Just came across this exercise suggested for seniors, to build muscle strength in the arms and shoulders. It seems so easy, so I thought I'd pass it on to some of my friends and family. It has to be good for everyone regardless of age. The article suggested doing it three days a week.

Begin by standing on a comfortable surface, where you have plenty of room at each side. With a 5-lb potato sack in each hand, extend your arms straight out from your sides and hold them there as long as you can. Try to reach a full minute, then relax. Each day, you'll find that you can hold this position for just a bit longer.

After a couple of weeks, move up to 10-lb potato sacks. Then 50-lb potato sacks.

Eventually try to get where you can lift a 100-lb potato sack in each hand and hold your arms straight for more than a full minute.

After you feel confident at that level, put a potato in each of the sacks.

Low back pain remains one of the most common presenting complaints to primary care physicians. Several recent studies look at complimentary therapies and the risks involved in using opiates. The first study which was NIH supported had 444 patients with acute low back pain of less than 21 days. They were randomized to usual care, 148 patients, or usual care plus a choice of acupuncture, chiropractic therapy, or massage (296 patients). Of these 296 patients 51% chose massage, 26% chiropractic care, and 20% acupuncture and 3% usual care only. At 12 weeks patients were given standardized questionnaires. Symptoms and function improved in both groups to a equivalent degree, however the patients given a choice were more satisfied with their care but it came at an additional cost of $244.00 per patient. To me this proves the adage that laying on of hands is therapeutic and physicians could do much with these patients by this simple modality.

Opioids are commonly used for chronic low pain that persists. In this systematic literature review researchers identified 38 studies where opioids were used and looked at the prevalence of substance disorders in these patients. In 11 of the studies the prevalence of opioid prescribing for chronic back pain ranged from 3-66%. A meta-analysis of four of these studies found that opioid treatment was associated with decreased pain but the decrease was not significant. Prevalence of a current substance disorder ranged from 3-43% in patients receiving opioids for chronic back pain. Clearly these drugs are an option in the short term but their efficacy for long term use in chronic back pain is not convincing and the possibility of co-existing substance abuse should always be considered. (Ann Intern Med 2007 Jan 16; 146:116-27) (Spine 2007 Jan 15; 32:151-8)

The American College of Physicians and the American Academy of Family Physicians have developed new practice guidelines for the management of VTE. Their recommendations are:

1. Low-molecular-weight heparin (LMWH) should be used for inpatient treatment of DVT; LMWH or unfractionated heparin may be used to treat pulmonary embolism.
2. Outpatient treatment of VTE is appropriate for patients without a prior history, thrombophilic conditions, or substantial comorbidity but not for those who are pregnant or unlikely to adhere to therapy.
3. Compression stockings, either over the counter or custom fit should be used starting within one month of proximal DVT and for at least one year thereafter.
4. Specific recommendations for VTE during pregnancy are not possible because evidence from clinical trials is lacking but warfarin should be avoided because of the risk of embryopathy and fetal bleeding.
5. DVT caused by transient risk factors should be treated for 3-6 months. Recurrent VTE for at least 12 months, and idiopathic VTE for up to four years.
6. In patients with cancer or those whose INR is difficult to control long term LMWH is effective and may be more efficacious than warfarin.

These guidelines are based on review of the evidence through mid 2006. Questions still remain however regarding duration of treatment. (Ann Intern Med 2007 Feb 6; 146:204-10) (Ann Intern Med 2007 Feb 6; 146:211-22)

John J. Mohr, M.D.