This article is a transcribed edited summary of a video Bob and Brad recorded in June of 2020. For the original video go to https://www.youtube.com/watch?v=gECNsPHgbc0&t=146s Bob: Today we're going to talk about five exercises all seniors should do daily. By seniors we mean, not seniors in high school. We mean the people that are maybe a little more mature. Brad: Fifty and older perhaps? Bob: Five exercises, I tried to think about which exercises I think people should have. It's essential, Brad. The first exercise, I feel there had to be one posture exercise. Everybody's struggling with posture. We deal with it all day long. We have to think about it all the time. Brad: And as seniors, if your posture gets poor, your balance automatically gets worse. They work together. Bob: Your breathing, your pain levels. I'm going to show different options on different postures ones you can do. Just pick one, but we're going to show you a few options. Brad: So if you get a ball, maybe for your grandkids, a softer one, actually a half flat one works better, it's more comfortable. You know a soccer ball that's blown up or a basketball will not work. So we're going to take that ball and put it behind you. You might need some help, you know if you can reach back. And don't get it too low on your back, between the shoulder blades, or whatever feels good. Everyone's a little different. I'm going to lean back, and stretch so the ball supports that mid-back, and then we're going to think about wrapping your shoulders right around the ball, with your arms in a 'W' position. You can do Bob's patented hallelujah stretch if you'd like to, with your arms up and just stretch and relax. Make sure you breathe, deep breath in, and exhale. Do those three to five times. And just keep the ball handy so you can do that a couple, three times a day. Bob: And you can move the ball up and down to different spots. And by the way, we have to give credit to our cameraman, Mike. He invented this. Mike is a physical therapist assistant. So next one, you can actually do it without a ball too. You can do what we call a chin tuck, and then grab your neck and bring your elbows up, and bring them back. If you don't have the ball with you, you can do a chin tuck, elbows up, and spread them apart. It's like a butterfly opening its wings. Brad: So, then you start to look up at the end a little bit? Bob: You can do that if you want to, sure. Brad: If your shoulders are tight or you have arthritic shoulders and you can't reach back like that, just do the best you can. And it's a good range of motion for them as well. Bob: So either one of those is fine. I'll give you one more. You can do the wall angel. So we're going to go ahead and do a wall angel. This is nice because it gets everything lined up. If you can't get your head all the way back, go back as far as you can, and make note of it. Maybe the next day you'll be able to get further. Brad: Sure. Bob: So you're going to do wall angels. And I'm trying to keep my shoulders up and arms against the wall as long as possible. The left arm is started to come forward. I'm working, struggling to keep this one back. Brad: If any of these create any sharp pain, you don't want to do them, that's for sure. So just that stretch, a stretching feeling is what we're looking for. Bob: All right so those are three variations. You don't have to do all three. We want you to do just one because we're doing five exercises. The next exercise is squats. You need that leg strength. In fact, we find a lot of people have those automatic electric chairs that help them stand up. They get so weak, that they later can't even stand up at all. So it's good to start with a chair. Brad's going to go ahead and jump into it. You can also use the arms of the chair if there are arms. Brad: Yeah, we don't have arms, but you could push off. We are going to show the sit-to-stand version. So I'm not leaning real far forward. You can put your hands on your legs to push up if that's easier for you. If you're strong enough and you can cross your arms in front of you, that is great, but if you're not, hands on the armrests or on your legs. And how many do you feel they should start out with? Bob: Well, whatever they can tolerate. I'd like to see at least five. Ten would be better. Brad: Right, and you may need to build up to that if you haven't been working out much lately. Bob: Another way to do this, is against the wall. You put the ball against the wall, if you have one of these exercise balls, they are inexpensive. Brad: So this is a little more advanced. Bob: A little more, but I think it's kind of nice because it gives you support. You can keep the legs in the right position. And you can just roll up and down. Brad: Yeah, it's very smooth. A word of warning, though. You have to make sure that your feet, like if you go stocking feet and you're on a smooth surface, your feet will slip out. So make sure your feet are gripping well to the carpet or the floor. Bob: As you said, even on the carpet you can slide. I'm going to show you one more, Brad. We're going to be really complete here today. Posture squats are the ones I do. I get the legs quite far apart, I bring my arms up overhead and I squat down at the same time. So I'm really working all the posture muscles when I'm doing this. Brad: Show them the incorrect one if you go too far forward . Yeah, we don't want that. Think about looking up towards the ceiling. Bob: And really keeping good posture. The back should be nice and straight the whole time. That's the purpose of doing a posture squat. Brad: And don't worry about getting really deep. We don't want you to fall. You're going to get plenty of exercise in a comfortable range. Bob: All right, exercise number three: as you start getting older and this is one that I've started doing, believe it or not when I run, you need to work on some lateral movement. Brad: Oh that's true, very true. Bob: So if you're a little bit older and a little more worried about falling, use a countertop to hold on to, and you're going to work on doing some lateral movements. Brad: So lateral movement means side to side, right to left. Bob: If this is way too much, you could even do behind a chair, just start doing some hip abduction, or kicking out to the side. But I'd really rather have you do the movement. Brad: Doing the movement at a countertop is really a nice option. Bob: If you want to get more advanced, you could do the carioca where you step in front and behind. Brad: If you've had a hip replacement, be careful on this one. Bob: But what I do is, I'll run forward, and then occasionally, I'll just do some quick side-to-side. Believe it or not, this has really helped my balance. Brad: What does your wife say? Bob: No, no, no, I do it out when I'm running outside. Brad: Oh so the neighbors are watching you. Bob: No, I pick the areas where nobody's watching. I'm serious there are spots where I know there is nobody there. Brad: Well that's good. Bob: This has really helped me. Okay next, number four: the ankle. A lot of your balance comes from the ankle so we're going to do heel and toe raises. So grab the back of the chair and I'm going to raise up my heels and raise up my toes. Brad: I would say the ankles are one of the first things to weaken as people get older. I don't know that for sure, but I just know people when they get into their 60s and 70s oftentimes have weak ankles. Bob: Yes, and the proprioception, where they are in space, gets thrown off. Brad: The nervous system's feedback, yes. Ten of those is a good number. Bob: Yes, and you can do them throughout the day if you want. Number five: we have to do at least one exercise because you know when you're working out through the day, you're going to push things, and you have to have some strength. So, I want you to do some wall push-ups, knee push-ups, or full push-ups, depending on what you can do. So first we'll show the wall push-ups. Brad: Yeah, if you're unable to get down, or you know you're not very strong, this is the perfect place to start. Bob: Yeah, keep your elbows in. Don't let them flare out. Keep them into your side. That's how you properly do a pushup. And you know, if you do not have enough strength, you could end up banging your head against the wall. Brad: Yeah, we don't want to wreck the wall. Now the other thing, if you have a countertop or a little lower shelf, that makes it harder. That's how you can progress it. If this gets too easy, you know you're doing 10, 20 of these then you're going to go to the knees. Watch your posture. Bob: I'm keeping my posture. How's that? Brad: Yes. There you go, so he's on his knees now. And there's probably some of these seniors that are really fit, they might do the typically G.I. push-up, I call them. Bob: You have to breathe. Brad: Yeah, make sure you breathe with all your exercises. Bob: How many do you want me to do, Brad? Count them off. Brad: Do 100. You've been a bad boy. No, get up Bob, people are getting bored. All right, so that's it. Bob: That's five exercises. Brad: So we showed options for each one. So pick them out and see how it works for you. These are definitely going to help your balance, and going to help your posture. They're going to help your strength. It's what we need as we continue. Bob: The full package. Thanks for watching. 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Medical Disclaimer All information, content, and material on this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

First, do the compression test in the video to determine if compression on your spine increases your pain levels. TEST: Sit on a chair without any arms. Flex or bend your back forward and then grab the seat of the chair and pull up. This puts compression through the spine. Did this make your back pain worse? If compression makes your back pain worse, it is possible that decompression can make your spine feel better. The idea seems to be sound. There are many ways to apply traction with equipment. We will discuss those later in the video entitled: Top 3 Ways to Apply Traction (Decompression) to the Spine (Low Back or Mid Back). For now, we will show you 3 simple ways to apply some decompression to your back without incurring any cost. The studies seem to indicate that you may be able to obtain some short-term relief from pain. The short-term relief may allow you to walk further which in turn can help your back pain and sciatica even more. If any of the techniques provide you with some relief, we believe they are well worth the time. They take less than 60 seconds to apply. Technique 1: Sturdy Park Bench Use a sturdy park bench (preferably one that is cemented into the ground). With your arms straight, place the heels of your hands (palms forward) on the top of the bench or on the edge of a countertop. Lean on to your arms and take the weight of your body. Keep your feet in contact with the floor but try to relax your mid and low back. Feel your back lengthen and monitor your pain. If your pain lessens, continue the decompression for up to a minute or as tolerated. You can also do 3 (20 second) sets of decompression- again if sets are pain free. Technique 2: Countertop Corner You will need to have two kitchen countertops that connect to form a corner. Face the point at which two countertops connect to form a corner. With your arms straight, place the heel of your right hand on the edge of the countertop forming the right side of the corner. The heel of your left hand should be placed on the countertop forming the left side of the corner. Lean on to your arms and take the weight of your body. Keep your feet in contact with the floor but try to relax your mid and low back. Feel your back lengthen and monitor your pain. If your pain lessens, continue the decompression for up to a minute or as tolerated. You can also do 3 (20 sec) sets of decompression, again if sets are pain free. Technique 3: Kneeling between two chairs. Kneel upright on the floor with two solid chairs positioned on each side of you (with the seat of each chair nearest you). With fingers pointed forward, place the palm of each hand on the center portion of the seat of each chair. Lean on to your arms and take the weight of your body. Lift your knees off the floor while keeping your feet on the floor. Try to relax your mid and low back. Feel your back lengthen and monitor your pain. If your pain lessens, continue the decompression for up to a minute or as tolerated. You can also do 3 (20 second) sets of decompression- again if sets are pain free. Check out the full Sciatica series of videos along with downloadable guide sheets for each video on our website. DISCLAIMER We insist that you see a physician before starting this video series. Furthermore, this video series is not designed to replace the treatment of a professional: physician, osteopath, physical therapist, orthopedic surgeon, or chiropractor. It may however serve as an adjunct. Do not go against the advice of your health care professional. When under the care of a professional make certain that they approve of all that you try. This information is not intended as a substitute for medical treatment. Any information given about back-related conditions, treatments, and products is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this publication. Before starting an exercise program, consult a physician. Medical Disclaimer All information, content, and material of this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

This article is a transcribed edited summary of a video Bob and Brad recorded in April of 2022. For the original video go to https://www.youtube.com/watch?v=kfuGk3Tc1y4&t=35s Brad: We are going to tell you and explain clearly how inversion tables work for back pain as well as Sciatica. And we're going to help you decide if you should actually buy one and get it to your house as well. Bob: Yes we are. Brad: What do you say, Bob? Let's go to work. This is how I explain it to patients and other people. The inversion table acts like traction. In other words, the weight of your torso from the waist up is hanging upside down and pulls on your lumbar spine. Let's show this model. Bob: It's like decompression. Brad: That's exactly what it is. Bob: I'm applying a force here. Brad: So you're like gravity. And the inversion table would be tipped or inverted. So what's happening is things are getting pulled apart. And the red is the injured disc with the herniation, there is the model and our pulling. Now let's look closely and zoom into there and we've got a model for this. Bob: Let's see what happens. Brad: Now, here it is. This we're going to pretend this cup is L5. So we're looking at this vertebra and here is L4. Okay. This red ball represents the disc. Bob: It's the same color. Brad: Yeah, it is. It's a wonderful thing. Now what happens here is the disc and the vertebra. Now here, the spinal cord actually goes right through the vertebral canal. Imagine that. And then there are the nerve roots that come out of the foramen. Now, what happens when you have a herniated or bulging disc, you can see it's bulging there. Now with the traction that we demonstrated that occurs with the inversion table, the two vertebrae pull apart, and as a result, look what happens to that ball. Bob: It's like it vacuums up. Brad: Yep, it brings it in that pulling apart, decompression brings that back in. Bob: Good demonstration! Brad: Yeah, it was kind of fun, huh? So what we want to do when you're on the inversion table and you're tilted back, that traction occurs and you want to continue that not more than one minute or two minutes, the first time on there. Okay, we have a video with some specific details, on how to set this up in exactly 10 steps. I also want to cover some precautions. In other words, some reasons that you may not be appropriate to use one of these. If you are a healthy person, chances are good. But a couple of examples. If you have blood pressure problems, you may be able to use one, but you need to talk to your physician and get that cleared. Bob: Heart disease. Brad: Heart disease, yup anything with that. If you have got eye problems, like glaucoma. Bob: It decreases the pressure on your eye. So you don't want to do that. Brad: So get that cleared through your doctor. Like if you have a hernia, that can change things and we want to make sure we're safe there. There is actually a whole list of other precautions. We promote Teeter because we like them, they're well built. And you can go to Teeter.com. There are other brands so you can just Google inversion table precautions, you'll get a list of them. The best thing to do is ask your doctor. But if you're a healthy person, you've had no surgeries, no hardware in your back. You're probably able to work with these. Bob: It'd be nice. If you could try one before you bought one. Brad: And that's a good point. Because these Teeters are so well built. This is why we cover these. I used one that wasn't a Teeter and it worked fine. These are just built well, they are FDA registered. They're UL certified. If you don't know what UL means, it's Underwriters Laboratory. If they stamp it, you know the quality is good. It's safe. Now the interesting thing, when you're looking at these, this has smooth plastic support or a backrest which you might think is better if it's cushioned but you don't want it cushioned. You want it smooth. Bob: So, you can slide. Brad: Exactly. You want your body to slide without resistance. So that's another thing to look for. This does have a lumbar support that you can remove, put in, and adjust it. I don't have it here. Bob: You don't like it either. Brad: I don't like it for myself, but you may like it. And some may or may not have that. It's not a big deal. It's just a little benefit. If you will. Traction handles are another accessory. This model of Teeter doesn't actually have them, but you could use these. And that's when you're inverted all the way back or to 60 degrees. You put your hands on them and you push a little bit. Just to get a little manual traction with your arms. Bob: Otherwise, just use your body weight. Brad: Right, typically it's body weight, but that just gives you a little tweak, it's not a big deal. And then make sure they're easily adjustable, which the Teeter is. Again, you don't have to buy a Teeter. If you want to know you're going to get a good one, we recommend the Teeter. Bob: You get what you pay for. Brad: Pretty much, yeah, exactly. I did want to mention should you buy one? Some people say I've got back pain, I'm going to spend a few hundred dollars on one of these. Is it going to work or is it just going to be something you could throw your clothes on? Bob: Right, a laundry catcher. Brad: Exactly. So the best way to know, if these are going to work is to try one. Which presents a little bit of a problem, particularly if you don't have one available. If you have a friend or whatever, that has one go over to their house, and make sure you know how to set it up for yourself. Again, we've got a video on that and try it. And if you get good results, yeah, you should buy one. If you don't have that option, I know Teeter gives you 60 days to assess it. If they don't like it, you can mail it back to them. They'll give you your money back in full. You have to do it within the time period. The other thing about it is to make sure you keep the box. Bob: Right. Brad: If you threw the box away, you could contact them they'll give you a box that it fits in. I do believe the shipping is not covered to get it back to them. I'm not a hundred percent sure about that, but I believe that's the case. Bob: By the way Brad, I want to mention that they have videos too, on this. Brad: Teeter does a great job. As a matter of fact, you know, Roger Teeter the inventor, he just passed away in January of this year. I believe it's his daughter, Riley, I don't know for sure. I believe it's his daughter. She does a lot of videos. Bob: Maybe daughter-in-law. Brad: It could be, I don't know, but she does a really good job of instruction on their products. So good company, you can't go wrong. Okay, and that wraps it up for this. Again, we do have one video out. We're going to put another one out with 10 steps on how to properly and safely use one of these. That's going to be to a point video and work out well. So Bob, what do you say? Bob: I believe you're getting taller, Brad. Brad: We should do a study on how much you actually grow. Bob: If only it would make you smart too. Brad: Well, all those things just not going to happen. Bob: All right, thanks. Brad: Take care. Interested in learning about the products mentioned in today's video: Teeter FitSpine Inversion Table: https://shrsl.com/2e6mo Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd, Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun (US) Fit Glide Q2 Mini Massage Gun (US) Knee Glide Back and Neck Massager Eye Massager T2 Massage Gun Foot Massager X6 Massage Gun with Stainless Steel Head Leg Massager Fitness: Resistance Bands​ Pull-Up System Pull Up Bands Wall Anchor​ Grip and Forearm Strengthener Hanging Handles​ Hand Grip Strengthener Kit Stretching: Booyah Stik Stretch Strap Wellness: Bob and Brad Blood Pressure Monitor Bob & Brad Amazon Store and other products Bob and Brad Love Check out our shirts, mugs, bags, and more in our Bob and Brad merchandise shop​ The Bob and Brad Community is a place to share your experiences, ask questions and connect with others regarding physical therapy and health topics. Medical Disclaimer All information, content, and material on this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

This article is a transcribed edited summary of a video Bob and Brad recorded in February of 2022. For the original video go to https://www.youtube.com/watch?v=Kfo4bwTQiIk Brad: We've got Chris here. He's done I don't know how much research on this topic with knee replacements and what you need to know if you've got a knee that's questionable. Do you need it replaced or what are the options. It's all going to be answered right here. Chris, I'll let you take it away, I'm going to give some advice on the exercises and stuff I know a lot about, in here too. Chris: All right, well, today we're talking about osteoarthritis of the knee. Brad: Osteoarthritis, that's different than rheumatoid arthritis? Chris: Yeah. Rheumatoid is more of an immune response. That's the one that your immune system is attacking the joint per se. Osteoarthritis is the wear and tear that we all, at some point or another as we age, are going to develop. It's that wear and tear. It's the tissues around the knee, specifically, the cartilage starts to wear down. That's our shock absorber. Brad: So, on the knee, the cartilage, we're looking at, right on the bottom of the femur and the top of the tibia here is where the two bones articulate or that's where they rub together. These surfaces here are nice and white and shiny when they're healthy. With arthritis, it's kind of like they're rusty and they start to develop pits and they're not shiny anymore. When the bones and the joints go together, instead of being nice and smooth, it starts to grind. It makes noises. We call that crepitus. And pain is almost always associated with it. Chris: Yeah, and so then that continually devolves in bad cases of it. So, what do we do? That's the big million-dollar question. Are we all doomed to have knee replacement surgery? And the answer is no. Brad: Right. Chris: So that's the good thing. That's where you come in, Brad, where you're so adept at everything that you can do from an exercise and strengthening aspect. But you know, a lot of it comes down to, what else can we do that is maybe non-drug related? So, it's going to be weight loss. If we've got a BMI over 30, there's a seven times higher chance that you can develop knee osteoarthritis. Brad: So like if you're 5'6" and you weigh 180 pounds, your joints are taking quite a bit more than if you were thinner. Chris: Yes, applied physics. Brad: But you know, weight loss is very hard, very challenging for many people. It's difficult for many reasons. Chris: Correct. And so, what's next? Then it's strengthening that leg so that we can take care of that joint. Brad: And actually, it's a therapist’s point of view, before we get into some of the other options, if you do have arthritis in your knee, it hurts when you walk, it feels better when you sit down, you need to check your range of motion. I'm not going to get into this in too much detail but look at your range of motion. You need to have a full extension. The knee needs to be fully straight. Compare your sore knee to the other knee, hopefully, your other knee is not so bad. If it straightens out all the way and the other one doesn't, it's very common with a painful knee. We have nice videos that show how to stretch the knee and this is one of the exercises. Simply stretch it gently like I'm doing here. Brad: You also want to look at the range of motion and make sure it flexes or bends all the way. Brad: And then when you get that full range of motion, you want to do exercises that keep the joint moving without weight bearing. In other words, a stationary bike. You could just put a towel on the floor and rub it back and forth. There's the Knee Glide made specifically for that, particularly on carpet or you can put it on an angle which makes quite a difference when you have a sore knee. So those are a couple of options. But if you Google Bob and Brad arthritic knee pain or arthritic knee exercises, we've got a number of videos that should come up and you can look at those and it'll go through those exercises in detail and get your knee feeling better or ranged out. And either way before surgery, you definitely want to have that. Pre-op they call that. But if you're just trying to maintain and avoid surgery, you still need to do that. Chris: Yes. Absolutely. Brad: Go ahead. I'm sorry, Chris. Chris: Oh, no, no, no. I think that's important to interject all those things because, at the end of the day, it's really about joint and joint integrity and preservation. You heard me say that not everybody's going to end up with a knee replacement. We can do a lot of different things. We talked about briefly controlling the weight if we can. Otherwise, strengthening exercises, which I think is absolutely paramount and critical. But actually, how we eat and feed ourselves is actually pretty important. So there's a variety of different things and actually, be kind of cool to do a video with Jordan on this. Brad: Oh, sure. Chris: Osteoarthritis diet. But there are a lot of foods out there and please feel free to Google it. You can look at foods that help prevent inflammation and also nourish your cartilage. So we often used to think that cartilage couldn't regenerate itself, but that's really not true. It regenerates very slowly at a glacial pace. So it's not going to be anything quick that can really just go ahead and just "I'm going to eat so well that my cartilage goes back to its normal spongy status." It doesn't really do that, but we can do things to slow it down or kind of regain some of that integrity of it. Brad: So, we probably don't want to get into details of a diet, but in general, are there some rules? Chris: Yeah, it's going to be your fish, like salmon and sardines, because they're going to have the omegas in there. It's going to be your green, leafy vegetables like kale and spinach and broccoli, those types of things. Things like beets and blueberries. They all kind of work together synergistically. So you want to have a very complete diet. That helps to kind of give your body the things that it needs to protect itself to reduce inflammation. When you eat kind of an anti-inflammatory diet, it helps to prolong and nourish those joints, and all of our body not just our knees. But we're talking about the knee today. So, I think that's very important. Brad: And if you eat that way, your joints are going to become healthier and you're probably going to lose some weight. It's a win-win situation. Chris: It is. Yeah, it's a self-fulfilling prophecy in a lot of ways. But there are times where, let's say, you're a runner, or you tweaked it when you're a kid playing football or tennis. There are a lot of reasons why. Genetics withstanding. Male versus female, and I think that's an interesting thing too, is that most osteoarthritis in the knee is 60% female. Brad: Oh, really? Because they work harder. Chris: They definitely work harder and they're totally stronger. But at the end of the day, it's also a little bit of just how their bodies are designed with the hip angle. I don't think we'll get too in-depth in that because that'll put you to sleep. But at least we see that with the statistic. I mean, you're looking at 600,000 knee replacements a year, roughly. That's only 6000,000 people per year. I mean, there are a lot of people that are walking around. Brad: That's just in the States, right? Chris: Yes. That's a US figure. So, with that, what do we do? Well, we move on, we do the physical therapy, we try pain relievers like ibuprofen and Tylenol or Aleve those things are useful. Brad: And those are okay, I'm assuming. Chris: They're okay. Yep. And they definitely help, but again, they begin to run out of gas. So what do we do to try and preserve this, and calm things down? So let's say you got a wedding you need to go to and you don't want to have knee replacement surgery and you want to prolong it, or maybe we can prolong it so that we get healthy so that we don't have to have the surgery. Those are options that are on the table. There are two main things that doctors use in their toolbox and it's going to be your hyaluronic acid shots or your corticosteroid shots, the steroid shots. Brad: Okay. Now I'm just going to say you just said that in you're pharmaceutical terms. What would people recognize that as? Chris: So, a lot of times, I think doctors kind of talk about the rooster shot or the rooster comb shot. One brand name is Synvisc, but there are about five or six other manufacturers out there. Some actually use the rooster comb, but other ones have found different ways to make the medication to minimize poultry allergies and things like that. Brad: And those, I understand, actually try to regenerate the cartilage or add to it. Chris: I think they aren't going to really regenerate it, but it's going to help to lubricate it. So if I had a can of WD-40 and I could spray it in your joint, and that's what these, specifically called viscosupplementation. So, we'll talk about the hyaluronic acid or rooster shot first. That one, it's a mixed bag of nuts. You know, all these shots are really designed for mild to modest osteoarthritis. So when it's severe, you can't do it. If you've got an infection, you can't do it. So there are limiting factors to these things. So, when you are bone on bone, these shots won't do any good. When you still got a little cartilage left, that's hanging on, I mean, hyaluronic acid shots or rooster shots can last up to six months. And it's a series depending upon the product your doctor chooses for you. There's a one, a three, and a five-shot series, so it just kind of depends on the product that's utilized. They're covered by insurance, which is good because they're about 1,200 bucks a pop. Brad: So Medicare in the United States will cover that? Chris: Medicare in the United States covers it. And I would imagine that over in Europe, there's probably a similar type of thing, but I'm not very well versed in that so I don't want to throw words in anybody's healthcare system. Brad: So that really is a conversation between you and your doctor because there are all these little variables. You need to decide, is that right for you. Chris: I think just to keep it organized, the hyaluronic acid or rooster shots, help once they find where they need to put it. They'll do a very extensive workup for you and figure out what's going on. They're going to put it into the knee joint itself. Brad: So they use a needle. Chris: Yep. They use a needle and they squirt it in. It's usually about five, or six milliliters, which is just about a teaspoon full of liquid. So, it's just a teeny tiny amount. So it's not much. A little bit goes a long way. So they place that, and sometimes they'll use ultrasound to show where the needle needs to go and place it. Sometimes that knee can be pretty swollen, so they might pull a little bit of fluid out to make room and put that in. That's twofold because also pulling some of that pressure off actually allows that knee to feel a lot better too. Brad: So they pull fluid out, your bodily fluid out because it's all swollen. Chris: Yeah, it's effusion swelling. Brad: To give it room to put in the medicine. Chris: Yes, so it's an important step. So it's just something so you're mentally aware and you know these steps may be coming. Not everybody has that happen. Sometimes it's not quite that inflamed, so it's not necessary. Again, your doctor is very well-versed. They are so strong in these areas. Brad: Yeah, I agree. Chris: It's above my pay grade. But the reality of it is it's just something that you will have to probably be prepared for, at least mentally. When they inject that in there, depending upon the product that they use, whether it's the one shot, the three, or the five. If you're coming back, it’s every week for three weeks, it's every week for five weeks or the one-time shot. So, your doctor is going to determine which one of those is most appropriate for you given your allergies and withstanding. They're going to place that in there and you have to have rest for two days after this shot. You can't just go out, "I got my shot, I'm all lubed up. I'm ready to run a marathon." It's not happening. So, it's actually very important to listen to your doctor's advice during the healing process to make sure that it sets properly, helps to bathe and nourish the existing cartilage that’s left, and help to create that good lubrication as we saw in the knee joint itself. It can last. The unique thing about the hyaluronic acid or rooster shots is the pain relief, in many cases, is more durable or longer lasting than what you get from the steroid, which is the next drug we're going to talk about. Brad: Right. I just wanted to make mention because I had my mother in, her weight is not healthy. She's got other issues. Surgery's not an option for her. And they talked about this shot and then they talked about the steroid. And after a little discussion, my mom wanted me there because "Oh, the therapist, he'll know what to do," so it was my decision, not hers in her mind. But it was pretty easy in her case, we decided on the next option. The steroid. Chris: Yeah. The steroid shot. It's a corticosteroid. The reason that those are, in many cases, favored over the hyaluronic acid shots is it provides more immediate pain relief early on. The hyaluronic acid shots take a little time to develop like in their wheelhouse maybe. Brad: So you're talking about weeks? Chris: Yeah, like about four weeks, and then it can last up to six months. So, it just kind of depends. Again, it's bathing and nourishing the joint. But for a lot of patients, and a lot of the research suggests, it's inconclusive or inconsistent relief. So, it's not for everybody and it's not for every circumstance and your doctor will recognize that very clearly and give you the options as they did like with your mom. So, the next option that we talk about is the steroid shot or the glucocorticosteroid shot, and that's the one that helps to reduce inflammation. By reducing inflammation, or swelling in there, it calms that down to hopefully allow your body's natural healing processes to take place. But we have to be careful when we're doing a steroid shot in any joint, but we're talking about the knee today because too many of them can actually degrade the tissue, the bone, the cartilage, and even the tendons. So, the example that we always see in a lot of cases, at least with the tendons, is, that we've seen a dry rubber band. So, you know how stretchy and how elastic a nice rubber band is. You can pull it and it goes back. If it were your cartilage, it kind of behaves the same way or if it's tendon, it behaves the same way. But when we use too many of these steroid shots and the magic number is four. You don't want to go more than four in a year. So, you keep three to four months in between those shots to help allow the drug to metabolize out and make sure it doesn't make it brittle. Brad: So, it's like an old rubber band in the sun. Chris: Old rubber band and it just pulls apart and it breaks. It may actually decrease the ability of the body to regenerate its own cartilage and it degenerates on the bone itself. So, questions your doctor will screen you for making sure there's no infection, making sure there are no allergies to certain components. It's kind of funny to be allergic. There are some people that are allergic to steroids, which is a strange irony because people get steroids to treat allergies in a lot of cases. But there are small circumstances. So again, you would be acutely aware of that because you would've experienced something quite negative. So your doctor will screen you to make sure it's appropriate and moving forward, we're going to say you are, they're going to place it again very carefully. You know, they might pull some fluid out, and then they're going to put it into your joint. A lot of times they mix it with a pain reliever called lidocaine and it helps to numb it. So, a lot of times, patients experience almost immediate relief and that's a little bit of a slippery slope because all of a sudden, "Wow, my knee feels really good, doc. I'm going to go mow the lawn." Or whatever. And again, the answer to that is no. You want to take a couple of days off to allow that shot to take place and let some healings begin. And then you can begin to strengthen, exercise, and enjoy. Brad: Right. Chris: So, we have to be really careful with that too. The side effects of both the hyaluronic acid shots or the rooster shots and the steroid shots are almost similar. So you want to report to your doctor if you get a little bit of irritation, or get some redness. Sometimes with the steroid shot, you can get some blanching of the skin if it's placed closer to the surface. So some little tweaky things that people notice from time to time. But generally, very safe, very effective choices to try and help to reduce that inflammation, improve pain and hopefully stave off or even maybe not have surgery. I mean, your mom responded unbelievably well. Brad: She did. She went in, the doctor was very good, he explained it to me and to my mother so we both could understand it. She got the shot. I mean, it wasn't even scheduled. We were just there for knee pain and I thought he was going to say, "Come back next week and we'll give the injection." He did it right there. It was almost pain-free for her. I thought it was one of those things where you kind of bite the bullet while they inject, but it wasn't. Chris: These guys and gals are so skilled. They are so good at what they do and they just understand anatomy and physiology so greatly. I mean, they're there to help heal, that's their job. I think that they utilize the tools in the shed to maximize it. Sometimes the inevitable is going to happen where the damage just is too great, and we have to have the replacement. But you know, there's a lot of people like your mom that are in that quasi-state. The other thing that we have to look at is whether we use the hyaluronic acid shot or the steroid shot, healing can begin. So if we're working on that strengthening, we can prolong or maybe even avoid that surgical result. So I think that's really critical to take home. Brad: In her case, it was last fall, and she got the shot. Within a week, she was feeling better and she hasn't mentioned knee pain since. Chris: Proofs in the pudding. Brad: Yeah, I'm very happy with that. Are we going to cover something else with this? Chris: I don't know that we were. I mean, we could talk about platelet enrichment if you want. Brad: Oh, is that an option? Chris: It's an option, but it's a little bit on the fringes. Brad: So, we're talking about PRP? I just got introduced to that with my shoulder issue and I watched a continuing education course last night about it for hip issues. So, it's like, "Oh, this is new, but it's out there." Chris: It's new. It's out there. The research is kind of all over the map. There are not a lot of consistent ways that doctors have been doing it. So, I think if they can find a more consistent way to deliver it, I think it's got promise. Because of what they do, they centrifuge it out, they oxygenate the blood, and they put the platelets back in. Brad: So, they actually take your own blood out. Chris: They're using your parts and that's what's nice because you're not going to be allergic to yourself. Brad: Sure. Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd, Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun (US) Fit Glide Q2 Mini Massage Gun (US) Knee Glide Back and Neck Massager Eye Massager T2 Massage Gun Foot Massager X6 Massage Gun with Stainless Steel Head Leg Massager Fitness: Resistance Bands​ Pull-Up System Pull Up Bands Wall Anchor​ Grip and Forearm Strengthener Hanging Handles​ Hand Grip Strengthener Kit Stretching: Booyah Stik Stretch Strap Wellness: Bob and Brad Blood Pressure Monitor Bob & Brad Amazon Store and other products Bob and Brad Love Check out our shirts, mugs, bags, and more in our Bob and Brad merchandise shop​ The Bob and Brad Community is a place to share your experiences, ask questions and connect with others regarding physical therapy and health topics. Medical Disclaimer All information, content, and material on this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

Absolutely avoid cutting lawn with a push mower if the activity increases your back pain. You should be attempting to eliminate all the pain-makers from your life in order to get your pain levels down. Who will cut your lawn? The same person who would do it if you had to go in for back surgery- because that may be where you are headed if you continue to injure your back. A. Avoid sweeps of the mower where you first push the mower down a side hill followed up by immediately pulling it up the hill. Your back will be in a bent position and under high loads. B. Keep your back in the locked-in position. C. It is generally helpful to keep your hands near your pelvis and perform movement with your legs and not with your back. D. Every 20 minutes stop and perform some standing back extensions (unless not recommended for you). Check out the full Sciatica series of videos along with downloadable guide sheets for each video on our website. DISCLAIMER We insist that you see a physician before starting this video series. Furthermore, this video series is not designed to replace the treatment of a professional: physician, osteopath, physical therapist, orthopedic surgeon, or chiropractor. It may however serve as an adjunct. Do not go against the advice of your health care professional. When under the care of a professional make certain that they approve of all that you try. This information is not intended as a substitute for medical treatment. Any information given about back-related conditions, treatments, and products is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this publication. Before starting an exercise program, consult a physician. Medical Disclaimer All information, content, and material of this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

This article is a transcribed edited summary of a video Bob and Brad recorded in August of 2021. For the original video go to https://www.youtube.com/watch?v=tmpK92juSFo Brad: Today we are going to talk about apple cider vinegar, its use for leg cramps, and more. This is a very interesting video if you have leg cramps, particularly, and if you want to find a nice way to get rid of them. We'll get into detail on that. But before we go any farther, Bob's not here today, obviously. So we're very happy to have Chris joining us. He's very knowledgeable and did a lot of research on this. So we got some anecdotal evidence and some great research. We've done this before. But this is kind of interesting because Chris has cramps. I have them, most everyone has cramps. Chris: Everyone has cramps. Brad: It seems like leg cramps are more prevalent overall. We don't have any research on that, but as a therapist, I worked with a lot of people and tried to help them with how to get rid of their cramps with stretching. I can't think of a time when it wasn't a leg cramp, hamstrings, quads, or calves. Chris: It always seems to be below the waist. But I mean if you think about it, we walk, we stand. We're creatures that move all around. Brad: Right, right. Chris: So I think it stands to reason, at least from a logical standpoint, that it's just day-to-day activity that can lead to cramps, whether it's muscle weakness, whether it's dehydration. There are a lot of things that lead to it, but it's always below the waist. Brad: And it seems to me, that either athletes are more prone to it or older people in their 50s and 60s, perhaps. Chris: Yeah, you bet. Statistically, it's the majority of people that have cramps, 60-year-old ladies. Brad: 60-year-old females? Chris: 60 on up, yep. That's from the research. For whatever reason, don't know why. They probably work harder than us. Bottom line. Brad: Well, that's a given. Chris: Exactly, exactly. Brad: All right, so we have that information. So we've got this bottle of Caleb Treeze Organic Farms Stops Leg & Foot Cramps. This is what happened. This is a true story. My wife saw this bottle at a hardware store in La Crosse, Wisconsin. And it says, "stops leg and foot cramps in about one minute." So she says, "oh, Brad, my husband, the famous physical therapist, might be interested in this." So she brought it home. And I looked at it and I laughed. I thought, yeah that's not going to work in one minute. So anyway and I looked at the ingredients, and Chris, you researched this in detail. Chris: Oh, yeah. Brad: Chris was having cramps consistently. So I happily gave this to Chris, and I said, "you can try this." I think Chris in his head said, " yeah right." Chris: I renamed it the salad dressing treatment. So this happens to be, it says "proven old Amish formula." And I kind of laughed at Brad, just like his take when his wife had mentioned it to him at the hardware store. And I'm like, "there is just no way this is going to work for a leg cramp." We've actually done videos on cramps, and we've done extensive research on cramps. We've personally had cramps, just like all of you have had cramps. And nobody likes cramps. They hurt, they wake you up in the middle of the night, or they happen at the most inopportune time. It's just not a lot of fun. So I really scoffed at Brad's apple cider treatment. Brad: You didn't even use it. You just put it out on the table and he called it the salad dressing because there's actually a little more than apple cider in there. Chris: The actual ingredients here are apple cider vinegar, pure, organic, and unfiltered. It's got the mother, so it's everything you want. But it also has a little bit of ginger and it also has a little bit of garlic. And so in my mind's eye, rationally as a pharmacist, I'm thinking pharmaceutically I can't come up with a reason for any one of those three things to stop a cramp. Brad: Right, and I'm thinking, well, this could be one of those old family remedies that for whatever reason works. I don't care why it works. But Chris, it's nice to know, because he wants to know how it works. Chris: I want to know why, because I like to tell my patients what really works and why, and what we have to be careful with. So to me, it's important. But one night I had a cramp. And I'm like, "well, darn it, I'm going to go down and try it." I had to go all the way downstairs with the cramp to go to the kitchen. Brad: Which location was the cramp? Chris: This one was in the hamstring, mine usually is my hamstring. But I do get lower leg ones, particularly in my feet, usually, when I'm swimming they hit my feet. But when I'm sleeping, it's the hamstrings. But moving on. So I go downstairs, almost fall down. I get to the kitchen and I threw a tablespoon in four ounces of water and drank it down. Brad: You were still cramping at the time? Chris: Yes, cramping at the time. An active cramp for probably five minutes, and it was not comfortable. I'm just thinking to myself, "this is going to work, this better work. I'm going to make fun of Brad if this doesn't work." And like 30 seconds later, I'm walking across the kitchen to go back upstairs, as I was limping, and all of a sudden, it just went away. Brad: The cramp released? Chris: The cramp released. And there is no explicable reason. Gut transit time is 30 to 60 minutes. So you're going to drink this, and it should take time to go from gut to body to create it. And so that raised a lot of questions for me at 2:00 in the morning, which is not the best time to be thinking, but I was. And that's what kind of bred to this video. But the reality of it is, that we looked at different ways why apple cider vinegar may help cramps. And there are studies after studies that existed, like 11 people here, six people there, 12 people there. It's hard to study cramping because unless you do some pretty mean things to people, it's hard to induce one. But they do seem to come when we're sleeping, or at rest, or even during activity. I mean, people and athletes have cramped during games. You'll see football games, you see marathoners, you'll see track runners. Brad: With fatigue and heat, I think. Chris: Yep, which makes sense. Because we can always think about hydration and electrolytes, which are kind of the mainstay. There are big companies like Gatorade and Powerade, that's how they make their bread and butter. But when we looked at some of this and the amount of evidence that is out there that studies hydration and electrolytes, they are anecdotal evidence probably at best. There is just not enough wide body of research on apple cider vinegar. The interesting thing about the vinegar was, that the first two that I found were really eye-opening to me. In the first one, there was a gentleman that actually was talking about it, he said that he felt that apple cider vinegar could promote more production of the neurotransmitter acetylcholine. Which is just something that helps with the muscle's actual potential and makes it work. And I'm like, well, that's fine, but we're drinking this. It takes a long time to get into the system. There's no way that you could possibly raise it enough by doing 15 milliliters of this and some water and drinking it. Brad: How much is 15 milliliters? Chris: A tablespoon full, like the tablespoon you keep in your kitchen. Brad: Put that in with four ounces of water. Chris: Mix it with four ounces of water, and drink. So that would be the dose for anybody for anything with apple cider vinegar. I wouldn't really recommend going beyond that for a variety of reasons, which you can touch on. But I just don't think there's any way we can naturally stimulate creating a neurotransmitter to just build up more and stop the cramp. So I read another article. I actually saw some Swiss research. And they actually said that they think the cramp is actually from just your brain being scrambled. It's a bad message being sent to the muscle, and the muscle doesn't release. So you're in this static state where it's just beating you up and it hurts. Everybody that's had one knows. And so when you take apple cider vinegar, you get relief within 30 to 60 seconds. What they actually believed in their research, whether it was consumed or rinsed in their mouth, and this is why they think it was a nerve problem, is they think the sourness of the apple cider vinegar sends a signal to the brain and it literally just stops off the transmission that is creating the cramp. Brad: So those brain signals saying cramp, cramp, cramp, cramp turn off. Chris: So whether it's dehydration or electrolyte driven, they actually think it's nervous driven. And the fact that even rinsing your mouth creates the same effect as drinking it and having the cramp stop in 30 to 60 seconds, seems to be that it's a lot more neurological in nature. Now, again, this is my opinion. I'd say it's much more anecdotal. But that's the only explanation that I can come up with without more wide burgeoning amounts of research done on that. So if there's a research scientist out there or a university that wants to study cramping and the neurological aspects of it, I really do think that there is probably something to this. So it's interesting. And I have to say, it works. It works well, and I swear by it now. Brad: Yeah, and you even wrote a testimonial. Chris: Yeah, Caleb Treeze is the manufacturer that makes this particular product. I think it's excellent. You can get it online anywhere, Amazon, or you can go directly to their website. But that said, I actually wrote on their site because I think it's fantastic. Brad: Sure, yeah. I thought, "he's never going to take this." I kind of gave it to you as a joke. Chris: Yeah, I tried it, and then my son had the same problem and he's a hockey player. He didn't care for the taste, but outside of that, it worked for him too. Brad: So we do want to caution, one more bridge here is if you're on some medications, there are some medications you do not want to consume apple cider vinegar with. Chris: Yeah, there's a special medication for your heart called Lanoxin or digoxin that helps control your heart rate and rhythm, and that can affect your potassium levels. And that can too with consistent use. I would think for occasional use it's probably fine, but it should be something you discuss with your doctor and your pharmacist. I would believe that most, even pharmacists, probably don't pay a lot of attention to apple cider vinegar. It's not in our wheelhouse. I had to seek out the research, and there's not tons of it. Also, diuretics or water pills, things that basically make you excrete through urine, you can lose electrolytes. And so when we're using things like this, we have to be careful. The last one that we want to be most careful of is, specifically type one diabetics that have diabetic-induced gastroparesis. That's basically where your gut motility doesn't work well. This is why it might work as a weight loss aid, which we'll talk about it in a different video, but that said, it can slow down gut motility. And for people that already have gastroparesis, that can be dangerous, specifically type one diabetics. Brad: So if you're a diabetic, type one, best not to take this, perhaps, or talk to your doctor for sure. Chris: Yeah, I would discourage it because it does affect blood sugar, which can be a positive thing, but in a type one diabetic when you're solely reliant on insulin and certain things, there's the diabetic umbrella, which we've talked about in other videos too. We have to be real careful with that. Brad: Sure, right, right. All right, so very good. Here we've got another positive thing for apple cider vinegar. Chris: Yeah, it's the stuff. Brad: Yeah, who knows what's going to happen with this in the near future? Chris: Well, I think it works, people. I'd say give it a shot. Brad: Yeah, so one tablespoon, and I go a little more than four ounces of water to dilute it a little bit. Chris: One thing I want to touch on too because it's actually acidic, rinse your teeth afterward so you don't ruin the enamel on your teeth. Another big one. Another big one. Brad: Right. All right, very good. Take care. We hope those cramps go away quickly. Chris: We're going to stop cramping, people. Have a great day. Brad: Be careful in all that you do. Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd, Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun (US) Fit Glide Q2 Mini Massage Gun (US) Knee Glide Back and Neck Massager Eye Massager T2 Massage Gun Foot Massager X6 Massage Gun with Stainless Steel Head Leg Massager Fitness: Resistance Bands​ Pull-Up System Pull Up Bands Wall Anchor​ Grip and Forearm Strengthener Hanging Handles​ Hand Grip Strengthener Kit Stretching: Booyah Stik Stretch Strap Wellness: Bob and Brad Blood Pressure Monitor Bob & Brad Amazon Store and other products Bob and Brad Love Check out our shirts, mugs, bags, and more in our Bob and Brad merchandise shop​ The Bob and Brad Community is a place to share your experiences, ask questions and connect with others regarding physical therapy and health topics. Medical Disclaimer All information, content, and material on this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

This article is a transcribed edited summary of a video Bob and Brad recorded in March of 2022. For the original video go to https://www.youtube.com/watch?v=eAtTjR1tNHk Bob: We're going to try today to unwrap a mystery. So, if you're female and you're out there and you have long-standing back pain or not even long-standing back pain, but you can't figure it out. We're going to go over some unusual cases here. Actually, it’s not that unusual. Brad: This is not a sexist thing. There's a lot of science in this. Bob: We'll go over the reason this occurs. So I had Dr. Abbasi on a podcast. He's a neurosurgeon, a very smart guy. And he said, they found with research, that 22% of the patients who are coming in with back pain is actually an SI problem. Sacroiliac. Brad: Right there. Bob: So if this is your spine, and this is the sacrum. It's kind of a triangle-shaped bone and it's attached to the sacrum, and it's attached to the iliac. Brad: Yeah. You can see how we're moving. There's a joint there and there. And the problem is these joints become unstable. And they're not really meant to move a lot. Bob: No, they aren't. And because there are nerves that go by it, they can send pain all the way down your leg. That's what throws the doctors off, Brad. Brad: Similar to sciatica. Bob: Yeah. They think sciatic, but they look at the low back and there are no problems. We're going to go over the signs that you might have this. And hopefully, it will help you because it's called the chameleon joint. Because it's like a chameleon. It's weird. So, a typical patient is often female. She often recently gave birth. And that makes sense because when you give birth these ligaments become lax so that the baby can come out of the canal. Brad: Right. Yeah, so then things spread, and there is a movement going on in those cases. That's why this is more of a female issue. Bob: It often hurts going up and down stairs which makes sense. The person often is a runner, which also makes sense, because you've got some pounding. Brad: The impact. Bob: I also just recently had a patient who fit in this category and she was only 17. Obviously, she did not have a baby but she was super flexible. She could easily do the splits, either way, you know, sideways. Brad: Yeah. That's kind of a genetic thing with her. Bob: And her mom who was 47 years old, could still do the splits. Brad: Yeah. So, runs in the family. Bob: So she was lax in that SI joint. She also had pain all the way down her leg. And so the doctors were perplexed and leave it to Bob and Brad to solve the problem. Brad: Yes. Well, there you go again. Bob: So what they do to make sure well, the other thing, Brad, I was going to mention is when you turn in bed, they often have pain. So, the pain could go all the way into the foot. It's actually, now another situation, Brad, where you might see it is in somebody who had a fused back. If their back was fused now, the movement has to come from somewhere. So it goes more into the SI. Brad: So typically, if it's fused as a result of surgery because they had back problems. Not necessarily though, it could be caused by something else. Bob: The number of people who get it then is 43%. So a lot higher. So how can you tell whether or not you have this? Well, first off, if you have any of the history that we just mentioned. I'm going to show you one test you can do. This is a Dr. Abbasi test. He made it up himself actually. Let's say you have pain on the right side, you're going to take that right foot and try to place it onto the right knee. If you can't even do that, that might be a sign that you have SI problems. Brad: Yeah, and test compared to the other side as well. Especially if there's no pain on this side it can give you some information. Bob: So, put the knee up, and then you actually push down and you try to relax while you push it down. Brad: Let me get some good posture here and so gently push down. And it's a positive test if it hurts. Bob: If it recreates the pain that you've been having. Brad: So, it may hurt in the back, and you might feel it go down the leg. It recreates your pain if you want to call it that. Bob: Right. Now there are other tests the doctor can try. But the most conclusive test they do is they actually inject the joint. With usually a little cortisone. And even if it takes away the pain for a couple of days, it's proof that it was the SI. Brad: Yeah. It gets, it specifies that joint. Bob: So, if it is the SI, the cortisone might help. It might actually take it away for good for several years. Or there's actually a surgery they can do where they actually fuse the SI. Brad: There's the conservative way. We do have a book of a therapist who specializes in SI joint and you know, it's oftentimes for women. Bob: So you can look up Bob and Brad SI or sacroiliac joint and we will have some treatments you can try. So Brad, do you have anything else to say? Brad: So for surgery, they inject into the joint? Bob: Right. But for real surgery, they actually fuse. Brad: Oh, really. I thought they injected a compound or medicine that actually in a sense fuses it? Bob: No, no, no. Brad: No? I was misinformed or misunderstood it. Bob: So if you want to go to an expert, see Dr. Abbasi. You can go to his website, inspiredspine.com. He is the man on this. Brad: So he has a private clinic and that's all they do is back treatments. And these really impressive surgeries. Bob: They are less invasive. Brad: Right. Yeah. The spine one was amazing too. Bob: Yeah, and he calls it the magic joint because women would have pain for years. And they'd walk out of that surgery without any pain. Brad: Yeah. That is magic. Bob: That is magic. All right. Thanks.

We highly recommend you avoid this task if you are currently experiencing low back pain or sciatica. We have several concerns: A. Most lawn mowers have poor back support. B. Many people when riding a lawn mower have their backs in a flexed position. C. The vibrations and bouncing that accompanies the use of the riding lawn mower are more likely to injure your back or prevent it from healing. D. Many people tend to sit for a long period of time when riding a mower. They are not likely to take needed breaks. If you are going to use a riding lawn mower, try the following: A. Strap a back-support cushion to the back of the lawn mower B. Stop the mower, stand up, and do some back extensions every 20 minutes C. If you’ll be mowing for over an hour, stop the mower and walk for five minutes D. After mowing, DO NOT perform any lifting or bending for at least an hour. More walking is advised. Products: 1) McKenzie SlimLine Lumbar Support 2) Kebado Lumbar Pillow 3) McKenzie Lumbar Roll Check out the full Sciatica series of videos along with downloadable guide sheets for each video on our website. DISCLAIMER We insist that you see a physician before starting this video series. Furthermore, this video series is not designed to replace the treatment of a professional: physician, osteopath, physical therapist, orthopedic surgeon, or chiropractor. It may however serve as an adjunct. Do not go against the advice of your health care professional. When under the care of a professional make certain that they approve of all that you try. This information is not intended as a substitute for medical treatment. Any information given about back-related conditions, treatments, and products is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this publication. Before starting an exercise program, consult a physician. Medical Disclaimer All information, content, and material of this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

This article is a transcribed edited summary of a video Bob and Brad recorded in May of 2021. For the original video go to https://www.youtube.com/watch?v=JGBOjUCYPfQ Brad: So today we're going to talk about the title how does aspirin work? And today's guidelines. This is going to be very interesting for people 50 and over, but everyone will have a good interest in it. We're going to explain how it works and the new guidelines, which is interesting to me, because it changed how my mother takes her medication. Chris: Yeah, it sure does. Brad: Right. So, before we go any further, Chris do you have anything else to mention about this aspirin? Because what I'd like to do is go through a little history because aspirin has been around forever. When I was a kid, that's all there was. I mean, I never heard of Tylenol, you know, in the sixties. All these others, like Ibuprofen, were not there. If you had a problem, it was aspirin. Chris: Everybody did aspirin back in the day. Brad: But I understand it goes back a little bit further than the 1950s. Chris: A little bit further. Brad: Then we can touch on that because some people might be interested. Chris: Absolutely. Well, aspirin has been around for thousands of years, but it hasn't been in the form you know, the aspirin tablet that we see today. Ancient Egyptians and Sumerians like 4,000 years ago, were chewing on Willow bark. And so Willow bark, the components of it, naturally have salicylate in it, which is the anti-inflammatory component of aspirin. Brad: Okay. Chris: So basically, they knew through trial and error, that if they chewed on the bark of this plant, and they had a headache or a fever it actually gave them relief, and it's documented. Brad: Oh wow. Chris: So ancient Egyptians documented it, Hippocrates, the father of modern medicine. He actually used to use a tea that he would give to pregnant mothers to help to relieve their pains with childbirth and labor. And he also used it for fevers and headaches. Brad: So, that had aspirin, that tea? Chris: Well, it was Willow bark, so it had the salicylate in it. There are a variety of different plants that actually contained salicylate. So it's not just Willow bark, but that is probably one of the more common ones that have been used for years and years. I mean, you're talking about thousands of years, and then as we fast forward into the 1700s and the 1800s, you had interested pharmacists and scientists that would just kind of tweak it and go, well why does this work? In the mid-1800s, an enterprising pharmacist actually isolated the active compound. And then a few years later, they could actually make it in tablet form. So they knew exactly what it was. And then by 1897, Bayer, which is a famous company in Germany, they got the patent in 1899. Essentially patented it, and was the first to produce it. Brad: So, Bayer was a pharmacist or a doctor? Chris: Bayer was a scientist. It was a huge German pharmaceutical company. But, that was based on a doctor, and they invented this and they used to actually market it exclusively to pharmacists. They actually did them in powder packets back then before they made tablets. So their marketing ploy at the time was to give it to pharmacists and doctors and they would give it out to their patients for fevers and aches and pains. Brad: So, then it continued to be a common use treatment, and then, how does it work? I mean, we talked a little bit about it. So you said it comes for this plant? Chris: It is the granddaddy of all NSAIDs, non-steroidal anti-inflammatory drugs. Brad: So anti-inflammatory, if you want to simplify it. Chris: Yep. So actually it works for fevers as well. So it's antipyretic, would be another name for that. Basically, you can use it for headaches. You can use it for toothache. You can use it if you sprain your knee or your ankle. You can use it for fevers if you're over the age of 18. If you're below the age of 18 that can cause very serious Reye's Syndrome, which you may or may not have heard of. That's a pretty fatal brain and liver condition that can be brought on by the use of aspirin after a virus. Brad: So is there an age component with that. Chris: Yeah, you really don't want to use aspirin under the age of 18. So at least if you're using it to treat a fever or if you've recently had a viral infection. Reye's Syndrome is very rare but very difficult to treat. Oftentimes it's even with the best best-trained minds it looks a lot like meningitis, at least in the early get-go. So it's something that we have to be careful with. Brad: But I'm thinking, you know, when I was a kid it was always talked about. But I mean, in the last 20 years, my daughter, 20 years ago, I don't even know if aspirin was an option. The doctors never said to use aspirin. It was usually some other thing. Chris: Yeah. It was either Tylenol or ibuprofen at that point or acetaminophen. Brad: Sure, right, right. But that's not because of this Reye's Syndrome? Chris: No, they just stopped using it probably in the mid-seventies. They just said, if you have a fever, don't use aspirin if you're a child below the age of 18. When I had my teeth extracted when I was like 11 years old, the doctor or the dentist just told me to take two aspirin. I still remember it. I mean, it was like two, and it was kind of a running joke always, take two aspirin, call me in the morning. Brad: Right, right. I remember that. Chris: And so, you know, we're old enough to actually remember some of those things. But, at the same time, it's certain, you know I mean the drugs got 120 years plus track record. So, it's unbelievably safe. It's unbelievably effective. The WHO, World Health Organization, listed it top of their list as one of the most essential drugs that everybody should have. Brad: Still today? Chris: Yup and a buddy of mine had a Pharmacy Professor that said, if you're trapped on a desert island, this is what you want to have with you, is aspirin. Because it's going to help if you have a fever, it's going to help if you had pain, a headache. So it actually does a lot of different things and oddly enough, there are the coronary effects, so it helps to thin your platelets and minimizes your risk for heart attack and stroke and it actually may help to prevent colorectal cancer. So there are a lot of things that aspirin does. It's a very versatile Jack-of-all-trades drug. Brad: So then, keeping that in mind, now they say like, for my mother, using it to prevent any heart problems or CVA or stroke. And they said stop that. That the new research says it's not good. Chris: It's because of her age, specifically So, we're talking about, about the 81 milligrams dose? Chris: Yep. That is low-dose aspirin, which therapeutically, most doctors now are going to recommend the 81 milligrams or the 325 milligrams is used effectively as well, but more often than not, you're going to see it as an 81 milligram. Brad: Yeah. Chris: And you notice the reason that we kind of selected these for a couple of different reasons. This is just plain old, normal, regular strength 325-milligram aspirin. This is low-dose, 81 milligrams aspirin. In the old days, they used to call it baby aspirin. You'll notice that it says safety coated. So, the 81 milligrams seem to be more efficient at helping keep the platelets from agglutinating or getting sticky and clogging up your arteries. So, this is why it works. It works a little bit better than the 325 mg one does. Brad: But not anymore because if you get over what age and they say not to use it? Chris: So, basically aspirin, the guidelines are now between 50 and 70. So the reason for that is, that there is a risk of bleeding with aspirin. And so I've seen that personally firsthand, with my mother-in-law. She had a hemorrhagic stroke and she was a regular aspirin user. So, whether or not it was the essential causative factor that caused her brain to bleed or not? It certainly didn't help. Brad: If you're over 70 doctors are probably going to say, drop the baby aspirin? Chris: With discretion. So, it depends on your risk factors. That's where all of this comes down to. So they're looking for stomach ulceration, which is a GI bleed, or other bleeds, or if you burst a blood vessel. Because this slows down the clotting effects which is why it's so protective for your heart. For heart attack and stroke, especially as we age, we all get atherosclerotic plaque that builds up in our arteries around the heart. And so, if we can basically just think of like when you take aspirin, you have thromboxane, you have cyclooxygenase, these are all things that help with the stickiness or the slickness of platelets. And when we take aspirin it makes those platelets slick so it's kind of like coating them with WD 40 to get them to squirt through. Brad: So you don't get a clot. Chris: So it doesn't clot. So it allows blood to move more freely. So it minimizes the risk of ischemic damage done. Let's say it's in your heart, the cardiac muscle, or obviously in the brain with a stroke. But then there are the two types of strokes. So there's the bleeding stroke, which is rare, like 3% of the strokes. And the other ones are all due to a clot. So that 97% is what aspirin does so well at protecting against. Brad: But if you're over 70 then there's a gray zone? Chris: After 70, it's a very gray area. The risks for bleeding is much, much higher at that point. And so right now, the newest guidelines on the studies that were done at Florida Atlantic, University of Wisconsin, Madison, and also Harvard, Brigham, and Young Women's Hospital. So those three schools all kind of came together and did a significant amount of research. Kind of, relaying these new guidelines. So it's not to say that if you're under the age of 50, you can't use aspirin. I mean, a lot of people can safely use aspirin for a sprained knee, sprained ankle, you have a headache, you have a fever. If you're over the age of 18 in that fever category, it's very effective stuff. It works, as you know, but there are risks with aspirin too. One of the most common ones is usually stomach ulceration. So, it's always important, you've noticed this one has a safety coating, the coating was designed to protect your stomach against stomach ulceration. So it doesn't dissolve in the gut. It dissolves in your intestines. And that's where it absorbs. Brad: It kind of bypasses that part? Chris: Yeah. But the controversy with that now is that they actually think that that's not that great either because you may not get as much benefit from the aspirin when you need it in a hurry. So particularly like if you're having a heart attack if you call 911, "hey, I think I'm having a heart attack." Those 911 operators are trained to ask some specific questions, like, are you on a blood thinner? Is there anything else? They may actually have you chew a couple of aspirin before the ambulance gets there. And that difference can save your life. Brad: Oh wow. Chris: So, it's important. And if you had a safety-coated tablet that slows down the absorption. It's not going to do as much good. So that's where some of that controversy is. Brad: So, the 325 milligrams, that's your standard-dose aspirin? And that's what you would take, one or two of those if you had a fever, or had some swelling? Chris: Yep. One to two every four to six hours apart. Yeah. That's kind of how that would be dosed for pain and inflammation or fever. Brad: But if you have a history of like GERD or heartburn, then aspirin is not a good choice. Chris: Yeah, when it comes down to "what do I, I'm between the age of 50 and 70, what do I do?" You want to discuss this with your doctor. Your doctor is going to have the most intimate knowledge about your medical history so that we can assure that what we're giving you is going to be the most essential thing. You can certainly talk it over with your neighborhood pharmacist. They're going to be happy to share their thoughts, but at the end of the day, your doctor is going to be the one that says. "Well, you know, Brad, you're newly diabetic, and you're a smoker and you don't exercise much". This is anti-Brad, but I mean, it's just one of these things where, in that case, maybe a daily aspirin. We're going to pretend you're 38 years old, maybe a daily aspirin would be effective for you, but your doctor should be the one making that choice. Because there is that bleed risk. Brad: Sure. Chris: Which actually can have some very severe complications. Usually, for the younger patient it's going to be mostly GI, but also older patients too. Just the way that our bodies work because we don't coat the stomach as well as they used to, so a higher risk for ulcerations. So we have to be careful. What do we tell people when they take aspirin to use it safely? You want to make sure they take it with at least eight ounces of water. That's probably one of the most important things you can do with aspirin. And probably to take it with a little snack or a meal that will also help to buffer and make it absorb a little bit more easily to the stomach. So that's how you try and minimize the risk for GI disorder, but really, it's that eight ounces of water. Then you probably don't lay down and recline because, that you can get some of the refluxing action and then they can sit, and it can start to cause some damage. It is a mild acid. Brad: So if you take it before bed, take it an hour or so before bed? Chris: At least an hour before you lay down. But the key to any time you're taking a daily dose of anything is consistent timing. So we want to take it at about the same time. And you know, the interesting thing about aspirin, it begins to work within an hour of it being put in your body. And it lasts, it has an effect on platelets for 10 days. Brad: Wow. So that's where you would prevent the heart problem or the stroke? Chris: Yup. That's the most common use these days, people typically gravitate more towards acetaminophen or Tylenol, or ibuprofen for headaches. You know, Motrin, Advil, that type of thing. It's just because they're faster acting. Ibuprofen does have platelet effects but not to the extent of aspirin. So they kind of gravitate to those more just because they're a little bit more gentle on the stomach less side effect prone, but still incredible stuff. Brad: So if we have someone, you know, older like me or even older were aspirin was their go-to thing and they're healthy. They don't have any problems. They could still go ahead and use it without any problem? Chris: Oh yeah. I think you could feel very confident in the product itself. So the things to watch out for, you don't want to take it if you're on a blood thinner, you don't want to take it if your doctor tells you not to, you don't want to take it if you have asthma, because sometimes it can trigger bronchial spasms. It could be due to the allergic component of aspirin. It's still kind of a hotly debated topic. But that said, those are a couple of precautionary things that would, maybe we would tell you to be careful with and or to avoid. Brad: That's pretty specific. So, again if you're generally healthy like I don't really have a doctor because I never go and, I've gone to have a physical and he doesn't know me that well. I mean, he just talked to me once in the last time I had a physical that doctor left and they keep running away on me. I don't know. They don't like me. But anyway, I personally would feel comfortable taking an aspirin if I sprained my ankle or had a fever. I would feel very relaxed. Chris: Oh yeah. And it's phenomenal stuff. And again, it goes back to how versatile the drug is. So it can be utilized by many. I mean, the other thing I wanted to touch on too, just as a precautionary tale, there's some debate as to, let's say you're going to have a dental procedure or a surgical procedure. Because this does create a bleed risk. It stays in your body for 10 days. So, if it's a minor procedure most doctors and dentists are saying, you can keep taking it. So, that is A-Okay because they have special hemostatic gauze and gelatin-containing products that help to cause clotting. Brad: And I'm sure if you're going to have a procedure, the doctor's going to say no aspirin so many days prior. Chris: Correct. Yeah, you should always let your doctor know, "Hey, I'm on an aspirin regimen". So it is important for your long-term safety as well, to let everybody that's going to be involved with whatever aspect of healthcare know what you're on. So share it with your pharmacist, because it's over the counter in so many cases. Although we do see prescriptions for it, you should let everybody involved know. Brad: Yep. So it looks to me like aspirin is here to stay. Chris: I think so, it's not going anywhere. It's cheap, it's effective. I just had a case the other day at work where I had an uninsured patient who needed to take a prescription anti-coagulant. What was selected by the physician was uber expensive. I mean like 1600 bucks a month. No insurance, so that's a mortgage payment. And it was just something that couldn't be, so, aspirin to the rescue. Brad: So did you make that decision or did you call the doctor? Chris: We called the doctor and said, okay, this guy's uninsured, even with discount cards and things that every retail pharmacist works on that use to try and defer costs if they don't have insurance, and it just wasn't making anything reasonable for the gentleman. So as a result of that we just said, what about aspirin? The doctor said, "yeah, we're going to have a discussion about that." So, I think it was on the doctor's radar but we weren't privy to the conversation, We saw the price tag and we're like, ooh, this is going to be really hard on this person. Brad: Sure. Yeah. Well wow. Good job. Chris: So, I'm not special. I mean, every pharmacist does that, that's normal. Brad: You know, I have to say outside of the aspirin thing, I've got a friend and he said, "yeah, Chris saved me a ton of money at the pharmacy, because he made some recommendations." And I didn't realize that that happened. Chris: Oh yeah, yeah. It's just an aspect of our job. You know, if we can see a cost-saving alternative, and we can mention it to the doctor and if the doctor, more importantly, the doctor has to agree to it. We don't get to do those things. It's like; "hey, this is available." And sometimes the doctor will say, "oh yeah, I didn't even think about that. Yeah, let's do it." So that's usually the case and it works out slick for the patient. Everybody wins. Brad: I say most excellent to that. All right. Very good. Chris: Most excellent, indeed. Brad: Aspirin, in a nutshell from 4,000, 6,000 years ago? Chris: 4,000 years ago to today. To the day and it's all right in front of you. Brad: And it's going to keep going. Chris: That's right. Enjoy. Brad: And hopefully you don't need any aspirin. Chris: Have a good day guys. Thank you. Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd, Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. 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This article is a transcribed edited summary of a video Bob and Brad recorded in June of 2020. For the original video go to https://www.youtube.com/watch?v=0IFcHaavWfg&t=341s Bob: Today, we're going to tell you about the best morning exercise routine without breaking a sweat. Brad: Bob, it always works. We keep it simple, and anybody can do it. Bob: We should also clarify that when we say exercise, we're talking about physical and mental exercises. Brad: Right. Bob: So it's the mind and the body. It has to work together. Brad: It all gels to one. All right Bob. So there are five steps here. They're very simple. It's a very user-friendly approach. Number one is don't get up in the morning and turn the news on. Don't do that. Do not listen to the news. Bob and I both agree on this. Bob: Yeah, 100%. Brad: We don't have any studies. But everyone will agree there is pretty much nothing but massive negative information on the news. They thrive on it. Bob: Yeah, and you can include finding it on Twitter or whatever. I mean your first thing should not be going onto social media because you're going to find negative news there. And it sets the tone for your day. Brad: Yeah, it really does. When your mind is fresh, you don't need to get beat up right away, you know. Bob: It's funny, Brad. I've kind of done this little experiment on me where I get up, and I'm like, feeling pretty good, and then all of a sudden, I'm feeling kind of bad. And I don't know why because I turned on the news. I was like "Why am I feeling so bad?" Well, they just said all these negative things. Brad: Yeah, they'll pick anything, anything, that will kind of set you down. Bob: You know, later on in the day, you can go ahead and check it out from your sources if you want. Brad: I try not. Get some music. Some music that you can appreciate and turn that on. And nowadays with Alexa, that little thing you talk to, there are so many alternatives to get you up and moving. Bob: Yeah, upbeat music. Brad: Number two, eat something healthy within the first thirty minutes after you get out of bed. There's no hard rule on this. I've read a couple of books that suggested this. I do it. And it just seems to get you moving better. Bob: Tim Farris, he’s one of the believers that you should eat breakfast. And you see this a lot. And, as you said, I'll see arguments on the other side of it too. But overall, it seems like, especially for weight loss, you're better if you do eat breakfast. Brad: Right, and a good breakfast. No sugars. Get the refined sugars out of there. Cut down on the bread and the carbs. That's up to you. We're not going to get into that in this video. But a good healthy breakfast. Bob: So no Cocoa Puffs? Brad: No, you can take the Cocoa Puffs... Bob: No Fruit Loops? Brad: I wouldn't feed those to my dog even. Bob: Throw them in the garbage. Brad: Number three, a brief five to ten-minute moderate to mild workout. Maybe just a brief walk down the road and back, around the block. A brief stretching routine that you might find on Bob and Brad’s YouTube channel. Or even a mild exercise routine that's more than stretching. To get your heart rate up, get the circulation going. We don't have to, I mean, I like to. I went for a twenty-mile bike ride this morning. But that's just me personally. I don't recommend that to many people. Bob: I went for a 2.7-mile run. It's not much but I mean. Brad: Yeah, you don't have to do all that. Just get your heart rate up a little bit so there's circulation going. Helps wakes up the mind. Bob: You feel a lot better. And I do a lot of stretching every morning. That's when I do my stretching. Brad: Yeah, exactly. You don't have to break a sweat to stay healthy necessarily. Number four, sit down with a piece of paper, it's a little old-fashioned, you can do it on your phone, but make a list of at least three goals you want to complete for the day. It might be personal. It might be work-related, or maybe a combination. Maybe more than three but write them down. It kind of sets your mind and gets your whole program going in the right direction. Bob: Yeah, well I actually use, this was actually from Tim Farris too, he uses a note card. So note cards are purposely small. Brad: Like what we used to use in chemistry. I used them all the time. Bob: So anyway the thing about the notecards, what's nice about them besides they fit in your pocket really well, you're kind of limited in the space. So I only put down the three, as you said, I put down the goals that I really want to get done today. Those are my priority. I don't care, I may not get anything else done. I might get a lot more done. But I'm going to get these three things done. So that's how I use them. And it just works out really well. Brad: Do you throw them away? Bob: Yeah, I throw them away at night. Brad: Do you use the backside? Bob: I should but I don't. Brad: Are there lines on the backside? Bob: No. There's a line on one side. Brad: Well, you can't use it if you don't have lines. I use a spiral. I don't know why I like spirals. I've got big spirals and little spirals and I put the ones I'm going to get done at the top. And then down at the bottom, if I have a little extra time, then I put my alternative goals to do. Bob: See then you kind of have a record, don't you? With the spiral notebook? Brad: Right you can turn the pages, yeah. Bob: So you can look back and say this is what I was looking at. Brad: I just went to the dollar store yesterday and bought three new spirals. Only a dollar a piece. It's a dollar store you know. You can't go wrong. So anyways, number five and this is very important. Now this varies depending on your situation at home. If you have family members, roommates, or someone that you live with, make sure you say something positive to them, you know. Bob: Or you can text somebody. Brad: Yes you can text. Say hi to your neighbor, you know, if you live by yourself. If you are not a texter, you might be like my mother, she calls someone on the phone. She's not techy at all but she can make a phone call. Bob: It's amazing how that sets the tone for the day. And how you're, you know, spreading goodwill throughout the world. I mean, if everybody did this, imagine what would happen. Brad: Exactly right. It offsets that negative news that's going out there. Bob: I think that's a great idea, Brad. Brad: So you know, we took seven minutes to get through this. But it really doesn't take that long you know except for the five-minute walk or that little exercise part. The breakfast you have to do anyway. And it’s a wonderful nice simple routine so. Bob: It makes a good positive upbeat message. Brad: I really think this one we can fit into our broken heart. Bob: That's right! Brad and I can fix just about anything... Brad: Except for... Bob: A broken heart. Brad: But how you start today can make a big difference. Bob: That's right. Brad:- There you go. Good luck. Bob: Give love and you can receive love. Thanks. Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd , Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. 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Avoid sitting on low surfaces, especially bleachers and low boat seats. As you can see in the photo, it is nearly impossible to keep your back straight when you are sitting on a low surface. This is often a concern for athletes who sit on benches when not in the game. It is also a concern for golfers who ride in carts. Golfers should take care to sit upright while riding. If you must sit on bleachers, try to get the upper row to make use of the wall for back support. To counter the effects of low sitting, perform frequent stands and frequent standing back extensions. If you can obtain the upper row, it will be easier for you to stand without drawing attention or blocking views. Take a walk between quarters or halves of sporting events. Stand as much as possible. It would be helpful if you could raise the surface with a firm cushion or folded blanket making it easier to keep good posture. Check out the full Sciatica series of videos along with downloadable guide sheets for each video on our website. DISCLAIMER We insist that you see a physician before starting this video series. Furthermore, this video series is not designed to replace the treatment of a professional: physician, osteopath, physical therapist, orthopedic surgeon, or chiropractor. It may however serve as an adjunct. Do not go against the advice of your health care professional. When under the care of a professional make certain that they approve of all that you try. This information is not intended as a substitute for medical treatment. Any information given about back-related conditions, treatments, and products is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this publication. Before starting an exercise program, consult a physician. Medical Disclaimer All information, content, and material of this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

This article is a transcribed edited summary of a video Bob and Brad recorded in July of 2021. For the original video go to https://www.youtube.com/watch?v=ap6kn3DfmZw&t=414 Brad: Bob is not here today, but we have someone even better to help us out, Chris the pharmacist. Today we are going to talk about understanding diabetes head to toe, symptoms, treatments as well as blood sugars and how you measure those. This is pretty comprehensive. It's not very short. This is a very complicated disease and we want to cover all the aspects. So if you want to learn everything about diabetes, if you have been diagnosed or a family member has been recently diagnosed and you really want to get some good information, this is going to give you everything you need to know. So bear with us. If there is a part that you don't understand, I'm going to help Chris. He sometimes gets too complicated. I'm going to see if I can have him explain it so that everyone can understand it, including myself. So very good. Both physical therapists and pharmacists work with diabetics all the time. Chris: Correct. Brad: And there are things that therapists have to know about treating a diabetic so they maintain good health and we can help maintain, monitor, and have good results with the patients and problems. Chris: Absolutely. Brad: And with pharmacists, you are very acute to what's going on with them and how to talk to them and educate them. Am I correct on that? Chris: Quite correct, it's an unbelievably prevalent disease worldwide. You're talking about 480 million people on the planet. Within the United States, we're roughly around 35 million people. Brad: So that is about 10% of the United States population has diabetes. And then there's type one and type two? Chris: Correct. There is type one and there's type two. Within the bigger framework is diabetes mellitus. Within that framework, you've got type one and type two. Type one is what was usually recognized as what they call childhood onset. But that's not really true. It does occur in childhood often or in adolescents, but it can occur later in life as well, even into your 20s. And that's the type that is insulin-dependent diabetes exclusively. Brad: So that means they have to get a shot? Chris: Yep, without insulin being introduced into your body, you would die. Brad: So you can't treat that or change it with your diet? Chris: No, but diet and exercise are still very, very important. We'll talk about that between the two. But it's interesting with type one diabetics, they tend to be, they are thinner patients. They tend to be pretty lean in general. But it has a variety of complications that we can certainly get into. Brad: So the pancreas is what produces insulin and puts it in your digestive system. So those type one people, it doesn't produce insulin or just not enough? Chris: We don't really know fully why you become a type one diabetic. But what we do know is that whether it's a viral cause or just simply autoimmune, our immune systems attack our pancreas and you have alpha cells and beta cells and your beta cells are the ones that make insulin. So when we eat food, our body generates insulin so it can take up sugar and put it into our cells for further use for energy. When we're exercising, walking, doing life. Brad: So with that, with type one, that pancreas is not doing that sufficiently. Chris: Those specific cells die off. The immune system for whatever reason said "I don't like these things and I'm attacking it." And there's a lot of research going into that as to how we can fix this medically. So there are doctors doing research on transplants using stem cells and artificial pancreas. Brad: What about genetics, is type one genetic? If I have it, are my children likely to have it? Chris: There is a possibility. There's a strong genetic component with both type one and type two. So it's one of those things where, if you have a diabetic parent or parents, there's a higher likelihood that you will get it. I see it all the time, we see diabetic families. I've seen where one parent is type one and the other is type two and the kids are all type one. It just kind of depends. You can't always outrun that. It's very complicated and researchers are trying to figure it out. Brad: Sure. Chris: And they don't have the key, they're getting better and better at things, but it is not easy. Worldwide it's really interesting and in countries that don't have access to care as the United States does, sometimes it can actually be missed because sometimes it looks like other things. Time is everything because there's this thing called diabetic ketoacidosis, which actually can be fatal if not treated right away. And that's how a young diabetic or an adolescent, or just a type one approaches, they're really acidic, their sugars are through the roof. And so we want to make sure that we're looking at everything. Brad: Let's talk about type two. So type two, is that the kind that typically comes with older people, so the onset is because of lifestyle? Chris: That was the older framework. You can have a type two diabetic that's 10 years old. So I would say it's more lifestyle maintained. Brad: But usually is it 10-year-olds or is it in 30 or 60-year-olds? Chris: It is going to develop later in life but what we're finding, particularly with childhood obesity is that we're seeing more and more children being diagnosed with type two diabetes, which in previous generations was just not a thing. Brad: So type two is influenced heavily by lifestyle? Chris: Lifestyle and yep. So the thing that happens in type two, that's kind of a hallmark characteristic, we have plenty of insulin floating around in our bodies, but the cells that use it are resistant to it. So it's an insulin resistance category. And so when we don't exercise well enough, we don't eat properly and we are overweight, and if there's a genetic predisposition towards it, it's a high likelihood that type two could develop. Brad: So with type two, they typically are not taking insulin injections like type one? Chris: No. No, they won't start there typically. The first thing when you get your first diabetic diagnosis, if it's a type two, is they're going to talk to you about modification of lifestyle choices. So diet and exercise are the first two things. If you're going to be on medications, the first thing we're going to talk to you about, no matter what, is to exercise well and eat well. And they're going to probably put you together with a diabetic nutritionist, so a specialist. They'll probably have a nurse care specialist, you are going to have an endocrinologist, there's going to be a team. And then the pharmacist will come in when we're talking to you about your medication. Brad: So as far as exercise as a therapist, this doesn't mean that you need to start running 5K's, 10K's, and marathons. Chris: Absolutely not. Brad: We're talking about probably walking 30 minutes a day or work up to that. Chris: Yeah, basically the guidelines are, they want you to do 150 minutes a week. So five by 30 minutes. So things like walking, gardening, ballroom dancing, swimming, biking, and running. You actually need to be kind of be careful with exercise and diabetics too, because there are certain things like say weightlifting, where let's say there's maybe some diabetic retinopathy kind of issues, or with your kidneys, sometimes we're pushing really hard or straining on a big, heavy lift. They can cause some problems and obviously, in your arena Brad, we have to be super careful with that with diabetes. Brad: So the big picture is, exercise does not mean you have to become an all-out exercise geek. You're just going to go five days a week, 30 minutes, like we said, walking, being active with things around your house is good for that. As far as diet, I think there's no real special diet. There is a lot of getting rid of your processed foods or the high sugar. Chris: The processed foods. Yeah, and I mean especially in the Americanized diet, we've got fast food and we've got processed food and those are go-to because they're quick, they're easy and you get quick energy. Brad: Relatively inexpensive. Chris: Yep, and that's one of the things that I think makes it so dangerous is everything is so cheap. All the stuff that tastes good, that's not good for you, it's cheap. And so if we can stay away from things that are in boxes and bags, I think that's a big thing. You want to go to whole foods, lean proteins, fruits, and veggies. If you talk to a nutritionist or a diabetic educator, they're going to talk about what are good fruits and veggies versus bad ones, and veggies, not so much, but fruits, some have more sugar than others. And they talk about the glycemic index which can probably glaze everybody over if I start into that. Brad: For example, I know grapes have a high sugar content. So I don't eat many grapes. I like them, but I like to stick to the berries, that kind of a thing. Chris: Yeah, berries, blueberries, and bananas are a little bit lower on the glycemic index about 63. So I mean in the middle of the road. So it just kind of depends on the things that you choose. And again, a diabetic educator and, or a nutritionist, you will be talking with both when you get these diagnoses because it's so important to incorporate those lifestyle changes early. And Rome's not built in a day and diabetes is, like I said, it's one in four of all healthcare dollars in the United States are spent on diabetes. Brad: 25%. Chris: 25%. So you're talking about the average diabetic patient spends $9,000 a year annually out of pocket costs. So that's not the insurance guy, it's out of pocket. Brad: We just had an amputee in here. They were talking about dealing with the amputee and the prosthetist talked about the percentage of people that get amputated in the knee, arm, or whatever, typically the legs are highly oftentimes diabetic. Chris: Yeah, the number one, when we talk about peripheral artery disease. Brad: Yeah, we'll get into that. I do want to talk about typical symptoms before we get any farther because we are going to cover seven different topics that they're all kind of interrelated, but we tried to break them apart. Let's say that you are not type-one diabetic or whatever, you're type-two, what do you feel? What does a typical diabetic notice before they're diagnosed? Chris: It's kind of odd, whether it's one or two, they're somewhat similar. In diagnosis circles, they're going to talk about the three Ps. It's going to be polyphagia, which is you're hungry all the time. Polydipsia where you're thirsty all the time and polyuria where you go to the bathroom all the time. So the three Ps. Brad: So all three of them or just one of them? Chris: No, all three of them are kind of characteristically all together. You'll see those as kind of a hallmark thing. Then there will be subsequent fatigue and you just don't feel well and things aren't right, you're not thinking clearly. Brad: Is this consistent day to day to day to day? Or does it come and go where you feel you have it for a few days then you're fine? Chris: No, no, it's going to be, think of a crescendo. It's going to start here and it's going to keep getting worse and worse and worse. So if you think of a big wave developing, you know how it starts kind of small, and then when it comes into shore, it gets bigger and taller. Brad: Could it go up and down, depending on your diet? Chris: No, when you first get diagnosed with type one, there's this honeymoon phase where you can actually somewhat spontaneously recover, but that's very short and it's less than six months. Brad: You said again, type two is what percentage of diabetics? Chris: 95% are type two, and 5% are type one. The problems all remain the same with the complications that are associated with it. Leading up to a diagnosis, there'll be asking you questions about your family. They'll look at your age, they'll look at things that have been going on around you. Did you have an infection? So they'll look at the autoimmune aspects for type ones if it's a younger diabetic patient. So there are a lot of things that are very, very complicated for a doctor or a clinician to try and figure out at the onset of this. You come in, something's not right. One of the first things we're going to do is take blood work to make sure that they see and the astute physician is going to look at your A1C, which is a diagnostic criteria. They're going to look at your glucose level and they say, "wow, it's 500. This is insane." And then they're going to immediately go into crisis mode and try to figure out how we can protect the body. And then they'll start to figure everything out. Brad: You don't go in to see a doctor in one visit and they say, "oh, you're diabetic." They're going to ask a lot of questions, do a lot of blood work, a lot of other tests and you're going to come back and they're going to analyze it. Chris: It can be really scary stuff, I mean, it can be a crisis situation. You could have a kid that's unconscious. You don't know why they're not arousable, in a type one particular case. Whereas an adult type two, the onset is much slower. If we weren't eating well, we're not exercising well and we're gaining weight, it builds up. I mean, they hypothesize that there's at least 8 million people in the United States walking around that don't even know they have diabetes, but they're diabetic. Again, that's going to be a type two. Type one it's medical crisis. You don't get that treated, you're dead. I mean, it's that serious? Brad: As far as symptoms, a typical symptom that I've worked with patients, is they get lightheaded. It's like, oh, they're diabetic and then we come down and the nurses come down or whoever, or we get something like orange juice or something. Chris: Yeah, when their sugar is low, it's called hypoglycemia or low blood sugar. Brad: Yeah, and that's when you get that lightheaded feeling. Chris: Yeah, they can almost behave drunk. So yeah, there are a lot of things to be aware of. Let's say that you weren't feeling well that morning and they brought you down for treatment and maybe you didn't eat breakfast that day, but you took your insulin, or you took your meds, and all of a sudden you're crashing. And so you can be unstable, almost drunk like, just talking about things that don't make sense. I mean, they can present in a variety of different ways. And so, yeah, a little bit of orange juice, sometimes they'll tell you to chew on lifesavers. We have glucose tablets in the pharmacy or glucose gels. There's a variety of different ways. If it's really serious, they're going to give you a shot of glucagon to stimulate blood sugar production. Brad: And what if it goes high, if it spikes, what are the symptoms? Chris: Well, if it spikes high, that's where you're not going to feel right, you're going to be fatigued, lethargic, and cloudy thinking. They sound kind of similar, don't they. So it makes it kind of tricky. They'll probably give you a bolus of insulin, so they will treat you specifically with insulin. When you have blood sugars over the marking would be 240 and that's milligrams per deciliter. Brad: What's normal, what's normal blood sugar, 120? Chris: For healthy people, it's going to be 80 to 120. Brad: So what numbers are high? Chris: After 120, but I mean, if you have what they call postprandial FTE after you eat, our sugar's going to go up, so it wouldn't be uncommon for you or me to be like a 200 if we had a really starchy meal. So let's say we had some pineapple and I don't know some coconut and some rice and some chicken. I mean, it's going to go up. Brad: That's normal. Chris: Yeah, it's got to be variable with what you eat, but it's going to come down right away because your body's going to uptake those sugars, put them in the cells, and then it'll be expunged when you have energy needs. So with somebody that's well, whether one or two and their blood sugar is way high, we have to watch out for that risk of diabetic ketoacidosis. And that can be actually fatal if not treated properly. The blood becomes acidic, the sugars are super high, so the clinician is going to recognize this. Brad: So if you're at home and you're diabetic, and you get these symptoms, it's probably time to go to the ER. Chris: Yes. Yeah, and with new diabetics, most doctors coach them, but you should have a kind of a diabetic rescue plan. And your family members and friends should know about it. Diabetes can be a long-term, frustrating situation for people to deal with. It's a big blow when you say "Brad, I'm sorry, but you're a diabetic." I mean people think, oh my God, am I going to die? And no, the answer is absolutely not. It's a very treatable disease state that you can live a great life. You can still have all your hopes and dreams can come true. It's not the end of the world. It's going to require work. And so we have to be willing to put the time in and make some of those changes if it's a type two. Type one, you make your peace with using your insulin and doing all the things that are necessary. Brad: Can we go onto our list of seven here, it's circulation, neuropathy, vision, internal organs, heart disease, mouth, and age-related issues. So let's start with number one, circulation. That's a big one. Chris: Yep, I mean our cardiovascular system, when you are a diabetic, whether it's one or two, and this will be a standard thing, the longer you have diabetes, the more these risks become more prevalent. So whether you're, let's say a 30-year-old type two diagnosis or a 15-year-old type one diagnosis, it's not as advanced, but when we're 65 and we've had diabetes for a number of years, the cardiovascular disease becomes a very real risk. And I mean, it can affect you in your 40's, your 50's, your 60's. Brad: So cardiovascular, we're talking about the heart then? Chris: Yep, the heart because basically with sugar, every single problem that we have in diabetes is a circulatory issue. So cardiovascular disease is much higher, I mean, you've got a much higher risk for heart attack, much higher risk for stroke. Part of those changes are because of the sugars in our blood, it causes the breakdown of vessels, and causes fatty deposits to develop. So it can cause atherosclerosis, which is the hardening of your arteries and clogging of your veins. It can lead to peripheral vascular disease in your extremities, which can cause circulatory issues. It can cause issues in our kidneys. Obviously issues around the heart. You can get just fatty deposits in your arteries. And then basically that can break off and become a stroke. So we have lots and lots of risks and they actually talk about vascular issues and for microvascular and macrovascular. So macro think of bigger, micro is in smaller, smaller at the capillary level. So it becomes unbelievably complex as a clinician because the diabetic umbrella is so encompassing. So you list off those seven things. And one of the things too, with respect to that is so what do you do? What do you do to protect yourself? Well, there's going to be medication therapy, for sure. So whether you're going to be put on a statin, is going to be absolutely critical to protect you. Obviously, hypertension, managing your blood pressure issues. Brad: This isn't all diabetics, this is where it can lead to this, but if you change your lifestyle? Chris: No, it's going to be all diabetics. You're going to have those lifestyle changes but if you don't make those lifestyle changes, this is your future. It's going to be managed with chemistry. We still want you to exercise. We still want you to eat well. I mean, that should be number one, "A" number one no matter what you do. Brad: What about neuropathy? Now that's a term that I think a lot of my patients will say "oh I have neuropathy." But with diabetics and neuropathy and the physical therapy world, we're always concerned about people's feet. Chris: Feet, feet, feet. Brad: Circulation is not good down there, and then you become numb and tingly and you don't have good sensation. Let's say you put your shoe on too tight or you have a wrinkle in your sock and it pushes into the skin and the skin breaks open. Chris: You've got the ulcer. Brad: Then you've got an ulcer that will not heal very well with a diabetic. And it can lead to an amputation. I've worked with a number of amputees as a result of a fold in their sock, or they stubbed their toe, broke something open and it will not heal as a result of circulation and the other effects of diabetes. So boy, keep your feet and your footwear properly fitting. Chris: Proper fitting shoes. Wearing wicking socks that are not like loose and droopy, I guess. Brad: Yeah, we can't have the folds on the socks. Chris: No, no, you want to make sure that everything's well-fitting. I mean, from the toolbox in your shoes, probably like what I'm wearing today would not be probably good diabetic footwear. Brad: You are not going to wear the pumps of the high heels where they're pointy. Chris: No, no, because you're going to be cramping your toes. That's one of the things with neuropathy, it's a progressive issue too. It starts out in a lot of cases, as pins and needles or burning, and then eventually, it's just numbness. It can affect their gates, it can actually affect the bone structure of their foot. And sometimes people just can't see their feet. And yet the ball of the foot is where most of those ulcers start or your toes. And so again, it's the footwear issue. So we want to make sure we're taking care of that. You want to make sure you have regular doctor visits. You should inspect your feet daily. After you dry off, you should put a moisturizer on them. Vaseline is a very simple way to help to maintain that, but you don't want to put it between the toes because that's where sweat collects. Then, you can get a variety of different skin infections too. So we'll talk about some of that as well. Brad: This is sounding pretty gloomy, but I do want to give some bright sides. I personally know a diabetic, she wears a pump so she has insulin in her system from a pump. You would never know it, she's got a very good job, she's very active, she's athletic, which helps. And she deals with it well. So again, I just want to say, if you choose to do your lifestyle changes, do whatever you have to do, what your doctor and whatnot coaches you. Chris: Absolutely. Brad: It's not all doom and gloom, but again, it potentially could go that way. Chris: But you have to work at it. And you have to realize that there are days when patients feel frustrated. Let's say you just went to a wedding last weekend. Well, I mean, there's always great food and there are always things that we're maybe not thinking about. Do I have the piece of wedding cake? Do I not have the piece of wedding cake? What kind of ramifications are we going to do? Did I do enough dancing at the wedding to kind of burn off some of those calories? Or am I going to have to take an extra walk or what's going to happen to me tomorrow? There are so many things with diabetes that makes it so incredibly complex to treat. And as a patient, it can be frustrating, but realize that if you can take a team, have a family member or a friend that can help support you, and have a plan to work on things. These are things that will help to minimize that. Most people on a pump are type one diabetic, but that's not always the case. You can have people on pumps with type two. And those pumps are incredible. It's kind of like having a fake pancreas. It's just put into you and it literally gives you a basal level of insulin. That's that baseline level. And then when you eat, you can program it for your meals, what you are going to eat. So they're incredible these days. So your endocrinologist is certainly going to be paramount in doing this. It's certainly something you don't see at the pharmacy level, other than the people coming in to pick up their insulin for their pumps. But it's certainly something that has been life-changing for many people. Brad: Good. Chris: And again, diabetes is a very livable disease. There's no reason why it's the kiss of death. If you don't take care of yourself, you can end up with an early grave. So I don't like to scare people, but it's certainly something that we have to be an active participant in managing our own disease states. So if we move to the neuropathy, I mean, it's circulatory at the end of the day, those nerves are not being bathed properly. But again, so we move on to vision where we start talking about diabetic retinopathy. That's the leading cause of blindness in working-class people throughout the world. Brad: So that means that as a result of the diabetic issues in your system, your retina becomes damaged. Chris: Yeah, damaged, and so it becomes part of the microvascular portion of diabetes. So this is the small blood cells. And so in our eye, it can affect our lens, it can increase the risk for glaucoma, and it affects the retina and the macula. I mean, there are all parts of the eye that are all in tune so we can see clearly. And what happens is that because it becomes a circulatory issue, it breaks down the little capillaries in the eye that feed the retina and the macula and the optic nerve and everything else. Just think of blood as your lifeline. When those vessels are broken down because sugar has basically screwed up the whole mechanism for delivering nutrients and oxygen in the blood, problems occur. And so in the simplest fashion, I mean you can get floaties, your retina can become detached, so your eye checkups are very critical. Brad: So again, with this same thing, the maintenance, your lifestyle changes and get things under control and actively manage it persistently. Chris: Every single solution that we have comes down to lifestyle modification, eating well, and using your medications appropriately. I mean, there is no in-between, there's no negotiating at this point. It's kind of like playing monopoly where you go to jail. It's like, do not pass, you go directly to jail. If you don't treat your blood sugars well and with respect, it's going to create a cavalcade of problems. Brad: Let's see, anything else? Like what about the mouth? Are there some issues with the teeth? Chris: Yeah, so again, circulatory. So, if we aren't getting good oral circulation in our gums, it can cause gum disease, and it can cause periodontal disease. And we're a diabetic too, so we don't heal as fast. So when we were talking about the neuropathy of the foot, diabetic foot ulcer, we don't have that rich source of blood to come and just try and oxygenate and help that foot heal. And so there are a variety of different things that doctors do with that, but the same thing with the dentist. You see how this adds up with the healthcare costs. So you've seen your eye doctor, you're seeing a kidney doctor, maybe, you're seeing your foot doctor, you're seeing your endocrinologist, you're seeing your regular GP. So it's a team-wise approach. And then you go into the pharmacy to get your stuff, and maybe you're paying your physical therapist to help you to improve your lifestyle. Which a lot of cases, physical therapists are paramount in developing exercise programs, how to do things properly, warn the patients what to look for. So, I mean, they are so paramount in treating and actually a lot of cases like with peripheral artery disease, which is circulatory again, physical therapy is better than drugs. So it's huge. Brad: Yeah, so appropriate exercise. Chris: Correct. And so going back to the mouth, because I just digressed, I'm sorry, I do that. Again, it's circulatory, keeping your sugars in check and making sure that your dentist is looking at those teeth. Because actually one of the things is, when you have a bad dental disease, you're not eating properly because you can't chew the right foods. So what do you go to? All the easy mushy sugary stuff. Worldwide, sometimes nutrition is hard to come by or at least good nutrition is hard to come by. And so with the mouth, it's very important. Our internal organs when we're talking about our kidneys, our livers, our hearts. So you talk about diabetic nephropathy as one of the leading causes of kidney damage. And so we have a little filter called the glomerulus and those fatty deposits into those little microvascular changes can cause damage. Brad: So you're compromised throughout your gut if you will. Chris: Everything, the average adult has basically 100 million miles of blood vessels. If you lay them end to end, that would wrap around the planet a few times. So that's what they theorize. The child has 60 million. So it's an incredible amount. And so circulation is key and to manage it, it all comes down to blood sugar management. Brad: So let's get to that. How do you measure? Because that's going to be a key thing. Once you're diagnosed, you are going to be responsible to measure your blood sugars on a daily basis. Chris: Every day it should be done. Brad: And that's where you poke your finger and you get a little drop of blood. Chris: That's one way. Brad: Okay, how many ways are there that you can measure? Chris: Well, it's going to be a finger prick or it can be through constant glucose monitoring. And that's one of the newer things that we have, they're wearable, implantable devices. Brad: Put on your arm. Chris: Yep, so they just have a special mechanism and it has a little capillary that if you could picture, would go in right below the surface of the skin. Brad: So something pokes into your skin. Chris: Yep and you'll wear it for 10 to 14 days, depending upon the manufacturer that you choose. And you have a little unit and actually, it's even integrated with cell phones, but you just wave it right over the sensor and it'll give you a real-time picture of what your blood sugar is at that moment in time. Brad: Wow, otherwise you're poking your finger, blah, blah, put it in the little machine and it takes some time. It's not a big deal, but yours is easy. Chris: It's not a big deal. But when you talk to patients, the one thing with the finger prick is it's a little sting, so they get frustrated with it. It can cause thickening of the skin. So we're talking about diabetics when they come in and actually checking, you want to use the side of your finger, not the tip of your fingers, a lot more nerve endings here. So it hurts more if you use the tip. So you want to use the side. Some people their circulation's not great, so they can run their hands under warm water to kind of work that up. Or you can actually rub your hands together and create a little friction, so you get a better sample. So sometimes it can get hard, especially for lifelong diabetics that are checking it three to eight times a day. Brad: Oh really that often? Chris: It can be, so that's why the constant glucose monitoring is a bit easier and a lot of the pumps now are integrated with that too. So like Medtronic and a variety of different companies. Brad: So they put the pump on that monitor? Chris: Yeah. Brad: And that goes for more than 14 days, as long as the pump is in? Chris: Yeah, and the pump to pump, they have different varieties because they're going to load it with their insulin. And then also it also integrates with their blood sugar. Brad: That gets pretty specific per patient. Chris: Yes, yes, yes, yes. But in so far as just self-monitoring, I mean the money's in the strips. When we talked about one in $4, I mean, test strips, I mean just an average box of 100 test strips is 180 bucks. Brad: Oh, really? Chris: Most insurance companies cover those. But if you take the new diabetic, the constant glucose monitoring, so there's the Freestyle Libre, Libre 2 and then there's Dexcom, which are the three units I'm most familiar with. They all, like the Dexcom are 10 days sensors and the Libres are 14 days sensors. They're a little bit cheaper than the strips, but interestingly, most insurance companies don't cover the constant glucose monitoring, which is strange because it's the most cutting edge, best possible information you can get to give yourself. And plus you don't have to prick your finger. So it's getting more comfortable. I mean, there are people like the Freestyle Libre product, you can swim with it. Brad: Oh really? Chris: Yeah, yeah, they stay right on, you can bathe, I mean, you don't take it off, you wear it for 14 days. Brad: Yeah, that information is documented, so if you can refer back to it for future reference possibly. Chris: Yeah, yeah. Like I said, you heard me say the test strip is about 180 bucks for 100 strips, for a sensor it's about 60 bucks. So it's cheaper. But for some strange reason, many insurance plans don't seem to cover those sensors. And I don't fully grasp why as a pharmacist. To me, when I talk to patients that use these devices, they love them. Their sugars improve. It tells them real-time, they're like, oh my gosh, I'm low, it's time for me to grab a quick snack or I'm way too high of, gosh, I'm going to have to go out and take a walk. Brad: You get to learn your body. Chris: You learn much more effectively, all of a sudden, wow, I went on this and I lost 11 pounds, my sugars are great, I'm feeling better, I'm more active, more energetic. I mean, they really are an incredible tool because of all these things that we talk about, as complications. It's the simplest thing that we can do to help ourselves on a day-to-day basis. And a doctor uses a different tool called an A1C, which has done about every 90 days. And that's a snapshot of how well you've been doing. And that's what the clinicians use. But if you're using your blood glucose, your self-home monitoring devices, hopefully, it will mirror what the physician sees every 90 days or six months, or whenever you come in for your checkups. So it is a critical, critical step in us helping to conquer the disease state itself, is just being in the know. Brad: I wanted to cover this earlier and I should have brought it up earlier, I feel bad, but people with type two, if you catch it early enough and you're not too far off, is that the point where your lifestyle changes could reverse it? Chris: Yes. Brad: But not cure it, but at least make it very manageable without medication. Chris: Yeah, absolutely, 100% yes. So I mean, and you can be a type two for five years and then you just find religion and say, I'm done with all this stuff. You exercise, you eat well, you do everything, your nutritionist says, your doctor says, you can get off the meds. It is a goal that I talk about with many of my patients, like, "Hey, if you can work at this and you commit to yourself." Because I think you're your own best asset. And so if you treat yourself as a billion-dollar commodity, you're a billion-dollar corporation, and it's like, well, I want to make this corporation last for a long, long time because I want kids, I want grandkids or I want to write a book. Brad: I want to live. Chris: You want to live. I mean, whatever your goals and dreams are, it should not crush them, is my point. This is very livable. And if you're active, if you pursue it actively yourself, you can beat the disease is not quite the right word because it's always going to be there in an underlying fashion, but you can reverse it and to the point where you don't need medications. Brad: Sure. Chris: This is a little bit of a side note, but like there are patients that are candidates for bariatric bypass, which is the special stomach procedure that doctors reduce the surface area and you're going to reduce caloric diet and very, it's very regimen and very difficult, and you have to be psychologically ready for something like that. But a lot of people lose 100 pounds and all of a sudden they're off all their diabetic meds, all their blood pressure meds. Brad: Oh, really? Chris: So it's an option for people that just can't quite get it done. Sometimes we just need a little help. Brad: It's a select group of people. Chris: A very select group, but it's something that's out there. And when you see all of a sudden, they're like, I am no longer classified as a type two diabetic because I've made these changes. But they're also exercising and eating well. A lot of times too they can clip a nerve that turns off the ability to even sense hunger. So there's a lot. It's pretty amazing stuff. Brad: Is that something that's pretty new? Chris: Newer. Well, I don't know, I guess you'd have to talk to a gastroenterologist that specializes in bariatrics. Probably, it's not new to them, but it's newer I think to us in the real world. Brad: I don't want to give people the idea that everybody should have it done. Get the nerve slipped for hunger and they're okay. Chris: No, it's not that simple. And there's a cost to those things too because people can forget to eat. They have to set an alarm to be sure you eat at this time. So again, that's a sidebar. It's not the end all be all. I guess the point being is that if you can commit to those lifestyle changes, you will see improvement, you will see your blood sugars under better control, and you will see overall better health. The one thing with all these things that we're talking about with complications is, that the longer we're diabetic and the less well-controlled we are, the more severe and the more frequent these complications can become. And so that's that diabetic umbrella. That's everything that's under there. I mean, it's the heart, it's the mouth, it's the nerves. I mean, it's everything, it's stroke, it's vascular disease, it's your circulatory, it's your eyesight, it's kidneys, it's the amputations. When we talk about all these things, it sounds pretty dire. But if we are willing to put in the work, we can live with it and we can manage it and we can manage it very effectively. Brad: And prosper it sounds like. Chris: Exactly! Brad: So that puts you in control of it, which is a big relief. And I know when I have my patients with pain, particularly back pain, if I can show them some exercises or some things not to do, and it puts them in control, it's like, oh, I can control this pain. Their whole life changes. They just have to realize and accept what they need to do and you do it. Chris: Yeah, you have to almost treat it like a job. I mean, and it's just like, all right, I'm packing my lunch box with healthy food and I'm going to work. It's one of the things that, cured, no, treated, yes. And I think if we're willing to commit to it, you can have a great life, an even better life. And I mean, there are athletes, there are movie stars, there are presidents. Brad: Everyday people that you may not even know. Chris: That you don't even know. They just don't talk about it. Brad: Yep, all right, very good. Hopefully, we've covered it. I think we covered it quite well. Maybe too well, I don't know. But good luck with it. It can be a problem, but you can certainly overcome and live well with it. So take care and thank you, Chris, for coming on and sharing all your knowledge. Chris: Absolutely. Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd , Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. 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