Leslie R DeLaney MD

“What Happened?”

June 9, 2016 by Leslie R DeLaney MD 1 Comment

This was what my new IT consultant asked me regarding the prescription narcotic addiction epidemic that this country is currently being plagued by. He said he wanted to get the information directly from an expert. So here is a more historical, although still oversimplified version of this complex issue.

Chronic pain is a medical problem that has existed for centuries. Soldiers in WWI were diagnosed with Complex Regional Pain Syndrome due to severe nerve injury, although it wasn’t named as such for decades later. Since the development of the Pain Management specialty in the early 1950s, new ways of treating chronic pain have been adopted into the physician’s armamentarium. In the 1980s, opioids or morphine like medications, i.e. narcotics, gained traction as legitimate and appropriate medications to treat chronic pain. The philosophy at that time and until relatively recently was, “give patients as much as they need to be comfortable.” Essentially what this meant was, if they continued to complain of pain, increase the dose. The risk of narcotic addiction was deemed “low” or less than 1% if the patient was being treated for a pain process. As a result, many people were helped and able to live more productive lives by the use of narcotic medications for severe pain.

Now, fast forward to 2003 when a national initiative occurred to treat pain as “the fifth vital sign.” The four vital signs to assess someone’s wellbeing or acute medical state are: Temperature, Heart Rate, Blood Pressure, and Respiratory Rate. As a new diagnostic tool, physicians were asked to evaluate and treat vital sign number five: Pain Score. I believe that it is absolutely important to consider pain a vital sign for an acute situation such as for the postoperative assessment or acute injury scenario. In medicine, it is accepted that untreated acute pain can cause a multitude of complications including hypertension, hyperglycemia, anxiety, depression and chronic pain, to name a few. As a result of the initiative, which turned out to be largely funded by Big Pharma; who has patents on “designer” narcotic medications; many physicians who weren’t previously prescribing pain medications began to do so in the effort to help more people.

Chronic pain is a complicated process commonly confounded by factors that aren’t directly related to physical changes. Any kind of chronic pain can be worsened by depression, anxiety or any type of external stressor. For example, if a person with chronic low back pain is also undergoing a divorce or dealing with a death in the family, the severity of pain will seem much worse because their pain tolerance is lower. Emotional distress can make a preexisting pain feel more intense because one’s coping mechanisms are being overloaded and compromised by the additional burden. Narcotic pain medications should not be used in these circumstances and the dose for someone already taking them should not be increased to respond to this type of exacerbation. When narcotics are used to treat pain associated with a weakened coping mechanism, or “emotional pain,” the risk of long term use and addiction are greater. Also, there are other ways to treat pain besides medication such as nerve blocks, steroid injections, physical therapy, chiropractic treatments, biofeedback and relaxation, and acupuncture, that should be incorporated into both short and long term plans to avoid narcotic side effects.

Using a pain score to decide the amount of narcotic medication needed without also incorporating other assessment tools such as physical functional level, emotional state, mental function and overall health, can lead to over-prescribing, continuous dose escalation and an increased risk of overdose. Narcotics also have what is called a “ceiling effect” which means that there is a limit to the pain relieving effect it can have despite how large the dose is. This is particularly important because there is no ceiling effect to the risk of overdose. The larger the dose, the more likely it is that a person can inadvertently overdose with it. Moreover, if a person is also taking a medication for anxiety and/or insomnia and/or drinking alcohol and/or taking illegal drugs, the risk of overdose then becomes exponentially higher because these factors all lower the threshold for overdose when combined with a narcotic medication.

In order to restrain the prescription addiction epidemic, we all need to accept responsibility and act accordingly. Big Pharma should fund treatment centers for patients who have succumbed to addiction disorders to prescription narcotics. Physicians who want to continue to prescribe narcotics for chronic pain should have appropriate training or refer to those who do. Patients need to have realistic treatment goals and inform their doctors of factors that could increase their risk of addiction. Families of patients with chronic pain and or addiction need to get involved by providing additional support or information in the patient-physician treatment dynamic when needed. I appreciate it when family members accompany patients to office visits because it gives me another perspective on their home lives and functional levels that the patients don’t necessarily divulge.

My philosophy and approach to treating chronic pain is to balance the treatment modalities so that the patient has the benefit of different treatments that lower the risk of side effects to any one particular approach. I use medications to treat a specific diagnosis and cause of pain; which may or may not be narcotic analgesics; along with steroid injections or nerve blocks that can break the cycle of pain and minimize the dose needed of pain medications.The goal of pain management is to reduce the suffering from pain and minimize disability in the safest possible way for the greatest benefit and least harm.

The Anesthesiologist: Your Medical Lifeguard.

May 7, 2016 by Leslie R DeLaney MD 1 Comment

I’ve been reading news articles lately about increased occurrences of patients who have to pay for costly anesthesiology services that are considered “out of network” with their insurance plans. Understandably, people are angry at these unexpected costs above what they’ve already agreed to pay or have paid for their surgical procedures. The insurance companies are taking advantage of all of us. As a doctor, I’m paid consistently less over time for the same hard work and medical expertise and as a patient I know that my insurance premiums and out of pocket costs keep going higher despite the fact that I have no health issues. Apparently, insurance companies are now unwilling to give fair reimbursement contracts to anesthesiology groups for their work and in turn anesthesiologists are deciding to not take less payment than they deserve. This is why the patient then is billed for something that is entirely out of their control and unfairly uncovered by some insurance plans. I believe the answer is to hold insurance companies accountable to offer affordable medical coverage for patients and a fair payment system for all doctors’ services. Something that I’ve also come to realize however, is that few people, even other physicians, understand who and what an Anesthesiologist actually does.

An anesthesiologist is a physician who has completed four years of medical school, four years of residency and in some cases up to three more years of fellowship for a specific specialty such as Pain Management, Cardiac or Pediatric anesthesiology, for example. The anesthesiologist’s role in the operating room is critical. We are there to make sure that you live through whatever surgical or non-surgical procedure you might need. In most cases surgery is a traumatic experience for the body, and depending upon the age, health status and type of surgery involved, the risk of complications or death can be immense. Unfortunately, even a seemingly healthy person can have an adverse outcome during or following surgery.

It is the anesthesiologist’s job to evaluate the patient in relation to the type of surgery needed, then devise a safe plan to successfully take them through the surgery with the least amount of stress, pain and side effects. We’re actually trained to have plans B and C in mind before going into the operating room with a patient to make sure that even the unexpected is expected.

“Putting people to sleep” is what most people know about anesthesiology. This is, in fact, an inaccurate synopsis of the specialty. A good doctor knows when not to put a patient to sleep and oftentimes the safest option is what is called a “regional anesthetic” which puts only the part of the body that is having surgery to sleep. A knee or hip replacement surgery, for example, is often done with an epidural or spinal injection that makes the person numb from the waist or groin down for the duration of the surgery. In this way, the patient is exposed to less anesthetic. An anesthetic is a medication or compound that causes loss of the ability to perceive pain.

All general anesthetics can affect heart, lung, kidney and liver function. In patients who are already ill or elderly, the anesthetic itself can be harmful. Anesthesiologists provide second to second monitoring during the surgery to ensure that a patient’s heart, lungs and kidneys are not being stressed. We are very knowledgeable of various specialties of medicine including cardiology, neurology, pulmonology, and nephrology because we need to anticipate how the body might be affected by surgical trauma and stress and know how to treat any emergencies that might arise to ensure the least possible harm from surgery. We are also real time pharmacologists as it is important for us to know how different drugs interact with each other and with the anesthetics we might need to use in addition to the medications that the patient might normally take.

Obviously, no one goes to the hospital to have anesthesia, but no one wants to have surgery without it either. Anesthesiologist services should never be an additional cost to the patient who needs non-elective surgery. Hopefully, we will eventually find a solution to the ongoing abuse by insurance companies on their insured members and medical providers.

Quit Smoking – It’s Bad for your Cat

March 30, 2016 by Leslie R DeLaney MD Leave a Comment

There is now an anti-smoking ad that is trying to appeal to smokers’ love for their cats. Cats that live in the homes of smokers are more likely to die of cancer and other diseases. If it’s not a powerful enough reason to quit for your own health or for the sake of your human family, then by all means, quit for your cat. Allow me to give you some specific and concrete information about why smoking is bad for you and your cat.

I speak to people everyday about how their smoking addiction is hurting their health. For the most part, people understand that smoking is “bad” and that they are at an increased risk of cancer. It seems though, that their belief is that the harmful effects of smoking are far off into the future and something to worry about “later.” This couldn’t be further from the truth, because the harmful effects of smoking are affecting organ function now on a day to day basis. Far before causing cancer, smoking causes COPD, Cataracts, Crohn’s disease, Rheumatoid arthritis, Infertility, Impotence, Psoriasis, Reynaud’s phenomenon and many other illnesses. Smokers have a general life expectancy of ten years less than non-smokers.

There are many toxic elements in tobacco, even smokeless tobacco, that cause disease and illness. Tobacco smoke contains over 4,000 chemical compounds including carbon monoxide, arsenic, cyanide and formaldehyde. E-cigarettes aren’t currently monitored or controlled by the FDA, so there are large discrepancies in content from manufacturer to manufacturer, but formaldehyde and other cancer causing compounds have also been found in the solution that is then mixed with nicotine in the cartridges. Even the “nicotine-free” cartridges have been found to have traceable amounts of nicotine.

Obviously, inhaling the poisons in cigarettes is harmful, but nicotine itself is a poison in the body beyond its addictive properties. Nicotine causes vasoconstriction or tightening of the arteries of the body so that blood doesn’t flow as quickly and easily to the places that it needs to go. Blood carries nutrients and oxygen to skin, muscles, nerves, bone and soft tissues. Some tissues don’t have blood flowing to them directly and they have to rely on nearby blood vessels to leak nutrients and oxygen by diffusion to get what they need. A person who smokes is automatically making their heart work harder by having to push blood into the body against the resistance of the narrowed arteries. This causes high blood pressure. The body works harder to get blood flowing therefore it has to decide which organs need the blood and oxygen the most. The brain, heart, liver, lungs and kidneys are the “vessel rich” organs that need it the most. The skin, nerves, bones, discs of the spine, ligaments and other areas get less. Skin is the largest organ of the body and its appearance is a tell tale sign of what’s happening on the inside of the body. Smokers look older than they are because their skin isn’t getting enough blood flow and oxygen causing early wrinkles, sagging and a dull, dry, off color look.

More and more studies on the effects of tobacco use are showing that chronic pain, especially neck and low back, is directly related to smoking. The discs of the spine only get oxygen and nutrients through passive diffusion of blood flow from nearby spinal arteries. Discs that don’t get proper blood flow and nutrients are more likely to have early degeneration and lose their cushion effect on the spine which can cause nerve pain and damage. Slower tissue growth and healing is a major problem for all smokers whether they are healing from a relatively minor injury or surgery. Any type of chronic pain is made worse by smoking tobacco or e-cigarettes because those toxic elements accumulate in the tissues and prevent the body from healing itself. Unfortunately chronic pain isn’t always preventable or treatable but the decision to smoke can be changed and the harmful effects of smoking can be reversed if done early enough.

Lose Weight and Live Healthier for The Rest of Your Life!

March 6, 2016 by Leslie R DeLaney MD Leave a Comment

Obesity has become an insidious national health concern over the past 20 years for multiple reasons. Fast food restaurants have made it easier and cheaper to eat an unhealthy diet than a healthy one. Our entire culture in fact has gradually moved to “bigger is better” mentality where literally everything can be Supersized. Since the 1970s the average caloric intake has increased by 600 calories per day. Over a week, 500 extra calories per day will cause weight gain of one pound—that’s 52 pounds in a year!

All of us can develop bad eating habits for different reasons. For one reason or another, food can satisfy needs other than hunger and sustenance. Boredom, loneliness, social events and emotional dissatisfaction are a few reasons to eat other than feeling hungry. If done on an inconsistent basis, most people are able to minimize the effect on their baseline weight by exercising and cutting back calories on other days.

However, this type of eating can change into a habit and become the “new normal” if it’s done too frequently. Behavioral research indicates that it takes three weeks of consecutive action to create a new habit. This is also good news because that means it can be as easy to break a bad habit as it is to start one.

I have added LeanMD weight loss program to my medical practice. This program helps people lose weight, but it’s also an educational opportunity to show people why they have gained weight and teach them what, when and how they should be eating. It also teaches how to manage triggers and stressors that add to overeating or preventing long term success in other programs or on your own. When you are trying to lose weight, WHAT you’re eating is just as important as HOW MUCH you’re eating. With LeanMD you will develop healthy eating habits that will change your mentality towards food and eating.

There are three phases to the program:
1. Weight loss phase (up to 5 pounds per week)
2. Transition Phase (increase calories and incorporate your favorite foods)
3. Sustainable Loss Phase (maintain your new weight and habits).

I have been extremely impressed with the philosophy and results of this program. I highly recommend it for anyone who has been struggling not only to lose weight, but also for those who have trouble maintaining their goal weight. LeanMD doesn’t give you food to eat or have you count numbers as with other weight loss programs. It gets you back to the basics of eating fresh, clean, healthy food and making smart choices regarding your diet.

The way you eat should be a healthy habit that you feel comfortable doing for life. It’s much like brushing your teeth twice a day. It would be nice if teeth were “self cleaning” but you feel good doing it and having done it. If you do miss a brushing once in a while, that’s okay because the groundwork for healthy teeth and gums is being done on a regular basis. The groundwork for our general health is done every day in the way we eat.

Carrying extra weight on your body is an enemy that unfortunately becomes more tolerable with time, but your health fails during that time. Chronic pain, osteoarthritis, high blood pressure, heart disease, strokes, diabetes, cataracts, gout, and sleep apnea are just a few of the chronic illnesses that are caused by being overweight, making poor diet choices, and obesity.

Visit my website for more information: www.delaneymd.com

Be Positive and Never Give up Hope: Go Warriors!

February 2, 2016 by Leslie R DeLaney MD Leave a Comment

One of the most common sentiments that my patients share with me is “don’t get old.” They tell me that “it’s no fun,” “it’s not for the faint of heart” and such. I completely understand this lament although I don’t know it firsthand. As a child, I daydreamed about the glamorous life of an adult. I assumed that life would be easier and less complicated once I’d finished my education and had a family and job of my own. Now I realize that was the folly of childish ignorance. The disagreeable truth is life gets more complicated and more difficult as we endure it. My personal belief has become that it’s most important to learn how to navigate and survive life’s turbulence and become a stronger, wiser, more tolerant person because of it. There will always be obstacles to overcome and there’s no shortage of physical, emotional and financial hardships that will remind us of the fragile human beings we are.

I enjoy hearing the musings of people who are more experienced than I am. I find that the sagest advice is gleaned when the person imparting the wisdom isn’t really trying to do so. Usually the lesson comes in the form of someone thinking out loud or sharing what they might think is a worthless anecdote. I have a patient who turned 82 not long ago. I remember the first day that she came into my office. She told me that she was still that same blond 24 year old on the inside although her physical appearance and capabilities no longer were. Our goal was to try to more closely align her physical being with her spiritual being by achieving better pain control. Mrs. K came to my office, for the first time in almost a year, last week. Unfortunately, she had suffered some acute illnesses requiring hospitalization, but had finally turned the corner and was doing well again. When I saw her, she was actually beaming with rosy cheeks and a big smile.

After reviewing her medical updates we chatted casually. I realized that a major positive impact on her health came from an unlikely source. The Golden State Warriors had brought her back to life. She is a season ticket holder and had not been able to attend any games until recently. She was loyally watching on TV throughout her convalescence and her only wish was for them to win on her birthday (they did).
Last week she was finally feeling well enough to again attend the Warriors game and her son escorted her there. Normally, she and her husband would go; however, having her son there made for a special memory as they bonded over a new experience together. As she told me the story, she twinkled like a young girl reminiscing about her first magical prom night. She told me how she was the only “little old lady with a cane” in the stadium, but everyone there was happy, courteous and positive. At one point she tripped as she climbed the stairs, but she never felt the ground because at once, arms were all around her holding her up and saving her from harm. Mrs. K was literally buoyed by the goodwill and harmony that was filling the Oracle Arena.

I believe that most people in the Bay area have been positively affected by the success of the Golden State Warriors. To many of us, they represent much more than a basketball team. Just when I thought that professional athletes were no longer fit to be role models, here come the Warriors! We are as proud of them for being personable, respectful and thoughtful people as we are of their near perfect record. They have become embodiment of what we can achieve as a community if we as individuals work hard in an unselfish way with a team effort. In short, they are gentlemen and leaders who exemplify what we are capable of at our very best. Whether they’ve won or lost, they have been gracious, patient and magnanimous. They help us feel young and give us hope of the possibility of a better day and a better world. The Warriors have taught us that life challenges are hard, but if we communicate with each other, give our best effort, protect each other and help each other, we can go far and further than otherwise would have been predicted.

I believe that Mrs. K’s emotional well being was affected by the “Warrior Positivity” which in turn benefited her physical well being. The more positivity you know, the more positivity you can imagine—even at 82 and despite life’s conflicts.

Three Tips for a Healthier New Year

January 5, 2016 by Leslie R DeLaney MD Leave a Comment

As a child, the New Year was a time of excitement, anticipation and adventure. I eagerly awaited what would “happen.” As an adult, the New Year is a time of renewal and promise of improvement. As opposed to waiting for something to happen, each year I try to have a goal to MAKE something happen. The good thing is that we really do have more control over our lives and our futures than we give ourselves credit for.

Our lives may not look exactly like the way we pictured they’d be when we were children, BUT we have time and opportunity to shape it into something more compatible with our dreams. Usually the only obstacle is fear of failure or ridicule, or of not being like everyone else. Fear is a truly poor excuse for not having a better, happier and more satisfying life.

I like the Mark Twain quote, “Twenty years from now you will be more disappointed by the things that you didn’t do than by the ones you did do. So throw off the bowlines. Sail away from the safe harbor. Catch the trade winds in your sails. Explore. Dream. Discover.” Whether you DO or DON’T DO something, there is still a decision involved to DO one or the other. I believe that all of us know what the right thing is—what we ought to do for ourselves. Confusion can occur when we second guess ourselves or place more value on another person’s decision or opinion.

There are many reasons for why some people develop chronic pain and others don’t. More studies are documenting the non-physiologic contributors such as depression and anxiety disorders as well as well known and documented causes such as obesity and smoking. Currently, addiction and overdose-related deaths are at epidemic levels related to the treatment of chronic pain with opioids and benzodiazepines.

As a result, pain physicians and patients are searching for alternative ways to achieve pain control. The most successful strategies to treat chronic pain are the ones you can do on your own.

1. Stop Smoking: There is a positive correlation between tobacco use and low back pain. This includes cigars, chewing tobacco and e-cigarettes. Nicotine slows down blood flow and oxygen delivery to all of the organs, muscles, nerves and bones. This increases the risk of injury, delays healing and perpetuates the inflammatory cycle; all of which cause chronic pain.

2. Lose Weight: Obesity (BMI>30) and Overweight (BMI>25) increase the risk of osteoarthritis and joint pain by up to 5X. The force on your knees when you walk is 1.5X your body weight and if you walk up stairs, the force is two to three times. If you bend over to pick something up or tie your shoes, the force is 4-5X your body weight. Every pound of weight loss results in 4 pounds of reduction in knee joint pressure. Eleven pounds of weight loss reduces the risk of osteoarthritis by 50%. These numbers may be extrapolated to show the effect of obesity on any weight bearing joint of the body including the spine and hips and ankles. Most of us need help developing a plan to lose weight. The best solution I’ve seen is LeanMD. It was developed by physicians and helps you lose weight and maintain a healthy weight with a program that can fit your lifestyle.

3. Socialize: Being around friends and loved ones increases your sense of well being and the release of oxytocin and endorphins. These are our natural “pain killers.” Unfortunately, people in pain tend to isolate themselves because they don’t want to be “a bother” to others. Invite your friends and family who may be suffering from chronic pain to engage in activities that they can such as playing cards and games, listening to music, or having a lively conversation over coffee.

This year, make the decision to be proactive when it comes to your health. Look forward to making progress in a positive direction—and if pain is an obstacle for you, please feel free to contact me so that I can help you move forward toward your goal in the New Year.

Osteoporosis and Fractures

December 7, 2015 by Leslie R DeLaney MD Leave a Comment

The risk of bone fractures from even small types of trauma increases dramatically as we age. A major contributing factor is osteoporosis or thinning of the bones. The most common bones that are broken are the hip and spine. Unfortunately, older adults’ overall health tends to decline exponentially when they suffer from one of these fractures. An increased risk of death within the next two years is associated with these fractures in the geriatric population, defined as age over 65 with serious health issues.

Fractures can occur if the bone density or strength is less than normal and then subjected to trauma, such as a slip and fall injury. If bone density is severely compromised, fractures can occur with little to no excessive force. In extreme cases, a hard sneeze can cause a fracture.

Bone density is evaluated using a low level x-ray test called a DeXA scan. With this test, a normal score is T -1.0 to 1.0. Osteopenia (lower than normal bone strength) occurs at a T score between -2.5 and -1.0, and osteoporosis (extremely low bone strength) is a T score of -2.5 or lower. The lower the T score, the higher the risk of bone fracture. Postmenopausal women, Asians and Caucasians have an increased risk of osteoporosis. Overall, one in four people, age 80 and older, has osteoporosis.

Diet, exercise and lifestyle changes can prevent or slow down the development of osteoporosis. Calcium and vitamin D are essential vitamins and minerals for bone formation. Diets that include green leafy vegetables, fish, soy, dairy, and fortified orange juice and rice are high in Calcium. Vitamin D can be found in fish, milk, egg yolks, fortified orange juice and rice. Avoidance of tobacco and excess alcohol also reduces the chances of bone thinning. Exercise, especially weight bearing, increases bone strength and density. Also, the more bone density a person has in their younger years carries through to their older years and decreases the risk of osteoporosis.

Vertebral fractures are especially painful and if left untreated can lead to chronic pain and deformity which can affect other body functions. When the back bone is fractured, even the simplest movements cause extreme pain. This is because the edges of the fracture are moving with each breath and change in position. Some people find that the only comfortable position is lying in bed, motionless. This, of course, is not healthy and leads to more problems such as pneumonia, deconditioning and weakness, and blood clots, to name a few.

A fracture of the spine can take six months to a year to heal naturally. For over 20 years, a non-invasive procedure called a Percutaneous Balloon Kyphoplasty, or PBK, has been available that can immediately fix the fracture and alleviate pain. It involves injecting cement into the fracture line through a small needle. Once the cement is injected, it immediately becomes hard and forms an “inner cast” for the spine. The cement cast also prevents the bone from collapsing. If the vertebra collapses, it causes a humpback type of deformity of the spine that can make it hard for people to stand up straight or take a deep breath. After having the PBK procedure, most patients are back to their previous activities of daily living within two to four weeks, with minimal to no pain.

Once you’ve had one vertebral fracture, your risk of having another one is five times greater, regardless of the treatment. This is why it is extremely important to start a plan that includes safe weight bearing exercise, balance and core strength re-education and bone hardening medications to lower your risk of repeat fractures.

Visit my website at www.delaneymd.com for more information on the PBK procedure and osteoporosis treatment options.

The “Secret” Key to a Healthy, Long Life

November 4, 2015 by Leslie R DeLaney MD Leave a Comment

The best advice is usually information that has been touted for centuries. It seems as if every month new medical recommendations are broadcasted regarding what supplements to take, which antioxidant foods to eat, and which vaccinations to have or not have.

Throughout history, health issues have been of foremost concern and thoughts on best practices have been shared by physicians and other intelligentsia. Benjamin Franklin is a good example of an impactful non-physician health advocate. Everyone knows his quotes: “An apple a day keeps the doctor away” and “An ounce of prevention is worth more than a pound of cure” and “Early to bed and early to rise, makes a man healthy, wealthy and wise.” Mr. Franklin was a great supporter of the individual taking an active role in maintaining their own health.

The key to having a healthy, long life is relatively straight forward—take care of yourself. Eat healthy foods, get good sleep and exercise. The most important of all three is exercise. In fact, if one focuses only on exercise, the other two will be incorporated into one’s lifestyle automatically. Studies have shown that regular exercise improves sleep habits and motivates people to make smarter diet choices.

The average life expectancy of Americans is increasing; however, a lower quality of life is prevalent due to chronic illnesses. It’s not hard to find 85 year olds in the community. Some octogenarians are living very active lives, while others are quite sedentary with debilitating, chronic pain.

The common denominator amongst the healthy people is almost universally that their activity level has remained significantly elevated throughout their lives, compared to their age-range peers. Many chronic pain problems can be prevented or minimized by making lifestyle changes earlier in life.

We should all plan for good physical health in the same way that we plan for our financial health. We put money aside for financial security in the form of retirement plans, investments, savings accounts, etc. The same planning and discipline should be applied to our physical health by maintaining a regular exercise program. The best example is people who are in their 60s, 70s, and 80s and above remaining active—swimming, running, biking and walking. Most of them aren’t athletes who have been exercising for years; it is something that they now choose to do in order to improve their chances of a healthy and active older age. They are making it a priority to fund their “health bank.”

It’s never too late to start investing in your physical health and strengthening your body. The really good news is that even small bursts of exercise can improve your health. Studies have shown that people who live in two story homes have better cardiovascular health and live longer than those who don’t. The energy it takes to climb a flight of stairs exercises the heart enough to keep it fit, if done on a regular basis.

A good fitness plan doesn’t have to be a burden and should be something that you actually look forward to. Start with small goals and build on them. If you don’t currently have an exercise routine, start with 15-20 minutes a day, twice a week, doing something you enjoy. It can be as simple as taking a walk, but be sure to quicken the pace or include hills. Maximum benefit occurs when you increase your heart rate or your breathing rate. Work towards a long term goal of exercise 30 minutes a day, five days a week. If you can find a friend to exercise with or share your milestones with, you’ll be even more motivated to succeed.

Dr. DeLaney is the founder and medical director of Balanced Pain Management, located at 114 La Casa Via, Suite 210, in Walnut Creek, California 94598. She is board certified in both Chronic Pain Management and Anesthesiology and has published multiple papers on chronic pain management. She continues to give lectures at local and national medical meetings on Pain Management. She is a member of the California Society of Anesthesiologists, the American Pain Association, the American Academy of Pain Management, the American Society of Anesthesiologists and the American Society of Regional Anesthesia and Pain. For more information, visit her website at delaneymd.com or call 925-988-9333.