This article is a transcribed edited summary of a video Bob and Brad recorded in April of 2021. For the original video go to https://www.youtube.com/watch?v=SKo2JtGBz8c&t=110s Chris: We’re going to talk about a couple different antidepressants. One is call fluoxetine; the brand name is Prozac. And the second one is call sertraline under the brand name of Zoloft. So, we’re going to use that for depression and we’re going to talk about the benefits and side effects and what to watch for over time when we’re taking these medications. Brad: And the goal is so that you understand what these meds are, how they work, how to take them, and things that maybe you don’t feel comfortable about. I think once you learn what Chris has to say it’s going to open a lot of information. When you’re educated on something, everything can change. Chris: Hopefully we’re going to help a lot of people. Brad: Exactly. So, now we’re going to run this as a format. Chris being the pharmacist, I’m going to be the patient. I come in with my prescription on paper from the doctor. Obviously, I can’t read it because you can never read those prescriptions. He says I got some depression things. I’m not excited about this. I am a little apprehensive that I want to start taking these meds because I don’t know, I heard bad thing about them, and Chris is going to address this. This is something that Chris does very well professionally as a pharmacist, better than other pharmacists I’ve been to for sure. So, I think it’s going to be helpful. So, here we go, Chris, I need this medication. Chris: All right, hey Brad. I see you had a visit with your doctor, and I guess just for the quick purposes of the conversation, fluoxetine and sertraline are antidepressants, they’re serotonin reuptake inhibitors, which that’s the class of drug they’re in. The consult that I’ll perform on both is the same for both medications. Brad: So, wait, the fluoxetine and sertraline, I’ve heard those called other names. Chris: Zoloft and Prozac. Prozac is fluoxetine and Zoloft in sertraline. Brad: You know, I've got a little gray hair and stuff and those terms I do remember. So, what you’re saying is they’re the same medication but different names? Chris: They do the same thing. I would consider them kind of like Coke and Pepsi. So, how they’re cola’s, they have little nuances that are a little bit different, but for the most part they’re generally used for the same type of thing. So, for depression, anxiety, there’s certain thing that woman take for their menstrual cycles. There are a couple differences, but we’re going to focus on depression exclusively. Brad: Okay. So, these two things because the doctor talk to me about both and he decided I’m going to go on this one, but he/she will look at my history. Chris: The doctor is going to diagnose the patient. So, you went in, and you visited your doctor, Brad. You had some sort of conversation to the amount of where, “You know, I’m just not feeling right. Things aren’t going my way, I’m just down. I’m sleeping all the time, but I don’t feel like I have any rest. I just, I feel really awful.” And really, this season right now with COVID, and this pandemic that we’re dealing with, there’s a lot of people in this boat. We’re in the holiday season which also brings out more depression. So, a lot of people are hopefully going to see their doctors because mental health is tricky to deal with. And there’s 40 million adults that are out there that are really struggling with it. So, if you think there’s even a question, reach out to a friend, but more than likely, go see your doctor. They’re trained to help you. They’re going to come up with a diagnosis which will probably generate a prescription and they might even suggest counseling and other tips, some lifestyle changes, getting more active, trying to get a little bit of better sleep. Brad: So, with these two medications, either one, am I on this for life? Is this a lifetime prescription? Chris: No, it’s kind of interesting. When these drugs first came out on the market, Prozac came out in the late 80’s, I believe a little bit before my time and then basically, sertraline followed and then there was Paxil and then there was Celexa. Brad: I don’t even know what they are. Chris: Whatever. Yeah, but they’re all just, “me toos.” Basically, from the standpoint, these medications when you’re starting to use them, we use them to create an effect to try and help to alleviate your symptoms. Brad: So, it’s not a feel-good thing. It’s not like an opioid where you get the buzz. Chris: No, no. It’s going to take time to improve. You know, when your doctor comes up with this, the original guideline, you’re only going to take this for six months. Now we find that people take this indefinitely. It comes down to you, the patient, and what your doctor, your clinician, decides is ultimately best. Maybe you only need it for 18 months, maybe you only need it for 8 months. Maybe you need it for 5 years. Maybe you need it for 20 years. The set guideline was six to nine months when these drugs were initially invented and brought out on the market. But we’re finding that when people come off the medications, sometimes the depression relapses or comes back. There are some strategies that we’ll talk about too when maybe it’s time for you to go off the drug and we’ll touch on that as we go through this. We’ll pretend that you came in and today we’ll talk, and it doesn’t matter if it’s fluoxetine or sertraline. The points that I make are going to be the same because the side effects and their benefits are generally similar. Brad: So, how do they work? They go into the nervous system through your brain? Chris: So, you take the medication, it absorbs into your body, gets into the blood, and it builds up into your brain. What it does is it helps to allow there’s a neurotransmitter called serotonin. Brad: That’s some nerve stuff in my brain. Chris: Yeah, and most of it is in your gut, which is one of the side-effect things we’ll talk about at that point. It bathes these nerves and allows them to get some more sertraline and so what that does is helps improve mood. Oddly enough, exercise can raise a certain amount of serotonin as well. There’s a lot of things that do occur from other benefits and we’ll talk about that as we go through this as well. Brad: Okay. So, what you’re saying, regular exercise could improve my mood? Chris: Yes. Very much so. That’s something that’s often overlooked and a lot of times when people go down this pathway of depression, they kind of lose interest in things that they may have enjoyed. They kind of stop and they shut down and suddenly, they’re just sitting in their house and maybe they’re just watching TV because they can’t find any excitement or any type of joy or satisfaction. So, at that point you visit the doctor, and this is a lot more involved than what I would deal with, with the patient. You get to this point, and you say, “Hey Chris, I have this prescription. My doctor just sent it to you. I’m going to take the drug fluoxetine today.” And so, I’d be, “Well, Brad. What did your doctor tell you this is for? Did he talk to you a little bit?” Brad: Yeah. He said I should take one, but I can’t remember how often, and I can’t read his handwriting. So, if I take one a day or two, I don’t know. Chris: Sure. Well, the way the doctor designed this prescription he’s going to give you a fluoxetine 20-milligram capsule. It’s a normal starting point for a lot of people and we’d like you to take it first thing in the morning, after breakfast. You heard me say first thing in the morning and after breakfast. Those two points are important. Most of the serotonin receptors are in our gut. So, what makes our gut move. Brad: Stomach. Chris: Yep, your stomach. Basically, it makes you feel either nauseous, queasy, or can even give you loose stools. So, we want to be careful of that. I want you to eat something first because that slows down stomach transit time. That wave slows down and so it slows down the absorption and kind of eases the gut. Brad: Put the brakes on a little bit. Chris: Exactly. That’s not why we’re taking the medication, but that’s one of the first things you’ll notice in that first week while you start it. So, food first, in the morning. Now, you heard me say in the morning. Most of us experience somewhat of an activating effect from these medications. I don’t want to feel like it’s you had a cup of coffee and it’s that spark like you get from a little bit of caffeine. It’s once the drug starts to kick in, you notice more of an alertness. Like “Hey, I’m going to get up. I’m going to brush my teeth, comb my hair, take a shower, and I’m going to get out and get on with my day.” Brad: But this won’t happen for a week or so? Chris: Yeah, it’s going to be a gradual build up. Particularly with fluoxetine, Prozac and sertraline, Zoloft. These drugs take about four weeks to really kick in. So, it’s a very gradual process. A lot of times, many doctors tell patients that, but there’s so many things going through your mind when you meet with your doctor, “Oh I’m depressed. Oh my God, what am I going to do?” You feel, “Now it’s even more despair, and I feel even worse.” So, it’s always nice to come and see us, and then we’ll spend a little extra time to make sure you understand it. We’re taking it in the morning, and we’re taking it with food. Well, one of the side effects that can occur is dizziness, and/or drowsiness. That’s something that’s like, “Oh. What’s up with that?” Well, there’s about 10% of the people who get more tired on either drug. So, what we suggest, instead of taking it in the morning, that 10% would be better off taking it at bedtime. So, we just make that simple switch from bedtime or in the evening and suddenly you sleep through that side effect, and you wake up and everything’s just a little bit better. Again, you also heard me briefly say, it takes about four weeks for these drugs starting to work. I mean, some people will report in about two or three weeks that they start to feel some benefits. Interestingly, one of the things that seem to stabilize with depression, specifically is, your sleep seems to get better. Many of the chief complaints when people are depressed are so much that when they’re down and low, they feel like they’re sleeping for 12-13 hours a day, but not feeling restful. They’re just tired, they’re exhausted. Suddenly, you start taking this medication and it gradually gets better. It’s going to be very gradual. There’s an important appointment that comes up in about four weeks for most of these patients that are on these medications. In about a month’s time, you’re going to meet back with your doctor, sometimes they’ll do a Zoom call or even a phone chat, depending upon how COVID has affected the situation. It’s very important to talk to this doctor now because they’re going to ask, “Brad, how are you feeling on this medication?” And we hope the answer is, “I’m starting to feel a lot better. I’m more engaged at work. I’m doing a lot more. I really enjoy the patients I’m seeing. With my videos, I’m way more effective, more effusive. Things are going a lot better for me. Julie, my wife, says things are going well.” I mean, these are things that sometimes people around you notice before you do even. So, your doctor’s listening for a lot of things that you’re saying to them, and they’re going to say, “Okay, Brad. I think this 20-miligram dose of fluoxetine is appropriate for you. I’d like to continue this for a few more months and we’ll touch back in about six months, but if there’s any questions, I’d like you to call me.” So, you go back to your pharmacy to get your refill, because it seems like it’s the right choice. Now, what if it’s the other end? “You know, my stomach is upset, I’m dizzy all the time, I have a headache.” These are side effects that can happen with these medications. A lot of these side effects for most people on any of these drugs, typically get better in about a week, but sometimes they linger and sometimes it’s just not the right choice for you. When a doctor meets Brad and says, “Hey, I think you’re depressed, and I’d like to address that with some medication.” They had an empiric thought, but there’s some companies out there now that can take a saliva swab and will look at your DNA and say, “Brad, fluoxetine is a great choice for you.” When we start with fluoxetine after we have the DNA testing that shows it’s the most appropriate choice, you’re like, “Oh, wow.” Maybe it should have been sertraline, which is the other drug that we’re hitting on here. So, there’s nuances between the two. Like I said, it’s like Coke and Pepsi. They’re colas and they’re the same, but Coke tastes a little different than Pepsi. Brad: Personal choice. Maybe a genetic component in there. Chris: Yes. It says your body accepts that molecule, and it helps to raise more sertraline more effectively than the other one. So, that’s kind of what we’re starting to see at least with some of these things that we’re unlocking with genetic codes. Brad: So, the saliva thing, they’re checking the DNA and they have all these statistics that show one works for me and one doesn’t. Chris: Basically, it’s a very fancy company and they read the result and then they spit out the answer. It’s like if you do 23andMe, where you’re finding out your genetics, your family history, where you came from, what you could be susceptible to. It’s the whole nine yards, but they’ve done that with medications. Brad: So, that just narrows it down and probably you’re going to be on the right medication? Chris: Yes, so this is where we get the right choice the first time. It’s somewhat expensive. I think it’s about $300 and it’s only offered to physicians. It’s not offered to the lay public now. With genetic testing, they show that this is the right choice right out of the gate. It narrows it down. I do know that at least Mayo Clinic in La Crosse, in their psychiatric department, they were using this for a time. I don’t know if they’ve continued with it or not, but it was interesting literature with it. Brad: But I could ask the doctor. Chris: If it’s offered. Brad: But it’s not. Chris: It’s not offered, and a lot of doctors are into it. The nice thing about these medications, is there’s so many different ones that ultimately, they can make another selection for you that maybe the things that you decided that were affecting you negatively and they can come up with another more positive, more effective choice for you. Brad: So, the doctor, with their experience and their knowledge, they probably have a pretty good idea on what to give you. They’re going to send you down the right path, but the saliva thing is going to help. Chris: Absolutely. Again, it’s not standard, it’s expensive. It’s just something that’s more of a sidebar, but if it’s offered to you, I think it’s worth its weight in gold. Most insurance companies are not going to pay for a service like that. It is about $300 so, it’d be something to be aware of, it could be an additional cost, but it might be well worth it. Moving forward, we made that appointment, everything’s going well and, “Ah, great, Brad. Well, I think we’re going to continue with this medication. How are you feeling?”, “I’m starting to feel a lot better”, “Well, that’s great. Here’s your refill Brad. Do you have any questions that you’ve notice about things that have happened to you since you’ve started this medication?” Brad: Are there any red flags out there? Chris: There are some things, because with all drugs, there’s risks. So, two things that exceedingly rare, would be serotonin syndrome which would be brought on by taking other medications with this. You pharmacist and doctor would be looking at your profile to make sure we’re not going to get you into trouble. Most commonly see it with the painkiller tramadol, but common is the wrong word because you’re talking an infinitesimally small chance for this to occur, but it’s life-threatening. It’d be things like serotonin syndrome, since we’re going to sidebar it, it’d be something that you feel hot, 104-degree fever, but you didn’t have an illness that brought it on. You can have muscle pain, rigidity, twitching, just not right. You feel agitated, unwell. Brad: So, you’re saying less than 1%. Chris: It’s less than 1%. It’s something else that we want to be careful with, but it’s not something that I would necessarily lose sleep over. If suddenly you wake up, you’re on these medications may have triggered it, yeah, you need to have a conversation with your doctor ASAP or go to the ER. Along with that 1% side effect, the other thing is, a lot of times, young kids will be prescribed these medications now, although there may be off label, but you’ll see particularly the age for male patients, particularly from 18 to 24, 1% of the time, they have suicidal ideation, where they think that they want to hurt themselves or end it all. It’s a big deal and we see it more with male patients than female patients. It’s something I think, if a parent comes in, and let’s say they have a 14-year-old or a 16-year-old young male, I’m going to be like “Hey, did your doctor talk to you about the possibility that your son may have suicidal ideations?” Brad: So, you’re talking statistically, right? Chris: Yes. Statistically speaking that you have a higher risk for suicide in that first 7-10 days of taking medication. A lot of times when we’re depressed, our thinking is not very clear. You can’t connect the dots. So, when we get on the medication, everything becomes more linear. Everything’s just a straight line. It’s like, “I feel miserable. I’m awful. I’m going to end myself.” And they connect those dots and it’s very tragic. The medications for whatever reason, in this small percentage, can lead to it. If you’re a young male, it’s something that, as a pharmacist and certainly as a doctor, they’re going to hammer that home because even though it’s so rare, it’s about as serious as it gets. So, it’s something we want to be careful with. The other thing would pregnancy. So, for our female patients that are either on sertraline or fluoxetine, they can be used during pregnancy, but during that last trimester, it can create some issues for the baby. In a perfect world, if it comes down to being depressed, and everything is awful, or not being depressed, your doctor may weigh out the benefits versus the risk. They may tell you to take it throughout the pregnancy or they may suggest, “Well if you can get off it, we can get through this and then we can get you started at the end of the pregnancy, when postpartum kicks in, to kind of reestablish it. It could be conceivably healthier for the baby.” There’s risk and benefit there. Brad: There’s going to be a lot of conversation between the doctor and the patient. Chris: There’s going to be a lot of clinical decisions there that’s best for you, but it’s certainly something you want to disclose with your doctor. We’re pregnant or we’re trying to get pregnant, just things to be aware of. Brad: To finish this out, with these two meds, you say they’re very similar. What’s the success rate? Are they, in general, because there’s some negative things that aren’t very common? Chris: I think in general, they’re very successful medications. We have millions of Americans, that successfully used as medications. Some is for a short period of time, and many is for much longer periods of time. I can tell you firsthand that I know people that use these things that have been on it for years, decades. Brad: And living a successful life. Chris: Yeah. It’s managing quite well versus not being on it. There are still things that you can do with certain foods and certainly exercising. That’ll go a long way to helping you and we encourage that at every step along the way. I think that’s something that will pay full benefit to it as well. Then there’s always the exit strategy. You’ll say, “When is it time to come off this drug?” Well, it’s something that we want to taper off. You don’t just stop taking it, you go off slowly. So, in the case of a 20-miligram capsule, you’d maybe drop down to 10-miligrams for 2-4 weeks. Brad: And that happens with the doctor? Chris: Yes. The doctor will make that determination and fluoxetine and sertraline have different half-lives. So, fluoxetine, you can stop, and it just goes away. Sertraline, not so much. So, one of the things we look at is adherence or how consistently people take medications. With a drug like sertraline, if you skip a dose, you’re going to feel it. You’re going to feel weird. You’re going to have headache, agitated, you can just not feel right. Some people describe it like an electrical sensation in the brain, they call them “brain zaps.” It’s something that with these drugs, the key is to use it consistently, to use it about the same time every day. When you and your doctor decide it’s time for you to come off it, there should be a tapering process. Then we talked about relapse briefly, but sometimes if we come off these medications too quickly, depression symptoms come back rapidly. When we do slow, it seems to be less likely to relapse, and with lifestyle changes, and staying active and fit, getting good rest, a lot of times maybe it’s corrected itself. So, that is a possibility. Brad: All right. I think you’ve covered pretty much everything from A to Z and I feel much more educated on the whole topic. Very good. Thanks for tuning in and we hope all goes well for you! Visit us on our other social media platforms: YouTube, Website, Facebook,Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe,Minds, Vero, SteemIt, Peakd , Rumble 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 Handheld Massager Back and Neck Massager X6 Massage Gun with Stainless Steel Head Eye Massager T2 Massage Gun Leg Massager Foot Massager Fitness: Resistance Bands​ Pull-Up System Pull Up Bands Exercise Ball Resistance Bands for Legs and Butt​ 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 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 2016. For the original video go to https://www.youtube.com/watch?v=-GUW4psHJ0k&t=10s Bob: Today, we’re going to talk about how to use an inversion table safely. Brad: Inversion tables are typically used for low back and mid back pain management, to get rid of it. Bob: Of the spine. Brad: Right, of the spine. There may be some controversy in that, but I don’t want to talk about that. I do want to talk about, if you have one or want to buy one, you want to know how to use it safely. I’ve had one for 2 years. Bob: So, you’re a good person to comment on this. Brad: Right. I’ve watched the video and read on how they instructed to use it and in general, I think I disagree. Not totally, but I want to go through it in general here. Bob: This is our opinion. Brad: Right. Bob: And first off, we should talk about the people who absolutely shouldn’t use it at all. Someone who has retinal detachment or glaucoma because you’re going to have increased pressure on your eyes when your being inverted. Brad: Exactly. Pressure on the inner ear. Bob: If you have inner ear problems, this may not be a good one for you. Brad: Blood pressure conditions. Bob: Yeah, increased blood pressure or have a heart condition, I’d be reluctant because your blood pressure is going to increase when you’re in that position. You could pull a muscle when you’re in that position and it does sometimes cause headaches. Brad: Right. When I first used mine, initially, I tested it in the store because they had one set up. This is what I would do if you’re going to buy one is go into the store, have one that’s set up and use it and invert and see if you have some results as far as decrease in pain. Bob: Or does it make things worse in some way. Brad: Exactly. So, when you invert, you should feel some immediate relief and that’s my opinion. If you do not, I don’t think it’s for you. Now, the big question I want to get to is if you look at an inversion table, I have three scenarios. You start flat, then go to a partial inversion (60-70 degrees) and then a full inversion (vertical). Brad: So, you must adjust properly, so when you lay down on the table, you should build a balance that you’re in a horizontal position, so you balance well. Then to invert, on the one I had, you lift your arms up and you would slowly go back, and you could go into a full inversion. Now, I’m looking at this and I’m thinking, what if the device for the ankle that holds you upside down fails, and you fall on your head and you break your neck? I’m thinking this is not healthy. So, I didn’t even go there, and I still think that this is not necessary at all. What I did with mine was, there was an adjustment on mine that went to 60-70 degrees, there was a strap that could stop you there and you would not go any farther. Bob: Okay, so, you can set it for that. Brad: Yeah. I found I had plenty of traction because that’s all this does to your back. It’s a form of traction and it pulls your back apart. It can help the disc and your muscles to relax. Bob: Using your body weight. Brad: So, that’s where I would set mine at. I would not recommend going more than 60-70 degrees. You will feel the effects. Now, the next big warning I’m going to have to say, when you get on one of these, and you invert, start out at 15-30 seconds, and then go back to the horizontal position and see how your body reacts. Bob: Okay, so, you may be surprised at the results if you go longer. Brad: Yeah. You might feel nauseous, you might feel like you had a headache. I inverted and I stay there for about three minutes because I time myself. It felt good, my back immediately felt better. I thought , this is good, I’m going to hang there for a while and really fix my back. Well, I got up and my back still felt better but I had a headache. It lasted all that night until bed. So, I went too much, too fast. So, start off with 15-30 seconds, come up and if you feel normal you can go back down, but I would not go more than that three or four times in a row the first time you use it. Bob: Were you able to build up to longer times then? Brad: Oh yeah. Eventually I would go no more than two minutes because my head would feel like there’s too much pressure. Bob: But you would be able to go up to two minutes eventually. Brad: Yeah, and it felt fine. I know people that go longer than that because I’ve talked to several patients that use these and they do go longer. I just had a patient who said she totally inverts. I still don’t think that necessary. It may be in certain circumstances, but I’m going to get that out of my head. Bob: It’s the risk, reward thing. Brad: Right, I think you can get the same results with just going the 60-70 degrees. Maybe not, but that’s my opinion, of course. Anyways, I would hang for 2-3 minutes, my back would feel better, I would get off it and my back would continue to feel better when I went upright and weight-bearing. You want to go all the way through that process. You could feel better when it’s inverted, but when you get up and stand up, what if it starts feeling bad and you get a bad reaction to it. Bob: Right. Brad: Obviously, you’re not going to buy one then. That’s why I think testing it in the store is a good idea. Bob: Absolutely. Brad: I use mine for two years and eventually the effects weren’t helping anymore so I sold it. Bob: Well, good tips Brad, from someone who used it. Brad: Yeah, and I hope that if you want to buy one, go ahead. There around $100-$200, you get what you pay for. Mine was over $200 but it was built well, and I really liked it. Bob: Thanks! Visit us on our other social media platforms: YouTube, Website, Facebook,Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe,Minds, Vero, SteemIt, Peakd , Rumble 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 Handheld Massager Back and Neck Massager X6 Massage Gun with Stainless Steel Head Eye Massager T2 Massage Gun Leg Massager Foot Massager Fitness: Resistance Bands​ Pull-Up System Pull Up Bands Exercise Ball Resistance Bands for Legs and Butt​ 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 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.

The term sciatica is used to describe the symptoms that arise from the sciatica nerve. The sciatic nerve is a large nerve formed from smaller nerves that branch off from each side of your low back. Symptoms from the sciatic nerve can occur in your buttock, the back of your thigh, in your lower leg and/or in your foot. Symptoms include pain, numbness, tingling, weakness, and/or burning. An important point to underscore is generally the more the sciatica nerve is irritated, the further down the leg the symptoms of pain, numbness, tingling, weakness, and/or burning occur. The reverse is also true; as the nerve becomes less irritated, the symptoms generally improve in an ascending fashion. This presents as less pain, numbness, tingling, weakness and/or burning in the foot or lower leg. Knowing this can help you gauge whether your self-treatments are helping your sciatica. In most cases of sciatica, the sciatic nerve is being compressed somewhere along the nerve. Common causes of compression include: 1. The vertebra (soft jelly-like discs located between bones) of your back may be herniated or ruptured, causing pressing on one of the nerve roots leading to sciatic nerve pain. 2. Degenerative changes in your spine, discs, or ligaments often due to age can result in a smaller opening for the nerve roots of the sciatic nerve to pass through. The smaller hole may cause increased pressure and irritation of the nerves. This may lead to spinal stenosis. 3. Compression from a small muscle in your buttocks called the piriformis muscle. This condition is often referred to as false sciatica, which can still create sciatica-like symptoms. It is also known as piriformis syndrome. This video series is focused on the first cause of compression listed, which is from the disc becoming herniated or ruptured. We will provide subsequent video series in the future to address the other two issues listed above. So, with sciatica you have a nerve that is angry and irritated. Can it get better? YES! Can we stop the compression, reduce the irritation, and eliminate the symptoms of sciatica? YES! Everything we suggest in these videos are recommended with that end in mind. Check out the full Sciatica series of videos along with downloadable guide sheets for each video on our website here: http://bobandbrad.com/programs 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 September of 2021. For the original video go to https://www.youtube.com/watch?v=NahD4dU8Ork&t=106s Bob: Today we’re going to talk about the top 10 reasons why resistance bands beat free weights. Brad: Whoa, that’s a strong statement Bob. But you know, free weights are likely the most common resistance type of exercise over time. But resistance bands are making a strong run. And there’s some real good reasons for it. Not to say they’re better than steel weights. But they’re different. And there’s some advantages that they have that you cannot get with steel weights. So that’s what we’re going to talk about. As a matter of fact, there are people who use both and combine them so they get the maximum workout that they can. Bob: Exactly. Best of both worlds. Brad: Absolutely, Bob. Bob: Should we start off with reason number one Brad or what do you want to do? Brad: Well, I’ve got 10 reasons here that I don’t know if that’s in order. It’s going to depend on the individual. Bob: It’s not like we’re creating a crescendo here. Brad: Whoa, crescendo. You’ve been studying over the weekend. All right, so the first one is they offer progressive resistance, which weights do not offer. They offer the same resistance for the same weight. Unless you’re working a machine like the Nautilus. That’s a different story, but we’re talking about free weights. Bob: You need to explain yourself. Brad: Yep so, if I’m doing my bicep curls, as I come up to 90 degrees, it offers the most resistance because of the distance from the elbow, the fulcrum point. As I get up to the end of the curl, it’s less and it’s easier. Bob: It’s easier, right. Brad: We would like it to get more difficult as we get forward so with the resistance band, that’s exactly what happens. Bob: The higher it goes, the harder it gets. Brad: It is. It’s just the nature of bands and that’s one of the beauties of bands. Now one thing you can do is, you can combine it with a loop, and you can go like this and I’m going to step here. Now I have free weight and as I get up its stronger, yes. So, this is really an ideal way to do some resistance. Bob: You could do this with bench press. You could do it with squats. You can do it with a lot of different things. Brad: Yeah, it can get challenging. You must figure out a way to attach the band. Bob: You’d probably need a big band, a big loop band. Brad: Yeah, we’re not going to get into detail about that, but it was something that some people work with. Bob: You know, is this the point where you want to mentioned if you step farther away, the resistance increases? Brad: Let’s add that in with the next one. The big advantage I find with resistance bands is they offer resistance, whether its vertical, horizontal, 45-degree angle, all over. Whereas you know, iron weights, it’s strictly vertical. Bob: Right. Brad: Unless you have a cable system and that gets more complicated, just because you must have quite a piece of equipment for it. Bob: It’s infinite. You can do resistance from different angles, and you can get every angle that ever was known to mankind. Brad: Well Bob, I’m going to show curls. Curls with this free weight, typically we’re going to stand up. Bob: Going up against gravity. Brad: Right, right. So now with this band, I’m going to show curls at a 45-degree angle with the wall anchor we must have something to anchor the band to. Not a big deal. We’ll go this way. Now we’re going to get to Bobs point. If I want more resistance, I just simply step farther away. Bob: As opposed to picking up another weight, and another dumbbell and have like 30 dumbbells. You know what I’m saying. Brad: I hear you, Bob. Now the next thing, this is the way I do mine at home. I’m going to use horizontal resistance. I lay down here and I get perfect form. My posture is perfect on the floor, and I can really do this. I just inch myself away from the wall. Bob: And now he’s isolated the muscle too. He’s not able to use the body to help. So, all the work comes from the muscle itself, the bicep muscles. Brad: Exactly. And of course, naturally I can go vertical just like the standard. So, I've got three different planes with the curls, and I could get more if I got creative. Bob: So, number three bands need no large steel benches or standing racks. Brad: Right. Bob: Which, you know, if you’re in an apartment it could be a problem. Brad: A little plastic anchor instead. Very easy. Bob: Or you could, it has a door attachment. Works with that too. Brad: Exactly. Brad: This comes with all the bands, and you do not have to have a wall anchor, you just need a door and that works out very well. What’s the next one, Bob? Bob: Next one is, number four. Brad: Ah, the cost. Significantly less. If you get a whole set of dumbbells, you need a dumbbell rack, and they’re heavy. They’re just cheaper. The bands are cheaper. Bob: If you’re a cheap person, this is the thing for you. Brad: And that’s me. Easy to travel with. This next weekend, I’m going away for the weekend. Bob: Even this little thing, a five pound weight, put this in your bag. It adds a lot. Brad: Especially if you need you know, four or five sets of them. Where I’m just going to take my loop with me this weekend. Very, very handy dandy. We’ve got some videos just on that alone. Let’s go to the next one. Bob: Sure. Brad: Superior for balance and proprioception. Bob: This is a biggie. As you get older, and your balance becomes an issue you want to have resistance in an upright position and test your proprioception and balance in that position. Brad: This is one that works to hip abductors and I’m doing it while I’m walking. It’s just an example to work that. Brad: Another one, now I do have a cuff on my ankle and I’m going to put the other end hooked to the wall anchor. Here I’m going to work my balance while I’m working my hip muscles. You can see I’m going to use a stick for balance while I bring the leg that’s hooked to the band front to back. If I’m going to get a little cocky, I’m going to go this way and we can work all four directions. This is hard to replicate doing something like this with weights. Bob: No matter what exercise you’re doing, if it’s attached to the wall, you’re working your core and your balance. Brad: Oh right, yeah. It’s just inherent. Bob: I remember my neighbor came over for a video and we’re filming him, and he started doing this and loses his balance right away. Brad: Well, you probably pushed him. Bob: Well, no I didn’t. God’s honest truth I didn’t. Brad: Anyway yeah, so they are wonderful for balance. Well, let us go onto the next one. Bob: High-level athletes are using resistance bands more and more. Tom Brady, quarterback for Tampa Bay Buccaneers is a good example. Brad: I think you could call that a high-level athlete. Bob: I would say the greatest football quarterback of all time. Brad: Yeah, well you know, when you’re dodging it takes, balance, speed, strength. Everything is involved at that position. Bob: The big thing is they want to maintain supple muscles while getting the muscles strong and be able to react and move. Brad: As a matter of fact, TB 12, he has fitness centers. Bob: I've got the book right here Brad. Brad: Yeah! In the book, they describe when you walk into one of Tom Brady’s fitness centers, where oftentimes you hear metal clanking and these steel plates banging around, it sounds cool and tough, but these are quiet. Bob: Right. Brad: Because they’ve got resistance bands. You know, maybe someone let’s go and snaps someone, they say ouch. But otherwise it's quite. Bob: What is Tom, like 85 years old? No, he’s 44, right? Brad: I think that is. Yeah, I believe he is this year. Bob: No need for knee or wrist straps or back belts. Brad: Right. I can’t imagine. Maybe you could use the back belt depending on if you had a bad back. This is one of my favorite squatting things where I go like this. Brad: You almost must have proper mechanics to do it right with a band, it promotes good body posture. Bob: Now we've got to be honest here. You can’t use resistance band to create huge bulk where you can if you bench press. Brad: Bob, that’s not on the list of 10. Bob: I know. Brad: That’d be a different video. But no, you’re right. If you’re going to want to become the Hulk. You know, you might want to combine them. Bob: But for athletic performance, this where you want to go. Brad: I agree. So, I’m not saying there’s anything wrong at all with weights. I think weights are great. These are just some things that people may not have thought about. Bob: Number nine, less space in home is needed for complete body workout. So, this is true. I have this in a bedroom. Brad: Yeah, you’re talking about the wall anchors. I have mine, you need a little space out when you’re working with the band, but it doesn’t take any space at all once you’ve set it down. Bob: If you want to hook it up to the door, you can hook up to any doors if somebody doesn’t go through the door while you’re on it. Brad: Yeah, put up a little sign on there. “Door in use”. Bob: There you go. Brad: Especially if you’ve got kids running around. Like they’re going to stop and read that when they’re chasing each other. Bob: Another advantage, what I think is a huge advantage Brad, is you can get sport specific strengthening. Brad: Exactly, Bob. As a matter of fact, I want to show something that maybe people haven’t thought about, but you can do swimming. I’m a swimmer. Bob: And this helped you, didn’t it? Brad: Yes, it did. Bob: This is a good one, Brad. Brad: I'm going to hook the band up to the anchor. I usually use a ball, or you can use a stool and you get on it so that your body is the same position as when you swim and then you’ve got some nice resistance. So we’re just working that same motion and I can easily make it more difficult by going back farther. I can work on my high elbow, come up forward. Bob: Didn’t you improve your time? Brad: Oh yes, Bob. When I started banding, I was shooting maybe 90 seconds for a hundred meters, a hundred yards. I cut down to 1:12, no 1:14 was my fastest. So, I cut like 12 seconds or 14 seconds off after I started banding. Bob: Wow. But you can do boxing, you can do tennis. You could do many different sport specific training exercises. Brad: We did have a video with the boxer using the bands. You can work the uppercuts. Boom, boom, boom. Bob: You've got resistance with every shot. Brad: We did a video on all the different sports you could be specific with. That was about four years ago. Bob: Well, it was, yes. Brad: Oh, is there more? Bob: I think that’s it, Brad. Interested in learning about the products mentioned in today's video: 1) Resistance Bands​ 2) Wall Anchor​ Visit us on our other social media platforms: YouTube, Website, Facebook,Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe,Minds, Vero, SteemIt, Peakd , Rumble 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 Handheld Massager Back and Neck Massager X6 Massage Gun with Stainless Steel Head Eye Massager T2 Massage Gun Leg Massager Foot Massager Fitness: Resistance Bands​ Pull-Up System Pull Up Bands Exercise Ball Resistance Bands for Legs and Butt​ 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 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 June of 2020. For the original video go to https://youtu.be/3R-QQOtrNkY Bob: Are you dizzy? We’re going to talk to you about the signs you need to call your doctor, now, immediately when you have dizziness. It’s not always an emergency, but sometimes it is. Brad: Right. Bob: Dizziness, very common, you get that light headedness, feeling faint, a false sense of spinning sometimes, the vertigo. Brad: Right. Bob: The problem is it can include unsteadiness, loss of balance, you can have a fall. It can lead to something bad. Some people also talk about, they feel like they’re floating, or like, swimming. I don’t know. Brad: Do you feel that way sometimes, Bob? Bob: So, we’re going to talk to you about when you should call the doctor immediately. At the end we’re also going to mention some common causes and cures. So, when to call the doctor immediately. If you experience sudden dizziness along with a head injury. So, like if you fell and then you have dizziness. Brad: Right, even if you lift your head under a countertop and bump your head and you get dizziness associated with that then, you better be concerned. Bob: Yeah, my daughter Jamie she got a concussion. It was something like that, I remember, so, it doesn’t take much. If you’re experiencing sudden dizziness with a headache and you normally don’t get headaches. You know we’re worried about a stroke or a brain aneurysm with a lot of these. I don’t want to panic people but, there are thing that could be along with that. Same thing with a neck ache. If you’re getting dizziness along with a neck ache that you didn’t have before. Brad: Right. Bob: Now, if you have neck aches all the time and then you get dizziness, then I’m not as concerned. Brad: Right, if it pops out of nowhere, you haven’t had it before, there’s some potential for some circulation problems there. Bob: A high fever along with dizziness, time to check with the doc. Blurred vision, hearing loss, difficulty speaking. What are all those Brad? Brad: Stroke or CVA potential. Bob: Right. Numbness or tingling, along with the dizziness. Brad: So, that would often, may be in the face as well. Bob: Right, exactly. Brad: It could be radiating down the neck or the arm, possibly. Bob: Droopiness of the eye or mouth. Brad: Typically, on one side. You would need to get ahold of the doc or get in quickly. Bob: Loss of consciousness, I sure hope people go in and see the doctor if they suddenly go out. Chest pain, always with chest pain you don’t want to mess around with that. You want to have that checked out, even if you had a lot, at many times. Ongoing vomiting, that happened to me. I had it one night, I was a little dizzy and I vomited. But I only vomited once, and the dizziness went away so I didn’t go in. Brad: Sure. Bob: But I think it was just something I ate. Brad: Really? Bob: Yeah, it was strange. Those are it, Brad, those are the things that you want to be concerned about and see the doctor. Brad: I know one thing, if you do get dizziness, the big concern is falls and we’ve got some of these common causes that, for instance, my mother recently had a fall and her blood pressure medication was involved, we’re going to get into that. Bob: Yeah, blood pressure, especially what they call orthostatic hypotension. Which means when you stand up your blood pressure goes down. Even when you go from laying down and you sit up. In fact, that’s a test we do. So, if someone is laying down, we first have them sit up. We check their blood pressure, then we have them stand up. We check their blood pressure again. If there’s a drop of 20 points that could mean that you have orthostatic hypotension. Brad: It usually only lasts up to 30 seconds or so and it consistently clears up and you feel fine, that’s very common. Particularly the people who’ve been laying, if they’ve been ill and been lying flat for a number of days. Very common, especially if you’re older. Bob: So, the easy recommendation or the easy solution, hopefully to that a lot of times is to sit up for a while before you get up. Also, stand up for a while before you walk. Brad: Exactly, right. Bob: Now, also, are they checking your mom’s medication at all? Brad: Well, that was the issue. She fell but we think she took her blood pressure medication twice in the same day, so, it dropped it even more, but, with this covid-19 thing we couldn’t monitor. Bob: Yeah, it’s been tough. Brad: Yeah, we’ve got a nurse coming in there now and monitoring for us. Bob: Okay. So, medication is a big common cause. Brad and I see this a lot. We work in skilled nursing facilities or have done a lot, and so we see a lot of these. Dehydration, very common in the elderly. Just seems like they don’t have the sensation that they are thirsty at all. And they don’t drink enough water and they become very dehydrated. Brad: Or they drink too much coffee, which is diuretic, which can lower the fluids, and when you get lower fluids the blood pressure goes down. Bob: And medications too. Brad: Right. All these things can overlap. Bob: What else Brad? One of the more common causes is when you have an inner ear, those little crystals, and they get into the wrong spot. We just did a video on BPPV. Brad: Vertigo. Bob: The only good thing about that is it’s generally very treatable. Brad: Right, without medication. Bob and I have treated many people. Bob: We’ve got a bunch of videos on that. If you have that, you want to check out the Epley maneuver. Often, a treatment or two and it could possibly take it away. Brad: Right. And that’s typically associated with head movement. Whether you’re laying in bed or up, if you move your head, sometimes quickly and sometimes not quickly and you get that associated nausea and spinning. A lot of times people will report the whole room is spinning, it can be very disturbing. Even younger people that have had it, they’re afraid. Bob: Yeah, they’re thinking something very terrible is going on and like Brad said, one of the biggest signs of that, if you’re lying in bed and you turn your head to get up and all of a sudden, the world starts spinning. Brad: Right, and if you feel like vomiting, typically that settles down within 30 seconds to a minute if you don’t move. Bob: If it’s that type of BVP or that type of vertigo. It does tend to settle down, but it’s very scary. Hypoglycemia, in other words you have low blood sugar. I had a friend that would have a lot of episodes of this and luckily now he’s got a monitor. He’s got a needle that goes into his skin, the entire time, he’s got the monitor there, and he can monitor on his phone. The only thing is, when he stays over at our cabin, he sleeps down in the basement and alarm goes off if his blood sugars are too low. Brad: Why would you send him down in the basement? Why don’t you put him with everyone else? Bob: Because he tries to bug me all the time. You know, there’s like three, four people down in the basement. Brad: I see. Bob: The alarms going off and everyone’s waking up. Of course, there’s been some drinking, you know. Brad: Oh Bob, let’s keep that to yourself. Bob: Yeah, alright. Anemia, we see that too sometimes, especially after surgeries and stuff like that. Brad: People who excessively exercise have that condition. Like if today I’d be out exercising for long periods of time, running, heat coming in, not enough salt, and I’ve gotten, not so much dizzy, but lightheaded. Bob: I do too. You become a lot more sensitive as you get older. I’m taking those Nuun tablets. Those work well. Brad: I need to get some of those because it’s this time of year where I’m going to be out riding my bike and sweating like a… Can I say pig? Sweating like a pig. Bob: No, it’s true. I’ve gotten to the point now where I’m taking it representatively. I took one this morning. I’m more sensitive, I used to be able to handle that. Brad: Yeah, well, Bob, the aging process takes its toll on all of us. Bob: Yeah, that’s right. Thanks. Visit us on our other social media platforms: YouTube, Website, Facebook,Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe,Minds, Vero, SteemIt, Peakd , Rumble 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 Handheld Massager Back and Neck Massager X6 Massage Gun with Stainless Steel Head Eye Massager T2 Massage Gun Leg Massager Foot Massager Fitness: Resistance Bands​ Pull-Up System Pull Up Bands Exercise Ball Resistance Bands for Legs and Butt​ 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 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.

How to use this program: This is a free program made up of a series of videos designed to help you manage or heal your back and leg pain caused by sciatica. The video series is currently a work in progress. We may add, delete, or alter the information or videos based on your feedback. Try not to be intimidated by the number of videos that make up this free program. You may not need to watch all of them. We do however recommend, at a minimum, you watch videos 1-4 to start. In addition, watch the videos whose titles appear relevant to you. For example, if you are experiencing back spasms, watch the video about back spasms. If your back is crooked, watch the video on that topic. Otherwise, you can skip those videos. There is a lot of videos, but you can watch them over a several week period and absorb the information as you go. We recommend watching relevant video several times. Those who understand and follow the details of relevant videos have a much greater chance at success. If helpful, print out the GUIDE sheet that accompanies each video. The GUIDE sheet will provide you with a portable copy of the information presented in each video. Questions? We are unable to answer questions about your specific case of back pain and sciatica. However, we absolutely value your feedback. Please let us know if a video is unclear or if further information is needed. If you do have a question about a certain video, please include the title of the video with the question. 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. Check out the full Sciatica series of videos along with downloadable guide sheets for each video on our website here: http://bobandbrad.com/programs 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 September of 2021. For the original video go to https://www.youtube.com/watch?v=qnBmrmgnVyw&t=564s Bob: Today I am joined by Jordan, whose title is… Jordan: Nutritional health coach. Bob: And glad that we have her here today because today we’re talking about the top 10 foods and food additives you should avoid. I am looking forward to this. I need to follow some guidance here. Jordan: We all need reminders. Bob: Alright, let’s start right off with the number one thing. I see you have listed vegetable oils. Jordan: Yes, and before we jump into this, I should mention these aren’t in any order. I didn’t rank them. They’re all just bad. Just stay away, but anyways, going on. Bob: That’s perfect. Jordan: So, vegetable oils is a big category of oils. So, any of our highly processed oils, canola oil, corn oil, soybean oil, safflower oil, there’s others that fall into this category. Those are kind of the mainstays. Vegetable oil in general. Some are just labeled vegetable oil. Bob: So, these could be a separate as an oil and in a product. Jordan: Correct. So, this would be like what we cook our food with, but also like when we’re shopping, you got to look for these on labels. They’re very common. Bob: You must be like a detective because it’s in a lot of stuff. Jordan: You do. Bob: So why are these oils so bad? Jordan: So honestly, main reason is that these are mostly polyunsaturated fats. I'll try not to get scientific and bore people but you kind of need a little bit of background knowledge. But, they’re super sensitive to heat, to light, and to air exposure. So, what food manufacturers do is they chemically modify them to make them resistant to these things. They’re highly processed and changed from their original form to make them so that we can deep fry in that. Bob: So, they won’t spoil, is that why? Jordan: Yes, so they won’t spoil. Restaurants use them so that they can deep fry. Well, you can’t do that unless they’re modified to resist heat. Bob: Gotcha. Jordan: Another reason why they are bad are that they are high in Omega-6, which is pro-inflammatory in our body, and you know about inflammation and how bad that is. Bob: Right. It’s kind of one of the key words right now. In the literature and Omega-3s are good, right? Jordan: Yes. Bob: Yeah, that’s salmon and stuff like that, right? Jordan: Yeah, fish oils, salmon. Bob: So, do you want to talk about alternatives to these? Jordan: Yeah, I guess we could touch on it. First, look at your food ingredients. If you eat whole foods, there’s nothing to read, but you know, the fact of the matter is we don’t always. I always teach people to read the ingredients rather than the nutrition facts. You’re going find way more information there. So, watching for these processed oils, and instead replacing them with three main oils. I always talk about our avocado oil, olive oil, and coconut oil. Bob: We went to avocado oil, because didn’t you say the other two are sensitive to heat or not? Jordan: Avocado oil can withstand heat. Coconut oil can withstand heat. Olive oil, not so much. Bob: Olive oil, right. We were doing olive oil and you had said that doesn’t really work. So, I make my popcorn in avocado oil. Jordan: Yeah, and it’s good right? No different change in flavor. Bob: Yeah, it’s very good. I spray it on stuff. I spray it on my popcorn too. That’s great. It changed our life. Why don’t we skip to number two here now? Jordan: Yeah, let’s do it. Bob: We’re going to talk about flour and we’re talking about both white and wheat flour. Jordan: Yeah, so flour. Go through your pantry and try to find something without flour. Unless of course you’re already following your whole foods-based diet but most of our packaged foods that we have, even our “healthy foods” that we think are healthy in our pantry, if you go and flip it over, they have some kind of flour in them. Our cereal, crackers, obviously bread. That’s an obvious one. Pastas, what am I missing here? The thing that most people don’t understand, I think a lot of people now have knowledge or that they think they have knowledge on is wheat is better than white. The problem with this, and we could probably do a podcast on this in and of itself if we wanted to, but wheat today, is not what wheat was 50 years ago. Bob: Yeah, they took out the currant, right? Jordan: Yeah. Bob: They took out the nutrition and left all the crappy stuff. Jordan: Yeah. You’ll see wheat products that have vitamins and minerals, but that’s fortified. That’s fortified in their cereals, bread. It’s not naturally coming from the wheat. Wheat in and of itself, in my nutritional opinion, has no nutritional value in our diets. Bob: Probably negative, right? Jordan: Yeah. I mean, we could get heavy but that’s a whole topic. Bob: You mention earlier to read the ingredients versus the nutrition label. It seems like the packaging, they come up with terms that make it sound like its healthy, but it’s not at all. It’s the exact opposite of health. Jordan: Oh yeah. They can put all sort of things that attract us now to make it look healthy. Bob: They know legally what they can say, and they totally lie, believe me. Jordan: Oh yeah. Bob: I’ve looked at things. I remember I was looking at two types of ketchup and they both had the same ingredients and they both sounded like two totally different ketchups. Jordan: Oh yeah. They’re very smart, food manufacturers, to get you to buy their stuff. So, when you go to buy a product that’s coming off the shelves that has ingredients in it, just skip over the nutrition label. You’re going to get everything you need to know on that ingredient list. Bob: Sure. All right, let’s go to number three. Low-fat or fat-free products. This is a good one. Jordan: Yeah, this is one of my favorites to teach people on, this and another one we’re going to cover later. Bob: What are some examples? Jordan: Examples of this would be milk, yogurt, a lot of dairy products, sour cream, mayonnaise, peanut butter, salad dressings. There’s more, those are just some things to throw out there. Bob: What makes the low-fat version or fat-free so bad in these products? Jordan: Well, so the problem is a lot of these products, in their pure form, they have fat in them, right? So, in nature, how they’re found, they have fats, a food manufacturer must physically go out and remove the fat to make them fat-free or low-fat. That’s not naturally occurring. So, when we do that, we’re altering them from their whole pure form. In addition to that, you take that out, and you put nothing else in as a replacement, it tastes like crap. Nobody would eat it. Nobody would drink it, so they must put something else back in. Sugar, food additives to make it more palatable. They’re smart. Food manufacturers are so smart at making things. Bob: So, again. When you say low-fat, fat-free to me, that’s going to sound like low calorie and it’s not because it might have sugar in it. Jordan: Right. A lot of time, some of these things, they’re taking the fat out of as it existed in nature and its whole form like fat is good, you know, to an extent and when we alter all these things and take it all out, I think it’s causing more damage to our health than just leaving it alone. Bob: This is the reason why the last generation is obese. Obesity is on the rise, like a pandemic. Jordan: Yep, diabetes along with it. Bob: Right. Because they push the fat-free and low-fat. Jordan: Right, a hundred percent. Bob: All right. Do you want to say anything more about that, or should we go to number four? Jordan: Let’s go on. I think that covers it, just don’t buy anything that says low-fat or fat-free. Period, end of story. Bob: There you go. GMO, corn, and soy is number four. Jordan: Yeah, this is kind of another heavy topic. Like the whole wheat. Bob: A lot of farmers aren’t going to be happy with you. Jordan: I know, I ruffled the feathers. I try to be careful who I have conversations with this about. I’ll put it out there. I’m an organic promoter. I buy it, I believe in it, to what extent we can always believe everything in the food industry can be a little bit sketchy, but let’s back up. I wonder if people even know what GMO means. Bob: Right, let’s talk about it. Jordan: Okay. So, I can define that in simple terms, GMO stands for genetically modified organism. So, something that was changed and altered from its natural form. A lot of our crops are genetically modified to make them more resistant to pests and things like that. I mean, they’re genetically modified for all sorts of reasons. So, things can last longer. Bob: Isn’t that true about every product created now, as far as, I mean like apples, aren’t they genetically modified or am I wrong? Jordan: Yeah, you’re hard pressed to find a produce item that isn't. There are some but yeah, most are modified in some way, shape, or another. Bob: So, what I understand about our gut flora, this has been developed over thousands of years, correct? Jordan: Our gut flora? Yes. Bob: And so, we’re making changes to that in just a span of a few years, our gut flora doesn’t have a chance to adapt to it. Jordan: Correct. That’s a good way to put it. We’ve seen more changes in our food supply in the last 50 years, than we have combined in hundreds upon hundreds of years. I don’t even think we understand the consequences it’s going to have quite yet. Bob: No, we don’t. The science hasn’t caught up yet. Jordan: No, no. So, in my opinion, when you can avoid those things like that, that we just don’t know enough about, I think that’s a good idea. Bob: Right. Jordan: How you avoid it. If it’s from a non-GMO crop, it will say on the label, GMO-free like companies do label that. You can find it, you can spot it out, but you must look for it. Bob: Number five is probably the most obvious one on the list. Jordan: Yeah, must include it though. Bob: Sugar. It’s a beast. Jordan: Yeah, whenever I do like any sort of nutrition talk or presentation or coaching with people, whatever it might be, this is one where I don’t get a lot of question on. People know they understand sugar is bad. Some of the other ones I get questions. But sugar, we can all agree, it’s not good. That doesn’t mean we avoid it. But I kind of wanted to focus today’s conversation though. We know sugar is bad, but I want to really talk about sugar in drinks, and just how detrimental that really is. I mean sugar is in everything. We should do our best to avoid it. Bob: What’s shocking to me is, I can understand the sugar that you see in a can of soda but there is a lot of sugar in a lot of the sports drinks. Jordan: Oh my gosh, yes. Bob: We found out; I think some of them were worse than the regular drinks. It’s supposed to be a sports drink. You’re downing sugar. Jordan: Energy drinks too. I don’t drink those, I think they’re disgusting, but I know a lot of people rely on those. Juice is another one people think is healthy. You know the problem is just with, sugar in drinks it’s just way too easy to just do too much of it. Bob: Like it’s fine for you to eat an orange or two, but an orange drink, you’re really concentrating the sugar. Jordan: Like there’s no way we could sit here and peel 10 oranges and sit and down those in this time we’re doing this podcast, but could we juice 10 oranges and drink it? 100%. So, it is just way too easy to overdo it. I know so many people that every single day they’re going through Starbucks or whatever drive through to get their latte and not understanding. Bob: A sneaky way of getting sugar. Jordan: Yeah. It’s amazing to me how people are living on these things, starting their day with them. Bob: I was coaching basketball, sixth grade and we had these kids they’d come in and they take these sports drinks before the game. They would just crash like by game two. Jordan: Yes! Bob: I could see it in their eyes. Jordan: We don’t put two and two together. Bob: I did, I stopped drinking those sports drinks. That’s for sure. Jordan: I’ll take a slight side tangent on this one. Personal story testimonial that happened to me yesterday if I can. So, I don’t drink sugary drinks because I know they’re bad for me. I don’t care for the taste. I’m good with water and some black coffee and tea, but anyways, I’m pregnant right now. I had to do a glucose tolerance test. So, they made me sit in the doctor’s office and drink 50 grams of concentrated sucrose or whatever form it was. Bob: Really? Jordan: Yeah. Then an hour later they test to make sure your insulin is working. That’s a standard test. Bob: Would that work for you? For somebody who never drinks it. Jordan: Well, that’s what my hesitation was with it, I had a lot of questions. Well, I mean I did pass it. But my story with this that I will share with people, I don’t understand how people can drink that and function in life. About 45 minutes when I was done, I started feeling dizzy. I was yawning. I was tired. I was vibrant, full of energy before that. Then, I got to work about two hours later and I was starving, so hungry, and I just crashed. Bob: And then you crave sugar. Jordan: Oh yeah! So that’s my personal testimonial. Bob: It’s a terrible cycle to get into. Jordan: It is, and I know your body gets used to it, but I don’t understand how people are walking around and drink after drink. Bob: Well now, number six. Artificial sweetener. If you don’t take sugar, can’t you take a false sugar? Jordan: We would think, well, we’re taking the Coca-Cola out, so we’ll just make it Diet Coke now, right? Bob: Right. Jordan: Unfortunately, I thought this was common knowledge for people that artificial sweeteners aren’t good, but there’s too many people now that are seeing sugar-free and they’re grabbing it. Bob: Right, exactly. Jordan: Yeah, so artificial sweeteners. There’s a lot of names, there’s a big list, I’ll just touch the two main ones. Aspartame and sucralose. Splenda is the brand name for sucralose. Bob: What is one that’s a little bit better for you? Jordan: Stevia. Still, to our knowledge in nutrition, in small amounts, because stevia is a plant, like it’s okay. Bob: Small amounts. So, if you’re going to do one, that’s probably the one. Jordan: Yes. So, just staying away from things labeled sugar-free. So no, your sugar-free latte at Starbucks is no better than your regular vanilla latte in my opinion. Bob: Am I right saying, isn’t it like your body will react to it like its sugar sometimes? Your insulin levels may shoot up. Jordan: Correct. Bob: It fools your body apparently too, sometimes. Jordan: It does. We’ll touch on that with the next one we talk about too, fooling your body. But in addition to that, we still just don’t know enough about them, but we do know that when they do digest and break down into our body, their byproducts in the whole digestion process are some compounds that we don’t want released in our body. Bob: All right. Next one is MSG. I remember one, we’d all go get Chinese and he’d say no MSG. I think he would laugh and leave it in there anyway. Jordan: Yeah, probably. So, you knew about this one before? Bob: Well, I didn’t know what it was. I just remember everybody told you, don’t order the MSG. Jordan: And you don’t know what it is. In fancy terms, it stands for monosodium glutamate. Bob: Gotcha. Jordan: It’s a food additive. It’s a flavor enhancer. It makes things taste good. It’s really that food additive that makes you want more. So, there’s a reason why, when you go open a bag of Doritos, that you don’t eat two Doritos, you eat the whole bag. It’s literally what food manufacturers do. It tricks your taste buds into wanting more, it’s addictive. Bob: It is addictive! I was hearing this doctor talk on the radio on time and he and his wife were in the car, and they literally had to stop the car, put it in trunk. And even then, they stopped later, and opened the trunk. It’s amazing. Jordan: I’ve heard stories that people throwing away in their garbage outside going and digging it out of their garbage. It’s addictive. Food manufacturers are smart. The more you eat, the more you buy. Right? But you’re going to find it in a lot of processed foods. Go to any chip, not like a plain salted potato chip, that won’t have it, but like a barbecue or sour cream and onion, Doritos, Cheetos, all those flavored, that’s going to have MSG. Bob: What’s bad about it, I mean in general? Jordan: First, you’re going to overeat those foods. They’re addictive. Then we’ve got all sorts of other things in it. As far as what else is specifically bad about the compound MSG, I would have to do some more specific research, but again, it’s an artificial food additive. Anything manufactured and made by food manufacturers, I’m not going to trust it. Bob: Right, exactly. All right, next one. Deli meat or processed meats. I used to eat a lot of these I’m afraid to say, but I stopped about 20 years ago. Jordan: Yeah. So, this is what I want to say too. They’re not all bad. There are some out on the market that you can find at your grocery store that are better. So, I don’t want to lump it and say that you can’t find a good one out there. Bob: You have to be particular. Jordan: We just want to kind of educate you on what to look at in a label, we could include hotdogs in this category too or sausage, things or that nature. A lot of what they have in them is a preservative. It’s a food additive to make the food last longer called nitrates, nitrites, if you’ve heard of those. That’s the big issue with it, linked to a whole host of health issues that I didn’t even begin to list on here. Bob: So, you’re looking for nitrate-free, basically. Jordan: Correct. Nitrate-free. If you are going to include these as a part of your diet and what you’ll see when you go and buy a package of turkey and they’re nitrate-free, what they’re putting in it instead, is an herb like rosemary. Because it can preserve a food in the same way, it’s beyond me. Bob: Just as long? Jordan: Yeah. Celery powder or celery seed is another one. Bob: It’s probably more expensive Jordan: Exactly. I think that’s the main reason why those things aren’t being used, but there are alternatives, but we need to be aware of what we need to look for. Bob: So, you’re looking for nitrate-free, but you’re also looking for quality raised meats, without hormones or antibiotics. So, what if you find a meat that says it does not have antibiotics in it, but you don’t know about hormones. Jordan: Well, that’s a gray area. You must have both on the label. Bob: That’s what I wanted to know exactly. I just saw this. Jordan: I think it’s chicken. I always get this confused. One of them is banned in all. Like you’re not even going to find it in the lowest quality chicken, yet they’ll still advertise it to you. It still has the other one, does that make sense? Bob: Yeah, that’s probably what I found, and I can’t remember which one it was either. All right. Second to last one, Margarine. I used to think that was the healthy one. Butter was so bad for you, so I ate margarine for years. Jordan: I think I grew up on margarine in the refrigerator. Not in my adult years, but margarine is a manmade food. It doesn’t exist in nature. I don’t know if you know anything about how it’s made at all. Bob: I don’t. Jordan: Remember the vegetable oils we talked about earlier. So, it started with one of those, a vegetable oil. Bob: So, a bad start. Jordan: Yeah. To me, margarine is worse than vegetable oils. So they start with that, but then what they do is they modify it, change it, to make it solid or partially solid. It’s nice and spreadable. They modify it to be a partially saturated fat in a sense. That’s trans-fat by nature. I think we have enough knowledge now in human nutrition that trans-fats are arguably one of the worst things that we can put into our body. So, there’s absolutely nothing natural about it. Completely synthetic, manmade altered to create this. Bob: Is there any of them that are good? Like, isn’t there vegan butters or something like that? Jordan: Yeah, there are. There’s maybe some that are a lesser evil or starting with a better oil. Bob: Do you just use butter Jordan: I just use butter. Bob: Gotcha. I mean, it tastes better. Jordan: I just use regular ole butter. I mean grass-fed butter. That’s what I use. It does taste better. So, if you have margarine in your house, if you’re going to do nothing else from this conversation, that that in the garbage because you’re really taking another from this list and making it even worse. Bob: Boy, that’s good advice. Number ten. Jordan: Number ten, I put in a food category, and I’ll tell you why, but donuts and cake and baked goods. Bakery items. Now, the reason I put this in here we can expand upon it, but now we’re taking and we’re combining a product that has sugar, the oils, probably GMO. It’s got flour we talked about. If you have frosting on your cake, you’re going to have margarine probably or vegetable shortening to make that, maybe some are using butter. My point is now we’re taking a bunch of these things that we talked about and putting it together. Bob: Here you go! Have it! Jordan: I don’t even know what that’s doing in our body, to be honest with you. I don’t even think we understand the compound effect when we put all these things that we already know are bad by themselves, but then we put them together. Bob: You know, I’m doing more and more reading on this and basically food is medicine. On the other end, I think the other types of food can be almost like a poison to you. They were giving an example of how food can affect Alzheimer’s and have a large effect. They were talking about the things that people eat. It’s like the exact wrong things to eat for developing Alzheimer’s. People eat like this daily. Jordan: We’re not talking about the occasional twice a year piece of birthday cake that you eat. We’re talking about the daily exposure having that compounding effect. If you’re eating a good, healthy whole foods diet, you can probably handle a piece of birthday cake but it’s when you compound it on top of all these other things it’s just toxic overload for your body. It’s no wonder we’re seeing the health crisis and people that we’re seeing today. Bob: This was a wonderful topic, Jordan. I said we’ll have to expand on some of these. Thanks to everybody for joining! Jordan: Yeah, thank you guys! 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This article is a transcribed edited summary of a video Bob and Brad recorded in January of 2021. For the original video go to https://www.youtube.com/watch?v=L9ig4EZp6_c Bob: Today we're talking hip pain. 15 signs that you need to see a doctor immediately. Let's get started Brad. Brad: There you go, Bob. Bob: Number one, you're unable to put weight on it. This is certainly true if you went through some trauma or injury. Brad: Exactly. Bob: Like if you went through an athletic injury and you just can't take weight on it, I mean, that's of concern. Brad: Right, yeah you've got to get in see if it's fractured or something. Bob: You don't have x-ray vision I'm sure so you're going to need someone to take a look at it. Number two, kind of along the same vein, you can't even move the leg or hip. It's so painful. Your body is going to naturally brace a limb if it's really injured. Brad: Right, exactly Bob. Bob: That's why nice about the body, it's smarter than we are. Brad: You have to get it checked out. Doesn't mean that it's necessarily injured seriously but you need to get it checked and find out. Bob: You need to get it ruled out. Number three, the joint appears deformed or is bleeding. Yeah, if you look at a joint and it looks angulated, I think people mostly know that you're going to go in to see the doctor. Brad: And when you're saying bleeding you don't mean necessarily like the skin is ripped open, but internal bleeding? Bob: Well, yeah. I have to be honest with you, this was off a list or different lists that I pulled off, so I wasn't sure where they were headed with the bleeding. Because you can see some bruising and bleeding and I wouldn't go in necessarily. It does mean a more serious injury by the way when there is bruising. Brad: I had a friend, he fell on his, it was very dark and purple, so it was bleeding inside. Not the skin. Bob: So did he go in? Brad: Actually he didn’t, and I advised him to. I take that back, he did, but it took a little bit of… Bob: Coercion? Brad: Yeah, a littler persuasion and he did and everything was fine. But yeah, that was that was definitely internal bleeding. Bob: It's one of those things I'm kind of on the fence. But look at other factors. Brad: Sure. Bob: Like if someone's really young, you know what I mean? Brad: Right. Bob: There's some bruising there. Yeah, maybe not. Brad: Especially if there's an obvious cause. They fell on it. If it just comes without any apparent reason. Bob: Yeah, if they fell on it and they're still able to walk on it and they're still, you know what I mean? They're still able to move it, I probably wouldn't go in. Number four, if you have severe back pain in addition to hip or leg, I would probably go in. Because that means it's, especially after an injury, it's probably pretty severe. Bob: Right, right. And there's too many things that it could be related to. Bob: You might also have numbness or tingling or pins and needles. And then we're thinking, of course that you might have a herniated disc in your back. Something from your back is pushing on the sciatic nerve. Brad: So he's talking about pins and needles pain going down the leg. That's a red flag, too. Bob: Previous history of cancer or tumor. Boy, we just got some bad news. A former girlfriend of mine, I don't want to obviously say her name, but one of the first girls I ever dated, I just found out she's got osteosarcoma. Which is really weird because I don't know if you remember this Brad, that's a cancer in the bone. Usually young people get it. Usually like 14, 15. So anyways, she broke her hip, not knowing what it was. Brad: Oh I see. Bob: And they found out that it was cancer. Brad: That's terrible. Bob: Number six, if hip pain came on suddenly for no apparent reason. That's always a red flag. And when we say a red flag, that means it's a warning signal to you that you probably should go in and see the doctor. Brad: Yup, go in and get it ruled out one way or another. Bob: Sudden swelling in the leg. Kind of the same issue. Brad: Either around the hip or down the leg because the hip could be causing the swelling and gravity pulls that fluid downward. Bob: Number eight, anytime pain in the hip is really intense. Again, your body's going to warn you. If something's really going on bad it tends to really give you intense pain. So you're going to go and check it. Number nine, signs of infection, fever, chills, redness, warmth. That's where often you can get really pretty severe pain too, if there's an infection. Brad: So I guess maybe we should clarify this. You have hip pain and then along with that, I mean it might be warm to the touch around the hip, but your body may have a fever as a result of the, if it is an infection in the hip. So, you know the body really reacts to infections, not just locally but throughout the whole system. Bob: I’m still amazed at my mother-in-law had an infection in her knee and she went to the hospital three times and they still didn't pick it up. And she went to another hospital and they picked it up within 10 seconds. Brad: So the second opinion or a different doctor. Bob: I don't know, it's just strange Number 10, if you've had a fall or another injury that initiated the pain. Especially again, as you get older. That I'm always concerned of course. It's pretty easy to break a hip as you get up in our neck of the woods, right Brad? Number 11, if you had to hip surgery in the past six months and you're having a lot of pain. You probably should have it checked. Brad: Yep, absolutely. Bob: Number 12, if you're a child and you have hip, groin, thigh pain without an injury. Brad: Yep, we did a video on that actually. Bob: I remember you did that, Brad. Brad: I'm trying to think of the name of it. Hip pain? Bob: You're trying to remember the actual name of the video. Brad: Yeah, but my memory is not there. Bob: It was a fairly rare occurrence. Brad: Yeah, it's not common. Bob: But when it happens, it happens. Brad: And it's easy to rule out. Just a simple x-ray and that's all. Bob: If you're feeling unwell in addition to the hip pain. Again, we're worried about something more ominous. If you've been feeling kind of crappy and all of a sudden you get hip pain along with it. You may want to go in. Brad: The two may be related and just check it out. Bob: Number 14, if you start hearing popping noise when you have injured it and you didn't hear popping noise before. Brad: Particular if there's pain associated with noise, then it's even more so of a red flag. Bob: It's funny it's not necessarily true with a hip as much as you might do with a knee or even an ankle. But like athletic injuries, you'll hear a pop. Quite often they say,” I heard a pop,“ and they tore ACL or MCL or something like that. Number 15, if you developed unexplained weakness in your leg. That would be another reason to go in. Brad: Exactly. Bob: No, I guess overall I would say, if you just don't feel comfortable with it go and see your doctor. It's so much easier to move forward and if you know that other things have been ruled out. Brad: Exactly, it's just that peace of mind is going to help you sleep. And then that's going to help your hip get better and your nerves and all those things. Bob: By the way, this is part of a series of videos on hip pain. If you want to see the entire series go to the program section at bobandbrad.com. Brad: Right. Bob: And under the program section you'll see the hip series and check it out. You'll see all different titles. Watch the ones that seem to apply to you. Brad: You don't have to watch them all, that's for sure. That's the beauty of it. We don't take your email, it's completely free. Bob: Nope, it's completely free. Thanks. Visit us on our other social media platforms: YouTube:https://www.youtube.com/user/physicaltherapyvideo Website: https://bobandbrad.com/ Facebook: https://www.facebook.com/BobandBrad/ Instagram: https://www.instagram.com/officialbobandbrad/ Twitter: https://twitter.com/ptfamous Pinterest: https://www.pinterest.com/mostfamousPTs LinkedIn: https://www.linkedin.com/company/bob-and-brad TikTok: https://www.tiktok.com/@bobandbrad Wimkin: https://wimkin.com/BobandBrad Mewe: https://mewe.com/i/bobandbrad Minds: https://www.minds.com/bobandbrad/ Vero: vero.co/bobandbrad SteemIt: https://steemit.com/@bobandbrad Peakd: https://peakd.com/@bobandbrad For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun US: https://amzn.to/36pMekg Now available in EU: https://amzn.to/3eiruwV Now available in Canada: http://amzla.com/t4qn7uniltfb Q2 Mini Massage Gun US: https://amzn.to/3oSMBu9 Now available in UK: http://amzla.com/qe4bmn3puczb Now available in EU: https://www.amazon.de/Massagepistole-Muskelentlastung-Handmassageger%C3%83%C2%A4t-Muskelkater-Entspannen/dp/B08M8YSFC7/ref=mp_s_a_1_2?dchild=1&keywords=bob+and+brad&qid=1620323625&sr=8-2 Handheld Massager: https://amzn.to/2TxZBqU X6 Massage Gun with Stainless Steel Head: https://amzn.to/38zRLEv T2 Massage Gun: https://amzn.to/3GfflX1 Foot Massager: https://amzn.to/3pH2R2n Knee Glide: https://store.bobandbrad.com Fit Glide: https://store.bobandbrad.com​ Fitness: Resistance Bands: https://amzn.to/36uqnbr​ Pull Up Bands: https://amzn.to/3qmI4Rv​ Resistance Bands for Legs and Butt: https://amzn.to/2G5mXkp​ Hanging Handles: https://amzn.to/2RXLVFF​ Grip and Forearm Strengthener: https://store.bobandbrad.com​ Wall Anchor: https://store.bobandbrad.com​ Exercise Ball: https://amzn.to/3cdMMMu​ Pull-Up System: https://www.optp.com/Pull-Up-system-by-Bob-and-Brad Stretching: Booyah Stik: https://store.bobandbrad.com​ Stretch Strap: https://amzn.to/3muStbi Wellness: Bob and Brad Blood Pressure Monitor: https://amzn.to/3hm721f Bob & Brad Amazon Store: https://amzn.to/2RTSLLh Check out other products Bob and Brad Love: https://www.amazon.com/shop/physicaltherapyvideo?listId=3581Z1XUVFAFY Check out our shirts, mugs, bags and more in our Bob and Brad merchandise shop here: https://shop.spreadshirt.com/bob-brad​ Check out The Bob & Brad Crew on YouTube by clicking here: https://www.youtube.com/c/thebobbradcrew 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.

Using a TENS Unit after: Stroke, Multiple Sclerosis, Fibromyalgia, Complex Regional Pain Syndrome, Reflex Sympathetic Dystrophy, Phantom Limb Pain, Spinal Cord Injuries, and other Ailments. If you are using an iReliev TENS unit we provide step-by-step video instruction on how to use the following types: iReliev 1313 iReliev 5050 iReliev 8080 Just go to the program section at BobandBrad.com and click on the TENS series. Under the series look for the videos with the 1313, 5050, or 8080 TENS units. If you are using a TENS unit from another manufacturer you will need to follow the instructions provided with the product. Where to Place the Pads: There is NOT a specific right way to position or place the pads. The best approach is to place the pads wherever they relieve pain the most. Experiment and see what will work best for you. Some general rules or guidelines for placement of two or four pads: 1. Before each use of the pads, you should clean your skin with gentle soap and water. This helps remove any of the natural oils that may take away some of the stickiness on the electrode pads. 2. After each use, the pads should be placed back on the plastic piece from which you originally got it. 3. Once the pads wear out you can purchase new ones separately. You can replace the old pads by simply detaching them from the leads (wires). If you find you are purchasing a lot of pads you may want to consider joining the iReliev Dollar Electrode Pad Club to help you save money. 4. If using the pads on an area that is hairy you may want to shave it first. The hair could interfere with the conductivity of the pads. 5. If the person who is using the TENS has a stroke or has multiple sclerosis, they should see a health professional before using. They may have areas on their body with decreased sensation or increased tone/spasticity. Either way they should be guided by a knowledge health professional. The other concern is decreased cognition. Individuals with decreased cognition may have a reduced ability to understand why and how the TENS is being used. 6. We have created videos to guide you on placement of pads for nearly all body parts (back, neck, shoulder, knee, etc.) Go to BobandBrad.com and then navigate to the program section. Next go to the TENS program and look for the titles that are appropriate for you. 7. If the area of pain is small (hand or wrist), you may want to use only two pads and one channel. 8. If the area of pain is large (back or quadricep), you may want to use four pads and two channels. One pad from channel one is placed above the area of pain and one pad is placed below the area. One pad from channel two should be placed in front of the area of pain and another pad from channel two is placed behind the area of pain. This arrangement forms a cross pattern. Another option for four pads: one pad from channel one is placed in the upper right corner of the area of pain and one pad from channel one is placed in the lower left corner of the area of pain. One pad from channel two is placed in the upper left corner of the pain and one pad is placed in the lower right corner of the pain. This arrangement forms an X pattern. However, one can experiment with the placement of the pads if they are following all precautions and warnings. 9. If using just two pads one might try to place one pad directly on the pain and the remaining pad above or below it. Experiment and see what will work the best. You can also place pads on each side of the pain. 10.The pads may cause a contraction of the muscles around the painful area. This is fine but it should not increase your pain. TENS is supposed to be comfortable and reduce your pain. For more information on the TENS programs visit: https://www.bobandbrad.com/tens-program If interested in purchasing the TENS/EMS unit by iReliev visit: https://ireliev.com/bobandbrad/?uid=15&oid=1&affid=10 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=hCAjFfd_cgo&t=80s. Brad: Today we are fortunate enough to have Bob off and Chris the Pharmacist on, we've got a very serious subject to cover. The title is “Fibromyalgia, (Have Pain, Fatigue, Brain Fog, Memory Loss)”, those are all typical symptoms. We're going to go through four steps to success to help manage and overcome these problems associated with this syndrome. Chris: There we go. Brad: Fibromyalgia is a very painful, debilitating condition and if you have it, you've been diagnosed, you're very well aware of this. It's oftentimes in some specific parts of the body, across, I'm not going to go through the points because I do have them mapped out, the most common locations in the body, but typically the upper back and the chest, around the hips and waist, and I may be missing some that you may be suffering from but it's a chronic condition, it goes on and its really life-changing. So, we have done research on it, we've both had patients over the years that have this and we came up with a four step guide that you can vary from, because everyone does not treat fibromyalgia in the same manners, it's not a cookie cutter thing. Chris, do you want to step in so I can quit talking so much? Chris: Yeah, fibromyalgia, it's not even really a disease state, it's much more of syndrome. So, when we think about it, it's many, many, different things and oftentimes, when patients have the diagnosis of fibromyalgia, it's arrived almost backhandedly like a process of exclusion. It takes an average of five years just to hit the diagnosis in most cases. And you're talking about, two to three percent of the population, about 70-90% women. Some unique facts about fibromyalgia, oftentimes when they come in they present with pain and they just don't know why, but you know, the doctors try. And, there's not a set test for it either, which makes it so darn frustrating to diagnose as a clinician and it makes it really, really hard on the patient, because they're just waiting for an answer! I think, so many times when we get an answer it's nice to start to turn the page and work on the healing process, and that's what's so darn hard. So, your doctor will rule out other arthritis form conditions, you'll see strange things that pop up like IBS, inflammatory bowel syndrome. Brad: IBS? Chris: Inflammatory bowel syndrome. So, basically, constipation, diarrhea-type dominant side effects with a lot of pain in the tummy and with that respect, you know, you're like, “well, are we treating one thing?” I mean, are we looking for an elephant and it should be a giraffe kind of thing, and they just don't know where it goes. Well, I still have these symptoms, but you know, I'm hurting here, hurting there, I'm in pain for every second of the day from the moment I wake up to the point where I go to bed. Your friends and family will be like why are you always hurting all the time? So ultimately when they get the diagnosis, then I think the healing can begin and then I think we have lots of things that we can kind of start to share to try. It's not a hopeless condition, it's something that can go into remission, and we can move forward and have very happy effective lives so there's lots of good things that we can do to help people. Brad: Right, and that can be the challenging part. I did want to mention, as far as from a therapy standpoint, when I look at it with people, is part of the explanation of the pain is, these muscles will tighten up in these painful areas and when a muscle tightens up, there's less circulation because the muscle's tightened up like a ball, a real knotted area and blood cannot circulate in that near as well as a relaxed muscle, it's like a sponge, it can absorb the blood and the nutrients and the oxygen that fresh blood provides and we want to get rid of the waste products. You may not have heard that term, thinking of in your muscles but the waste products being carbon dioxide, lactic acid, and these things when they build up create that pain in there, so, getting to be able to relax can be a big part of this. We're going to talk about that a little bit more, so again, oh, the point I wanted to bring up, Chris, is this is kind of like back pain, although it's different, in the way that you look normal. I mean, it's not like you have a broken arm, you look healthy, but you've got this pain that the average person is not familiar with it, who's ignorant of fibromyalgia. They don't understand. Chris: No, and that's one of the biggest, I think one of the biggest tragedies of fibromyalgia is we all look perfectly normal if we're suffering from it, except for the fact that we're not, because we're feeling so miserable. What we think is that it was probably brought on by a stress event, a traumatic event, so whether it's a car accident, stress, an infection, so we don't really know that nexus event that caused it. We know that it runs in families so we don't really know. But what we think we understand right now is it seems to be nerve transmission is the problem. So, if you think of your nervous system as a series of highways, something's not right with that. When we talk about the pain points, and there's at least 18 of them that they look at pretty routinely but I think there may be others as you alluded to. But what happens is that, let's say we're listening to the radio and we like it loud, we're rocking out, we're driving, it's on ten, well, your pain, if you have fibromyalgia, is easily an 11 or higher, so it goes beyond that and just simple things like if you went in for a massage or you know, you just hit your arm on a door in one of those tender spots, it puts you through the roof. So it's not a normal response, like, for anybody else it's just a little slap and you're like, why did you almost want to drop to your knees or actually have tears in your eyes. You know, and it's a very real pain. I mean, just because it doesn't look bad, it's bad. Brad: Right. Chris: And so you know we go through a lot of different things to treat these and we'll jump into those as we go forward. Brad: I'm not a fibro specialist, so I went to Adriaan Louw. He's a physical therapist, he's got his PhD in pain, he treats people with fibromyalgia on a regular basis and he does research and he has dedicated his life to pain, people with chronic pain. We've had him on our show actually, he lives in Iowa not too far from here. Chris: Yeah, right down the way. Brad: Yeah, and he's just a heck of a nice guy, you can just tell he is, life is, you know, this is his passion. So he does have a book specifically for fibromyalgia, he has them for other chronic ailments as well, painful ailments. The name of his book is "Your Fibromyalgia Workbook", it's made for the layperson. Chris: Yeah, it's made for everybody! Brad: But one of the things I wanted to bring it down to, and I heard this from him, break it down to the simplest areas to address for pain and so there was sleep. Chris: Critical. Brad: Yeah, as opposed to going after this painful condition as a whole, break it down into four. One is sleep, the next one is understand your pain, try to get a better understanding of why it is. People come out after they see the doctor, maybe someone else, they say,” well, they think it's just all in my head,” which is the farthest from the truth. You're not going to progress if you don't understand it a little bit better and he does a really good job of explaining. I've watched some of his videos and talking to him, his way to communicate that to the patient is really good, as opposed to coming across in a real technical manner. He comes across in a personal manner so you can relate to it. And then exercise or motion. I'm going to show you a little, a way to work into movement because most people with fibromyalgia don't want to move because it hurts. Chris: No, the pain is so extreme. Brad: Right, exactly, so it's like, “I know I should be moving but it hurts worse,” so there's some ways to work through that. Then we are going to touch also on some diet at the end. We're not dieticians but we can give some good general rules for that. Chris: Absolutely. Brad: Did I miss one? Chris: No, I think, I think we'll start with sleep. Brad: Yeah, and that's what Dr. Louw said, if you can get your sleep under control that's half the battle right there. And it's not easy, because we have people having problems with sleep without pain because of other issues. Do you want to talk about sleep? Chris: Well, we can. One of the hallmarks of fibromyalgia is the fatigue. Not only are they in pain all the time but they're always exhausted, I mean, we're talking like just bone weary tiredness. So you're just dragging tail every moment of every day and so how do you fix that when you're sore, painful, tired? It's just a very frustrating point, so one of the things that we can do to try and gravitate towards better sleep, I always call it sleep hygiene, but there's other ways of looking at it. But some basics with sleep, whether you have fibromyalgia or anything else, are just keys to getting a better night's rest. Everything follows through from sleep in a lot of cases, so if we can get the rest, our bodies begin to heal, things calm down, your nervous system seems to settle out, so we'll kind of see that as we talk. The reality of it is to go to bed, you want to have a nice, quiet setting. You want a dark, dark room. You want to be putting away your iPhones, your iPads, your laptops, you probably don't even want to be watching TV. Your phones and your iPads and computers reflect that blue light and that's stimulating to the brain and that keeps us awake to begin. It is kind of strange, because a lot of people, think, “oh, I'm just relaxing, playing a little, you know, keyboard Sudoku or words with friends or whatever.” Brad: Even on your cell phone, there's enough blue light to affect you? Chris: Correct, and some of them now have recognized that. I know that with Apple they do have a dimming setting, so it's certainly something that I would encourage to take advantage of even as you're approaching bedtime. But I would still encourage putting all the things away so that you're heading into bed in a quiet, relaxed manner. We want to have same set times. You want to have the same bedtime and you want to try and establish the same wake up time, too. Brad: Sure, some consistency. Chris: So that you're getting a nice, round-the-clock chronologically, you just want to have that same set time. Ideally seven or eight hours. Some people need a little bit more. You know your body and you know what you need. But you want that quiet time. I think white noise is actually important for a lot of people. What is white noise, well it's not a color, but it's like a fan. A gentle whooshing. Brad: That's what we use, we just use a fan. Chris: There's lots of studies outside of this, what we're talking about, that actually shows that white noise just relaxes the brain and when you look at the brain waves and the delta waves and all the things that they're looking at with sleep, specifically, you just get a deeper level of sleep. So it does help to promote that healthier sleep. And you know, you want kind of a cool room, you don't want it real hot, so your body, as the temperature slows down, heart rate slows down, you promote deeper sleep so we head into REM, which is actually one of the restorative parts for our brain but also our body, we're learning. So, there's a lot of fascinating things with sleep that oftentimes we take for granted. Brad: I just want to say, I just read a book a few months ago by Sean Stevenson, and it's about sleep. If you look up the author, Shawn Stevenson, it’s called “Sleep Smarter.” The whole book talks about things, one of the things, he was so specific on having a dark room is if you need light to be able to see your time, get it in red, if you need a nightlight, get a red nightlight so you don't trip over. There's something about red that does not produce the same, is it the melatonin in the brain? Chris: Blue is stimulating and red, red actually doesn't throw off a lot of effect, so if your partner is there too it doesn't annoy them. It just doesn't reflect, so that's why the military uses to read their maps and things. Lots of studies on those wavelengths. Brad: Ah, I want to get to the next number, understanding, some understanding of the pain, but before we do that, medication for sleep, that's your specialty? Chris: I dispense it, it's not my specialty, but I can tell you a lot about them. The reality of it is, is that sleep does not come easily to millions and millions of Americans and when you're talking about three to five million Americans with fibromyalgia, sleep is one of the things that's a challenge to achieve. So there's a lot of different ways that we can approach falling asleep. We've talked about some of the basic mechanistic things that we can do but sometimes we need pharmaceutical help. Not always, I mean, sometimes it can be something as simple as melatonin. For some people, you can get it through foods like raspberries or pineapple or cherries. Some people like that because it also gives you other healthful nutrients, and it also helps to stimulate that sleep about 30 minutes before you want to lay down. Otherwise, we have to use medication so something like trazadone which is an old-school anti-depressant, which isn't much of an anti-depressant, but interesting with fibromyalgia, it has unique capabilities because it works on some of those neurotransmitters which we talk about fibromyalgia as being a kind of a highway disorder where the nerves are firing improperly, it raises serotonin and some dopamine and norepinephrine levels to try and help to improve transmission. The benefit for people who can't sleep is that it just makes you doggone tired. So it helps you to sleep and get more fitful sleep. But there's other drugs that we can use, like the Z drugs, which we did a video about awhile back, so you talk about zolpidem is probably one of the more common ones, but also zopiclone. Brad: So, the big picture, pharmaceuticals for sleep is not going to be a long-term fix. Chris: No, we hope that you can naturally do it on your own because there's really no substitute for it. When it comes down to pharmaceuticals, yeah, America is a society of better living through chemistry, but if we can do it without, it's best. And I'm telling you that as a pharmacist. But if you can, you can, but if you can't, you can't, and those of you that know that you just can't sleep, you understand it and you realize the need for these medications, obviously your doctors do and they do a very good job of trying to diagnose and they'll try and mitigate where they can. It depends on the circumstance; everybody's case of fibromyalgia specifically is different. So, if you had it and I had it, we'd have two totally different stories. Brad: Yeah, I should have said that if sleep quality is not one of your biggest problems, you could probably skip this section, but it's probably part of it. Chris: No, but everything stems from that well, fitful night of rest. And that's one of the things that is hard to achieve. That's why you want to go into a pattern and that's why it's so important going forward, that if we have this diagnosis of fibromyalgia that we learn to make some of these lifestyle changes so that we can go forward. Brad: Sure, yep. Okay, so let's go on to the next topic, understanding why you hurt. I know, from my point of view, my understanding as far as the physical part where I talked about tight muscles, we need to get them relaxed, so we get the blood flow, I'm going to show you an exercise warm-up that actually you could do before you go to bed. It may help you relax so you can sleep better. But I think my best advice is to go to an author like Adriaan Louw, read some of his information. Search YouTube for his name, see and listen to how they talk about these experts that have studied it and dedicated their life to it. I know one of the analogies he talks about is, and it's a lot better coming from him, but he talks about pain, you know it's there and it's so painful and he relates that to a lion coming into the room. Like if you get tapped and you have that pain, he says, there's that big lion and there's that fear response and if you can work it out so that that big lion coming in and getting that fight or flight response, if you can get that big lion down into a little cub. So that that fight or flight response settles down as well, and that's one of those things that is easier said than done. Again, that's why from an expert it's going to make more sense than from me. Chris: Well, I think that's why his workbook is so important for a lot of people. I think it gives nice easy-to-read steps that are going to allow them to relate to their day-to-day activities. One of the things that they talk about also is cognitive behavioral therapy, and it’s kind of an understanding of the condition and I think the more we know, the more we can cope with things more effectively. Whether it's more of a CBT kind of, cognitive behavioral therapy thing where we reach out and we get that understanding for why we're hurting, when we understand the why, and whether it's writing down some things within what Adriaan has done with the workbook, it definitely helps us. When we have that understanding it allows us to accept it, make it become part of us and so we can face it more easily without the fear and the frustration that is associated with it. Brad: I do want to also mention, you said there was a patient of yours that had chronic low back pain. Chris: This was a chronic pain, but yes. Brad: But he used one of Adriaan’s books. Chris: One of his workbooks, specifically, and he completely is opioid free close to eight years now. Then he was a strong, strong opioid user and he just knew that he was to a point in his life where he couldn’t keep doing that, and he was actually having other subsequent side effects as a result of that. Brad: Sure. Chris: Which, you know, just to briefly touch on for fibromyalgia, there's a lot of drug therapies that we do. Over my career, I've been doing this for 26 years, fibromyalgia just kind of came out in the mid-90s when I started coming out of school and one of the things doctors just figured out, well, we got this thing, let's put this label on it, it's fibromyalgia and its pain, it's chronic pain, so what do we do? Well, we treat them with opioids. Well, we found out that that is the last thing on Earth you want to do simply because they're addictive and the reality of it is, is what do pain medications do, they just make you not care about the pain. The pain is still there. So when we're treating FM patients, a lot of it's going to come down to sleeping well, we're going to talk about exercise and things like that shortly, but the medications that we rely on are going to be anti-depressants and maybe muscle relaxants. So those are the things that help to bridge and improve neuronal transmission, that highway, so things like pre-gabalin, things like Sevala, which is menilsopram, any of the antidepressants but duloxetine, or Cymbalta, specifically, are indicated directly for FM. Brad: Should we jump right into the exercises? Chris: Yeah, let's go to the exercises. Brad: So, exercise, and Chris, we've talked about this, as a pharmacist, you're saying exercise seems to be the way to go versus drugs. Chris: Absolutely. Brad: And again, we talked about the pain gets worse with exercise, so why do I want to exercise? So I want to show you, this is from a fibromyalgia patient, she was actually a doctor, and I kind of modified it a little bit for my therapist background. Before you exercise, and I'm talking about exercise as simple as a mild walk, which, that can really be uncomfortable, do the warm-up. This is one thing I do with my back in the morning, I’ve got spondylosthesis. If I try to warm up in a standing, weight-bearing position, it is uncomfortable, it's not fun at all. So I lie down on my back, your muscles are much more relaxed. Chris: You don’t have to fight gravity. Brad: Yep, exactly. So, you're going to lie down, you can do this on your bed. It might be better on a carpeted floor; it depends on how you feel about getting down onto the floor or not. You're going to start out with a deep breath, everything should be quiet, you're not going to have your dog licking your face or the kids running around. Chris: That's going to make a problem. Brad: Yeah, just take a deep breath; two or three deep breaths, in your nose and out your mouth. They talk about meditation, if you can meditate, anything to allow the nervous system to settle down and relax. We're going to start with the feet and probably shoes off, I'm not going to take mine off, you can do it with your shoes on. You're going to do, five to ten ankle pumps. You can do more if you'd like. Allow your feet to relax, get that circulation going. Everything is relaxed, you're going to take your time and we're going to go to single knee-to-chest. Brad: Everything is just in slow motion, I'm going to go down to two or three motions for the video, you do as many repetitions as you'd like to and let it go down slow. Go to the other knee, and you may find one leg or one arm, when we get to the arms is more painful than the other, just take your time with it, read your body, get used to it. Brad: Then we're going to go both knees up and bring them up, help it out, stretch here, get that low back and those hips. In the back, you'll feel those muscles, just take your time with it. If it's too uncomfortable, skip that stretch and go to the next one as we go on here. And then in this position, relaxing again and I call them windshield wipers every time I have a patient. I say windshield wipers because I say hip rotations and it doesn't make much sense, but it's like windshield wipers going back and forth. Brad: If it's painful one direction, don't go that way. Go the other direction a few times and then bump in to the other painful direction, and it may get better as a result of going the other direction. Do it as appropriate, as your body allows. The next thing we're going to do is we're going to go up to the arms, and here we're just going to do shoulder flexion as tolerated, if you want to bring both hands together, if that helps, that may be a thing to do if one arm is weaker or has more pain let the other one help, so it relaxes it more, whatever works out best for you. Brad: These are the nice kind of a pushup you can do with fibromyalgia is just, I call them air pushups. I used to do these when I was in karate just as part of a warm-up, and it was kind of a fun way to do pushups. Chris: Get those shoulders going. Brad: Yeah. Okay, and then I’ll do like, snow angels, just bring your arms out to the side and bring them up as far as you feel comfortable. Brad: Okay, and then we're going to go into the shoulder squeezes, squeeze the shoulder blades back and down and then you can make your circles. Brad: If you don't feel comfortable doing it this way you'll find out, we're going to get up and oftentimes people find it better in a seated or standing position. Again, because a lot of the pain is going to be up in those shoulders and you need to relax you shoulder and neck muscles. Brad: Throughout this whole thing we're always thinking about relaxed, deep breathing. This might be a good warm up for either getting ready for bed or for going out and doing your walk or whatever your exercise program is. What kind of exercise programs are there that you have found in your research? Chris: Well, it comes down to what you can commit to and what you enjoy, what makes you happy. When we have fibromyalgia and we're in that much pain, you know, we want to do something simple. It might just be a walk to the mailbox for your first go-round. Then we just progressively add to it and it's not to say that you can't go out and enjoy weight lifting, aerobics, kayaking, biking, swimming, hiking. There's just so many things that you can do but we have to realize that we have to know thyself. You have to know when you're overdoing it. So, you might find early on, particularly, you might not know what you can get away with and what you can't and it might set you back a few days. It might be something where, we have a little bit of mild soreness or stiffness from exercise like we've all kind of experienced. For the FM patients it can be much more severe, really. “I can't get out of bed, that just smoked me.” And so we want to ease into it, so short walks, gradually building up, maybe gradually building in intensity. But when we start those workouts, like, your warm up that you just showed, I think could be done with just about anything. I think that would probably apply to that, and then when we start, you don't want to start out sprinting right away, you start walking. Maybe add a slight little jog if that's something that motivates you but maybe it's mailbox to mailbox. Brad: And that impact, I have a feeling, a lot of people, most people don't like to jog. Chris: No, and it doesn't have to be, I mean, it can be yoga, it can be tai chi, and it's actually, they've done very extensive studies on things like yoga and tai chi, and Pilates, specifically. Brad: With fibro patients? Chris: With fibro patients, specifically. They actually show, like yoga in particular, you have these poses that we hold and such. They also work on the flexibility, which does a phenomenal job for those muscles. Again, I’m preaching more in your church than I am mine. Brad: That's all right! Chris: But at the same time, they've shown to be very, very, effective. I think a lot of times, too, you always hear the phrase misery loves company. I think that, you know, look out for groups. A lot of places now, we belong to the YMCA locally, where we go, and actually within those organizations they have groups for fibromyalgia patients. I would encourage you whether that's, let's say you're going to Mike's Gym or whatever, see if they've got a fibro board where they have other people with like problems where you can talk to people. See what worked for them, how did they start, what helps them, maybe you can share your experiences and a lot of times when we talk about things, all of the sudden it's like okay, well, this worked really well for Mike and I'm going to try it. You know, and I think there's some positivity in there. Brad: Put some light at the end of the tunnel! Chris: Yeah, put some positivity on there and I think the one thing that we have to know is, if you accidentally overdid it, just realize that this is baby steps and we have to work towards a goal. And that goal is getting back out there and not letting the syndrome control our life. We're going to take control and one of the biggest things that we can do, number one, in my opinion after sleep. I guess we'd call it number two, would be getting that proper exercise. Because we need to help make those nerves and muscles work together and when you're stronger by even just simple things as walking or just, yoga, Pilates, tai chi, swimming, biking, whatever you choose, I think goes a long way to helping improve those symptoms. Not only that, but when we fatigue the body, we sleep better at night, so it all kind of falls back to sleep anyway. Brad: And we did segue actually into the, number four, on the four steps is motivation, a reason for you to get up in the morning. Whether it's your job, I know there's one woman, she was a farmer, and she had to get her work done and that worked out good for her because she kept moving throughout the day to keep the farm going and she said it really helped manage her pain. She was still working on at the end of the day because it would come back to get her, so that was part of her next step was to get that aspect of it so it's a 24-hour relief but still, it was a whole point. I like what you're talking about is, to be around positive people, support groups, what you read, you know, from books like Adriaan Louw and other people who are experts or people who have written their success stories if they've had it. You know, if someone else did it, maybe I can too. It gives you that light at the end of the tunnel, so critical. Should we go onto the, now this is number five, we put this in because we wanted to just touch on it, and that's diet. Chris: Diet. Brad: We're not dieticians or nutrition experts but we have some general information. Chris: Yes, nutrition is a critical component of any health aspects anyways but actually eating well, one of the things with fibromyalgia is maintaining a healthy body weight. We can get vitamin D through food, obviously it's going to be your sunshine vitamin, too, magnesium is an interesting element but it seems to help with muscle functioning and so it's going to be your leafy green foods. Brad: It's like spinach. Chris: Spinach and kale and lettuce, romaine lettuce, because it's darker. Brad: The darker greens, yep. Chris: Yeah, your darker greens, broccoli, nuts, almonds. There's lots of things, you know, legumes of any type unless you have like certain allergies to things but we want to be mindful of that. Lean protein, so you want to find things that will help because that helps with muscle restoration and building and bone health. A lot of times, and I didn't touch on it heavily, but most people with fibromyalgia have multiple other syndromes or issues or disease states whether it's osteoarthritis, osteopenia, rheumatoid arthritis, IBS we had talked about, so, nutrition comes into play with all of those and so for helping, whether we're going like a gluten-free diet for some people seems to be a very effective choice, so taking the wheat out of the equation, basically, so if we can do that, that seems to be very beneficial, the lean proteins, whether fishes, lean beef, grass-fed beef, that type of thing. Brad: And I think this next part we're talking about what we should eat and what we shouldn't eat. Everyone is hearing this now, stay away from those highly processed sugars. Chris: Oh, yeah, nothing in a box. It's just bad, they have lots of other chemicals in there that just aren't going to really support what your body needs and so when we give the body the right fuel, I think a lot of other good things happen from that. It gives us the energy to sustain and be able to do the exercise programs. So, all these things are very holistic and kind of work together kind of like a big circle. You take something out, and all of the sudden you have a leak in your circle, so to speak, if it was holding water it'd have a leak. So they're all very, very important aspects of treating fibromyalgia. So I think it's just critical to, and its baby steps guys, I mean, this is not easy for anyone and for the people that are naïve to fibromyalgia patients, just do what you can to support them because they need your help. They need your understanding, and sometimes it's just, it's hard to relate when you don't walk in somebody else's shoes. It's really difficult to see from another point of view but when they tell you, I hurt, don't just go “ah, you're being a Sally.” No offense to people named Sally, but, you know, at the same time, we need to be respectful of that and support them and say, well, how can I help? Brad: Sure, exactly. Chris: And so maybe you can pick up the grocery bag for them, or maybe you can grab the milk from the grocery store. Just little things, it helps out quite a bit and I think there's a lot of good things that we can learn. Brad: All right, so one step at a time, don't try and tackle everything at once. Look for everything you can, you're going to find ways and all of the sudden, someone will say, “oh, that's helping.” You get to that point and we're going to go to the next step and we really wish your success and progress one step at a time to get through this. So, very good, from Brad and Chris and Bob is also along with you on this journey as well, thank you. Chris: Thanks guys! 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This article is a transcribed edited summary of a video Bob and Brad recorded in March of 2021. For the original video go to https://www.youtube.com/watch?v=F6CxDNE9hKA&t=1s Bob: Today I'm joined again by Chris the pharmacist. One of the smartest guys I know. That's my tagline with him. And he's going to talk about understanding the pharmacology of benzodiazepines and how to reduce anxiety, and it also can help us sleep, correct? Chris: It sure can. Bob: All right, so let's get started. What role does this drug play? We had another video where we talked about the SSRIs. You maybe want to tell what that is really quick, and what the benzodiazepines are. Chris: When we're dealing with anxiety specifically, anxiety is an awful, awful feeling. And there are several different forms of anxiety, but most commonly is general anxiety disorder. But the reality of it is when people feel like garbage, you're talking about one in five Americans, so that is a lot of people, upwards of 50 million Americans experience anxiety. And it's horrible. Bob: And worse this year. Chris: Yup, it seems to be a lot worse this year, 2020 has been a highly unique year for that. And then at least my pharmacy, I'm seeing more of these drugs going out left and right. Bob: Than ever, would you say? Chris: Yeah, I would say so. I mean, it's not scientific, but my staff and I have kind of talked and are like “wow, we're really kicking these out.” But the reality of it is, when we have anxiety, the mainstay of therapy is first talking with your doctor. Well, first seeing your doctor, because we need to know if there's a physical underlying cause. You know, certain medications can cause it, thyroid condition can cause it, cardiac conditions. There's a lot of things. So once we’ve established it's nothing physical that's causing it and it is anxiety, and you're having these horrible thoughts, what they say most days of the week for six months, which again, in my opinion is way too long. You know, they would start you on either cognitive behavioral therapy or the SSRIs, which are the serotonin, selective serotonin re-uptake inhibitors. Bob: Do they start the cognitive behavior therapy right away, or do they wait until the medication has started to kick in? Chris: No, I think, the patient drives the bus. I mean the therapy is centered around what the patient's willing to do. So if you're willing to go through therapy, I think it is one of the best things out there, because it's non-drug. Cognitive behavioral therapy basically teaches you, and they have very skilled clinicians that are going to help you to teach you to replace the negative, horrible thoughts with positive ones, to help you to kind of balance things out and understand why those feelings occur when you're having those negative thoughts, so that we can kind of come to a better place where you can control it more naturally. Bob: I've seen the studies where you take one, drugs, or you take the therapy. They both can help, but together they’re more effective. Chris: They're far more effective. And I think it's a widely underutilized aspect of our healthcare community. I think counselors have a lot to offer. Unfortunately, there's been a stigma with mental illness and people are like, “well, I don't need that kind of help.” Bob: The stigma seems much less, but it seems like yeah, it's still there. Chris: Yeah, and we have to crash that door down. I mean, it's something that, that people need to take advantage of because it's there for them and it's helpful. It leaves lasting beneficial results for the rest of your lives. Bob: What about like meditation? Does that fall in that same category? Chris: Yep. Mindfulness and meditation actually are all within that. And you know, it's interesting there's books about it. You can go to group talks about it. Sometimes there's apps on your phone that you can actually utilize. And for some people, they're wonderful opportunities to help you to help mitigate and manage anxiety. But, sometimes we just need the medications. And so, and it's just, sometimes that's the easier choice. Maybe you've got three small kids that are running in five different directions, although with COVID, it's a little bit different these days. But you know, it might not be optimal for you to go in and see a counselor. So medications certainly help. And a lot of times they'll start you on the SSRIs or even the SNRIs but that point, those take time to work. Like four to six weeks. Bob: They take a long time to work. Chris: So that's where the benzodiazepines kick in. And so those are the ones that work immediately, but they have a strong, negative connotation. They are addictive. We have to be careful with them. Tolerance develops, and there's lots of side effects that are associated with them, so they're just a small stopgap. Bob: How quickly, typically, could a dependence occur? Chris: Within a couple of weeks. So it doesn't take long. Bob: So if you took it every day for a couple of weeks, you mean? Chris: Yeah, I mean if they need to, and again, it's kind of intermittent. There's a phrase that doctors put on prescriptions called PRN. It stands for as needed. It's actually just a derivative of Latin, but a lot of times these drugs, depending upon which one, whether it's lorazepam, clonazepam, diazepam, alprazolam, those are the ones that are the most, those are the four most commonly used ones. And there are others, many others actually, and they all have different potencies and lengths of action. So a doctor is going to certainly listen to you and make sure that there's something appropriate. And if it's something that's like, “I am just so panicky, I'm about just explode”, I think sometimes clinicians will say, you know, I think it is reasonable for you to consider taking a benzo. Bob: Make that bridge. Chris: And let's get you something so that we can help you to relax, get you the sleep, so that your brain can recover, so that we can wait for the other drugs to kick in. Or your therapy to begin to help you. So it's a short term thing. Bob: Yeah I have a family member, I’m not going to mention her name, but she had cancer and so they actually let her be on the clonazepam the entire time. Chris: Sure. Bob: And it's funny, you know, she, she got off it fairly easy. She did pretty well with it. She said, "I really don't like how I feel on it, so it was easy for me to get off", but apparently she didn't get dependent upon it. Chris: Yeah, and you know, the things drive addiction, are, you know, there's a genetic predisposition to a lot of these things. And again, your clinician is very skilled at looking for these cues. And so they have to assess you every time you come in. So you're meeting with a doctor, you know, in some cases monthly, three months, six months, depending upon the circumstances that they deem appropriate for your particular situation. And so they're going to be looking for those cues and seeing what's appropriate, what's not appropriate. The generalized guidelines are, you only want to take it for a couple, two to four weeks. And actually if you take it for as long as four weeks, then you have to actually taper off it at about a rate 25% per week to step down safely, because you could have withdrawal effects. And that can be very, very serious even to the point where a severe withdrawal with benzo could actually create a cardiac type of emergency. Bob: Oh my gosh, yeah. Chris: So it's things that clinicians are very, very careful with when they're treating their patients. Us as pharmacists in the community, we're kind of looking at to see refill patterns, how they're doing. We want to make sure that they're safe with their medication of use, making sure they're tolerating everything okay. Not having problems with dizziness, drowsiness, falling asleep at work. You know, those are the mainstay. That's why they work, is they make you tired, but they can make you dizzy and they can make you drowsy. Bob: How long are they in your system? Chris: Well, and again, that kind of depends. Bob: On which one you use. Chris: Yeah. So clonazepam, much longer, diazepam even longer. Things like lorazepam and alprazolam much shorter, but the problem with the shorter acting potent benzos is they can cause rebound anxiety. So these things are not designed to be used, they're just a stop gap until hopefully other measures will take place and really help to the patient to safely manage their anxiety symptoms. Bob: Yeah, the same girl would use it when she'd fly, because she had a fear of flying. Chris: Yep, very reasonable, fear. That's a phobia, so that's an anxiety. Bob: And she would use it for that alone now, and always worked quite well. Chris: Yeah. And so that's a onetime thing, unless she's flying for a living, I mean, obviously pilots don't get to take it. But it's one of those things where yeah. People that travel, some people do not like sitting in a tube that's 44,000 feet in the air. It's not a comfortable feeling for some people. Bob: Same storage advice with these? Chris: Yeah, any medication really, it comes down to, unless we tell you specifically. Bob: Avoid the moisture. Chris: Yeah. So it's not in the kitchen, not in the bathroom because those are the two most moisture prevalent rooms in the house. So you want it to be out of reach of children and really somewhere that's cool and dry. So usually it's a bedroom high up where little kids and pets can't get at it. Bob: Sure. Now, I saw, when I was doing some research, there's people that actually had to go to rehab for the addiction. Chris: Benzos are absolutely dangerous medications when used inappropriately. And that's the key. Bob: And again, you talked about the genetic portion of it can really weigh heavily. Chris: Yeah, I mean, the science of addiction, is fascinating and scary all at once. And I mean there's books and books and programs to help people to try and avoid those perils, but it happens and it happens much more commonly. And right now with COVID, we're seeing even higher addiction rates, with other drugs too. And a lot of times benzos are mixed with other products like alcohol or other drugs. That's where the real dangers can set in, you know, an overdose on a benzo can cause respiratory depression and stop your heart from working, and that's it. Bob: I know she talked about alcohol that you just don't want to do that. You don't even want to have a glass. Chris: You don't want to go anywhere near mixing and matching with these types of medications. It can be devastating. I mean, you may not wake up depending upon how much you've imbibed. So we have to be exceedingly careful. And it's something that, as pharmacists, we're kind of looking for that too. We all want to be safe and sometimes it's an accident too. I mean, and some of these drugs affect how you think. Bob: Yeah, you're not even thinking correctly. Chris: Yeah. And so all of a sudden it's like, well, I don't remember if I took one a couple hours ago, I'm going to take another one because I feel panicky. Well, all of a sudden now we've taken three or four doses and all of a sudden it can have some devastating consequences. You know, and so as we age, I mean, it can definitely affect your memory and your cognition, so it's certainly something that clinicians, again, they look very, very carefully at their patients. Sometimes some more than others, it just kind of depends. I mean, there's, we run into clinical inertia all the time. We see, you know, an 80-year-old lady taking these medications, and is this really the safest thing for you to do? Sometimes that's a very hard conversation to have because these people have taken these medications for a number of years, which again, you heard me say earlier, only a couple of weeks, and you heard me just now say a couple of years. And so, it's the clinician's responsibility to make sure that the patient's using it in a responsible way without the side effects. But sometimes, you know, doctors can be busy and also, it's like a quick visit. And it's like, that one just got by the goalie. Bob: Oh yeah, you maybe have so many medical issues to address. Chris: There were seven other things on the docket that you wanted to talk about. And that one just got, it just slid under the rug, so to speak. Bob: I was talking to a doctor friend who has all these little old ladies and they're on Ambien and, they don't want to be off. Chris: They don't want to be off, nope. Bob: It gets them to sleep, they don't want to get off it. Chris: Exactly. And that's one of the hard things, it's very hard. I actually was reading an article last night about a doctor suggesting how do people stop these things? And it's like, they try. Bob: It's difficult. Chris: And it is, long-term, it's just not a good solution. And so we don't want people on them indefinitely. Bob: Do you have to take these with food or not? Chris: No, in a lot of cases, it's not. The biggest thing, just stay away from alcohol and some other substances while you're on it. But you know, it can be with, without food. Kind of depends on your stomach and you know, what your GI tolerances are. So if it's something that you got a little bit of a touchy tummy, you have piece of toast, some crackers with that. And always, you know, full glass of water is ideal from that regard. But for the most part, there's not a lot of GI side effects. The biggest things that we watch for are central. So it's going to be the dizziness, the drowsiness, the impaired driving of an automobile. I mean, and that's a big thing with benzos, take it with a panic attack and let's say you're at work. All of a sudden, now you have to get home. Taking these types of drugs, if you got in a car accident and the police are like, “were are you on any medications?” Well, I just had some little alprazolam at work. That's now a DUI at that point, driving under the influence. Bob: If somebody got hurt, you'd be… Chris: It's devastating. And I mean, their responses you know, I mean, it can go on forever, depending on how bad the scenario is. So these are things that you don't want to drive on because they do affect your coordination. I mean, you wouldn't go out and play baseball or golf on these things because you wouldn't be able to control, you just don't have the coordination physically because of how they work with the polarization in your cells and why it relaxes you. It's also why it works so effectively is because it allows the communication in those nerves to work a little bit more efficiently so that they tell the cells to kind of calm down. Bob: These, I imagine there's over the counter meds you don't want to take with this, too. Chris: Correct, there's actually several, a lot of the herbal products like kava, dangerous. Bob: Well maybe, some that make you sleepy. Chris: Antihistamines. So, I mean, if you look at, let's say Benadryl. Benadryl is kind of the granddaddy of all antihistamines, what is the number one side effect? Well, it's sedation, because it binds the histamine receptor and it makes you sleepy. It's also why you don't itch or have allergy symptoms. Well, when we take something that makes you sedated by itself, and then we add another ingredient that, we'll just pick on alprazolam today, that makes you tired. We take them both together, you see a synergistic response. And so what would be maybe somewhat tolerable or okay, now all of a sudden becomes, “wow, I am really knocked out.” Bob: So it's not one plus one equals two, it might be one plus one equals three? Chris: Six. Bob: Or six, wow. Chris: Yeah. I mean, it just depends on your metabolism and the doses of what you've taken. So there's a lot of factors, your genetics. So there's a lot of factors that go into these things and, these are the things that pharmacists talk to you about, your doctor talks to you about. But you know, there's certain things that, yeah, we can't just indiscriminately, just medicate with other stuff when we're on certain things. And so that's why I like to think I have a job. I encourage everybody, if there's a question, please call. I am happy to take any phone call, anytime, anyplace, anywhere. Bob: Yep, he does a great job. Chris: If they have a question on something. So we're going to try and minimize those effects, just because at the end of the day, we have to keep you safe. Number one. Bob: Awesome. Well, I think we'll wrap it up there. If you got questions, put them in the comments below and we'll maybe address them in a future video, if we see the same one popping up a lot. So that we know what people are thinking. Chris: All right. Sounds great, Bob. Bob: Thanks. 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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. For more information on Chris the Pharmacist check out our experts page.

How to Use the TENS Unit: If you are using an iReliev TENS unit we provide step-by-step video instruction on how to use the following types: iReliev 1313 iReliev 5050 iReliev 8080 Just go to the program section at bobandbrad.com and click on the TENS series. Under the series look for the videos with the 1313, 5050, or 8080 TENS units. If you are using a TENS unit from another manufacturer you will need to follow the instructions provided with the product. Where to Place the Pads: There is NOT a specific correct way to position or place the pads. The best approach is to place the pads wherever they relieve pain the most. Experiment and see what will work best for you. General Guidelines for Back of Hand: Use one channel and two pads. Place one pad (either one) directly on the pain. Place the other pad either directly below the other pad (at least a pad’s width apart). See Photo for Example Use one channel and two pads. Place one pad on each side of the pain (at least a pad’s width apart). General Guidelines for Pain Referred from Another Area: An example would be hand pain that is coming (referred) from the neck. Use of two channels and four pads. Using channel one (yellow pads), place the two pads along the nerve pathway. Using channel two (green pads), place one pad on the pain and one below the pain (at least a pad’s width apart). Reminder: do not place pads over open wounds or areas with excessive hair. Clean the area with soap and water prior to placement of the pads. Hand Treatment: Hand Range of Motion (6 pack) (Do 5 Repetitions) 1. Finger abduction (spreading apart) 2. Tabletop 3. Claw 4. Full curl into fist 5. Touch each finger with thumb 6. Touch tip of thumb to base of fifth finger For more information on the TENS programs visit: https://www.bobandbrad.com/tens-program If interested in purchasing the TENS/EMS unit by iReliev visit: https://ireliev.com/bobandbrad/?uid=15&oid=1&affid=10 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.