Primary Care for Low Back Pain: We Don’t Know the Half of It

Author: Frank M. Painter

Evidence-based medicine helps health care professionals and patients decide best care, drawing on research about effectiveness and safety of interventions. Systematic reviews summarise the evidence; guidelines report consensus between experts (including patients) on interpreting it for everyday practice. Although guideline recommendations are only one component of shared decisions that will vary patient-to-patient, the hoped-for outcome is health benefit for each individual. Guidelines also inform starker decisions by policymakers and health care leaders — for example, when to withdraw approval or funding for a poorly evidenced or harmful intervention. To assess whether all this research-driven activity is useful, 2 questions need answering: how well are guidelines followed in real-life practice and do patients benefit in the long-term?

In a new systematic review, Kamper et al. tackle the first question in relation to first-contact care for patients with low back pain provided by family practice and emergency department physicians. As the authors state, low back pain has major significance for the international pain community. It is the leading single cause of years lost to disability globally, and there is good evidence for what constitutes best first-contact treatment. The review selected best-quality studies of routine health care data to investigate whether first-contact physicians are putting back pain guidelines into practice (“usual care”). The results paint a bleak picture: only a minority of patients apparently receive simple positive messages to stay active and exercise, while inappropriate use of analgesia and imaging persists. The review adds to evidence that the care doctors give patients with low back pain is dominated by guideline-discordant interventions that are unnecessary, expensive, and “low-value” (ie, harm is more likely than benefit).

These findings are not entirely unexpected nor, as the authors point out, should blame be placed entirely at the door of front-line physicians. Qualitative studies reveal family practitioners agreeing with guideline conclusions but frustrated in implementing them by factors such as patients with complex needs or lack of resources for behavioural interventions and rehabilitation.

Furthermore, physicians will point to the nuances of individual patients who do not neatly fit the template for guideline recommendations. The review’s authors acknowledge this when discussing the difficulty of measuring “appropriateness” of physician requests for imaging.

The review did not study nonphysician primary care providers. Many such practitioners deliver care aligned with guidelines, such as advice about activity and exercise. More allocation of first-contact low back pain care to professionals such as physical therapists [AND chiropractors] could help to address the problem of inappropriate care. However, although some back care, such as imaging requests by physical therapists, may be more guideline-concordant, a recent systematic review indicated physical therapists have low adherence generally to guidelines for musculoskeletal pain, and a comparison of nurse practitioners and physicians in primary care revealed similar rates of unnecessary imaging requests.

It is increasingly clear that simply expecting individual clinicians to adhere more closely to guidelines is not going to close the evidence-practice gap. Recent articles have argued that effective “high-value” care for patients with low back pain (“benefit more likely than harm”) will only be achieved through large-scale top-down changes across health and social systems (“system strengthening”).

Such changes include engaging policymakers, politicians, and profession leaders to change laws and reimbursement practices; addressing counterproductive commercial pressures; creating incentives for optimal care; providing adequate resources for delivery of guideline care (including digital innovation); shifting professional education and training toward high-value care, including nonpharmacological approaches; dissolving boundaries between health care professions to create unified programmes of care; and changing culture and pain literacy among patients and populations to encourage prevention and positive health activity. The success of such innovations, however, cannot be taken for granted and will need evidence that they bring long-term patient benefit.

There is a second important issue highlighted by the authors of the review — the scarcity of relevant information to answer their question “how well are back pain guidelines implemented?” The review focused on studies reporting actual clinical care because it was recorded in health care or insurance databases. A challenge for data collection systems, particularly in family practice and emergency departments, is how to ensure such records include all aspects of care. Prescription medicines, imaging requests, and referrals to other services tend to be routinely recorded, whereas the nature and detail of patient assessment, and the content of advice and information given, often go unrecorded. Absence of data may mean either care has not been delivered — or it has been delivered but not recorded. Thirty years after randomised controlled trials reassured patients that an average low back pain episode did not require a week in bed, there is no high-quality data on what primary care physicians have been advising about bed rest.

This absence of information about relevant areas of the primary care consultation should concern us as much as the size of the evidence-practice gap or how to close it. Having the right information will itself help change policy and training and behaviour about guideline treatments, for example, by easing the path to audit as a means to improve practice. The “finely grained” information the review calls for (such as linking prescription records with the indications for prescribing) would address concerns that health care databases do not currently convey all the nuances of decision-making — not all imaging requests are wrong, not all opioid prescriptions are wrong-headed.

The authors of the review could find no high-quality studies using actual practice data from first-contact low back pain care in low- and middle-income countries (LMICs). This is of particular concern because LMIC populations are being exposed to technology and treatments for low back pain (such as opioids) that high-income countries have popularised and made profitable but that are often inappropriate and harmful. Low- and middle-income countries need appropriately strong systems to support delivery of high-value care, including guideline-concordant approaches to low back pain prevention and care that align with local practices and cultures of health and wellbeing. Achieving data collection systems and routine analysis to document low back care is a plausible investment target for LMIC populations such as Nepal that are digitally equipped even when geographically remote11 but will be hindered while pain research has no priority and remains focused on low-value items of care.

It is a strange situation to contemplate. In an information-dominated world where people’s purchasing actions are instantly known, retrievable, linked to other data, and acted upon, the [medical or “usual”] care that most people are receiving for the world’s leading cause of long-term disability is not known because it is either not recorded or the data are not accessible or reported. The challenge to digital science and modern informatics is how to record and retrieve this information without overloading already busy clinicians or saturating patients with data collection. But, along with the challenges and the risks, there is the potential for new technology to change and improve delivery of health care globally for conditions such as back pain.

The case revealed by Kamper et al. for having more accessible, better organised, well-resourced, easily collectable information about the daily content and outcomes of consultations for this most common of disabling pain conditions is clear. The international pain community, in collaboration with health care data scientists, should get behind it.

Antioxidant Dietary Supplement

Aging? Sure, it’s a fact of life. But what if there was a way to slow down the process, perhaps even cure it, what would you say?

The aging process brings with it not only wrinkly skin or tired joints and muscles. Those can be tolerated. After all, they are part of the natural cycle of life. But what isn’t natural is the disease. They are disorders – unnatural conditions of the body.

Aging is caused by harmful molecules called “free radicals.” This was according to Denham Harman, M.D., Ph.D., who first proposed the theory in the 1950s. Since then, scientists and researchers have sought to understand the body’s oxidation process and free radicals contribute to its acceleration. It seemed that these so-called free radicals are rogue oxygen molecules that are highly unstable and which have harmful effects on the body.

There is growing evidence that the production of reactive oxygen species (ROS), including free radicals, is behind the aging process and initiation of age-related disease. The reason free radicals are highly unstable is that they have an unpaired electron which they try to recompense by stealing an electron from a stable molecule. This actually sets off a chain reaction that can damage the body’s proteins and cell membranes, weaken the cell’s natural defenses, and disrupt the cell’s DNA. Such damage, when accumulated, could lead to degenerative conditions.

Fortunately, nature has provided us with a system to help control free radicals. Antioxidants are natural enemies of free radicals because one of their functions is to break the chain reaction and destroy free radicals.

Therefore, while antioxidants can be found in many fresh fruits and vegetables, it still pays to take an antioxidant dietary supplement along with your food. Vitamin C antioxidant dietary supplement is perhaps the most famous form of antioxidant available. Also known as ascorbic acid, bottles of this antioxidant dietary supplement can be found in any pharmacy or health food store. Research shows that this particular form of antioxidant dietary supplement greatly helps in boosting the immune system and thus aid in preventing the onset of degenerative diseases.

Another popular form of antioxidant dietary supplement is Vitamin E. This antioxidant dietary supplement works best when taken with Vitamin C as it seems that both vitamins have a synergistic effect when taken in combination.

Besides vitamins, antioxidant dietary supplements may be in the form of botanicals. Green tea, for example, is a rich source of flavonoid derivatives (polyphenols) epicatechin (EC), epigallocatechin (EGC), epicatechin gallate (ECG), and epigallocatechin gallate (EGCG). All these contribute to what makes green tea a good antioxidant dietary supplement.

The Benefits of Yoga

Yoga, as you may know, is practiced by millions of people throughout the world for several good reasons. It has been around for thousands of years now and it is continually gaining popularity for a number of benefits that it is capable of giving.

Well, speaking of benefits, one may find the benefits of yoga countless. There are too many of them to mention, but all are tailored to one particular purpose – to maintain better health and well being through the unity of the mind and body. The benefits of yoga can be classified into three categories according to where they may occur: physical, mental and spiritual.

Physical Benefits of Yoga
Yoga is in the first place a philosophy composed of exercises that is highly capable of making the physical body as healthy as possible. Several claims have it that the exercises involved in the practice can help increase the muscle strength of a person. It strengthens the muscles and joints in the back and abdominal muscles, which are but two of the most vital elements of the spine’s muscular network which works to help the person obtain a proper posture.

The yoga can also aid relaxation. It is said to alleviate pains and stress not only in the muscles, but in the entire body. This benefit is made possible by the yoga movements that involve stretching, as well as for the breathing exercises which are done throughout the practice.

Most of all, the practice of yoga will make you aware that your body has its own limitations. Knowing this fact will help you prevent all sorts of injuries and bodily imperfections knowing that you already know what and what not to do.

Mental Benefits of Yoga
It is believed that if you are doing the yoga techniques regularly, there is a great possibility that you will be relaxed to the highest possible level. You can also handle certain situations that are stressful more easily. And, most of all, you will know exactly how to encourage yourself to think about positive thoughts. Recent researches have further revealed that the mental benefits of yoga may also include self-acceptance.

Spiritual Benefits of Yoga
In terms of spiritual benefits, yoga is deemed to be so potent for making you aware of everything about your body, as well as your emotions and the feelings of others. Many of the expert yogis even claim that practicing the yoga exercises will help promote a sense of interdependence that may involve not only the body, but also the mind and spirit. This is actually where the idea of “oneness” comes in.

Effective Headache Remedies

Everybody has definitely experienced a headache once in his or her lifetime. Since it is one of the indispensable and common illnesses everyone experiences, people have learned to find ways to relieve the discomfort brought by headache.

REMEDYING HEADACHES

Headaches are usually caused by physical and emotional stress. If you are dying to find a solution to your persistent headache, try taking in over the counter remedies like aspirin, acetaminophen, and ibuprofen. But if you are not a big fan of prescribed or over the counter medications, try these home remedies for a change.

  • Try using compresses or cold packs. For tension headaches—the most common form of headache—try applying a warm or cold compress to your forehead and the base of your neck to numb the pain.
  • Try using heat. If cold compresses wouldn’t work out for you, try using a warm washcloth or a hot water bottle can ease pain.
  • Develop a routine of deep breathing exercises. If you suffer from headaches very often, try sitting in a darkened room, take in deep breaths using your nose, and let it pass through your mouth.
  • Experience the wonders of acupressure. By squeezing the web of skin between and the thumb through acupressure, it can reduce the pains and can help you relax.
  • Try relaxation techniques such as meditation, yoga, and biofeedback. By trying these relaxation techniques, the person who suffers from headache can feel the pain flowing out of the head. It can also help reduce stress.
  • Relieve the affected area by applying ointment with heat. Ben-Gay or Icy Hot rubbed on forehead or on the base of the neck, can give a soothing warm feeling to your head.
  • The power of music. Try listening to a relaxing music while lying down or resting.
  • Exercise regularly. Physical activities like regular exercise can relieve stress because it can loosen up the knots and balls of pain in your head.
  • Get enough sleep. Having six to eight hours of sleep can help you soothe your tired nerves. But, beware of sleeping more than 10 hours because it can cause major headache as well.
  • If possible, use a neck pillow in bed. If you are prone to experiencing morning headaches, try using a neck pillow to your neck while you sleep.
  • Totally eliminate caffeine, salt, MSG, and chocolate in your diet. Load up on lots of fruits, veggies, and water to keep your body well hydrated.
  • If you can, avoid bright light because it leads to a major headache once your squint.
  • Don’t skip meals. Skipping meals can lead to low blood sugar. When your sugar level goes down, your blood vessels in the brain tightens that leads to headache.
  • Don’t eat foods that have nitrates, sulfites, and MSG because these are primary headache causers. Also avoid aged cheeses and nuts so you won’t experience headaches.
  • Don’t smoke and avoid smoke-filled rooms.

Acupressure more effective than physical therapy

We all know Acupressure has been around for some 5,000 years now and those of us involved in Holistic and wellness remain convinced that the procedures encompassed within this sphere are more efficacious than physical therapy. Every living being has a life force, or energy, called qi or chi (pronounced “chee”). When this energy, which runs along meridians, is in balance and flowing freely, the body is in a state of health. Acupoints tap into the the major energy pathways of the body

When this energy is blocked or deficient, illness can result. These energy disruptions are often the result of stress or injury. It is believed that acupressure causes the brain to release endorphins. Endorphins play an important role in immune function, pain relief, stress reduction, and slowing the aging process.

Lower back pain has long been the bain of the modern world not only in lost man hours but also because of the numerous side effects, complications and nuances of lower back pain complaints. Further studies now confirm the benefits of acupressure over physical therapy. Albeit that the studies failed to take into account functional status and disability as recommended by most low back pain researchers the results are still very meaningful and relevant.

In February 2006 a randomized controlled trial took place at The National Taiwan University in Taipei. 129 patients with chronic low back pain received acupressure or physical therapy for 1 month. Primary endpoints were self-administered Chinese versions of standard outcome measures for low back pain (Roland and Morris disability questionnaire) at baseline, after treatment, and at 6-month follow-up. After treatment, the mean total Roland and Morris disability questionnaire score was significantly lower in the acupressure group than in the physical therapy group regardless of the difference in absolute score or mean change from baseline.

Compared with physical therapy, acupressure was associated with an 89% reduction in significant disability and that improvement was maintained at 6-month follow-up. Study limitations include a confounding psychological effect of therapy; loss of 15.5% of patients to follow-up at 6 months and effectiveness of any manipulation therapy dependent on the therapist’s technique and experience.

Participants were aged 18 to 81 years. Exclusion criteria were pregnancy and contraindication to acupressure. 64 patients were randomized to acupressure and 65 to physical therapy. Conclusive or inconclusive the results still point towards the undeniable and positive aspects of acupressure and holistic healing.

On a more lighter note Acupressure has also been cited as a new aid for sleepy students. 39 student volunteers found that those who were taught to self-administer acupressure to stimulation points on their legs, feet, hands and heads were less likely to drowse during class. The acupressure consisted of light tapping of fingers or using thumbs or forefingers to lightly massage the stimulation points. It was conceded that more study is needed in relation to acupressure and the effect on human alertness.

Benefits of Chair Yoga

We have all heard the saying, “Rome wasn’t built in a day.” Those words are extremely profound, when thinking about correcting poor posture and alignment. It takes years to create poor alignment.

Therefore, poor posture cannot be corrected in a single day. A more appropriate saying, when thinking about posture and alignment might be, “The leaning tower of Pisa cannot become straight in a week.”

However, improvements to posture can be made through Chair Yoga exercises and through daily “posture awareness.” In my classes, I refer to posture awareness as “homework.” It usually draws a chuckle from students, but they also know that class time is the time to learn and practice Chair Yoga together.

Time away from the Yoga class is when you put the principles you have learned, in motion, and adapt them into your lifestyle. I cannot promise Chair Yoga is a “cure all,” but you will see improvements in every aspect of your life. However, practicing your homework separates the fantastic success stories from those who see some modest improvement.

So, what is posture awareness? This is taking the time to be aware of your posture, on a daily basis. The first thing you want to do in order to open your awareness is look at your side profile in a mirror and any photographs of yourself. At this point, look at your spine from top to bottom.

Do you see slumping, forward tilting of the neck, or extra large curves? Your spine should be aligned so that it is fairly straight at all times. During a number of daily activities such as: Standing, walking, reading, eating, sitting, lying, typing, and more, you should make a conscious effort, to keep your head and back straight.

Now, we can all remember a schoolteacher who preached, “Keep your back straight,” but now we know that he or she was absolutely correct. Take the time to adjust your spinal alignment, from this moment on, and every time you can remember to do so.

If possible, you should also attend any workshops about Chiropractic and Orthopedic medicine. Educate yourself about your body, your spine, and your choices. You can usually find these workshops and many more valuable meetings at your local senior center. These workshops are usually free, you are under no obligation, and it makes for a good “Fact finding mission.”

The alignment and posture principles, you learn in a Chair Yoga class, can be as simple as, “Pain or no pain.”

Acupuncture for Effective Weight Loss

In a generation when physical fitness is given topmost attention, people are always on the lookout for the newest and most effective means for weight loss. Acupuncture, the method of inserting thin, filiform needles on certain points in an individual’s body, has been found to be one effectual method for losing weight.

Not many people may find the idea of being inserted by needles quite comforting in their quest for weight control. However, this ancient Chinese alternative treatment seeks to deliver a control mechanism, enabling the patient to manage hunger cravings more successfully in the long run.

The Skinny on Acupuncture Weight Loss

It has been found that weight gain is directly related to emotions. Other than physical hunger, people reach for a huge chocolate bar or a big platter of burger and fries because of the sense of comfort derived from food and eating. More often than not, excessive weight gain is an emotional issue, rather than a mere physical one. You may not realize it, but you tend to take in more food whenever you’re stressed, upset, or pressured.

In Acupuncture, there are specific spots on the body being targeted by the hair-like needles. These spots are linked to certain areas in the body and by stimulating these spots; the patient will achieve a greater sense of inner balance. As these points are inserted by the needles, certain hormones are released throughout the body. These substances work by helping you manage hunger and efficiently control the impulse to overeat.

How Acupuncture Induces Weight Loss


Most acupuncturists will target the spots behind the ear when it comes to promoting weight loss. When these points behind the ear are stimulated, endorphins are released in large doses. Endorphins are called the feel-good hormones, and these are also often referred to as natural pain and fever relievers. The release of endorphins is what makes you feel better after an increased level of physical activity, as in the case of a good workout.

These bodily compounds allow the patient to experience better relaxation, thus considerably alleviating stress. There is a greater possibility of enhanced weight loss when the patient has already achieved emotional wellness. Endorphins are also released whenever the body experiences low levels of bodily pain, thus their moniker as a natural pain reliever.

Patients of acupuncture typically experience very minimal or no pain at all, however most of the points are located near nerve endings and muscle tissues. As the needles are embedded in the body, signals are sent to the brain thus promoting the release of endorphins from the pituitary gland.

There are also other points in the body that serve as gateways for better weight management. One of these placements promotes a decrease in an individual’s appetite, while another has the ability to reduce water retention in the body. The acupuncturist may choose a multi-targeted approach, depending on the requirements of the patient.

Consulting with a Professional Acupuncturist

There are a number of acupuncture practitioners in existence nowadays, offering a host of services. If you are considering this form treatment for your weight management, make sure that you settle with no less than a trained and professional acupuncturist. A poorly trained acupuncturist may not be able to pinpoint the specific meridian points and worse, may cause unnecessary bodily pain and discomfort.

Moreover, your acupuncturist may require an herbal supplement for your treatment, to encourage a longer-term effect. Your sessions need not be maintained for an extensive period; however you may be required to visit your acupuncturist during the entire course of the sessions.

There are other means for losing weight successfully, and this does not include crash dieting and strenuous work outs. If carried out by trained professionals, acupuncture can be the answer for effective weight management. While it is far from being a cure-all, it may just be the right weight loss solution for you.

Chiropractic Care

Chiropractic care dates back to ancient Egypt. This modality took root in 1895 when David Palmer presented the theory that all illnesses had the root of their problems in the spine and the nervous system. According to palmer, when the vertebrae are misaligned, the person will experience any number of ailments.

Chiropractic care holds that the body has the innate ability to heal itself if it can achieve balance or homeostasis. When we have a misalignment of joints, this is said to cause an imbalance in the nerves and cells. The chiropractor after several treatments gets our spines back in alignments and we are surprised by how much better we feel.

The proof of Chiropractic working is seen on x rays taken before and after the treatment series, usually for a month to two months. The chiropractor will give you specific adjustments designed to place your spine back in its natural position. They may also use electric stimulation to get the muscles to relax better while this is going on. This does not hurt, but rather feels like little ants crawling on your back.

When chiropractic care started, insurances wouldn’t recognize it as a health treatment. However, today, in the 2000’s, some insurances have started to see the benefits and have added it to their policies so people can get the specific help they need from a trained specialist. Medicare covers the treatments and most third party payors accept claims from chiropractor visits.

The manipulation of the spine has shown to produce good results for back and neck pain, headaches, and musculoskeletal problems. Some say it even helps with infectious diseases to strengthening the immune system. Adjustments are given in the office and are painless. You may hear a “crack” as the air pops out of the joint being manipulated. They are non-invasive treatments and you will start to feel better after the very first one.

Facial Acupuncture

Looking beautiful both inside and out is something we all want to achieve. Since your face is ridden with emotion and hormonal issues, you have to take care of it. Fortunately, there is a technique that can do that using painless mini needles and this is better known as facial acupuncture.

Facial acupuncture is a painless procedure that renews not only the face but the body as well. This is because it can erase lines and eye bags making you look younger. At the same time, it can also help clear up pimples and acne.

For this to work, fine needles are placed in acupuncture points on the eyes, face and neck to stimulate the person’s natural energies. As a result, this also improves your facial color.

Anyone can try facial acupuncture because it is painless and it has proven to reverse the signs of aging. However, if you are pregnant, suffer from the colds or flu, have acute herpes or an allergic reaction, it is best to wait until this has passed.

But before anyone can try facial acupuncture, they first have to be evaluated by the acupuncturist. This person will evaluate your age, lifestyle and diet. If everything looks good, then you will probably do an average of about 12 to 15 treatments. More could be done if your skin tends to sag, manifest jowls or have droopy eyes.

Facial acupuncture treatment needs to be done twice a week for about 45 minutes to 1 hour. For those who can’t make two sessions in a week, they can opt for the 1 treatment that will last 90 minutes.

After the regular sessions, it is advisable to go back for follow up treatment. It should be every 2 weeks for the next 2 months and then once a month later on.

Aside from needles, most clinics use herbs in the form of masks, poultices and moisturizers. Before you use it, check with your doctor to make sure there is no allergic reaction to any forms of medication that you are taking.

After the first facial acupuncture treatment, you will usually seen an increased glow to one’s complexion which the Chinese say an increased Qi or blood flow to the face. It becomes more open, the wrinkles start to disappear and the skin appears more toned.

In the 5th or 7th treatment, this becomes more evident as your face looks more relaxed as though you just came from a vacation.

The end result is that you will look and feel 5 to 15 years younger but of course this depends on how well the patient has taken care of themselves outside the confines of the clinic.

To sum things up, facial acupuncture can do for you. It can eliminate fine lines and reduces wrinkles, improve your overall facial color and add luster to the skin, relaxes tension in the face and furrows in the brow, brightens the eyes and reduce dark circles and puffiness, improve muscle tone for sagging skin, enhance your natural radiance in the skin and eyes, slow the aging process within, promotes overall health and well being as well as relaxes and revitalizes the entire body.

All you have to now is find a clinic that offers this service to customers so you will soon look radiant to other people.

Are You Well?

Wellness refers to the condition of good physical and mental health, especially when maintained by proper diet, exercise, and habits. Nutrition refers to the nurturing of our body, in our ability to keep it healthy and functioning as it is supposed to do. Our ability to provide the body with all the necessary food, vitamins, and minerals so that we continue to thrive in our daily life processes. But do we know if we are really well? How do we tell?

The first place to start would be with the examination of your eating habits. Since we are a product of what we eat, if our eating habits are unhealthy, or do not provide for the nutrition we need, we’re not going to be healthy individuals at the end of the process. Do you take in more calories than your body needs? Are you supplementing your vitamins and minerals to make sure you are getting your recommended daily allowances? If you’re not making the most basic of efforts to take care of your nutritional needs, you aren’t a well individual. You may not look sick, you may not have any noticeable symptoms of ill-health, but you’re not the well individual you could be.

Next, you might want to look at your exercise habits, if there are any. If there aren’t any exercise routines to examine, no wellness. Everyone, no matter what their age, benefits from exercise. It keeps our bodies conditioned, our mental sharpness working at top speed, and thanks to the physical aspect, we get a boost to our cardio health, extra calorie burn, and more oxygen to those cells!

What about the stress levels in your life? Do work in an environment with high levels of stress? Is your personal life a source of comfort or does it add to your stress levels? Do you engage in some form of stress-relieving activity? Stress is the number on contributor to heart attacks and strokes, since they manage to speed up the affect of the real culprits. Stress is basically an out of control situation for most adults today. We manage to schedule every moment of our free time, and leave ourselves with no time for quiet reflection, or time to deal with life’s unexpected emergencies.

Stress brings us to the next two topics of health abuse. Smoking and drinking are often used to offset the effect that stress has on our nervous system. These solutions however do not provide any real help. If you smoke, drink, or lose sleep to excess, you’re not the well individual you could be. Smoking, drinking, and loss of sleep work to our detriment, and it takes extreme discipline to stop. Smoking fills our body with carcinogens, and works to keep us tired and lethargic.

There are so many occasions to stop and question our efforts at maintaining optimal health, that we usually don’t even take the time to begin the examination. But it is beneficial to our overall health, the quality and quantity of our life, to make every effort to be well, healthy, individuals.