste to the creditor they're also working on trying to do in injection and do recombinant DNA injection is to play restore the ability of the cells in the distal reproduce the matrix that keeps it from dropping down so maybe that in the future I go for your annual disc injections to keep this one bat that can get back to Google I don't buy the working working on that this is a very interesting slide here is your cross-section through a desk here's the annulus here's 's idea of notice is endless see the anterior longitudinal ligament that that they doesn't have much maligned nerve fibers he had a posterior on his ligament it does have some award a look at this box right here you see the little box is a Christ just a little arthroscopic section of the junction of the desk with the vertebral body and it's over here on this site right here and I wonder what you look it is these little red channels these are the blood channels writers CDs all these Lemaster channels later in the inning and paintball and I'm going up into the Highland College of plate once you hit eighteen between eighteen to twentieth or so let's applied the disc is gone so how does the disc it is nutrition how does this get rid of the metabolic waste products is a new buildup metabolic waste management have a toxic picture right so you want to get rid of all which wanted to good stuff and get rid of them then bringing that it's all done through diffusion the reason for these vascular channels writer at the junction of the disc with the ball now what do you think would happen if I plugged these channels up yet affect your diffusion right enacted in as much nutrition and and your building up toxic products which what which happens to lead to degenerative disc disease which leads all this cold task a all us on related degenerative changes yet that this collapses now the facet joints ran down the night of impingement in the frame when the nerve comes out a Soyuz letter that is available better and that's what happens with the back of that's what happens with tobacco tobacco clogs up these channels in the what happens is the body against sclerotic you'll see it as white on the MRI yoga sclerotic so now if I quit smoking and I have brought again place that's it it's nine and go back the other way because the bone is already deposited more ball in an area so the sclerosis is is not good because it exists even if you cannot should quit your patient should quit because there other things the back windows besides just that's right so they need acquittal and anyway but it affects that I really like these lies right here these light shows what happens to like this throughout the day and when episode is throughout the night of a woman your left over here shows of the red arrows show the amount of pressure when you're standing when you're loading the desk when your vertigo and loading the desk is no question the discovered a great so when your windows when you squeeze a washcloth that well what comes out waters of these green arrow pointing away from this join the axonal water so throughout the day some standing and upload to my desk I'm losing water in my desk I can I can sit there and I can I can bring some more which I should drop today for multiple reasons but at the end of the day I have less water in my desk now look what happens on this one he earned a right the red arrows on either the inner there's less pressure when I'm laying down the now about the green arrows there's more water going into the desk in the disk hydrates so in the morning I get up I get dressed I get my car to work I have to think my near and pointed up with some color and nighttime at sundown at the end of the day to get my car on the mayor 's not right bringing on some shorter so we we did were taught in the morning were shorter in the new knowledge would third shift at night under men's reverse rating as well as only interested in the dynamics now that happens an area of Raymond Raymond is an open this is where there comes up or ship out Governor comes out right here so when this collapses is my joy right here the relationship of the joint is that this is going to ramp down this is going to get narrower minor come out here to come on down my leg is going to get tighter than the none the all the above joint there is maybe working abnormally is going to need become arthritic developer crosses develop on squares in part which England here awarded to the now also is not just another common element that are coming about my arm was literally comes up to be the joint the nurse comes out to feed your muscles and you can see what he can develop multiple causes of back pain and here is just shows a uncomfortable shots about the different ligaments and of course any in the ligaments can overly so whatever they can be a source of chronic pain as well also and if you like this all the time what happens to the dish use Bigelow contract to write now I come in and operate on you and I got joined this the homage you love the stretcher hamstrings I is him that I had singles friends lovers all right I buy it does lead to a molecular hearse at the stretch of butter vitals are a middle stretch they're never going to get Lorraine of his levels less than an related two-level fusion in the eyes are enormous emotional weight to build upon the floor I came upon answer but identity of the ligaments are our intellect is logged in to review what I was going to do that now you may have some yet the stretch of junior soft tissues and to some degree and an again looking at the boat was still under the ligaments thicker in the middle and the as is a little thinner schools on here that's why a lot of the distributions are not central but paracentral in the nerve is coming out right there and then there's nerve coming right past at this right here and and so a lot of things up your smile ligands in the Negev are important to maintain our alignment and a connection to the head of a allowed the PR when attached to the skull and the ligaments in the neck and the test of skull interestingly this is other a cervical nerves and they come out on number one it comes up above C one number two above see two above the three above C4 Busey five above C6 but the Sabbath SCA does above the one and if you wanted below T1 and from there on everything exits out below the corresponding people by and the mid to lower neck is the usual area C four five five six are the most frequent errors for the discovery and pendency six seven hi Bob bring does not get affected very much I don't know why maybe so this protects some reason and is in effect and I sometimes see one with Doug about transitional anatomy sometimes see one will be partially attached to the skull which can limit your motion sometimes will have auto fusion conjunct uses the neck as I used I was using a couple 's life it is an x-ray of normal looking on that internal molybdenum writers respond for this great thing here the whites the street was spinal fluid that's made in resolving your Pringles although it on your sacrum it's in real life it's clear computer makes the whites we can see in some of them I think with this it's a start his feelings were in Isaiah MRIs and the fantastic tool that the shot here I I put it here for this reason I have this little piece of tissue Carmen escorts in Mobile phone and there's some that think that this can be a pain generator and what happens that recently says I've been over to pick up a pencil a letter something very light making up the abhorrent payment of stock like this what they went of living happens is that when you been for this joint physical this way uncovers this and sometimes this gets split into human comes back is this trap and expansion of honors a fashion similar and that causes significant pain that is what initially can often be alleviated with the manipulation in an trap of using is better in a few days I have the nerve right here is in the cross-section and you can see how it this guy gets arthritic it can impinge on the one above it work if of the spacer collapses this gets to trap within a dozen vessels and other vessels also can get engorged and and blood vessels and nerves to them as well in the engorgement of the blood vessels can also be another source of of of of pain anemia and one are arranged as a but is anything wrong with this this is a sagittal or a lateral view of a neck this is a CAT scan this can put one so that some three four five six seven Susan businesses to transfuse vitreous news this is congenital fusion this is degenerative and a strong writer the steps be unfortunate genitals a motorcycle accident and sustained this injury and I was I happen to be in the surgical allowance of the time that they were doing this exploratory laparotomy for internal injuries and trauma surgeon I came into the lounge and put this up once on the viewfinder and set in administering this out as a long order seizing the operator among them month engine with his bellies may be implemented as strange as these often size and I look at this and I is is this a severe soft tissue injury as well as it is a look at a gap 's head got pulled somehow and he and instead of separating appears everyday here but this shows the congenital anomaly PLC Tuesday three ROP is here because the increased space between C1 and C2 here he has a congenital huge C2 probably joins the three vertebral artery foramen so if you are going to come in and put a student here you don't have enough room to do it we went in I had to trust me I had to my resident residence with me and that he was a quadriplegic and that he was advantage of massive soft tissue swelling we can budget we try to move it gently under CR had little traction try to do anything anywhere to do in the piano look just like that and conflicts he expired on the next day massive soft tissue swelling you as well it looked like the space that demand this year by the you know we don't see the falsely one month on this lens please begins one that the industry doesn't invent but anyway letters on the different types of payment we thought we has a lot of lingo and and the neurosurgeons have lingo of the answer to settling on the Radeon assembling the design does have lingo and we we message across in some areas and then assembling them as well write it different than but I don't think that we comes from the axial skeleton and for several compression fracture system the arthritis and we talked about then it would come from the exoskeleton were negative they would be coming from a nervous being pinched I refer to send a pain in the distribution of that nerve of the bigger sciatic nerve follows S one oh five and and welcome bonus that the five following on foot on the flipside food going on the wheelset pain this route referred pain for example Eva Toomer this referring page you got a liver issues and can be referred pain in the back of gallbladder I hear itemized example of abdominal aortic injuries and was in back pain and well as a Internet outpost in the emergency this general had acted without paying and the problems inspect policy and a huge pulsating AAA and which inserted the next day and I was rewarded that much for finding by the allowed scrub in the new heavy attending in the fellow in the chief resident he has the agenda resin and then you had me a little enough bottom original reporting a retractor land exposed at all that they put their lives above and below and then we watched that split and an hundred summers are there goes that I am forty one will space this economic this because in your right in the face by face is one of those things existed going to see the above shortages the splitting of the anagram in the face am proud to say I maintain my position I never let my pulse I don't on every track there are though they got control I was at all it important enough for economic phenomena messenger again I made neuropathic pain this is becoming more more a lot of it has to do with diabetes alcoholism delete and add B-12 deficiencies and that even the healthiest people can get neuropathic pain for whatever reason but you've got four million people in the US per year and half neuropathic pain it can be a primary lesion when the nurse can be a dysfunction of the nervous system as you can have postherpetic neuralgia it can be got HIV related disorders of hybrid radiculopathy and a lot of times it's hard to diagnose it and because a lot of has become in the head after meals if I had a nickel to try to sort out exactly what they have and then you have a lot of whom comorbidities diabetes pension kidney disease heart disease liver disease and it's a it's a mess chronic neuropathic pain also can be so significant injury in last a lot longer competencies are based in the reason called reflexivity dystrophy I remember that if type one type two no differences by two has unnerving that it may have happened Goodman pinched nerve good than optimal surgical equipment traumatic event whatever and out I knew a lady on a patient some years ago they had this in reform the pain was so bad she was going back to the doctor can't find some decoder because it hurt so much joy and advice you found somebody in Cleveland but it can be a very very debilitating thing would be to just take it off please what happens if you just take it off of this poster pattern around to from shingles and it I well the celebrations on ten euros seventy years will continue to express significant pain and provision for one year that's not to understand this concern for me because my almost hundred and two -year-old grandmother professionals I got a phone call away here the grand shingles are linkages on hundreds of years old but I can need the constant burning pain in and the condition goes in your optic nerve agent she was in ride very painful very painful your facial nerve very painful it can be extremely debilitating it can cause up paying a Mayo Clinic TMJ a significant list of the variability that pain was posted back in round of this was referred to post amputation pain we a lot of trauma and all three medical centers and level one trauma center and something to get the mangled extremities and try to save them but you television look I can spend hours trying to say that you spent two years in an operating room at the end I will stop and people like me to take up now we taken up later I'd rather take it off now because people get attached to their extremities and two years later even those just a stump this paper they don't want to take them off and will continue so but the and I'm paying what happens is if I lose my lag and to aggregate my leg you have to cut through my very difficult through my site and write and what happens is when the nerve gets transected the price to reattach itself and so little theaters they did come up all the sins aroma can be very painful what we do is we pull down on the nerve and then we codicil to pop back up and try to avoid the area where you put pressure on your stop and then you need a will very well but also remember that the brain for years said any of them coming from that nerve means there's allowing their right to my brains as anything coming from those there is this is what there's always as amazing really bad and then does one explain 's them talk about why people still say I can feel my point I can feel my leg it still hurts Phantom pain and this is one of conditions that you might be what he's aspire for stimulator and medical slides on their chronic chest wall pain syndromes we going to do an entry procedure through the chat to bridge originators in the nerve comes out underneath the red when you spread the red in essence present on the net on that matter right and I you can have chronic pain and distribution of nerve along the incision and something Geneva has some awesome name inbox done or even transected nerve or do a spinal cord stimulator side of the five course dinner therapy can be helpful for these and nothing else works Billy and Gloria Pena get hernia repair very common procedure write it will not be put at hernia repairs that can also lead to some chronic pain a either with ileal inguinal nerve you will have a passive verb General Feller England is going to go to the genitalia and can go to the needle inside of her thighs and that can also love the chronic pain syndrome whoa what about Bill back surgery syndrome some as surgery maybe one survey to better surgery feedback surveys for back surgeries and a patient came in one accountable the bacteria it was a she still had back pain so I won't drop I said alone is not much to do here I get lumen stenosis here but I'm these can take care of them and you just got bill that syndrome cost twenty billion dollars annually by the other man was a juicy chronic back pain back pain my chronic back pain is the second most common visit to the doctor second after all respiratory infections and it's the direct cost has been estimated to Bob of the above a hundred billion the indirect cost nobody can put a big bigger on your indirect costs include lost work productivity people lose the job all the more good file family dissolution this is the solution where because of the main breadwinner can't work anymore financial pressures and families divorce on the next four years on the family kids may become true antenna may be to become thieves maybe lunch owes money is on the psychosocial dishes all the societal issues go along with that inner cost cannot be measured but a hundred billion dollars just in the charges generated is a lot of money and eighty percent of people in the United States they say will have back pain at some point in their life most the time it is better but the principles you have a lot of psychosocial disorders I don't know about the events in your practice but it seems to me I am seeing a lot more people commencing their bipolar bipolar even teenagers come in insane I what's up with your medical history the circle mental disorders what happened on bipolar also I have major depression something a lot more depression and in people all the way down to the teenagers and kids I'm seeing a lot more bipolar unseen schizoaffective disorders anxiety Samantha 's agent always preservice or secondary gain issues the government owes me in awe I serve my country they only I work for General Motors they only everybody owes them but they don't say I will myself to do my best to but everybody owes them something and I know I haven't not all but the sausage of an attorney in your case was set forth as to help me get Social Security benefits is that McGinnis a size on the with my disability winery disabled walking in your talking of Christmas cards I can't work why can't you find ones go back to school and a gentleman that I saw and we we do give instabilities and use them and the Galileo quarters and we use the are you so go back to school over one proviso and help colleges and then get some counseling why go to the library fines under the batteries of your family a year later again sizzle would have done less or nothing remember we talked about going school allegedly known as whites and correlate this with her head in her hands no motivation he's got a families got children no motivation to do something to get some as discussed in that while I get the blessing of people in the splitting life I don't do it if you walk in the talking point job may take some creativity that you can work I know P Stigler work I don't love people they're paraplegic to go to work you want in your talking do something if you have some measure sellout iron is less than about eighty percent hundred billion annually for the societal costs goes beyond financial and nonfinancial all the psychological distress over related illness behaviors and needs instability this is from an article in the spine Journal just this year I can only thought respiratory infections this causal work absenteeism accounts for forty one eighty seven percent of workers compensation causes the most common industrial injury in the United States when I was sent to Haiti with the latest six months in hate of the Navy with Goldwater hated from the Port-au-Prince area they have these cards that know me of course with all the people home and I saw this gem he looked like he was probably in the sixties and so in the heat of the day of calling this thing loaded of the bananas rice whatever and any talk of a payload from this without an asset allowing them to let the Social Security on the Google working on it but here all I can work his mother but anyway it's the most common dose of injury high workers compensation costs look at this the opioid use of why was my pain increased from nine four two million prescriptions nineteen ninety seven to almost twenty million in two thousand and four the injections injections have become a property of an injection clinics on on all of the corner and I need also said that the injections sex love and popularity just facet procedures along the facets of the joints was fine just procedures involving the facet joints a lot of going on over five hundred percent from nineteen ninety seventh two thousand six again this is from the spine Journal from MJ Smith at all in this year ER there's not a business model morbidity associated because there's unintentional overdose deaths with the opioid use as a bottom-up tenfold in the past thirty years there's also some evidence to suggest that it may decrease the function menu system affect your hormone levels and therefore can lead to an increased sensitivity to pain but they're not alone not sort on anti-inflammatory drug driving problem with the Motrin ad loop in your leave which is Naprosyn Junior all these other ones that they have out there sixteen thousand five hundred deaths per year from the use of incense and lumbar MRIs to you guys so much an MRI cost what they got gone from three hundred forty nine thousand MRIs the one four two million and a ten year span from ninety four two thousand four Casa -based weblog that you would make for for the egg because insurance costs go up every year we just had a partner meeting our interest cost for employees is going up twenty to twenty five percent this year and it did that last year and the year before before long I just hope we make it so I can retire fellow they were what some of the respective for back pain repetitive lifting of pulling obesity ligaments on lack of exercise and a negativity sedentary lifestyle when you are when you guys send the and myself when we're going up with was an playwright Naomi to pay the kids go outside and play and get away from there whatever the reason the one hundred other their game boys on the computer is our plug-and-play cigarette smoking pregnancy vibrations conflagrations of depression and psychological issues it's been documented that psychological issues can adversely affect whatever treatment plan you have with his non- opera with his operative lack of compliance lack of motivation I suppose his arthritic disorders I like this I dislike the fact that we are on the system twenty ten and this is the percent of the population from Michigan twenty nine percent of our population is obese melena status Colorado nineteen one Nevada state of Mississippi and almost thirty four percent of the population is obese and this is from twenty ten and even in your sunshine states rethink before outside of work that it was theirs the PI still pretty high and everybody what about Colorado Salinas nineteen Arab and Islamic interests are that's a lot of obesity in and in Michigan I have a patient on the night four five six pounds linebackers sorry when limited to your YouTube it from a table I can't put you face donkey when they were brief and all those couple hundred pounds and come back uncertain what else can I do my hands are tied and will will go through us and reserve easier for the treatment on the Sorrento grantors will start from your work away around of physical therapy I use a lot of physical to it with the therapist to teach the patient home exercise properly at home because they identify with a single cup committee medicine behavior programs in this area here with that all what we would call alternative treatments that either we been talking about then and now some of these other things within an area I know anything I wanted it was surgery and lasting unwanted use the will there are economies this is the spot of course in later phases and in a use of a few that indications are multiple right when I dismantlement and talk about all that which is go through this quickly now I want to get a list by here the world to stop the precipice right things I have a very quickly to finish the end of this world people are are are are also at the brink because of the back pain the neck pain they do not know what to do and then some of them feel that they take another step for the ball down the precipice what can we do for them everybody tells up my uncles brothers neighbors son did this in a better nominal nineties that this is so much information out there in the NNN and everything pointed the direction when needed we make sense of this how can we help them and it's up to us as health professionals to help people that there is a God that will lead you in a calm manner beside the still waters you need to take that time he will show you the path of life the sun is setting on this world of the scissors is sitting on this one would be much longer we don't have much time we don't have much time we ourselves have to be careful that we do not forget to be still and know that there is a God we don't beat ourselves we can't beat anybody else write we need to know and need to go a step in the time to figure patient at a time but I'm happy to report to you and you can take it in the bag that eventually has got to be in the pain management eventually when I will be out of business and I'm looking for that that because God will wipe away all tears from their eyes there should be no more death no sorrow nor crying neither shall there be any more pain for the former things are passed away and he that sat upon the throne said behold I make all things new and he said on the right with these words are true and faithful God tells us in Isaiah sixty six seventeen for behold I create new heavens and a new earth and the former shall not be remembered or come to mind remember this promise is about and apply the patient by patient not all pages may want to pray with them I've I told my when I first got to Michigan and from the Navy in ninety nine I told him in our societal salmon Esser named Sammy can forget that when pigeons want to sanity ever seen startup and operating style you have carte blanche to stop this day X number one eleven years later twelve years later if she doesn't M interested in rooms that did you do your thing and I did I said yes ma'am and on seven hundred isn't what you think I pray I pray I'm going to pray with people not be a purported area when we dig a patient at a time we may not be able help everybody but we convicted vision time would be able to climb any mountain in the double twice thrown away this is Machu Picchu in Peru and climbed on the climb up the space right here and we were right up your writer the third sentence you can get this is called one of the Jew in the Machu Picchu secular facing the mountain Machu Picchu is back this week this is one of each of it much of each of the monkey for what much of each of the choices that we claim that lesson we were there but one when we find it I will stick with sinusitis infection it can do it but might my oldest are stuck with me and Anderson with me and then certain chest pain vulnerable so I went through the grid itself I encourage you to pray for your patience they would to patient when you will remember him fill in the will this video was produced by audio verse four amen as medical as you like to learn more about Nina please visit www. a manner to him his life is more free online sermon www. download universe

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