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Corner Clinic: Caring for Workout Injuries, the Ideal Weight and Sleeping with Contacts

 

By UC San Diego Health Experts   |   January 02, 2019

Our experts answer your questions on everything from headaches to tummy aches. This month, our experts discuss whether to ice or heat an injury, how to determine your ideal weight and the dangers of sleeping with contacts.

 

  1. Should I apply ice or heat to my injury?
  2. How do I determine my ideal weight?
  3. Is it safe to sleep with contacts?
Kathy Weber

Should I apply ice or heat to my injury? Kathy Weber, physician assistant, urgent orthopedic injuries clinic at UC San Diego Health

For a recent injury, I recommend applying ice for 20 minutes every couple of hours to reduce the inflammation. As symptoms improve, you can use ice less frequently. Applying heat to some injuries too soon can increase swelling, which can increase discomfort. For back and neck injuries, I would consider using heat sooner, as muscular pain and spasms tend to feel better with warmth. If the pain is due to known arthritis, ice can exacerbate symptoms, so don’t continue icing if your pain is worsening with use.

When icing, place a thin towel against your skin to avoid frostbite. If you don’t have an ice pack on hand, frozen peas are always a cheap and easily accessible alternative.

After the initial injury period of rest, as you begin home exercises, physical therapy or return to sport, I suggest applying heat before activity to warm up the injured area and ice afterward to decrease swelling and pain.

Many people think ice and heat are only good for the initial injury period. But since some injuries can take weeks to months for full recovery, ice and heat can continue to be helpful tools. Listen to your body. If you find that heat helps more than ice or vice versa, do what feels best.

How do I determine my ideal weight?
Eduardo Grunvald, MD, medical director, Weight Management Program

Eduardo Grunvald

Determining one’s “healthy weight” can be a very confusing topic. Most people assume that using the Body Mass Index, or BMI, determines one’s optimal weight. The BMI is a calculation that standardizes one’s weight for their height. A BMI between 18.5 and 25 is considered normal, 25 to 30 is overweight, and above 30 is obese, with further classifications depending on the degree of obesity. These values have been determined by large population studies examining health complications. It is therefore best applied to populations, and not necessarily to individuals. That is why it is a great measure for research on large groups of people.

Having said that, it is a good initial screening tool. The problem is that it tells us nothing about our body composition, like the relative amount of fat, water, muscle, and other lean tissues in our bodies. More importantly, it provides no information on the distribution of body fat, which is more relevant when it comes to the risk of metabolic consequences, such as diabetes, cholesterol problems and risk of heart disease. One easy, and more informative, way to estimate this risk is for your health care provider to measure your waist circumference. A more detailed assessment can be undertaken with your doctor. To complicate matters further, health risks for a given BMI also depend on your race or ethnicity. For example, East Asian and South Asian individuals are more likely to develop metabolic consequences at a lower BMI.

I think the real confusion lies when someone is trying to determine their goal for a specific number on the scale if they struggle with excess weight. The assumption is that the ultimate aim is for a BMI in the “normal” range. While this may be obtainable for someone with only a few pounds to shed, it may be very difficult for a person with significant weight to lose. There is extensive scientific evidence that in the long-term, for most people losing and maintaining more than 10 percent of one’s initial weight with lifestyle interventions alone is extremely difficult, owing in part to the body’s defense mechanisms against reducing energy stores. Aiming for unrealistic goals often results in disappointment, frustration and cessation of healthy behaviors. The good news is that with just 5 to 10 percent weight loss folks can enjoy improved health, such as blood sugar control, less joint pain, better blood pressure, and overall optimal quality of life. Of course, more is better — and attainable for some — but thinking about maintenance should be part of any plan. These health goals may be more important in determining one’s “healthy weight” than the weight itself.

Here’s to your health. Happy New Year!

Is it safe to sleep with contacts?
Chris W.D. Heichel, MD, ophthalmologist specializing in cornea, cataract and refractive surgery

Chris Heichel

The short answer is no, it is never safe to sleep in contact lenses. In general, contact lenses are a wonderful way to treat myopia (nearsightedness), hyperopia (farsightedness), astigmatism, and even presbyopia (difficulty seeing up close). Whether it is for an active lifestyle, or simply cosmetic, contact lenses may offer many patients an additional way to improve their vision other than just with glasses. With a proper fitting, a little training and some simple lens care, most patients can successfully wear contact lenses. However, contact lenses should be used with care and caution so as to avoid potential serious complications.

Some of the more common issues contact lens wearers face include dry eyes and allergies. Mild dry eyes and allergies are frequently managed with artificial tears, while more advanced cases may benefit from prescription eye drops, and/or in-clinic treatments. Contact lens wear can exacerbate these common conditions, and may end up limiting their use. As a corneal surgeon, the most serious complication from contact lenses that I see is a corneal ulcer (infection of the front layer of the eye). This condition, if caught early enough, can usually be treated with antibiotic eye drops. Sometimes, more serious infections may require corneal transplantation (transplanting the clear window at the front of the eye) in order to restore vision. One of the most common causes of corneal ulcers is sleeping in contact lenses. Why does this happen? When we wear contact lenses we limit, or block the amount of oxygen that reaches the cornea. During sleep, when our eyes are closed we lose the natural protective immune effect that tear turnover and blinking affords us. This is a perfect storm for many organisms — bacteria, fungi, and parasites to invade the weakened corneal defenses.

So what can we do as patients to prevent this? First, make sure your contact lens fit is checked annually. Second, never sleep in your contact lenses. Some patients do better with daily disposable contact lenses, rather than extended wear contacts that need to be stored. Patients can simply discard their contacts each night, and place a new pair the following morning. Third, refractive surgery, such as LASIK, PRK, and ICL (implantable lenses) can offer many, if not all, of the same benefits of contacts without the daily hassle. Prior to any surgery, it is imperative to have a detailed exam and discussion to confirm whether someone is an ideal candidate, and to ensure safety. Until then, whenever you think it is OK to sleep in your contacts, please think again.


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