Dr. Jonathan Nzoma

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Thursday November 30, 2023

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Happy Father’s Day!!!

Introduction

Hi my name is Dr. Nzoma. I help athletes and active people with shoulder, hip, and knee pain. For a person who falls and dislocates their shoulder, I can help control pain and swelling. My goal is to get a patient from an unstable painful shoulder today, to a stable shoulder that is functional in the future. In many cases I recommend physical therapy, but in some cases stabilization surgery is needed to get the best results.

&sportsmedicine

drjonnzoma.com

There’s nothing quite like using a scope to make things better!

Sawbones

Big shot out to Thom and Colleen at Sawbones. Our first set of sawbones for Detroit community health education. I’m excited for the new opportunity for project based learning.

Strength Continued

Don’t forget your core! The biceps, triceps, forearms and deltoid muscles all need regular tension and recovery. Strengthening the core muscles is a must along with upper and lower body muscles.

In the orthopedic journal JAAOS an article Covers core stability titled:
Core Stability and Its Relationship to Lower Extremity Function and Injury
Willson, John D. MSPT; Dougherty, Christopher P. DO; Ireland, Mary Lloyd MD; Davis, Irene McClay PhD, PT

Definitions include:
“Core stability is the ability of the lumbopelvic hip complex to prevent buckling and to return to equilibrium after perturbation. Although static elements (bone and soft tissue) contribute to some degree, core stability is predominantly maintained by the dynamic function of muscular elements.”

How does the core help?:
“There is a clear relationship between trunk muscle activity and lower extremity movement. Current evidence suggests that decreased core stability may predispose to injury and that appropriate training may reduce injury. Core stability can be tested using isometric, isokinetic, and isoinertial methods. Appropriate intervention may result in decreased rates of back and lower extremity injury.”

Consider that some people do 1,000 to 3,000 sit ups per day like old school football players. Add in moving planks, side planks, leg ups, and it’s easy to put together 10 exercises at 100 reps per day. The hard part is staying consistent. It can improve your posture and your breathing as well.

Physical health has so many benefits to health. There are hormonal, protein, neurological changes that happen as a response to physical stress. Our bodies and joints are meant to move. It’s our lifestyles that have changed. We are so busy living that we often put exercise on the back burner.

To be successful at physical health, my tips are to get organized, set goals, set yourself up for small regular wins. Reward yourself whey our stay committed.

Strength is absolutely necessary and often not discussed. We all know that walking is a great exercise for cardiovascular health especially for people who need an alternative to running. Cycling is also a reasonable alternative to the impact from running.

So what about strength? I’d first like to point out that sarcopenia means the loss of muscle as we age. We can’t stop the process but it can be slowed down.

What exercises? Body weight exercises are a great start. Push ups, pull ups, etc. Resistance bands are an alternative to weights. Work the deltoid, pectorals, biceps, triceps, and forearms. Work the back muscles like latissimus, trapezius, rhomboids, and multifidis. Work the gluteal muscles, hamstrings, quads, and calf muscles. Don’t forget the rest of the core muscles like re**us, obliques, and transversus abdominus.

Do 100 reps of each muscle in isolation ( just kidding). Or consider exercises that work multiple groups. The key exercises being squats, overhead press, bench press, and bent over row.

Who is this exercise for? My opinion is that it is for everyone regardless of age. Unless you have a medical reason not to or have an orthopedic condition or past surgery, it’s for you.

It’s about strength not size of muscles. Some people want to look like muscles more than looking normal and having strength. If you use supplements for growth, you can’t stop and expect the same results. I recommend a healthy diet without supplements. The book “Eat Plants, Lift Iron” proves that no supplements are needed to add muscle.

How exactly can you accomplish this. Step 1 talk to your doctor and make sure it is safe for you to do. Consider a free training program complete with downloadable spreadsheet for exactly what to do. I recommend looking at the videos and all of the details on what not to do. Go slow and make sure you can safely and easily do 5 reps before moving up in weight. Visit www.stronglifts.com for more information.

This program allows you to go at your own pace on your own. If you need support, do it with a friend, or a trainer. Always practice correct form. Video record yourself if you are alone. You can injure yourself if you don’t heed these warnings. It’s also important to stretch after your workouts.

I wish you the best should you take on this journey to better strength. I’m not just recommending it, I do it myself. I am sure this program is not for everyone but developing muscle strength is part of being our best healthy selves.

Strength Training, Lifting Weights, and 5×5 Workouts | StrongLifts Get stronger with free weight compound barbell exercises like Squats, Deadlifts and Bench Press. Simple, effective strength training workouts that work.

I recently saw a young adult patient who I have been looking after for several months. He had an orthopedic problem and he will need surgery. Just looking at him, I knew there was a lot more than the surgery on his mind.

He began telling me about his frustrations and how his life has changed drastically. I empathized with him when he explained how his injury ruined his senior year of high school. When he recovered from his injury, COVID-19 was declared a pandemic. He has had to deal with ill family members. Instead of being on campus as a freshman, he is stuck at home with no freedom.

I listened and I empathized. I told him to try to see from his parents point of view. We discussed a variety of topics including the role of higher education, personal development and life planning. I hoped he would understand and take to heart what I recommended for him.

It had been a while since I had the opportunity to be in the role of advisor and mentor. I started to think about my mentors. They listened to me dream about the life I’m living today.

Not only do I need to reach out and thank my mentors, I also need to find a way to help others the same way my mentors helped me. Helping others is a gift that brings our lives meaning and purpose. I’m thankful for the surprise opportunity.

How do you manage yourself?

Peter Drucker answers this question in his book “Managing Oneself.” The concept distinguishes a person who has to be told what to do from a person who does not have to be managed.

How can a person develop this skill? Drucker says that we all have different strengths and weaknesses, but we should focus on growing and cultivating our strengths. He suggests constantly give yourself feedback on how you’re doing. It takes time and planning. “Whenever you make a key decision or take a key action, write down what you expect will happen. Nine or 12 months later, compare the actual results with your expectations.” Look for gaps in your knowledge and fill them in.
He emphasizes spending your resources on making the good aspects of your skill set great, not on making the bad aspects mediocre.

How do you learn? Most people are either
readers or listeners. Gain information by way of strength as a reader or listener.

Questions to Ask Yourself
Am I a reader or a listener? How do I learn? Do I work well with people, or am I a loner? If you do work well with people, you then must ask, In what relationship? Do I perform well under stress, or do I need a highly structured and predictable environment? Do I work best in a big organization or a small one? What are my strengths? How do I perform? What are my values?

Drucker gives insight on planning. Should be for max of 18 months reasonably clear and specific.

Ask yourself: “Where and how can I achieve results that will make a difference within the next year and a half?”
It should be difficult to achieve and require you to stretch yourself, and the results should be meaningful. Finally, results should be visible and, if at all possible, measurable.

From this will come a course of action: what to do, where and how to start, and what goals and deadlines to set.

How does the work of managing yourself benefit relationships?
You can quickly communicate who you are and how you operate. You also can get others to communicate with you in the same manner.
When working with someone, always tell them: “This is what I am good at. This is how I work. These are my values. This is the contribution I plan to concentrate on and the results I should be expected to deliver,” and be sure to ask: “And what do I need to know about your strengths, how you perform, your values, and your proposed contribution?”

One quick action step is to write down your top 3 strengths. Don’t struggle with this. Ask your family and close friends to help.

Why should you organize and run your life like a business?

Business’ don’t have all the answers. In fact, It is impossible to know what people will like in the short term or in the long term. What business gets right is the way they approach and plan for success. Just like real life, it is often more important to have a process to achieve your goals and a focus on the journey not just the end result.

The example I see often used is the airline flight. The pilots put in the coordinates, they follow a checklist for every step of the flight. From the moment the plane takes off, there are gusts of wind that try to take the plane off course. What happens? There are adjustments that are made that get the plane back on track.

In business the important factors are leadership that the employees believe in, measures and metrics that determine how well the company is executing, and the outcomes on the balance sheet or profit and loss statements that are a result of the actions taken every day. It is not enough that people know their jobs, the culture has to be created and directed. The team has to be able to hold one another responsible for making the right choices.

Kate Lorig was the first person that I am aware of that proved that health can and should be managed. She started in the 1970’s and has decades of research proving that her methods work. If the idea of spreadsheets, meetings, and reports for your health make you cringe, sorry. I realize that doing this kind of work is not for everyone. We should all at least be aware of it. Most people don’t decide to do the right thing with their health until they have no choice. My point is to remind people of their choice and encourage them to be proactive when it comes to their health.

You don’t have to wait to you get a chronic disease to manage your health. Start by managing your health like an athlete. Create your plan for health. Have a vision, a mission, values, goals. Imagine a better future for yourself. Consider these business approaches to your health.

-Ari Weinzweig Visoining
fil:///Users/jonathannzoma/Downloads/Zingermans-2020-Vision.pdf
-Zig Ziglar
https://www.madeforsuccess.com/PDF/Born_to_Win_Workbook_by_Zig_Ziglar.pdf

www.madeforsuccess.com

How do you reduce sports injuries during covid times?

There are guidelines that I have attached to help youth return to sports safely. The key takeaways are that several factors have led to less optimal play conditions. Seasons are shorter and the normal preseason conditioning has been reduced and altered. These differences have led to increased injury. Increasing volume over 5 weeks is recommended. Frequency and intensity has to be adjusted as well.

Athletes are eager to return to play but the risks of sports are injuries are higher. Coaches, parents, and athletes need to be aware of these factors and make the appropriate adjustments.

https://www.sportsmed.org/aossmimis/STOP/Downloads/Posts/WeightTrainingGardnerPaci.pdf?utm_source=informz&utm_medium=email&utm_campaign=American%20Orthopaedic%20Society%20for%20Sports%20Medicine&_zs=dMe8V1&_zl=oN1B7

www.sportsmed.org

How to you cultivate healthy relationships?

Here is my deeply personal story. Today, I attended the funeral of a great man, my uncle Moses. He was a tall deep voiced man of strength who was loving and compassionate. He was in my life since the day I was born nurturing and guiding me. He eventually left Michigan and to start his 20 + year military career in the Navy. He was retired and spent his time with his family and supporting his church community. He would come visit us in Michigan regularly. When he came to town he was the fixer of all things. He truly had a gift with mechanical, electrical, and carpentry. He was also the family photographer. He took pride in his work. He was a lover, he gave the best hugs. He was known as “grandpa” to my children because he was a father to me. We were in a family zoom call 3 weeks prior that I almost missed. I logged in late and true to form, he started his customary trash talking and giving me the flux about it. ��I have been writing about health and one of the Big 4 areas of health is cultivating relationships. I was in the midst of planning to organize my work, home, and community relationships. His passing was sudden and unexpected and I wish I reached out to him more often. The benefit was that he did not suffer, the downside is that I did not have a chance to say goodbye.

Life is precious, short, and sweet. All day my mind has been blown by our capacity as humans to be emotionally devastated after the death of a loved one but to quickly return to taking for granted opportunities to connect with our loved ones. If you have someone that you love, make time to regularly reach out and let them hear from you. I started a spreadsheet today to organize my contacts. The plan is for regular outreach with no specific agenda. I will do this in the memory of my uncle Moses. If you have tips or want me to share with me how you organized the people in your life, send me and email to [email protected]

It’s Your Choice But We Can Help

What can we do to improve interest in healthy choices? What helps people make better choices?

In her book, ”The art of Choosing” ,the author, Sheena Iyengar, cites several examples of how we make choices every day. Some choices we make on our own and some of our choices are influenced by others. If someone is trying to get your attention or get you to buy something, they have to make choices on what to show you. She explained how many the number of samples a salesperson chooses to show you can affect what you choose. Consider this example from the book:

She describes a study where her team set up a table in a grocery store to sell jam. In one trial example, the table is set up with 24 jars of jam. In the second trial example, the table is set up with 6 options. Which table do you think sold the most jam, and why?

When you have a display with lots of choices, you will get more people interested in what you have. If that attention is all you want, then that's all you have to do. 24 jars led to 60% of attention but only 3% bought jam. If you want to create a change, you will need to do it differently. 6 jars lead to only 40% attention but 30 % bought jam.

It turns out that when faced with too many choices, most people decide not to choose at all. She noted that if there are more than 10 choices, people make poorer decisions. When there are fewer options and a person can recall how they are different, it is easier to find a choice that fits the person.

We can help people make better choices? Is it possible to make it easier to choose? Let's take a look into some of her suggestions:

First she suggested cutting. She says less is more. From the example we discussed with the jam. If you have fewer options, people can look into each option without the pressure of having to make a decision. There is enough time to try on the options if there are only a few of them (less than 10).
When Head and shoulders cut the number of shampoo types from more than 10 to less than 10, sales increased.

Concretize or make the choice vivid. She gave an example of a beautiful road with serene backgrounds that is a tourist destination. She used a long paragraph of words that most people would have a problem with wanting to read. If you decided to read it, it was hard to make out from the words exactly what kind of road it is. With only the information from the paragraph, you are not sure if it is a place you want to visit. She then put up a few images of the road. It was a horrible visual that you take one look at and say no thanks.. It was a one lane road off a steep cliff which makes for dangerous driving.
In a a second example they were able to get people to save more money for retirement by asking one extra question. They asked people to imagine a future in which you saved money, write a list of what you would have saved. Just by asking the question, more people choose to save money for retirement.

Categorize means to group together similar items. It turns out that our brains are good at categories because it is a way to take a lot of information and organize it.

The important tip with categorizing is to name the categories in a way that the person who is choosing can understand them instead of a way you can understand them.
The same rule of 10 or less categories is easier to understand than more than 10.

Conditioning is to a complicated process of choosing with several combinations, it is better to start with the smaller combinations first. Starting small helps a person make progress by way of small steps at choosing. For example if you are buying a car, it is better to start with the type of engine if there are only 4 types and move on to interior colors, and end with paint colors since there are more paint color choices than engine types. If people start with the largest group of options first, they get tired of choosing faster and may not make the right choice.

The Magic of Choice
�Today I learned how magicians, marketers, and politicians influence human behavior. It turns out that our minds are very suggestable. They have the upper hand because they know what we are more than likely to do. Advertisements work, that why we are exposed to so many in our day to day lives.

Their method is simple. Get us to make a decision without thinking. Then when they have us, they take us down the path as far as we are willing to go. If they had our best interests in mind, that would be great. Unfortunately, that is not the case.

One example using a deck of cards is to instruct a person to pick a card and push toward you. A study showed that based on your hand dominance, 60% of the time the second card in from the edge is chosen.

We also know from the same study that reminding people that they have a choice in the matter affects how they choose. Using the same deck of cards, asking a person to choose one of 4 cards decreases selecting the second card in from the edge down to 35%.

We always are choosing. Unfortunately, if we are not aware that we are choosing, someone can take advantage of our suggestible nature, and get us to choose something that is not in our best interest.

I am a firm believer that our health could improve if there were commercials promoting healthy behaviors. I am even willing to create my own version. The key is to use words and phrases that are easy for the brain to process, and easy to share. The more you make it familiar to something people already are aware of, the easier it goes in.

So what happens to us when we meet up face to face?

There are physical, emotional, and chemical changes that benefit our health when we meet in person. We are able to restore our personal emotional health with human moments. Physical touch helps us feel supported. Our hormones change when we meet in person.

Lack of normal human contact, social isolation, lack of a social network have a negative impact on our health. Connection on the internet is not a good substitute for human contact.

What happents to us on a hormonal level with face to face contact?

Stress hormones are reduced including epinephrine, norepinephrine, and cortisol.

Trust and bonding hormones increase with the feeling of empathy including oxytocin and vasopressin. These same bonding hormones are decreased when people are physically apart.

Attention, pleasure, neurotransmitter dopamine is increased with in-person contact. Fear and worry decrease with the increase of the neurotransmitter serotonin.

The current pandemic has made us more physically isolated. We have to wear masks and socially distance. Historically, pandemics end and life goes back to normal. Hopefully, we can get back to all of the physical, emotional, and chemical benefits of meeting in person.

This topic was summarized from the human moment article published in the Harvard Business Review by Edward Hallowell, MD, a psychiatrist.

https://hbr.org/1999/01/the-human-moment-at-work

The Human Moment at Work E-mail and voice mail are efficient, but face-to-face contact is still essential to true communication.

The Human Moment is an article published in the Harvard Business Review by Edward Hallowell, MD, a psychiatrist. It explains the value of in person communication. It turns out that in an in-person discussion, you can read a persons body language, facial expression, and tone of voice. You can use that information to dig deeper or back off. Email, texting and other forms of technology, get in the way of this normal communication process.

Frustration can build up over time and can become worry or worse, what Dr. Hallowell calls “toxic worry.” It is anxiety that has no basis in reality. What comes first before the toxic worry are little misunderstandings. We are feeling the effects of COVID on our ability to get together and have human moments.

Hopefully, we become even better at it when this moment passes by. Follow the link to learn more about the human moment.

Please also consider that the American College of Lifestyle Medicine has 6 domains. In my opinion there are 4 main ones and the others were added to be comprehensive. That being the case, for a healthy lifestyle, 25% has to do with your physical health, 25% how you manage stress, 25% is what you eat, and the remaining 25% is how many human moments you have.

How much love and support you get from your family, friends, coworkers, community, and places of fellowship matters. We will dive deeper into the science behind it next time.

https://hbr.org/1999/01/the-human-moment-at-work

The Human Moment at Work E-mail and voice mail are efficient, but face-to-face contact is still essential to true communication.

How do you advise people to be physically active?

The American College of Lifestyle Medicine recommends:

MOVE MORE
Whether it’s a vigorous workout before or after work, a brisk mid-day walk, or some weekend gardening, daily physical activity has been shown to be more effective than medication in the treatment of heart disease and other diseases—with very few negative side effects.

The United States Government published Physical Activity Guidelines for Americans, 2nd edition in 2018. Their promotional campaign included:

Move Your Way Campaign
• Vision: Consumer-focused campaign to promote physical activity recommendations in the second edition of the Physical Activity Guidelines
• Purpose:�o Raise awareness of recommendations
o Change behavior among consumers
• Target audiences: physical activity contemplators, or those who are not yet meeting the recommendations in the Physical Activity Guidelines and health professionals (as conduit to consumers)

150 minutes per week is 30 minutes per day 5 out of 7 days of the week. 30 minutes a day can be broken up into 10 minutes after breakfast, 10 minutes after lunch, and 10 minutes after dinner. Several types of exercise count for this but the easiest and best is walking. Done correctly, this type of exercise keeps the heart conditioned.

The second recommendation is to strengthen your muscles at ease 2 days per week. Body weight exercise like push ups and pull ups can work. Or, you can use weights or resistance bands. Done correctly, this type of exercise can slow down the normal process of muscle loss over time.

The bigger challenge is getting people to understand these recommendations and change their behavior. The campaign offered the following:

Can we do things differently to help people become more physically active?

Guidelines

What does a healthy workplace look like?

The American College of Lifestyle Medicine (ACLM) offers a short review of the important proven ways to be healthy at work. They cover the Lifestyle Medicine concept and the role of ACLM as an educational organization. They make a personal and timely argument for a different approach to workplace wellness. They discuss a shift in healthcare from the current model of fee for service to one based on outcomes and value. They point out that 80% of healthcare spending is used on conditions that require individual behavior change. This education model can create positive change and can improve well-being, productivity, benefiting the employee and the employer.

Teaching the 6 domains
There are 6 areas of focus that treat, reverse, and prevent chronic disease. The areas are eating smarter, moving more, sleep more soundly, manage stress better, cultivate relationships, and avoid risky substances. These healthy choices lead to better health, decreased absenteeism, better engagement, improved focus, higher energy, improved creativity, fewer accidents, and higher productivity. Prioritizing employee health and creating a healthy culture leads to improved financial metrics. A university decreased medical and prescription drug spending, earning 210% return on their investment in a worker healthcare pilot after 6 months.

So what does a commitment to workplace wellness look like?
There are programs, tools, services, and benefits in a addition to changing the physical environment and culture. The key ideas are leadership, conducive environments, supportive policies, engaged peers, and expansive benefits.

The workplace offers an opportunity to teach and reinforce healthy behaviors. The difference between ACLM and what most companies do is in the details. ACLM programs combine treatment and prevention. The same program treats a variety of conditions. Another added benefit is that the employees can deepen their connections on the same journey. The program improves the quality of life of the employees and the company benefits as well.

Does that sound like the wellness at your workplace? If not, consider sharing these resources with leadership at your company.



What does a whole food plant based diet look like? This is a video from a chef and wife of Derek Moore from the Tennessee Titans NFL football team. She uses vegan and plant based terms. It is important to note that these terms are not the same. You can be plant based without being vegan. Vegan includes no animal products or harm to animals, no milk, and no dairy. The food in this video looks amazing.

https://youtu.be/ys8ks5uSthI

The Morgan Menu Derrick Morgan's wife Charity Morgan is creating a new vegan meal plan for over a dozen Tennessee Titans.

Should my doctor tell me how to shop for and prepare my food?

It’s not that my doctor should or shouldn’t teach me nutrition, its more likely that it is not possible to cover the entire topic in the 15 minute doctor visit appointment.

I am not providing my doctor a pass on a complicated topic. I still should be educated or be directed to educational materials on what to eat.
I would expect to be told to eat fruits and vegetables. Lower my sodium intake and reduce my sugar intake.

I previously mentioned a resource entitled "Learning how to shop and prepare meals with Culinary Medicine syllabus and comprehensive curriculum, authored by Chef Michelle Hauser, MD, MPA, FACLM.” I asked my friendly university librarian to help me find an electronic version of the book. I was provided the book via email the same day.

Who is the book for? This book was actually designed to teach and demonstrate culinary medicine to medical students. Traditional medical education only spends on average about 0.6% instruction on nutrition.

The purpose of the book is to help help treat, reverse, and prevent chronic disease related to lifestyle. The book is not comprehensive but provides practical resources and key points. The goal is present healthy food as delicious, fast, tasty, and inexpensive.

They also take into account that people have beliefs and traditions related to food. They suggest meeting people where they are, and finding out how ready the participants are to make these changes. The strategies in the book show how the physician can provide assistance, and partner with the patient to move them along the spectrum of food from bad to good over time.

The curriculum is designed to mirror other educational courses from Stanford University. It has 9 sections which take 2 hours each. Prep work before each class can take up to 30 minutes. The original course was MD chefs teaching medical students.

The book covers how to find healthy food as well as how to prepare it. The facts presented in the book are that the standard American diet (SAD) is not healthy. SAD is full of ultra-processed foods, refined flours, added sugar, and salt. 80% of chronic disease is estimated to be preventable and diet is a top contributor to death and lost years.
The alternative is to choose a Whole Food Plant Based diet of fruits, vegetables, nuts, legumes, seeds, and whole grains.

The information above was adapted from the Culinary Medicine Curriculum text. Feel free to obtain your copy online or from your librarian. Alternatively, if interested in reading the book, send an email to me at [email protected]. Enjoy!