Rihanna, Don’t Take Him Back: A Physician’s Perspective on Sexual Pain and Domestic Violence

Rihanna Don t Take Him Back A Physician s Perspective on Sexual Pain and Domestic Violence

Young people all over the world who look forward to Rihanna and Chris Brown’s next album, teasingly released last week, will be getting the wrong message about the thin line between love and hate.  Consider the sexually charged lyrics in Rihanna’s 2011 hit song “S&M”: “[S]ticks and stones might break my bones but chains and whips excite me”.  When you juxtapose these fantasy lyrics with Rihanna’s very real abuse at the hands of her former lover, the images of fear, submission, and pain become undeniably disturbing. Indeed, I certainly agree with Rihanna that “nothing could measure” to the physical pain of being hurt by a loved one, but it is extremely dangerous to rationalize a violent relationship by recasting it as sadomasochistic “pleasure.” Many people who associate pain and danger with pleasure and love have died when they put themselves in the way of danger again and again.


You know it and I know it—Rihanna should not be reuniting with Chris Brown.  Their reignited flame and its promotion through controversial song releases like “Birthday Cake” and “Turn Up the Music”, are an uncomfortable intersection of art and life. Though we generally pride ourselves at drawing a distinction between what an artist says and what an artist does, it’s hard to forget that today’s overtly sexual Rihanna was being badly and conspicuously battered not so long ago. Though her lyrics may blur the line between violent sex and domestic abuse, she can’t completely repackage her victimization as a show of sexual liberation.


Nor should she. It is not appropriate for any partner to endure physical, emotional or sexual abuse in relationships, whether they are female or male, famous or otherwise. Underneath the celebrity façade is still an innocent person, who in this case is a victim of severe domestic violence.


To be clear, many partners have a dysfunctional “love-hate” relationship without any undertones of masochism; any sort of unhealthy relationship volatility can escalate dangerously when the cycle of domestic abuse is left unchecked.  Short courses in anger management are hardly enough to maintain this fragile balance when passions reignite.


Rihanna reported to Rolling Stone: “I love to be submissive… being submissive in the bedroom is really fun. You get to be a little lady, to have somebody be macho and in charge.” Like all adults, Rihanna should be able to choose to explore the sensations of power and powerlessness alike with a sexual partner she knows and trusts. But Rihanna knows that Chris is violent, and she shouldn’t trust him. Being submissive with someone who has physically battered her is not what Rihanna needs, nor is it the narrative she should be pitching to her fans.


Yet this is the narrative that is being presented by the PR storm that surrounds Rihanna and Chris Brown. Rihanna and Chris are both young and reportedly in love, but they are also caught up in a social media and marketing frenzy to move as many albums as possible.  The commercial aspect of their very public private drama is one of the most harrowing aspects of it; the financial structure of Rihanna’s career would welcome Chris Brown, even as the emotional structure of Rihanna should refuse to see him again.


Let’s stand up and send a clear message to entertainers that not everything that makes money while compromising safety is “just art.” Every public failure to recognize and reject abuse helps countless more to justify their own tragedies in private.  Yet the story of the personal and emotional triumph of a high-profile victim like Rihanna can help many other victims on their own paths to reclaim their strength. For this reason, I urge you, as a physician who is a parent, to screen the content of what your children listen to on the radio and through their iPods to ensure that if your children’s music pushes the envelope that it doesn’t cross the line into their young ears and formative minds.

Source:   Rihanna’s Rolling Stone’s Interview Lee, Joyce (2011-03-31). “Rihanna talks Chris Brown, S&M tendencies in Rolling Stone”

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Free Apps Might Carry Huge Price Tag For Physicians

Free Apps Might Carry Huge Price Tag For Physicians

There’s been a lot of buzz about Google and their stance on user privacy recently. When it comes to the internet and technology, you can always assume some malicious company or person is after your private information. This is no different in the new “app” economy. Free applications are known to search your smartphone for personal information, many times for malicious purposes. These applications don’t give any indication they are sucking in your personal data, so to be safe you must assume these free applications will take your data in order to turn a profit. For more information, be sure to read this PhysiciansMoneyDigest article.

Moshe Lewis, MD, a pain management specialist, is referred to as the “Digital Doctor” due to his use of social media to establish better doctor-patient relationships. He says that these apps really are not free when it comes to the privacy of information.


“The fact is that information is always being collected,” says Lewis, noting that Amazon absorbs information like a wet sponge. “I think the challenge is that we almost have to stay off the Internet to avoid it.”


However, the best site at gathering information may be Google, according to Gray, who finds Gmail “the spookiest of all.” Google’s email service lifts and saves keywords from email. For example, if you send an email to someone discussing the fact that you’re planning a vacation to Florida, you’ll soon see ads popping up on your screen promoting Florida vacations and airfare.


“It’s actually delving into your correspondence and using that information to market to you,” he says.


And physicians need to be aware of that, says Gray. They should realize that if they’re using an app to write or chart patient prescriptions, that information is likely being monitored.


“If you’re a gastroenterologist, presumably there’s some organization that would like to know what you’re prescribing and target certain products to you based on that information,” he says.

Read this article on PhysiciansMoneyDigest.com.

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Do Women Feel More Pain Than Men?

Do Women Feel More Pain Than Men Study Says  Yes

Chronic pain has the ability to strip individuals of their productivity, happiness, and well-being. ABC News wrote this great piece about Tiiu Leek and her pain in the workplace, describing how women feel more pain than men do. The article references a relatively new study from The Journal of Pain that showed women generally feel more pain than men. However, this study wasn’t thorough since it didn’t account for confounding factors such as emotional effects or an additional painful disease. Women tend to be better at analyzing and describing their pain to doctors which give the illusion they feel more pain. As a culture, men are expected to complain about pain less as well as talk about their emotions. One’s mental well-being has a huge effect on physical pain, thus conclusive studies are hard to produce.  Nevertheless, the findings reflect what I see as a chronic pain specialist. Here is a telling excerpt from the ABC News article:

Meyer saw 13 doctors before she got a proper diagnosis and the majority were men. “It’s very uncomfortable for them to see real emotion: ‘Tell me the facts, m’am, just the facts.’ I see them tune out.”


Now, she consciously spares the doctor the emotional talk. “I can literally be in so much pain I am crying when the staff is in there, but I pull it together when the doctor is in the room and have no tears at all. And it’s not easy to have to do that.”


She said doctors need to listen more to their female patients – “feelings are a part of the equation … Patients shouldn’t have to shut things down.”


Both Meyer and Leek sit on the leadership circle at For Grace, an advocacy organization that educates, supports and empowers women in pain through annual conferences and legislative outreach.


For Grace’s “Fail First” bill recently got through the California State Assembly’s appropriations committee on a 12-5 vote. If signed by the governor, it will allow women in pain much better access to pain medications, bypassing insurance companies.


As for Leek, she has seen marked improvement in her pelvic pain thought exercise and homeopathic approaches. She also tries to surround herself with positive people.


“My career was lost, but not my optimism,” she said. “I continue to live well. I once read that if you can get through your 60s unscathed, you can have a pretty good life.”

Read this article on ABCnews.com 

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Time – And Brain Chemistry – Heal All Wounds

HeartAche moshe

Many consider pain to be a physical sensation. It seems too obvious that pain originates around the body because that's where many feel it, but in reality pain is created in your mind. Since we perceive the world through our brains as we gather external sensory information from our surroundings, any sort of pain we feel becomes reality. In this way, heartache and mental pain can surprisingly cause physical pain. As acknowledged by the holistic medicinal community, one's mental well-being can effect how their physical bodies feel. In this recent Scientific American article, author Christie Wilcox explores how emotional turmoil caused by those close to us can have very real and physical results:

I know I’m not physically hurt. Though it feels like I’ve been kicked in the stomach with steel-toed boots, my abdomen isn’t bruised. Spiking cortisol levels are causing my muscles to tense and diverting blood away from my gut, leading to this twisting, gnawing agony that I cannot stop thinking about. I can’t stop crying. I can’t move. I just stare at the ceiling, wondering when, if ever, this pain is going to go away.


It doesn’t matter that my injuries are emotional. The term heartache isn’t a metaphor: emotional wounds literally hurt. The exact same parts of the brain that light up when we’re in physical pain go haywire when we experience rejection. As far as our neurons are concerned, emotional distress is physical trauma.


Evolutionary biologists would say that it’s not surprising that our emotions have hijacked the pain system. As social creatures, mammals are dependent from birth upon others. We must forge and maintain relationships to survive and pass on our genes. Pain is a strong motivator; it is the primary way for our bodies tell us that something is wrong and needs to be fixed. Our intense aversion to pain causes us to instantly change behavior to ensure we don’t hurt anymore. Since the need to maintain social bonds is crucial to mammalian survival, experiencing pain when they are threatened is an adaptive way to prevent the potential danger of being alone.


Of course, being able to evolutionarily rationalize this feeling doesn’t make it go away.


I lie flattened, like the weight of his words has literally crushed me. I need to do something, anything to lessen this ache. The thought crosses my mind to self medicate, but I quickly decide against that. Mild analgesics like ibuprofen would be useless, as they act peripherally, targeting the pain nerves which send signals to the brain. In this case, it is my brain that is causing the pain. I would have to take something different, like an opioid, which depresses the central nervous system and thus inhibits the brain’s ability to feel. Tempting as that might be, painkillers are an easy – and dangerous – way out. No, I need to deal with this some other way. Slowly, I sit up and grab the guitar at the foot of my bed.


Where music comes from, or even why we like and create music, is still a mystery. What we do know is that it has a powerful affect on our brains. Music evokes strong emotions and changes how we perceive the world around us. Simply listening to music causes the release of dopamine, a neurotransmitter linked to the brain’s reward system and feelings of happiness. But even more impressive is its affect on pain. Multiple studies have shown that listening to music alters our perception of painful stimuli and strengthens feelings of control. People are able to tolerate pain for longer periods of time when listening to music, and will even rate the severity of the sensation as lower, suggesting that something so simple as a melody has a direct affect on our neural pathways.


So, too, does self expression. Expressive writing about traumatic, stressful or emotional events is more than just a way to let out emotion – college students told to write about their most upsetting moments, for example, were found to be in remarkably better health four months later than their counterparts who wrote on frivolous topics. These positive results of self-expression are amplified when the product is shared w


So, I begin to write. At first, it is just a jumble of chords and words, haphazardly strung together. But, slowly, I edit and rewrite, weaving my emotions into lyrics. I play it over and over, honing the phrasing, perfecting the sound.


The rush of dopamine loosens the knot in my stomach ever so slightly. For now, the agony is dulled. Still, I can’t help but think that I’m never going to really feel better – that the memory of this moment will be seared into my brain, and a mental scar will always be there, torturing me with this intense feeling of loss.

Scientifically, I know I’m wrong. As I close my eyes, I am comforted by the thought that the human brain, though capable of processing and storing ridiculous amounts of information, is flawed. The permanence of memory is an illusion. My memory of this moment will weaken over time. It will be altered by future experiences, until what I envision when I try to recall it will be only a faint reflection of what I actually feel. Eventually, this pain won’t overwhelm me, and I will finally be able to let go.

Read and comment on this article on ScientificAmerican.com.

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Whitney, We Can Still Hear You

Whitney houston dead 2

“I will always love you” icon Whitney Houston died Saturday, her body reportedly submerged in the bathtub of a Beverly Hills hotel.  Whether substance abuse issues played a role in her death remains to be seen pending autopsy and toxicology results.  The death of Whitney Houston comes as the latest in a growing and alarming trend of celebrity deaths—from King of Pop Michael Jackson to singer Amy Winehouse. “All too painfully we are seeing an increasing trend of untimely celebrity deaths following a long history of substance abuse issues,” says San Francisco pain management specialist Moshe Lewis, MD.  A fan of Whitney Houston’s since the age of 16, Dr. Lewis is devastated by her passing adding that he “grew up with her music on a daily basis.” Unfortunately, as a physician with sub-specialty training in public health he is identifying drastically diminished life spans amongst celebrities whose “lives seem to be cut short almost exponentially with fame” notes Dr. Lewis.


To Dr. Lewis it seems like just yesterday he was giving interviews on King of Pop Michael Jackson’s death from the anesthetic propofol. Sadly less than three years later following Michael Jackson’s death in the midst of a massive comeback tour we are overwhelmed by the loss of the Queen of Pop in the midst of promoting a new movie as part of her comeback campaign.


Whitney, “we will always love you” and can only hope that your life provides a valuable lesson for the public at large to hear. When we address the demons of low self esteem, depression, and anxiety with therapy instead of substances, we can live long enough to appreciate that we are not perfect, but a work in progress. We do not need to be the richest, the prettiest, the smartest, the most athletic or the most famous person all the time.

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Does Acupuncture Have a Place in Western Medicine?

Does Acupuncture Have a Place in Western Medicine

As I’ve mentioned several times in my blog and in my videos before, acupuncture has been around for thousands of years and withstood the test of time, but the traditional medicine community turns a blind eye towards the eastern approach to acupuncture. In this article written by BeckerSorthopedicAndSpine.com, author Abby Callard quotes me along with Christian Nix, an acupuncturist in Chicago, about the utility of acupuncture. Christian Nix explains how many aren’t educated in philosophy and practice of acupuncture and its place in the medical industry. I always recommend acupuncture to my patients due to its effectiveness, its low cost, and practicality. Below is an excerpt from the article:

Moshe Lewis, MD, SpineCare Medical Group, Daly City, Calif., and Pain Management and Rehabilitation, Redwood City, Calif., is an interventional pain management physician who employs acupuncture to help his chronic pain patients. He agrees that acupuncture has a place complementing interventional pain management procedures.

“Everything that we do in medicine is based on experience, data and clinical presentation,” he says. “I don’t want to say that acupuncture is going to work for everyone. However, on the flip side, I think that it has an important place in medicine and can be an effective treatment for several conditions.”

Acupuncture can be helpful with acute conditions such as epicondylitis, and it can also treat chronic conditions such as repetitive stress syndrome well, Dr. Moshe says. “Anyone who sits at a computer long enough is likely to encounter symptoms of repetitive stress syndrome or tendinitis,” he says.

This disorder generally presents with pain in the wrists and hands, and can cause achy muscles and even myofacial pain. Dr. Moshe says acupuncture works better with muscle disorders than bone disorders because the treatment can help to relax the muscles. Bones, discs and cartilage disorders are much harder to treat definitively. For example, an 80-year-old woman who has arthritis and is no longer walking straight will not be likely to improve her posture with acupuncture. It might alleviate the pain, but it won’t actually treat the problem, Dr. Moshe says. Therefore, acupuncture should always be customized for the appropriate patient and diagnosis where it is likely to be of benefit.

However, it’s the low cost of the treatment that has some insurance companies realizing the benefits of acupuncture, Dr. Moshe says. The cost is low, and patients want it. Insurance companies are beginning to cover it for some providers.

Read this article on BeckerSorthopedicAndSpine.com.

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KTVU Video: Certain Stretches Could Inhibit Athletic Performance

KTVU's John Fowler interviews Dr. Moshe Lewis on the negative aspects of normal stretching. What kind of stretches lead to less injuries and allow you to perform 11% better? Watch to find out.

Watch this video on YouTube.

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7 Ways to Improve Your Mood and Restore Your Body

7 Ways to Improve Your Mood and Restore Your Body

Do winter blues have you down? Here are some simple, inexpensive ideas to rejuvenate your body and improve your mood throughout the winter season.


1. Treat yourself to some spa time.

Even if going to a spa is out of the budget, get yourself a handheld massager to use in the comfort of your own living room. And when it’s cold out, the next best thing to a massage is a hot bubble bath with some soothing music. You get the added benefit of increased blood flow to muscles, helping you relax. Music itself can be a relaxing way of helping you take your mind off your worries as it is the universal language of emotions. From timeless classics to contemporary jazz, indie, and fusion, the secret is to turn the volume down so low that it is almost imperceptible. This little trick allows you to focus on listening and helps silence racing thoughts.


2. Unwind with a relaxing walk.

Chronic stress can produce too much cortisol, a hormone that can ramp up appetite and lead to overeating. A simple exercise like walking just 30 minutes a day helps facilitate weight management and stress reduction all in one.


3. Treat yourself to a little R&R.

Nap time. Sleep loss causes slowed metabolism and increased appetite, putting us at risk for overeating, unhealthy food choices, and inactivity. Most of us don’t make enough time for rest. Curling up with a good book and some hot cider or tea before lying down can help us fall asleep faster during stressful times.


4. Keep finances in check.

Cutting your expenses is a good idea any time of the year. Studies show that financial stress is one of the main reasons adults worry. This concern can be transmitted to your kids. While most kids don’t bear the financial responsibility of their parents, they can often sense something is wrong. Save money by drinking water instead of coffee and sugary beverages. Don’t plan to make any large purchases on credit until you are out of debt. Lastly, pay yourself first, even if it’s only a dollar a week.


5. Go Zen.

Take up mood-boosting yoga, tai chi or meditation! These mind-body strategies incorporate improving posture, relaxing, and stretching to improve balance and coordination while simultaneously decreasing stress. Take time to breathe deeply and say a prayer, or just sit down in a quiet place and simply meditate with relative peace and quiet.


6. Release inner tension.

Never underestimate the power of a good, healthy sex life and reconnecting with your significant other. Enough said.


7. Take time to laugh.

Comedy is good for the soul, and there are clear health benefits of laughter. Whether you rent movies, download comedy sketches, or even go to improv or karaoke, a good laugh goes a long way. Consider taking your kids or young family members skating, skiing, or snow boarding, where everyone is engaged in lighthearted physical activity. Laughter lowers stress hormones and improves blood flow, which increases your energy levels. The more energy you have, the less likely it is you’ll be overwhelmed by depression that sometimes comes with the winter season.


This article was featured on SutterHealth's "MyLifeStages".

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Podcast: Can Yoga Be Bad for You?

Can Yoga Be Bad for You

Listen: Can Yoga Be Bad For You?

Podcast Interview length: 51 minutes


Yoga Journal estimates that Americans spend over $5 billion a year on yoga classes and products. And this should come as no surprise – yoga is credited with lifting moods, revitalizing sex and reducing stress. But a recent New York Times Magazine article focused on how yoga can also cause serious injury. We discuss the safe practice of yoga.


In this interview I talk with:

  • Baxter Bell, director of the Piedmont Yoga Studio’s teacher-training program in Oakland and a board-certified family doctor
  • Glenn Black, yoga teacher featured in the New York Times Magazine article
  • Jason Crandell, yoga teacher and contributing editor of Yoga Journal
  • Kaitlin Quistgaard, editor in chief of Yoga Journal

Listen to this podcast on KQED

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Walk On: The Causes and Treatments for 'Foot Drop'

Screen Shot 2012 01 23 at 7 19

I was recently interviewed for an article about foot drop on AdvancedWeb.com. Foot drop is when the front of one’s foot hangs lower than it should due to a weakened or damaged nerve or muscle in the lower part of the leg. Individuals with foot drop will drag their toes along the group or will bend their knees in order to not drag their feet. In this article Danielle Bullen discusses how doctors and hospitals use exercises, as well as convectional and alternative treatments to ensure those with foot drop walk safely again.

Foot Drop Conditions

From exercise to medications to modalities, clinicians have a lot of tools at their disposal to treat foot drop. Just as its causes are many, so are the treatments. While the same approach may not work for each patient, trial and error can help doctors and physical therapists figure out the best possible outcomes.


Foot drop is not a disease itself, but rather a symptom that develops as a result of various neurological, muscular or anatomical problems. Patients who suffer have difficulty lifting the front part of their foot due to muscle weakness or paralysis. Sometimes they drag their toes along the floor as they walk.


Finding the Cause

Some of the common reasons patients present with foot drop include stroke, spinal cord injury or injury to the peroneal nerve on the outside of the fibula, below the knee. ALS (Lou Gehrig’s disease), Parkinson’s disease and multiple sclerosis can also lead to foot drop. Patients who have had a total knee replacement can also present with foot drop, although that is less likely. Moshe Lewis, MD, MPH, chief of the department of physical medicine and rehabilitation, California Pacific Medical Center, San Francisco, described one unique case where a surfing accident lacerated someone’s peroneal nerve, causing foot drop.


The Old and The New

Other than exercise, clinicians have other options to treat foot drop. “We’re seeing a blend of the old and the new,” said Dr. Moshe regarding treatment.  He cited vitamin therapy, particularly B6, as helpful. Nerve medications, which are relatively new on the scene, decrease pain and improve nerve function without peripheral swelling. Topical pain medications are another new development but Dr. Moshe advised his fellow physicians to use them wisely.

Read the entire article on AdvanceWeb.com.

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