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Welcome to the July issue of Arizona Pain Monthly! We hope your summer is going well so far. We’re especially excited about this month’s issue. We are debuting two new columns – one is Stars of Arizona Pain Specialists. Each month, we will ask patients to let us know which staff member really stood out during their office visit or procedure. This is a great way for patients to get to know the staff even better! This month’s Star is Teddy from the procedure center – our patients always have something great to say about him! Another new column is our Guest Expert Column. At Arizona Pain Specialists, we often team up with other physicians in many other specialties. You can look forward to columns written by orthopedic surgeons, podiatrists, cardiologists and other expert physicians we team up with every day in our continuing efforts to bring our patients the best care possible.

Do you “water-cise?” In the middle of another Arizona summer with quite a few hot days ahead of us, many find exercising outside to be impossible. We recommend taking your workout to the pool! Read this month’s Ask The Expert column for some great exercises that can all be performed in the pool. Just remember, even though you are in the water, you are not a fish – you cannot stay hydrated through skin absorption. Keep drinking your water! Do you want to be part of a group that is on its way to being 100,000 strong? Join a community where you can find others just like you, support them and be supported. Go to www.ChronicPainSupportGroup.com and join the Chronic Pain Support Group through Facebook.com. This group already hosts over 175 discussion topics – come join in! Also on Facebook.com, Arizona Pain Specialists will once again be featuring a monthly topic dedicated to health and wellness in relation to pain. July is Make a Change, Make a

Habit month. Did you know it takes at least 21 days to form a habit? Beginning July 1st, we challenge you to decide what you are going to change. If you commit to this change, by the end of July, you will have formed a habit, hopefully for the better! Your change can be anything – from taking nutritional supplements daily, to writing down a great thought on a daily basis. Log on to the Arizona Pain Specialists Facebook.com group and let us know what your change is going to be! We hope that this issue is educational and informative. Please contact us at newsletter@ArizonaPain.com if you have any questions or comments. We thank you for your continued loyalty if you are a long-standing patient, and we welcome you to the Arizona Pain Specialists family if you are a new patient. Until next time, remember at Arizona Pain Specialists, we believe you can be pain-free. Dr. Tory McJunkin & Dr. Paul Lynch


Expert Guest Dr. Mark Forman Welcome to a new addition to Arizona Pain Monthly – our Expert Guest Column. Periodically, we will bring you a column written by an expert physician from the local community. These physicians collaborate with Arizona Pain Specialists to bring patients the highest level of care.

lege or high school any longer, and our bodies don’t repair as fast as they once did. Just ask some of our professional athletes who are in trouble for trying to heal faster with the use of Performance Enhancement Drugs. A night splint can also be used, and is an excellent way of stretching feet and legs.

Dr. Mark Forman is a podiatrist practicing in Scottsdale at the Put Your Feet First clinic.

H Hydrate

As I was sitting watching the TV show “Biggest Loser,” I was very impressed how one of the contestants had tried to finish a triathlon. As a podiatrist, I thought about the points I would want to discuss with a patient before they undertake an exercise program to eliminate the risk of injury and pain. I instantly thought of the acronym SHOES. S Stretching We need to stretch; there is no way around it. If we don’t stretch both before and after we exercise, we pay for it later. If you have not stretched or warmed up, not only do you have an increased risk of tearing a muscle or tendon, but you are also risking injury in future workouts. Stretching warms up the muscle, and exercising on a cold, tight muscle will hinder your workout and performance. Some of my patients mention that they never stretched before. I often remind them we are not in col-

Hydration is very important for any exercise program. When exercising, the body loses water due to sweat. Without replenishing your body of those liquids, you will become dehydrated, have poor workout performance, and feel drained post-workout. Some of the most common symptoms of dehydration include: nausea, headache, vomiting, lethargy and fatigue.

cal control and function (of course you will need proper running shoes for the orthotics to fit into). E Eating A Balanced Diet You are what you eat, and what you eat will either help or hurt your fitness program. A balanced diet, consisting of a balanced meal program eating 4-6 times a day will make you less hungry later at night, and will stop that late night snack before bed. S Start Slow Slow down! You need to start slow and slowly increase your workout. Do not burn yourself out – that can lead to injury. Listen carefully to your body and if you feel actual pain during your workout (not just discomfort), stop and rest.

O Orthotics A foot orthotic needs to provide a rigid lever for propulsion while allowing for shock absorption and terrain adaptation. This need is only magnified in athletes. Whether you are on a bike, in running shoes, or in ski boots, your foot is always working on shock absorption and propulsion. To assist in these functions, a foot orthotic needs to be properly calibrated to your weight, foot flexibility, and activity level. Different athletes and sports require different orthotic sizes and properties. However, all require the same biomechani-

Dr. Mark Forman, DPM FAPWCA is an associate in the American Podiatric Sports Medicine Association and an avid runner. He is currently the President of the Arizona Podiatric Medical Association. He has two office locations in North and South Scottsdale and can be reached at (480)423-8400 and via email at Drforman@azfootpain.com. His website is www.azfootpain.com.


Meet Rachel Johnson, Nurse Practitioner! As a nurse practitioner in the Glendale Arizona Pain Specialists location, Rachel Johnson brings a high standard of care to all of her patients. Nurse practitioners are important, supporting members of the Arizona Pain Specialists care team. They are available to give patients extra time and attention, and to assist the physicians with medically treating patients. Nurse practitioners are legally able to practice on their own, however, many team up with doctors to provide a dynamic care team. See how much you have in common with Rachel! Favorite activities: Hanging with family, hiking, rollerblading. Favorite TV shows: Grey’s Anatomy, Meet the Browns, and any show on HGTV! Favorite Sports Team: Any team Shaq is on! Favorite food: Chicken and pizza. Favorite movie: Love and Basketball. Favorite location in the world: Wisconsin (home!!).

Favorite location in Arizona: I haven’t had a chance to explore Arizona very much, but I would have to say Sedona. Favorite things about Arizona: Warmth, sunshine, mountains, and very few bugs! Favorite bands: Alicia Keys, John Legend. When you were little, what did you want to be when you grew up: A singer. Favorite book: Dan Brown books. What is your favorite part about being an NP? The rewarding feeling you get from helping others. Any pets? Two dogs. Your favorite things to do on Saturday: Drink coffee, watch HGTV, and then go for a walk with the pups.

Crazy fact about you: I lived and played basketball in New Zealand for a summer. Unknown Talent: I used to be a Klompen dancer (wooden shoes)! What celebrity do people say you look like? I’ve heard Daryl Hannah in the past.


The Art of Pain Management If someone has suffered with chronic pain for over 40 years, it would be easy to understand if they wanted to quit trying to find solutions for their pain, or if they had a negative outlook on life. However, for Patricia Kruger, quitting – or even being negative – just isn’t an option. When she was 27, her orthopedic surgeon told her she would be in a wheelchair by the age of 35. When she was in junior high, her art teacher told her she would do better to focus on her studies, and that she just wasn’t an artist. Today, Kruger is an award-winning artist and a walking optimist. No matter her pain, her attitude is not one of a quitter, and she urges other pain patients to adopt the same attitude. “I really think it’s important for chronic pain patients not to give up, no matter how bad it gets,” she advises. “There is help out there.” Kruger suffers from fibromyalgia, degenerative disc disease and arachnoiditis. Most specifically, it was the severe neck pain from her degenerative disc disease that led her to Arizona Pain Specialists. On her first visit, radiofrequency ablation was recommended for the neck pain, and upon further discussing her pain conditions, the medical team recommended a spinal cord stimulator (SCS). But she was a bit wary of the procedure. “I had an SCS in the early 90’s that was unsuccessful and had to be removed,” she explains of her apprehension. “The medical team explained that technology on the SCS had come a long way, and how the new technology may be able to help me. My husband and I were really impressed with Arizona Pain Specialists.”

Patty Kruger, Artist Kruger let the medical team know that she would think about SCS, but before she had even left the practice, she knew that she wanted to try it. The radiofrequency ablation went well for her neck pain, and she had the trial stimulator placed. “The relief from the trial was so good, that when it was over, I didn’t want to have it removed!” she says of her experience. “I knew then I wanted to have the permanent device placed.” “The first time I felt the stimulation, I burst into tears, because the stimulation was in the right place. That’s what is key – having a physician who is educated enough to place


the stimulator leads in the correct place,” Kruger says of the pain relief provided by the SCS. “And everyone at Arizona Pain Specialists has been wonderful to me. It makes a difference when you know someone cares and respects your individual pain problem.” The SCS has helped Kruger develop her art in a tremendous way. She explains that the right side of the brain is the side that is the most creative, and that she can actually feel a “shift” to the right side of her brain when she really gets into her art. “The pain, before the SCS, would often keep me from getting to the right side of my brain,” she says. “I just wasn’t able to focus enough and get the pain under control enough to do my artwork. I’ve found with the SCS as the months go by that I’m definitely being more creative.” Recently, Kruger heard of an art teacher that is internationally renowned and would be teaching a week-long workshop in Sedona, Arizona. When she told her husband she badly wanted to attend, he was doubtful. “He said, ‘do you really think you could handle taking a painting workshop like that?’ I told him I really think I could, and that I really, really wanted to.” Kruger was not only able to successfully make the trip in the car from New Mexico, something she hadn’t been able to do before, but she was able to attend the workshop and gain valuable experience from it. Kruger credits her compassionate attitude to her lifelong battle with chronic pain. “I’ve been able to

relate to other people because I feel I know what they are experiencing. Thirty years ago, I decided I wanted to become a hospice volunteer. I thought maybe I could help someone else. When you can turn things around and help someone else, you are able to take the focus off yourself and off your pain.” Kruger encourages other pain patients to try to keep their relationships strong. “I think most people with chronic pain would acknowledge the fact that they have a very difficult time with relationships – and I’ve found it to be true. People get tired of hearing about your problem. But I have been blessed with family and friends who truly support me, and it’s their love and support that gets me through the difficult times.” “I could have given up a long time ago, I could have been in a wheelchair at 35. My pain has been a lifetime experience, and I’d encourage other people to know that they can handle it, and that they should never give up. If you quit, you’re done – and I’m not quitting.”


We get numerous questions regarding the use of inversion tables. Inversion tables are a good tool to stretch the lumbar spine and help reduce the axial load on the discs and nerves of the lumbar spine. It is important to note that these types of tables are designed for the low back and do not affect or benefit the midback (thoracic spine) or neck (cervical spine). The idea and technology for this type of table dates back to Greek antiquity with Hippocrates and Galen. Currently, there are many manufactures and models with a large range of options and prices. How does it work? The discs in the lumbar spine are under constant pressure. This pressure is measured in mmHG, just like a weather barometer. While standing, the pressure within the lumbar disc is significant - the gravitational load from your upper body plus the muscular tension within your spine measures 100mmHg. Even when you are lying down, the muscular tension keeping your spine together measures 75mmHg. Inversion tables use gravity and the weight of your upper body to help reduce this pressure and stretch the tight ligaments and muscles of the lumbar spine. Inversion tables have been shown to reduce this pressure in the lumbar disc by about half (40mmHg) when compared to lying down. Computerized decompression tables are able to pull at greater forces and with repeated programmed rest periods to actually achieve negative pressures within the disc (-160mmHg). Many brands of decompression tables can target the cervical

spine as well. We often recommend inversion tables for home use after a patient has undergone a series of decompression treatments in our office. Decompression tables will be discussed in the next Chiropractic Corner. How often, what angle, what duration? The number one recommendation for all home based treatment and therapy is: DO NOT TRY AND PUSH THOUGH THE PAIN. If it hurts, stop. More is not always better. Ideally, inversion treatment would be done on a daily basis while the symptoms persist. Each session should consist of 5-7 two minute intervals with at least a minute rest between intervals to avoid muscular guarding and spasm. Let’s do some math, geometry and physics. Depending on your body shape, about 60% - 70% of your total weight is in your upper body above your lumbar spine. That means if you weigh 150 lbs, about 100 pounds of your weight is in your upper body. If you are using an inversion table at a 45 degree angle, half of the weight of your upper body (50 lbs) is now being axially distracted from your lumbar spine, hips, and knees. At 60 degrees, this increases to about three quarters of your upper body weight (75 lbs), which is now half of your total body weight. This is typically enough unloading of the lumbar spine to have some therapeutic effects. 50% of body weight is where we typically start our computerized lumbar decompression therapy. It is important to note that decompression tables only distract the thoracolumbar spine, while

with inversion tables, distraction is spread throughout to the lumbar spine, hips, and knees. What to watch out for? Inversion tables create distraction on the knees and hips, which can be aggravating and possibly damaging for patients with knee and hip pathology. Those with conditions such as labrum tears, meniscus tears, and joint replacement should get clearance from their physician before starting inversion therapy. Inversion tables also increase pressure within the cranium and eyes and cause the heart to work harder to move blood. Patients with head, eye, or heart pathology should seek medical clearance. I encourage you to have someone within shouting distance, or a phone in your pocket, just in case you have difficulty getting off of the table or get stuck in an inverted position. Ease into each session gradually and take short breaks every few minutes. Remember that you are stretching muscles in a direction that have they haven’t been stretched before. One of the most common side effects of inversion therapy is muscle spasm. There are large variations between different manufacture models in quality and price. The best have a large amount of foam padding, especially for the lower leg and shin area. Remember, you are putting a significant amount of pressure on your shin and ankles. These areas of your body have minimal padding and will get sore with prolonged pressure. -Dr. Chance Moore, D.C.


Your ePainBook has been a great resource for me when researching pain conditions for both myself and my family members. However, I still have questions that the ePainBook did not answer – and I am specifically wondering if there is a website where I could watch a video of my upcoming procedure? Can you help? There is a new website I would like to refer you to and believe you may find useful – www.PainDoctor.com. This website, while new, is quickly emerging as the global knowledge base for pain. Specifically, PainDoctor.com hosts The Knowledge Center, a vast virtual library of articles written by experts in pain management. Articles are categorized into procedures and conditions. You will also be able to find a section on health and wellness which should prove useful, as it will include information and suggestions for techniques to be used at home to relieve pain. PainDoctor.com also hosts live procedure videos! The video library is constantly growing, so if you don’t see the procedure you were looking for, continue

to check the website for updates. Additionally, you will now be able to see shorter, more informative episodes of The Pain Show, brought to you by PainDoctor.com. This exciting change features expert sections in which physicians fully explain the procedure, as well as testimonials of patients who have had success from various procedures. With the start of summer, I am finding it harder to walk outside for my daily exercise. Is there something else I can do? Move it into the pool! Known as water aerobics, water-cise and aqua-cise, exercising in water is a great workout – in addition to being extremely beneficial for those with chronic pain conditions. Water aerobics classes can be fun and offer a community of people exercising right along with you. If a class is not an option, you can get good exercise in any pool, any time. If you are a good swimmer and your pain condition is not negatively affected by swimming, doing laps is fantastic cardiovascular exercise. If swimming laps isn’t ideal for you, merely walk-

ing in water that is up to your shoulders will also give you a good cardiovascular workout. Be sure to keep your feet flat, however – walking on your tiptoes can cause your calves to ache and cramp. Another good exercise to get your heart rate elevated is to simply march in place. Standing in water at shoulder level, march in place with exaggerated motions – be sure to extend your arms and legs as far as possible. While both of those exercises may seem ineffectual in theory, in actuality, water creates enough resistance to make walking and marching difficult enough to elevate your heart rate. If your fitness level and pain condition allow it, there are weights made specifically for pool exercising. These can be ordered online, or found in your local pool or sporting goods stores. As with any fitness program, check with your physician before you begin, and go slowly until you are used to the resistance the water provides. -Dr. Tory McJunkin


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A new, recurring column, Stars of Arizona Pain Specialists will feature a staff member each month that has stood out among the patients as a star. If you want to nominate a staff member for Stars of Arizona Pain Specialists, please contact us at newsletter@arizonapain.com. This month’s star is Teddy, an overwhelming patient favorite from the procedure center. Teddy is an IV Tech in the procedure center. He is responsible for patient intake, IV’s and making the patient feel safe and comfortable. He has been at Arizona Pain Specialists for a year, but has been an IV Tech for 3 years. He began his work in medicine as a Physical Therapy Tech, and then became certified in IV’s – all in all, he has been in the medical field for over 8 years. Teddy says his favorite part of the job is knowing that he can make a difference. He truly likes people and gets a lot of satisfaction from helping someone feel at ease before their procedure. He says, “I believe people heal faster when they have a positive experience.


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