Living at the Epicenter: Israel in the Middle East, by January blogger of the month Claire Gahm

I would not consider myself informed or qualified enough to write an editorial on political situations anywhere, let alone the Middle East. So take this perspective - from a person trying to synthesize news and personal experiences while living in Beer Sheva, Israel - with a grain of salt. 

The general state of war and peace in the Middle East has been at the center of the world’s attention for as long as I can remember. It is the epicenter of three major world religions and therefore it is no surprise, as Judaism, Christianity and Islam intersect, to find life defined by an unyielding tension hovering on the precipice of a revolution for truth.  It was quite a change to come from the States where the post-modern battle for tolerance and ‘whatever you believe is fine for you’ is underway to Israel where God undoubtedly exists is met with a fervency to do what he says in all circumstances.

One of the chief concerns for my family in coming here related to questions about my safety. How could it not when the news is laden with horrific images of blazing buildings, missile strikes, and war-torn peoples? When the only resolution to the ‘racehorse’ mentality for uprisings seems to be another round of talks and negotiations?  And now with the violent protests in Egypt calling for Mubarak’s resignation, leaving Israel with questions about its future allies and the world with questions about the ramifications of the situation, it is reasonable to be concerned with the future. I believe things will get much worse before they ever get better.

Agur Winery: I would like to Skype lectures from
this house!

But all of that is said on a macro scale of breaking news headlines that I would fail to notice if I did not read the news.  The city of Beer Sheva is nestled into a small-city routine only occasionally disturbed by the sound of planes roaring overhead on their way to the Israeli Air Force base near here or choppers delivering patients to Soroka landing outside our classroom.  I walk around town at night frequently (it’s hard not to when I leave class at dark on Sundays and Tuesdays) and never worry about my safety. I was cautious, alert, and always nervous in July when we first arrived, but now I might be a little too relaxed because I’ve never felt threatened or in danger.  Sometimes I think about my impression before I came and am convinced some of the news is propaganda - the day-to-day life of Israelis in Beer Sheva is not full of fear and sirens – there’s shopping at the market and the recess bell that plays nursery rhyme tunes and honking in the street and leisurely Shabbat walks. 

Tzuba Winery.

My goal here was hopefully to affirm that we’re very safe and cared for, taking our cues from the locals (who don’t even flinch at the thundering sounds we eventually discovered were planes), and MSIH holds the students best interest in mind.  All of that said, the tension I’ve described is the color and culture here, it is giving me a more complete perspective for my work as a physician, and it is teaching me how to understand and relate to my patients in an incredibly unique way.  So much of the experience that I believe will make me a better doctor will be fruit from living in Israel!

Listening to Shuki, the winemaker at Agur.

[Here are a few pictures from a Friday a number of us spent touring vineyards outside of Jerusalem. Tsuba and Agur are boutique wineries.  It was a perfectly sunny day and we loved the atmosphere!] - by January blogger of the month Claire Gahm

Evan (on the right) next to his beautiful wife Katherine, she organized the tour and she is a food
writer and amazing cook too!

The cost of managing chronic pain, are there better options?

I recently came across an article on the NY times regarding Treating chronic pain and its associated costs (http://www.nytimes.com/2011/02/05/health/05patient.html?_r=1&ref=health).

There are many causes of chronic pain as discussed in this article.  Most of them are afford-ably treated in our office but many of them never quite get to us. Whether from a bad lower back disc, or from a bad auto accident, or from functional mechanical pain, many of the patients who have visited us have already seen the neurologist, the orthopedist, the rehab therapist, the rhumatologist, all at great cost from the care, the injections, the medications and other types of interventions, many of which have little worth because quite simply, they are expensive and have little effectiveness.

The big problem for most people is that most doctors know little about body mechanics, believe the pain is a disease process and treat problems that they quite frankly, do not understand.  This leads to treatments for the pain, rather than the cause of the pain which more often than not can be explained and proved to be mechanical in nature.  Mechanical problems require a mechanical based evaluation to understand the problem and finally, require a mechanically based solution.  This is why many medically based treatments simply can't work.  They do not find the source of the problem and many doctors recommend muscle relaxants believing inflammation just happens which is just ridiculous.

The benefit of seeing a chiropractor is all their solutions are mechanically based and chiropractic has a long history of helping people with chronic pain.  In our office, you have the added advantage of myofascial release treatment and Graston techniques, two methods that address the myofascial system, commonly part of the cause of chronic pain syndromes.  Secondly, we check out posture and your feet, often at the root of chronic pain.  The best part is that care is based on functional improvements that will become more pronounced from visit to visit, resulting in a marked reduction of pain. The other major benefit that as compared to many of the medical rehab and drug based regimens, chiropractic uses no drugs and the rehab is closely tied to manipulative therapy, improved joint function your body will age better because it functions better. Chiropractic should be on the top of the list of treatments people should explore before doing less conservative methods of medical care because quite simply, its more appropriate in most cases.

Is working standing up too expensive? It could cost you as little as $10

Spending too much time sitting down is clearly unnatural, particularly if you sit down on very comfortable chairs. Sitting down per se is probably natural, given the human anatomy, but not sitting down for hours in the same position. Also, comfortable furniture is an apparently benign Neolithic invention, but over several years it may stealthily contributed to the metabolic syndrome and the diseases of civilization.

Getting an elevated workstation may be a bit expensive. At work, you may have to go through a bit of a battle with your employer to get it (unless you are "teh boz"), only to find out that having to work standing up all the time is not what you really wanted. That may not be very natural either. So what is one to do? One possible solution is to buy a small foldable plastic table (or chair) like the one on the figure below, which may cost you less than $10, and put it on your work desk. I have been doing this for quite a while now, and it works fine for me.

The photo above shows a laptop computer. Nevertheless, you can use this table-over-table approach with a desktop computer as well. And you still keep the space under the foldable table, which you can use to place other items. With a desktop computer this approach would probably require two foldable tables to elevate the screen, keyboard, and mouse. This approach also works for reading documents and writing with a pen or pencil; just put a thick sheet of paper on the foldable table to make a flat surface (if the foldable table’s surface is not flat already). And you don’t have to be standing up all the time; you can sit down as well after removing the foldable table. It takes me about 5 seconds to do or undo this setup.

When you sit down, you may want to consider using a pillow like the one on the photo to force yourself to sit upright. (You can use it as shown, or place the pillow flat on the chair and sit on its edge.) Sitting on a very comfy chair with back support prevents you from using the various abdominal and back muscles needed to maintain posture. As a result, you may find yourself unusually prone to low back injuries and suffering from “mysterious” abdominal discomfort. You will also very likely decrease your nonexercise activity thermogenesis (NEAT), which is a major calorie expenditure regulator.

With posture stabilization muscles, as with almost everything else in the human body, the reality is this: if you don’t use them, you lose them.

Interesting reports

No, really.

Oregon has put out its annual "Health Insurance in Oregon" report. Among the findings:

-About 17 percent of Oregonians had no health insurance in 2009.

-Enrollment in commercial health policies through Oregon's 7 largest insurers fell 15 percent from 2007 to 2009.

-Reforms under federal health care reform "have typically accounted for no more than 4 percentage points of the rate increases submitted to the division" recently.

-And Oregon regulators in some cases approved lower rate hikes than an insurer requested, due to the size of insurer's surpluses.

-Oregon, under a federal grant, is studying how to use its rate review authority to help lower medical costs.

And in much sunnier Tampa, the Insurance Information Institute's Robert Hartwig yesterday released a new report looking at long-term trends -- 80 years of them -- in the property/casualty insurance market. Claims paid since 1931, he said, total $12.5 trillion, after adjusting for inflation.

Among Hartwig's points: that "claim payouts in recent years are volatile but have reached a jagged plateau."