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Extreme Shoveling: Make Loads Even Smaller, And Other Tips From Spine Expert

CommonHealth (WBUR) - Mon, 02/02/2015 - 1:45pm

Energy efficiency specialist David Adamian shovels a sidewalk in Cambridge, Mass. (Robin Lubbock/WBUR)

My back aches just thinking about it: An additional foot of snow, possibly followed by rain in some areas to add more weight to each shovel-full. This is back-blowing territory, made all the more perilous by the need for speed, to shovel out before night’s chill coats every snowy crenellation with ice.

So for back-saving tips, I turned to an expert: Dr. Carol Hartigan, a physiatrist and the medical director of the Spine Center and Spine Rehabilitation Program at New England Baptist Hospital. My personal takeaway: Smaller shovel-loads. Even smaller than you think you need. Slow down. Bit by bit. And if you possibly can, avoid the whole thing: Outsource. Borrow a snowblower. Or at least share the labor. Ignore all this wisdom at your own risk — the risk of weeks of misery. Our conversation, edited:

First, what’s at stake: What are the most common shoveling injuries you see?

We basically see strains: People who’ve been shoveling, sweeping, clearing snow, breaking up ice, cleaning off the car. Usually it’s the low back but it can also be the neck and the mid-back.

And the worst?

Really just severe, acute back strain: Pulling, stretching, tearing of the muscles and the capsules around the joint and the ligaments causes release of chemicals that irritate the nerves and trigger inflammation and that gets to be a vicious cycle that feeds on itself, and then the muscles tense up and spasm, and then the blood doesn’t flow, and then we get cautious and guarded — those things happen. And there’s no easy way out of that — that’s a situation that has to run its course. It can take a day or two, a week or two, it can take up to eight weeks to resolve.

In terms of prevention, what do you most wish people knew?

• Snowblowers do help! Having a plow shovel the driveway, for people who are older, is not a bad idea if that’s an option. If people are shoveling themselves, using the right shovel — like a back shovel that has a curved handle — can minimize the back bending.

• Using your legs is a good idea.

• Turn with the snow to throw it, and try not to throw it really far away from the body — keep the shovel close to the body.

• Don’t try to shovel deep snow — like with the 24” we had  last week — the whole entire depth of the snow at a time. Just do a few inches at a time.

• Split the job up with your family members. Don’t let one person do it.

• Pace yourself.  Do a little, go inside, come back an hour later, as opposed to doing it all at once.

And specifically for today — it looks like it’s going to be extreme shoveling, trying to put another foot of snow on top of walls that are already three or four feet high. What do you advise?

There’s no way around it being a very difficult and challenging situation. We’re going to have to make our driveways a little less wide. Find new spots to put the snow. We want to be very careful to have on shoes with a good tread so we don’t slip — we see injuries when people slip and fall and land on their butt and get a compression fracture. So we don’t want people slipping on the ice. But there’s no two ways about it — it’s going to be a difficult snowstorm  today.

What about the weight of the snow, with rain coming in some areas to make it heavier? Is there any rule of thumb about how heavy a shovel-full you should lift?

It’s better to do more lifts of less heavy shovel loads than trying to do it as quickly as possible with the least amount of maneuvers. It’s very personal to each of us. We’re different sized people. We don’t want it to be super heavy, we want it to be like a medium intensity challenge.

And the height problem? If you have to lift snow up higher to get it onto a pile, does that pose special risks?

Absolutely — to the arms, the shoulders, the mid-back, the neck — that’s all going to be affected. And then the reaching, the lifting: when we’re not holding a load close to our body we’re at more risk to have stress and strain delivered. So I really think we have to make the driveways narrower, we’re going to have to find new spots to put the snow.

In terms of movement: If you need to get a shovel-full to four feet in height, is there any good way to do it?

I really can’t think of any ergonomic way to do that. It’s one of those things where we’re stuck. I really can’t. Could we step up on a ladder and do it? Theoretically we could — a step stool or a bucket brigade of sorts…

So as we have to lift a load higher, it puts our mid-back, upper back, shoulders, arms and necks at higher risk of getting strained. So do we want our shovel loads even lighter if we get that high?

Absolutely, definitely lighter.

So just chip, chip, chip away… 

Yes, and take our time — though we do need to get it done before the rain and the freeze.

So should we try to use little shovels?

There are arguments to use a small shovel, even more like a digging shovel, but we don’t all have those — and using that curved shovel is good for the back. Just pick up less snow with each lift.

And just in case the worst happens, if you do get a strain, that generally means you need to rest it? 

Not complete bed-rest. We usually try to keep people as active as possible, as tolerated, to keep the blood flowing, and the oxygen and the nutrients flowing, and to clear away the inflammation with the circulation. So we usually have people do what we call ‘relative rest’ and then we have them use anti-inflammatories if they tolerate that, and apply ice to reduce the inflammation.

Readers, other smart shoveling tips? 

Categories: Health Care

Florida Leads Nation in Obamacare Enrollment Despite GOP Opposition

Kaiser Health News - Mon, 02/02/2015 - 5:00am

When Florida workers promoting President Barack Obama’s health law marketplace want instant feedback, they go to an online “heat map.” The map turns darker green where they’ve seen the most people and shows bright red dots for areas where enrollment is high.

“The map shows us where the holes are” and what communities need to be targeted next, said Lynn Thorp, regional director of the Health Planning Council of Southwest Florida. She hands out information about the health law’s marketplace at rodeos, farmers markets, hockey games —almost any place where people gather.

That mapping strategy is one reason why a Republican-controlled state like Florida, whose leaders have criticized the health law at every turn, is leading the nation in signing people up for private Obamacare health plans. With two weeks to go until the deadline for 2015 enrollment, Florida’s tally exceeds that of even Democratic-led California, which has embraced the law building its own online marketplace and has twice the population and uses three times as much federal funding for outreach.

“It’s surprising Florida has done as well compared to other states, and they will be looked at by folks who want to learn lessons to promote enrollment,” said Joel Ario, managing director for Manatt Health Solutions, a consulting firm, who worked for the administration setting up the exchanges soon after the law was passed.

This KHN story can be republished for free (details).

As of mid-January, 1.27 million Floridians had enrolled in exchange plans, according to federal data, compared to 1.2 million Californians. Texas, which has 6 million more people than Florida, enrolled about 919,000 people in private plans. Both Florida and Texas have a 22 percent uninsured rate. California’s rate is 17 percent, according to latest Census data.

“It is truly ironic that Florida leads the nation in enrollment … with leadership that has actively opposed the law,” said Leah Barber-Heinz, executive director of Florida CHAIN, an advocacy group involved in outreach efforts. “It shows true commitment on the part of many and it portrays an extremely high need for affordable coverage.

There are other reasons cited for Florida’s robust enrollment —including intense competition among insurers in several big counties and the high degree of coordination among the nonprofits and community groups which received federal grants to sign people up.

Another key factor is the state’s decision not to expand Medicaid under the law. That’s left consumers with incomes above the federal poverty level of $11,600 per year with no coverage option other than to buy a private plan — with help from sliding-scale government subsidies.  About 800,000 Floridians who make less than the federal poverty level are shut out altogether because they make too little to qualify for subsidies for private plans, but too much to qualify for Medicaid. In Florida, adults with children qualify for Medicaid only if their income is below 34 percent of the poverty level. Childless adults are ineligible. Florida is one of 22 states that chose not to expand Medicaid after the U.S. Supreme Court made that provision optional for states.

In contrast, California expanded Medicaid to those making up to 138 percent of the poverty level, or $16,100 for an individual. The program has grown by 2.3 million people since fall of 2013, boosted partly by publicity for the online marketplace.

Covered California spokesman James Scullary said the exchange is not allowed to enroll people in private plans if their incomes fall between 100 and 138 percent of the federal poverty line, because they qualify for Medicaid.

A snapshot of the “heat map” of a four-county area around Tampa used by Obamacare outreach workers.
The darker the dots, the higher the percentage of enrollments in that zip code. The darker the green color, the more residents who received outreach. (Source: Family Healthcare Foundation)

Jon Urbanek, senior vice president of Florida Blue, the state’s dominant insurer, credits Florida’s strong enrollment in private plans, in part, to the state’s decision not to expand Medicaid.  He also points to the intense outreach by thousands of the carrier’s insurance agents. Florida Blue has conducted about 3,000 “town-hall” style meetings at its 18 retail centers. “We knew going in that this was going to be a face-to-face, get in the community type of action to build trust with people,” he said.

Florida has also gained from having an older population which is more likely to buy coverage than younger people, Ario said.  That population is centered in a handful of urban areas such as Miami, Orlando and Tampa, making them easier to target, he said.

In contrast, many uninsured Texans live outside the big markets of Dallas, Houston and San Antonio. Texas also has a higher proportion of Hispanics who have been more challenging to enroll because of language barriers.

Then there’s the unusual effort to coordinate outreach. John Gilbert, national field director for Enroll America, a nonprofit doing outreach in 10 states, said Florida has benefitted from having several large nonprofits with experience signing up children for Medicaid.  They have worked together closely  – helped in part by the heat map.

Thorp of the Southwest Florida Health Planning Council describes how every time she hands out Obamacare flyers at a fair, or counsels at a local library, the action get entered into a computer log, which immediately changes the heat map. That way, other outreach workers see where contacts have been made.

Data from actual enrollment in the Obamacare health plans is added using dots, although that information lags because it is controlled by the U.S. Department of Health and Human Services.

The darker the dots on the map, the more saturated the enrollments in that zip code. When users hover over a dot, it pulls up a box showing how many residents in that zip code received outreach, including how many got one-on-one help filling out an application.

“We can then make sure we are appropriately allocating resources,” said Melanie Hill, executive director of the Tampa-based Family Health Care Foundation, which devised the mapping tool. Her group is working with the University of South Florida, which received a $5.4 million federal grant to help people anywhere in the state enroll. In all, Florida nonprofits received $6.8 million in federal “navigator” grants.

Perhaps another, harder-to-measure factor is how advocates have been fired up by the opposition of many of the state’s political leaders, said Barber-Heinz of Florida CHAIN.

“Stakeholders that didn’t work together in the past are working together on this,” she said. “It drives us to work even harder.”

Barbara Feder Ostrov contributed to this story.

Categories: Health Care

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