The hip, the hip; no wait, it is the Greater Trochanter. Anytime someone says that he/she has “hip” pain I always question where exactly she/he is talking about. Nine times out of ten the area of pain is not the actual hip joint, but rather the Greater Trochanter.
The Greater Trochanter is at the top of the femur, on the side (see Picture, the green pen is pointing to the Greater Trochanter). The actual hip joint lies deep within the pelvis, near the pubic bone (see picture, the pink pen is pointing to the hip joint). Distinguishing between the two areas of potential pain is very important to arrive at the correct diagnosis and treatment plan.

Why would the Greater Trochanter become painful? I can think of six reasons: 1) Quadratus Femoris 2) Gluteus Medius 3) Piriformis 4) Gluteus Minimus 5) Obturator Internus 6) Obturator Externus. These six muscles all attach to the Greater Trochanter and these insertion points can become inflamed and painful (called tendonitis). Another reason that the area of the Greater Trochanter can become painful is called bursitis. A bursa allows freedom of movement and cushioning for the tendon as it passes over a bone. This bursa can also become inflamed and painful—bursitis. Greater Trochanter pain is not a sign of hip joint arthritis because the hip joint is in a totally separate area. For this reason, Greater Trochanter pain is treated differently than hip joint pain.

Thus ends the anatomy lesson.

Drugs in the Water Systems

Some tasks should be done once per year like spring house cleaning or closet cleaning. Reorganizing and regrouping the clutter that accumulates over the year is necessary to avoiding a heap of chaos. The same can be said for the medicine cabinet. Medicines accumulate over time and that can lead to a potentially dangerous situation; the more bottles, the more confusion and chance for an unintentional medication accident. Recently, I discovered that an 86 year old patient of mine had amassed a huge amount of expired prescriptions. Plus, she was medicating herself with this supply depending on how she felt. That’s scary.

Opening a medicine cabinet can also be scary. Petrified toothpaste, tangled dental floss, and dust bunnies lie along side drugs that date back to the 90’s, 80’s, and even 70’s. Now is the best time to clean out the medicine cabinet. But here is the dilemma: What do you do with the old drugs? Some people prefer for the convenience and ease of the flushing them. What’s the harm in that, right? Wrong, the Environmental Protection Agency is now charged with monitoring the drugs in the drinking water. That is right; drugs are in the drinking water. Most of these drugs are there not from intentional dumping, but from being excreted in the urine. Still, flushing drugs is not the best way for ridding ourselves of unwanted medications. In fact, the Federal Drug Administration has an official “Flush it” list of approved drugs for flushing, most of which are opioids and benzodiazepines. What about the non-“Flush-It” medications? What do you do with those?

The safest way to discard the drugs is through medication “take-back” programs. Locally, the Grass Valley Police Department has a collection system for drugs. This year, the Waste Management Company will also start a medication collection program. Pharmacies, hospitals, and clinics do not want the prescriptions returned to them. So, if a “take-back” program is not available, the FDA recommends mixing the chemicals in “kitty litter” or “coffee grounds” and put the whole thing in the trash. The whole idea is to keep the drugs out of the wrong hands which can be very small hands indeed.

The whole idea for cleaning out the medicine cabinet is to keep you safe. Besides, who wants a 30 year old bottle of drugs that has been hanging out with dust bunnies.

Is 2010 off to a good start for you? January is the month when many people think about making improvements, changes, and refinements. All of this is in an effort to create something significant, something momentous. Each New Year, each new day presents an opportunity for distilling an earthshaking potion for a better life. What ingredients will you add to your potion this year or today?

Happiness might be a good place to start. You have the right to pursue happiness despite what ails you. Recently, one patient told me about her mission and a website called the Happiness Project. If anyone needs some advice about how to find a bit of paradise in the world, this website is a great place to spark your quest. We should all be In Pursuit of Happiness.

Another ingredient in your world-shattering potion should also be relaxation. Do you start your day in a calm or anxious state of mind? Have you started your year in a calm state of mind? Energy levels not only effect how you feel, but also effect every being around you: children, pets, parents, co-workers, and friends. With four dogs, I can attest that starting the day with calm state of mind helps my pack. We begin each morning with a meditative walk. With each turn around the property in the right, relaxed state of mind, I am one fundamental step closer to having a momentous day. What is your next step into the first turn of 2010?

Ultimately, your day and your year is what you make of it. You will go in the direction that you are looking towards; be it mundane or momentous.

Men, how can you control pain with food? A critical link to feeling better is the inflammation process that can be fueled by what you eat. Learn what an anti-inflammatory diet can do for you by joining Dr. Christina Lasich at In The Kitchen on March 4th, 2010. Sign up by calling Wendy VanWagner at 530-478-0669.

Event Description:
This dinner program is designed with the thought that food can represent a form of medicine and be pleasing to even the manliest man. Dr. Christina Lasich, MD has designed a menu for a small group of MEN ONLY that will emphasize the ways cooking can control pain. Please look for nutritious spins off of these old favorites. Dr. Lasich will discuss topics such as antioxidants, glycemic index versus load, herbal remedies for pain, and full flavor, manly cooking. The cost is $35 per man. The event is on March 4th, 2010 from 6:30 pm to 8:30pm. Please sign up soon because space is limited.

Menu

Chips and Dip

Spaghetti and Meat Sauce

Apple Pie

Most people do not think that “healthy” and “holiday” can be in the same sentence. Wrong. Surprise your friends with a tasty, nutritious treat from my favorite cookbook, “Vegetable Dishes, I can’t live without” by Mollie Katzen.

Broccoli Dipped In Wonderful Peanut Sauce
1 large bunch broccoli (pound or more)
1 cup good smooth peanut butter
3 to 4 Tablespoons light-colored honey
1 cup hot water
2 to 3 Tablespoons soy sauce
1 ½ teaspoon minced garlic
2 teaspoons cider vinegar
4 Tablespoons of minced cilantro
Salt to taste
Cayenne to taste

Bring a large pot of water to boil. Meanwhile, trim and discard the tough ends of the broccoli stems. Cut the broccoli into spears.

When the water boils, plunge broccoli into the water for 3 minutes. Remove and cool under cold water. Drain and dry the broccoli completely. Transfer to Zip bag and store in frig until ready.

Place peanut butter and honey in bowl. Add the hot water. Whisk smooth. Stir in remaining ingredients. Season to taste and mix well. Serve peanut sauce warm or room temperature with cool broccoli. Enjoy.

Even children will eat this appetizer. Plus, it is a healthy way to celebrate without any guilt.

Have you ever needed a kick in the butt? Some type of push that motivates change is what a kick in the butt is meant to do. Sometimes the push works, sometimes the push backfires. Most of the time, a push, a nudge or a shove in the right direction is what someone needs. However, the one who does the pushing is usually risking retaliation. Is the risk worth it? Absolutely, especially when it comes to getting someone to quit a destructive addiction, a kick in the butt can be a life saver.

Recently, I kicked a patient’s butt. She came into my office smelling like an ashtray. I said to her, “How do you expect to feel better if you continue to smoke?” Her immediate response was that she did not smoke that much, only “8 per day”. I responded by saying , “Well, that is more than most people like me who do not smoke.” After pondering what I just said, she left rubbing her butt a little after that good, stiff kick. The next visit (yes, she did come back to see me) she gave me a huge hug and thanked me for pushing her to quit smoking. “See, I do not smell like an ashtray” she said. That lifestyle change is the most important one she will ever make. Each day of abstinence from smoking is a step towards being pain free.

That’s right; smokers cannot expect to be pain free because smoking causes pain. Smoking damages discs in the spine, cartilage in the joints, nerves in the limbs. All this damage makes smoking the single most common denominator in my chronic pain population. I would even venture to guess that if it was not for smoking (and obesity) I would be out of business as a pain specialist. Surprisingly, most people do not connect smoking with pain. People connect smoking with cancer, lung disease, and maybe heart disease. But when I tell a patient that his/her spinal discs have rapidly degenerated because of smoking, that person gets a deer-in-the- headlights look of shock on his/her face. The next thing out of his/her mouth is usually, “Really, no one has ever told me that”. After being in and out of doctor’s office because of a painful condition, I find it hard to believe that “no one” has ever suggested to this patient to quit smoking in an effort to stop the painful process. Maybe the patient chose not to hear the suggestion or maybe “no one” ever risked giving a patient a kick in the butt. Either way, the time has come to get tough on smokers. No more excuses.

Here in California, the public health department has a “No Butts” program which includes a smoker’s hotline and information for the public and health personnel about kickin’ the butts. Help is out there. Locally, community hospitals often have “quit smoking” classes and support groups. However, unless someone is pushing a smoker in the right direction, these addicts have little motivation to stop the behavior of destruction. With a new year approaching, now is the perfect time to give someone you know a kick in the butt. Tell a friend or family member to “kick the butts now because the New Year can bring a New You”. Kick hard, kick often, and share the knowledge.

The bedroom is not just about sex; it’s about sleep. That’s right, sleep, a rejuvenating weapon against stress and fatigue. But sometimes, those little aches and pains become a barrier between you and a good night’s sleep. No, don’t reach for the pill bottle. A perfectly placed pillow may be all that you need. Side sleepers, stomach sleepers, and back sleepers; cushioning works for all types of sleeping. Let’s talk pillow strategy.

SIDE SLEEPERS

Most people are side sleepers. This position is usually the most comfortable for those with back pain, especially when the knees are pulled close to the chest—the fetal position. However, the shapely curves of your womanly figure can be problematic while sleeping on your side. Here are some strategies to bring you a more comfortable night’s sleep.

• Use a pillow (at least 5” thick) between your knees because our hips are wider than the knees, so a pillow here insures proper alignment of the spine.
• Use a pillow thick enough to fill the space between the head and shoulder tip. Again, proper alignment is gained with a pillow to fill this gap, without this you might wake up with a kink in your neck.
• Rest your upper arm on cushion like a body pillow. The upper arm needs support; otherwise, gravity pulls on the shoulder or tugs on the sensitive nerves in your neck.
• Try a small towel or soft, small pillow at your waist because our hips are wider than our waist (usually!?!), a gap is created and gravity fills the gap by misaligning our spine.
• Do not sleep on your side with a thin, flat pillow supporting your head. The head/neck will reach for the pillow in order for the head to rest on the pillow. Stretching and bending your neck all night will cause a pain in the neck.

STOMACH SLEEPERS

This position is favored by some for a change of pace; although, the neck will not favor this way of sleeping. Also, lying on the stomach can be uncomfortable for those with back pain because tightness around the hips causes extra strain in the low back. But, one key pillow placement may be all that you need to make stomach sleeping work for you.

• Try a pillow or stack of pillows under your stomach and chest. The extra height of the torso above the mattress will flex the hip and ease the back strain

BACK SLEEPERS

Again, this position can be uncomfortable for your lower back because your hips are too tight from sitting all day long. With proper pillow placement, sleeping on your back can actually be very comfortable.

• Use a thin pillow under your head. Very little gap exists between the back of the head and shoulders in this position; therefore, a thin pillow is required for good alignment.

• Try to support your knees on a few pillows. Remember, when the knees are closer to the chest (like a fetal position), back discomfort is eased.

ALL SLEEPERS

Now, you may be visualizing yourself in bed surrounded by pillows that create a barrier between you and your loved one (see page 65 in my book, High Heels to Hormones: A Woman’s Guide to Spine Care). Rest assured, just a few strategic pillows will not prevent a little romance and will provide you some rejuvenating sleep. Hopefully, you noticed the common denominator for the use of pillows—alignment. If your spine spends a whole night out of alignment, you will have pain. No matter if you sleep on your side, sleep on your stomach, or sleep on your back, body positioning is the key to comfort. If you change position throughout the night, keep some pillows handy that you can grab and place strategically. Waking up in pain is no fun. So, work with your curves, fill the gaps, and sleep well tonight because pillow talk just makes sense.

Faith comes in many forms: a faithful friend, faith in expert advice, and faith in a higher power. When it comes to living with chronic conditions, faith can heal in many ways. Some draw on faith for strength and comfort. Some use faith to distract from the suffering. Others use faith to find hope and solstice. How do you use faith for healing?

That question was posed recently by The Washington Post. I see faith used in many ways by my patients. By far, the most common form of faith is found in the act of communing. Communing is a type of interaction and communication. Whether one communes with a friend or with a higher power, both ways provide support in times of need. I invite you to read further about Communing and Healing.

When I need a restorative force in my life, I turn to the natural world. Upon looking at a beautiful vista, Ralph Waldo Emerson once said, “Now let me die, for I am happy”. I have certainly felt that way when witnessing something divinely beautiful, like the time when I watched the sunrise over the Grand Canyon (see picture) or the time when I skied through a quiet stretch of forest after a fresh snowfall. Yes, God has revealed himself to me through nature.

I also remember my darkest day when the will to live was kicked out of me. On that day, I took a walk and let the healing powers of the wilderness wash over me. At that moment of seemingly endless suffering, I worshiped God’s creation in God’s cathedral—the wilderness. Somehow, the connection with the trees, the water, the wind, and those that live in the woods reminds me that my problems are small and surmountable.

Recently, a special series about the National Parks by Ken Burns aired on public television. The first episode was fittingly called “The Scriptures of Nature”. John Muir, Ralph Waldo Emerson, and Teddy Roosevelt all felt compelled to preserve the holiest of lands for future generations to have some way to feel grounded. We all need to feel grounded in times of distress and suffering. The natural world has inspired many cultures across the history of time. Such inspiration can only be called one thing—the Gospel of Nature. This gospel says that a spiritual communion awaits you in God’s cathedral. Thus ends the lesson, Amen.

Any doctor who prescribes opiate painkillers is required by the Drug Enforcement Administration (DEA) to monitor for inappropriate use of the prescription drugs. Prescription drug abuse is a very big problem in this world and prescribing doctors should feel morally obligated to make sure the drugs he/she prescribes are not doing any harm. Patients should also welcome monitoring because it improves safety by looking for hidden problems. Two types of monitoring are used by most doctors: Urine Drug Testing and Prescription Monitoring Systems. I use both in my practice. By monitoring, I am able to identify addiction behavior, prescription abuse, prescription non-compliance, and dangerous poly-chemical use. Monitoring is not fool-proof or perfect. The information gathered serves as pieces to a puzzle and means to an open, honest dialogue. In this imperfect world, patient monitoring is necessary for anyone who treats pain with chemicals.

With that said, those who prescribe marijuana should also be concerned about patient monitoring. Many people are using multiple substances from multiple doctors. The interactions between these mind-altering substances can have serious personal and public safety consequences. Just as I do not allow those who use opiates to drink alcohol, I do not allow those who use opiates to use marijuana and vise-a-versa. Mixing chemicals exponentially increases the risk for disaster.

Now that the federal government has relaxed its regulations about medical marijuana, we should all start wondering about the implications. Are those who prescribe marijuana monitoring properly? Are those who use marijuana mixing it with other mind-altering substances? Is that driver next to you driving under the influence? Until something bad happens, Americans have become comfortably numb to the use of chemicals from caffeine to morphine and now to marijuana.

Recently, a 17 year old died from a heroin over-dose. That woke-up this town and local law enforcement to take a harder look at what we allow to happen right under our nose. The U.S. Center for Disease Control and Prevention has reported that prescription opioid painkiller deaths are higher than deaths from illegal drugs such as heroin and cocaine. But don’t let anyone tell you otherwise, all chemicals have the potential to cause harm. Any chemical use can quickly turn into a harmful or dangerous situation if not properly monitored and regulated.

As a doctor, I am happy to diligently monitor in order to protect my patients and the public from the harmful effects of chemicals. I hope that the federal government does not completely give in to the wants of the people and relax all regulations about mind-altering substances. Of course, the government does not have an obligation to do no harm. But, I do.

Have you ever been in a starkly white room waiting to see the doctor? Feels a bit uncomfortable and harsh, such an environment is not conducive to comfortable openness. If any place, the rooms where hearts are mended or broken should be warm and inviting. The use of colors can break through the barriers of ice-like white. Everyone has a favorite color. Some love the entire spectrum. Whichever colors are chosen, your spaces should be colored.
Colors portray personality.
Colors set a mood.
Colors embrace the occupants.
Colors provoke thought.
Colors provide accent.
Colors attract the mind.
Colors evoke memories.
Colors stimulate ideas.
Colors dazzle the eyes.
Colors comfort the soul.
Come see the new colors in my new office and let me know what you think:
900 East Main Street #200
Grass Valley, CA 95945

I look forward to seeing you in my new space for healing.