Rami's Blog

Like the Yin-Yang, Eastern Martial Arts and Western medicine are two halves of a whole. My mission is to preserve the ancient mind-body tools, and pass them on to you.


Integrative Pain Management, Part 1: The Problem of Pain

Chronic pain is a common symptom of countless conditions and injuries. Whether it's from fibromyalgia, knee osteoarthritis, cancer, or any other ailment, chronic pain can take you from 60 to 0 in no time flat. When doctors can't treat the underlying causes of chronic pain, "Take two aspirin and call me in the morning" just doesn't cut it.

Over the years, numerous solutions to the problem of chronic pain have developed, such as surgery, Cortisone shots, and Physiotherapy, to name a few. Each of these strategies has their ups and downs with regards to cost, invasiveness, permanence, chance of success, and so on. Many people find that one or more of these treatments is the solution they were looking for. Others, however, try all of them without any luck.

A recent development in the world of pain treatment is the widespread use of prescription painkillers, opioids in particular, which are a type of drug that works on the nervous system directly to inhibit pain. Common prescription opioids for pain relief include oxycodone, hydrocodone, codeine, morphine, and fentanyl, an accidental overdose of which is believed to have caused the death of the late great musical artist Prince

The consequences of prescribing addictive substances to patients, even in highly controlled dosages, are only coming to light now. The numbers, however, are already staggering. In 2012, 259 million opioid prescriptions were written in the US, which is enough to give one bottle of pills to every adult in America. In 2014, nearly 2 million Americans were addicted to prescription pain killers, and in the same year, almost 19,000 Americans died from overdosing on them. The rate of such deaths has quadrupled since 1999. (For these stats and more, check out the ASAM's opioid addiction report, as well as the CDC's section on opioid overdose.)

And perhaps the worst part of this national situation is that these people still have chronic pain. The painkillers only work for as long as they are taken, and eventually the body will develop a tolerance for the medications that will make them less effective. The solution that I and many others have collaborated on is Integrative Pain Management. This mind-body approach not only avoids the dangers of prescription medication or surgery, but also seeks to incorporate the entire being (body, breath, mind, energy, and spirit) into the healing process, and fix the underlying causes of the chronic pain so that, through practice and discipline, it can be cured and not just numbed.

Over the next several weeks I will be posting integrative pain management content selected from my chapter in the book Integrative Pain Management: Massage, Movement, and Mindfulness Based Approaches. Share the blogs with your friends, post them on Facebook, and retweet me on Twitter so that we can get this pain-fighting knowledge to the people who need it.

Happy Stretching!

Surgery, Exercise, and Understanding Your Body's Limits

One of the most difficult aspects of maintaining a healthy lifestyle is adapting your exercise, diet, and activities to your body's changing capabilities. There are countless reasons why our body may not work the same as it used to. Injury, surgery, having children, and even the natural aging process can change our body's ability to function. It could even be something as simple as not getting a chance to exercise for a while.

In my experience, if I don't do arm exercises for a couple weeks, I have to ease back into a routine to avoid straining myself too much and risking injury. When I am in good practice, I can do two sets of 30 wall push-ups (elbows in then elbows out). But if I even go two weeks without upper body exercise, I need to start back at 15 repetitions on each set, rather than the full 30.

And what if you have just had surgery? Many exercises on the blog are related to recovering from or preparing for surgery. I always show you how to do the exercise with no resistance, because adding resistance when you are weak after surgery is dangerous. You have to accept your new level of ability, and slowly work your way back up to your previous capability. Even if you are not strong enough to completely lift your arms, or if you have very low range of motion after an operation, do not feel ashamed and do not push yourself to get better too fast. The wise thing to do is to be confident that you will get better with time, and stick to your new routine very closely.

Recently, I had a blog reader ask me how they should do the breast cancer exercises when they aren't planning on having surgery. Should they do them the same? Differently? Should they bother to do them at all?

My answer was, of course they should do them! These exercises are not just for surgery, but for getting oxygen and healing energy to the site of the cancer. The difference is, what is your 80% level when you have not had surgery? 80% effort after surgery might mean just stretching your chest a tiny bit while lying in bed. If you aren't having surgery, but are going through chemo, 80% effort may be doing a few chest exercises for 10 minutes while sitting in a chair. If you are completed treatment and are feeling healthy, 80% effort could be chest and arm motions with some 5lb weights in your hands, while standing up.

It's all about recognizing what your ability is at this stage of your life, and doing the right amount of exercise to maximize healing and minimize your chance of further injury or illness.

Happy Stretching!

Easy Yoga Series on Cancer Wellness TV

Hello mind-body students! I have exciting news about some great content you can get on Cancer Wellness TV.

My amazing Dana-Farber colleague (and cancer survivor herself), Anne Marie Turo, has released a new video on Cancer Wellness TV to kick off her "Easy Yoga" series, which is focused on helping cancer patients, or anyone who is suffering from serious illness or trauma and have low mobility and energy, to recuperate as fast as possible.

This first piece, the Bed Yoga routine, is designed to increase a person's levels of strength, flexibility, and energy, from the comfort of their bed. And of course, I wouldn't say this exercise is complete until you incorporate deep breathing and empty-full moon, which Anne Marie mentions right at the beginning. She also ends the video with a helpful guide to getting out of bed when you have very low strength and energy.

Please continue to support Cancer Wellness TV, such as by making a free account or giving a donation. We will be producing very high quality, useful content for anyone looking to lead a healthier life, cancer patient, survivor, or otherwise. 

Happy Stretching!

Visualize Your Goals

Many inspiring people and self-help authors have told people that visualizing your goals helps you achieve them. In recent years, studies have even supported this, at least as far as athletic performance goes. But can it work for healing?

Well, I don't think you can make cancer disappear with sheer force of will. That being said, if you aren't using the power of the mind and visualizations as part of your treatment, for cancer, back problems, chronic pain, or anything else, then you are wasting a potent, and totally free, resource for health and wellness.

I use visualizations with my patients, but they are very concrete. They are focused on where you are now, and how you feel, and how to slowly change that.

Here is an example you can use at home.

If you have stiff muscles or joint, anywhere on your body, go outside and sit in the sun. If it is cold or raining outside, sit inside with a blanket to keep you warm.

Set up some sounds of gently running water. If you have a stream near your house, or a fountain in your yard, that's perfect. Otherwise, just search for some river sounds on YouTube.

No sit or lie down comfortably so you aren't putting any weight on the tense or painful areas. Close your eyes and picture the affected areas like blocks of ice. Stiff, cold, painful ice that is attached to your body. Most people find this part comes pretty naturally.

Next feel the warmth around you, from the sun or the blanket, and visualize it sinking into your body. Breath deeply. Your body is like a glacier and the sun has just come up.

Slowly, as though you were watching a real glacier, visualize the ice on your body begin to melt. Picture tiny streams of cool water trickling down to the ground. Think about what the water would sound like. Feel your muscles and joints relaxing and picture the ice cracking and melting as it happens.

If you feel very warm, and it feels good, you can even picture the ice evaporating into steam and floating away. Make believe you hear the steam just like you hear the water running.

You can do this visualization as long as you want. Just make sure you aren't experiencing any pain, and put on sunscreen if you plan to sit in the sun for a while.

June is Men's Health Month

June is the nationally recognized month for educating people about men's health, and raising awareness of health issues specific to men such as increased risk of heart disease, prostate and testicular cancer, etc.

With the exception of a few sexual health exercises, all of the techniques I have talked about on this blog are for men and women alike. One exercise, the testicle massage, is not only an important tool for improving men's sexual health, but also a perfect time to check for possible testicular cancer with a self exam

If you are a man, 14 years old or older, you should be doing a self exam once a month. Testicular cancer has an extremely high rate of cure when detected early. Don't let something that can be found so easily in a few minutes go unnoticed.

For men 35 and above, regular prostate exams are a must. Although the survival rate for prostate cancer is also very high, it is about 30 times more prevalent than testicular cancer, and if metastasized, prostate cancer's survival rate sharply decreases. The exam for detecting an enlarged prostate requires even less of your time than the testicular self exam, and can be done by your doctor during your annual physical.

There is plenty more to talk about regarding men's health and prevention, but I'll let you explore other resources for those things. Make sure one of those other resources is your primary care physician!

Happy stretching!