Rising Sun Physical Therapy April 2019

April 2019

“Sí se puede!”You have probably heard this phrase before, but did you know it was popularized by Cesar Chavez? You may have seen his name on buildings or street names. In San Francisco, dedications to Cesar Chavez are very popular, and in California, it’s a state holiday. Cesar Chavez Day, observed May 31 and April 1, is a holiday dedicated to the Mexican-American civil rights activist and labor leader. With Dolores Huerta, Chavez founded the United FarmWorkers union, which successfully negotiated on behalf of tens of thousands of migrant farm workers. From the ‘50s–’80s, Chavez helped organize boycotts for higher wages and farm workers rights, using aggressive but peaceful tactics for change. This is especially important to the Rising Sun Physical Therapy team, because we help a lot of patients with pain acquired from physical labor. Sometimes work can be hard on the body, and we want to take a moment to recognize one of the people who helped to make life a little easier for those who put their bodies on the line to earn a living. To those struggling on their healing journey :“Sí se puede!”We believe in you, and we are here to help. Happy Cesar Chavez Day from all of us here at Rising Sun Physical Therapy. MONTHLY MOMENTS Bettina’s

The Rise of the Juul W hat to K now A bout T his T een E pidemic

There’s a public health crisis blooming in the corners of high school bathrooms and classrooms, in clouds of mango-flavored vapor exhaled from the mouths of teens. As conventional cigarette use among high schoolers remains at its lowest point in years, overall use of tobacco products among young people has seen a recent uptick as e-cigarettes surge in popularity. Chief among these devices is the Juul, a sleek, discreet e-cigarette shaped like a USB drive. Since it first became available in 2015, the Juul has dominated the e-cigarette market, claiming close to 76 percent of U.S. e-cigarette market share at the end of 2018. It was developed as a safer alternative to smoking for adults, but unfortunately, it has become extremely popular among adolescents in the U.S. According to a 2018 survey conducted by the BMJ, “Juuling,” better known as “vaping,” is now considered a trend among teens, with 1 in 4 high school seniors familiar with the devices, and a little under 1 in 10 reporting recent use. The New York Times reports that as many as 3.6 million middle and high school students currently vape. The problem has gotten so widespread that U.S. Surgeon General Jerome M. Adams declared that e-cigarette use among young people has become an “epidemic.”

-Bettina Neumann

The question is how does Juuling work, and what are the risks? How worried should parents be? And, most importantly, what can they do about it?


The popularity of Juuls among teens is due to a couple of simple factors. Its attractive and covert thumb drive-like design makes it easy to use without getting caught at school. Plus Juul “juice” comes in fun, appealing flavors, like mango, strawberry kiwi, and mint, making it especially appealing to kids. The vast selection of flavors is one of the company’s major selling points, and their marketing boasts the tagline, “Discover your favorite flavor today.”

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Cover story, continued ...

But the main reason Juul users keep coming back is the same reason smokers reach for a pack of cigarettes: the nicotine itself.

of whether or not they would have engaged in tobacco use before.

gain are all symptoms of nicotine withdrawal — symptoms that pretty much every parent would like to spare their child from.



Each “pod” is packed with e-liquid that contains 59 milligrams of nicotine per

Fans of e-cigarettes, especially Juul, often insist their habit is less harmful than smoking traditional cigarettes. But the reality is e-cigarettes have only been available in the American market since 2007. Researchers are only just starting to realize the impact long-term e-cigarette use can have on our health. While Juuls might not as bad for you as traditional cigarettes, they are still extremely toxic and addictive. According to the National Center for Health Research, “The popularity of Juuls among adolescents exposes them to large amounts of nicotine that can have adverse health risks for their physical and emotional development.” At least one study has tentatively linked nicotine to cardiovascular issues, and it’s no secret that nicotine has been proven to be one of the most addictive chemicals in the world. Anxiety, depression, irritability, hunger, and weight

millimeter — a much higher concentration than in other e-cigarettes — in order to mimic the buzz that regular smokers experience from traditional cigarettes. When users inhale, the device vaporizes this liquid, which is then absorbed into the body at a speed comparable to regular cigarettes. Normal cigarettes use freebase nicotine, which can irritate the throat and lungs, but e-cigarettes use nicotine salts, which are designed to go down smoothly. The vapor doesn’t carry the clinging smell of cigarette smoke and disappears almost immediately. According to health experts, the lack of negative traits associated with traditional cigarettes —mainly the smoke and the bad smell —may lower the initial barrier to tobacco use and encourage teens to get started on e-cigarettes like the Juul, regardless

It’s clear that Juuling, vaping, and all forms of e-cigarette use are a huge danger to kids. The strategic marketing of Juul specifically seems to have successfully gained them customers for life in our nation’s youth. In 2018, the FDA announced it was cracking down on the illegal sales of e-cigarettes to minors and “kid-friendly marketing and appeal of these products.” If you’re looking to prevent your child from becoming one of the millions of teenage Juul users, simple awareness goes a long way. In one survey, most teen respondents didn’t even realize that Juul pods contain nicotine. The first step to protecting your kids from the dangers of Juul usage is to do your research and have an open conversation with them about the facts.

IS IT OKAY TO SKIP BREAKFAST? The Truth About the First Meal of the Day

Sometimes you skip breakfast simply because you don’t have time to eat. Other times, you skip breakfast because nothing really appeals to you. This is a common occurrence for many people across the country. But when you skip breakfast, you may find that you feel just fine. It begs the question: Is breakfast really that important? Do you need to eat breakfast? It depends. Most people can skip breakfast and be totally fine. They’ll make it to lunch without skipping a beat. It all comes down to how you feel . Some people need breakfast or they’ll have to deal with mood swings — often referred to as being “hangry”— caused by low blood sugar. A healthy breakfast can stabilize your mood, helping you feel more positive, energized, and focused throughout the morning. We can, however, bust the notion that breakfast is the “most important meal of the day.”This phrase was used to market breakfast cereal in the last century. In reality, it doesn’t mean anything. The most important meal of the day is whichever meal you get the most out of, whether it’s nutritional value, enjoyment, or both.

Having a healthy, protein-rich breakfast does come with benefits, though. It gives you energy for the day and helps you avoid scrambling to find something to eat a couple hours later when hunger sets in. All too often, skipping breakfast (or having a carb-heavy breakfast) leads people to raid the vending machine or make unhealthy food choices they wouldn’t ordinarily make. Along these same lines, skipping breakfast may encourage you to eat more later in the day at lunch or dinner. You may think you’re saving calories, but over the course of a day, you can end up consuming more calories than if you had simply eaten breakfast. With so much research on the subject of breakfast, one thing is clear: You should eat when you feel hungry. You don’t have to live by the conventional wisdom of “three squares a day.”When you listen to your body, you’ll feel better for it!

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3 Travel Myths You Should Stop Believing


Traveling has many social and educational benefits, but some people have hesitations that prevent them from jetting off on new adventures. Below are three debunked travel myths to give you some ease as you plan your summer vacation!

Fact: While jet lag can make you sleepy, it’s actually caused by a disruption in your circadian rhythm. Our bodies are cyclical, and the circadian rhythm is set by both a natural need for your body to reset and outside forces, such as your job, time zone, and diet. Travel can disrupt this rhythm and routine, which leaves you lethargic during and after your vacation. Sticking to water before and during your flights and staying physically active during and after traveling are great ways to fight jet lag and get back into your normal rhythm. Don’t let these travel myths keep you from seeing the world. Set a budget, go with your gut, and prepare for a shifting rhythm to make your next adventure the best one yet.


Fact: You can travel anywhere on a budget. Tracking flights to score the best deal, setting spending limits, and packing meals are a few ways to save money. Hostels and Airbnbs are great alternatives to spendy hotel stays. Additionally, you don’t have to cross the country to have a great trip. Every state has museums, unique roadside attractions, historical sites, and a booming nightlife. When you know your price limits and what you want to do, traveling can be a fun and inexpensive venture.


Fact: If you’re smart about what you do and where you go, traveling can be safe. Go with your gut and only stay somewhere that is approved by travel guides. Visit places you feel comfortable in, and do your research by reading travel blogs, websites, and books to find places that have been vetted by others. Traveling in groups can also be a great way to lower your risk of danger. As long as you plan ahead, you will have a safe trip.

Take a Break!

Pasta Primavera


12 ounces pasta, ideally fusilli

1 pint cherry tomatoes, halved

1/2 pound broccoli florets

1/2 teaspoon crushed red pepper flakes 1/2 cup grated Parmesan cheese, ideally Parmigiano- Reggiano Kosher salt, for pasta water and to taste

2 carrots, shredded

1 yellow bell pepper, cut into strips

1/4 cup extra-virgin olive oil

4 cloves garlic, thinly sliced


1. In a large pot, liberally salt water and bring to a boil. Add fusilli and cook according to package directions. Add broccoli, carrots, and bell pepper during the last 2 minutes of cook time. 2. Drain the pasta and veggies, reserving 1/2 cup of cooking liquid. Return pasta and veggies to pot. 3. In a large skillet, heat olive oil to medium heat. Add garlic and cook until translucent and golden, 30 seconds. Add tomatoes, red pepper flakes, and 1 teaspoon salt. Cook until tomatoes are wilted, about 2 minutes. Stir in reserved pasta water. 4. Add tomato mixture to pasta pot, stirring to coat evenly. 5. Divide into bowls, top with Parmesan cheese, and serve.

Recipe courtesy of foodnetwork.com

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Rising Sun Physical Therapy


risingsunphysicaltherapy.com (415) 282-4083 M-F 8:00 am - 7:00 pm

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INSIDE THIS ISSUE Bettina’s Monthly Moments PAGE 1 Why 3.6 Million Teens Are Using E-Cigarettes PAGE 1 Should You Skip Breakfast? PAGE 2 3 Travel Myths Debunked PAGE 3 Take a Break PAGE 3 Pasta Primavera PAGE 3 PT Helps Curb Opioid Abuse PAGE 4

AMID AN EPIDEMIC, PT HELPS CURB OPIOID ABUSE Why Exercise Therapy Should Be the First Step in Recovery

Today, a startling number of Americans suffer from opioid addiction. According to a report published in the Annual Review of Pharmacology and Toxicology, more than 4 percent of U.S. adults misused prescription opioids in 2018. Prescription drugs can lead to enough tragic overdoses on their own, but as the physical aspects of addiction set in and prescriptions dry out, addicts desperately turn to more serious drugs like heroin and fentanyl. Opioid addiction is indiscriminate; it can strike anyone of any social class, race, gender, or economic standing. This is one reason the overprescription of opioids over the last two decades, coupled with a more recent flood of street opioids, led to more than 70,000 deaths in 2017. In an effort to stem the tide of opioid- related deaths, the CDC issued a set of new recommendations to doctors in 2016. They questioned the effectiveness of opioids for the management of chronic pain and encouraged

physicians to instead focus on physical therapy, cognitive behavioral therapy, and other nonopioid pharmacologic options for long-term intervention. Studies show that physical therapy may have the potential to dramatically reduce opioid reliance, abuse, and overdose. In one 2017 study published in the Journal of the American Board of Family Medicine, researchers discovered that, in cases where doctors referred patients suffering from low back pain to a PT as a first-line

The evidence seems clear: If patients follow the recommendations of the CDC and consider physical therapy before taking pills, they substantially lower their risk of dependence on and abuse of prescription drugs. Of course, you should always follow the advice of your doctor, but consider requesting a referral to PT first — it’s just a safer, more consistent, and less expensive option. And who knows? It might just save your life!

treatment, the odds that the patient ended up needing an opioid prescription decreased significantly. Other studies have also reinforced the same trend for treatment post-surgery:

When physical therapy is the first recommendation, patients tend to use fewer opioids and actually spend less on treatment in the long run.

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