five days in the midst of venezuela's crisis in a fight to get aid into the country with a convoy of god own supporters and exclusive d.w. report alongside venezuelan journalist says are. a close look at the country's catastrophic conditions on the way to colombia a showdown for it. starts march eighteenth. locum to be in good shape here's what's coming up. rob veganism is going without cook food healthy. spider veins how to get rid of the unsightly blood vessels.

also back pain and how best to treat it. and here's your host dr constantly out. many of my patients don't feel well and they come to see me in my practice and i treat them and then they're in good shape but it's not always so simple sometimes it's really difficult like in chronic long ago which is lower back pain and this is why i'm getting some help today from a specialist from doctors and i look to me here in berlin welcome to in good shape . for many years doctors kept saying that if you have back pain you have to rest and avoid exercise right now we know that that is wrong and if you want to know why we are telling you right now. in different parts of the world doctors treat

back pain differently take south africa for instance doctors in just prescribed painkillers in india they suggest better este and then there is something like the rise skin. pills and physiotherapy but what has really helped. chris stop meyer has always stayed active going jogging playing tennis going to the gym but right now he's limited to swimming and stand up paddle boarding due to back problems. looking back there were personal issues that threw me off track i always tended to compensate for that with lots of exercise and work up with. the combination of stress and pushing himself too hard too gets told on his back. i'm just not worth the pain is like sticking your finger in a power socket it's

a pulsating pain that always shoots down my left side right down to my toes. he was unable to work for eight weeks his orthopedist prescribed painkillers injections and physio therapy but nothing helped. eventually he was referred to. a neurosurgeon he's been in treatment here for several weeks now. come i'll. come as if i. was. to give him a he's doing better but he still has some pain together they look at a scan of his spine so you. see that there's. some minor slip disc you can see this is where the disc begins to bulge and presses on the nerve these are good work one that's interfering with the function of the nerve and as a result the muscles here are growing weaker. normally that would mean surgery.

by a large of this base case the position of the slipped disc makes surgery tricky. and from the counts one for his for it would mean damaging structures that are important for the long term stability of the spine and perhaps result in instability eventually. to prevent we'll try a more conservative approach to fighting them for some of the some. one option that doesn't involve surgery is perry ridiculous therapy or p.r.t. this is chris stock miles fifth session p.r.t. involves injection with a combination of different drugs guided by x. rays they will be administered directly to the root of the compressed nerve the goal is to support its regeneration. is a. very ridiculous therapy helps support the natural healing process nature's

response to a slipped disc is to try to dry it out. the question is how long can the nerve tolerate the compression of what the p.r.t. does is accelerate that drying out process so that the nerve can recover more quickly and doesn't suffer any permanent damage. both up to eighty five percent of patients are p.t. obtain some benefit from p.r.t. so did christophe meyer even though he was skeptical at first. but it have my doubts i'd already been through a lot and you reach a point where you basically give up hope along with the medical help dr rahm's brother provided me with a lot of emotional support and all those factors combined to help. with. the p.r.t. therapy helped but christoph maya is also doing his bit going to physiotherapy and getting plenty of exercise. he's

a doctor for sports medicine and the head of the program for health and fitness at the sports medical center in berlin thanks for having me today when i see patients with normal big pain they often ask me think head and get some x. ray or an m.r.i. scan but and when do we have to do an american is a doctor in most of the cases it's not necessarily cause lower back pain is limited and last for only a couple of days you can receive ear but most of the cases it lasts for a short time but if it does not receipt after a some days or repeated after a certain time or if the doctor suspects change in this case is indicated to carry on for their examinations for example with. x. rays why do so many patients problems in their lower back if there's a problem that mother nature just messed up. really not but right now we are observing that about eighty percent of the patients reporting back pain have

some kind of mental or social stress and that means that this the sort of this excess of tension is reparable on the back but most of the patients also present with pain because they do not exercise have a trolley they do not use their muscles so what kind of behavior or absence of behavior cause no big pain. it is important to understand one principle or three indeed if you use it it grows if you don't use it you waste it and if you all or use it you can break it and it doesn't apply to every function and every organ in your body if you use your muscles they are going to develop and to be stronger and larger if you do not use them you are going to waste them and if you all are used then you can develop pain due to an injury or two broken the sure many of my patients do have to sit because they are working in

a sitting position are they doing something wrong they do not have to see if they decide to see it for example you can stand up every five or ten minutes and walk around the table you are not forced to see it the whole time and meanwhile there are other means to see it for example you can use a ball a huge ball and sit on it and your stent in continuously trying to compounds the movement and to find your center since it is a beautifully when you are extremely active you can also be tired after one hour because you are moving so much if you don't if you are always in this position your muscles are we sure are going to be shorter this group of the muscles and the muscles on your back are going to be weaker that means that you walk around and everybody's going to observe that you have this position but some of my patients even have active lifestyle in the physical work and they still do have back pain.

they can be forgetting the thought principle if you over use it or if you use it in a wrong way you're going to break it and people understand that it can apply to your credit card by they do not understand that it can apply to your body so spartan exercise is good for our back it's very important for back but some of my patients who are very active and really exercising or a lot still have problems in their lower back if you exercise too much you can develop problems because the body is not prepared to that you have to build up and you need to start on time if you exaggerate the movement that intensity the frequency the weight that you are working with you are going to develop problems so sports is good exercise is good and it's really not it is indispensable it's indispensable and that really helps if you do have lower back pain and that at how effective is it compared to painkillers and to massage. cutting cliches

thirty seven and has only been plenty of exercise a year and a half ago she was struck with bad pain since then she's been through various treatments to no avail. wouldn't it i had an m.r.i. done and then physical therapy which included much sergeant acupuncture i also saw an osteopath i did everything i could but in the end i was prescribed a painkiller ibuprofen. phenols. ibuprofen is generally safe but can have side effects some of them serious like kidney damage painkillers are not a good permanent solution something had to change cut think we should began a four week outpatient therapy. none of the therapies i tried worked so this really was my last hope. let's just walk home. first her doctors wanted to make sure no. more serious had been

overlooked a slipped disc for example or an irritation at the root of the nerve. and inflammation in the vertebral joint or even a tumor. the m.r.i. scan was inconclusive it did something but nothing that could explain the severe pain she was feeling. it's not serious your spine looks fine for your age this bright spot inside one of the bones is cold and. stuck can sometimes cause pain. began working with physiotherapists. that also included lifting heavy objects something that most back patients prefer to avoid. but cutting has to learn how to undo the pain response instead of squatting to protect her back she's supposed to bend over to put the crate down. no way hurts too much. the patients take part in

a comprehensive workout program five hours a day preferably without painkillers. the exercises include threading a rope through the strings while bending forward two weeks into the program. pain is becoming unbearable. physiotherapists don't provide standard treatments where they manipulate the patient. patients have already tried that and it didn't help instead we give them tasks they carry out on their own the four week program involves more than just strength training and exercise. in many cases chronic back pain is accompanied by to pressure and exotic disorders the program also includes regular sessions with a psychologist to address mental issues and how to cope with the pain. along with strengthening her back cut has also learned a lot about herself in these four weeks. i've learned that changing my behavior can

make a difference things like exercise but also cultural activities and other distractions they can also help bring me some relief from the pain i've also learned to take more time for myself wow that's really important that is considered. today cutting cliche no longer has back pain she's even started jogging again which does wonders for both body and soul. so let's summarize what we just learned of this report no physiotherapy no massages and no rest and this is why i'm sitting on this ball and it's even fun it is fun what we try to do is to integrate physical activity in your daily routine because if you decide to exercise and do workout in the gym two or three times a week for thirty or forty five minutes with different machines but easier is if

you decide to exercise they for example in doing the walk you are sitting on a chair on your moving not at all the whole walk is done by the chair but if you're sitting on a ball you're bouncing continuously you're using your body to compensate the fine and it leaves and you can also in taste insulate it just using the floor please let the water roll. move the ball and you have to lie on your knees so on lenny's on your knees and on your half brother your answer right and please stretch your right leg and your left arm and you look down world and just stay in this position for five or six seconds and then switch the sight. and again in this position for five or six seconds. so i don't have any lower back

pain to start with but what if my patients say that this exercise hurts this exercise does not go into hurt if you do not have an injury or some kind of problem and it is the idea it is an exercise everybody can do if you have pain the one who decides which exercises to carry on which exercises to avoid what to do exactly is your doctor or your physiotherapist and you can repeat that ten fifteen twenty times thirty times with the time you are going to improve your ability and increase your strength and it is going to be easier for you i can even do this at work that is the idea you can do it at home at work everywhere and anything else i can you yes please lie on the floor that is it for this time or your elbows and just rice your body you just stand

like this yes that is rope planking on your toes and also on your elbows it's quite exhausting actually stay there for fifteen or twenty seconds at the beginning shorter maybe five or ten seconds until you learn the sex of size and down relax quite exultant again it is hard if it's too hard for you what you can do is on your knees not on your hose. and legs and with your back like a cat and you upwards and downwards and up and down not that first slower you just feel the tension and down. and even lower so how often do have to

do that just start believing that many people ask how often and what should i do in between and they are not exercising of all they are just they just want a program just stop moving move yourself more use the stairs walk a lot and you are going to improve your ability or want to feel all so much better so thanks so much for answering all my questions you are very welcome and i will start right away with the exercise and if you have any questions be sure to thank me an email. on an upcoming show will be looking at the problem of loneliness more and more people now live a lot so how does feeling solitary impact your health and your questions to be in good shape at d w dot com just write loneliness and the subject line we look forward to hearing from you. the problem we portrayed on next

report affects fama women than men i'm talking about week veins and they are not always a medical problem like in spite of they are more like a cosmetic problem but fortunately there is help. yanna shown here as everything she should be doing she stays active and walks are two dogs regularly but it thirty four she already has spider veins which she tends to keep it under long pants. as i just don't. bother me a lot in the summertime because everyone can see them and they're very dark blue or purple. they're very noticeable on my fair skin. these are the unsightly spider veins and large to pillory so usually caused by poor circulation in muscle tone the condition may be hereditary yamma started getting them in her early twenties. yanis decided to take matters into her own hands she

has an appointment with a vein specialist. an initial checkup reveals that she doesn't have varicose veins. to be the reason the spider veins are medically harmless but they can be an indication of varicose veins that would have to be treated. with one hundred four so that's why it's important to start with a proper diagnosis. in a procedure called sclera therapy the blood vessels are closed off with the help of a special foam a solution of the active agent is mixed with air and injected into the network of enlarged to pillory. so how much does the advantage of the foam is that it expels the blood from the vein much better. by foaming the agent i can empty the vein allowing the solution to work much more effectively. with the medication attacks the inner wall of the vein destroying the blood vessel and

making the spider veins vanish. that's one good thing you do you feel a brief jab but otherwise you don't notice anything i thought it would be worse that. apart from square zero therapy spider brains can also be removed using laser treatment that's the option to call shoal chose she's already had varicose vein successfully treated by laser specialist tons coach john benson her spider brains a relatively small making her a good candidate for laser treatment. for the person you just stand vantage for the patient is that it's a good way to close up very thin compare the recent ones that a so tiny that it's hard to access them with a needle. in. the laser light acts on the tiny red cup hilary's beneath the skin the spider veins trade and disappear the damaged tissue

is reabsorbed within four to six weeks laser therapy is gentle and also works for a very small spider veins square all therapy with foam usually take some months longer and while both treatments are effective if you're predisposed to spider veins others could appear in the future. in the kitchen we cook we boy we grew food but not in every kitchen chefs that don't produce anything especially if they are who do is they believe that heating up the food destroys vitamins and minerals but more than a truce and scientists do. just going to see a doctor who specializes in sports medicine. cmon has spent years studying athletes and nutrition. patients today as a diet that consists almost exclusively of role fruit and vegetables.

mention photog most people find that kind of diet doesn't agree with them. for one thing they cannot beat their energy needs and for another they get a lot of problems with bloating mention that many people also have intolerance and start getting diarrhea when people don't get enough of important nutrients you'll eventually see that in the person's blood count it affects the formation of new blood cells leading to fatigue and a drop in performance before they get off on. the doctor first will be going through his paces blood tests and blood samples provide information on his heart and system. doctor seen on evaluates the results so what does he think. s. my faith. first of all it's clear he has a good body composition and doesn't look like he's suffering from any kind of

deficiency. and that's despite engaging in extreme sports as well as having this extreme diet. so where does his body get the minerals and vitamins it needs given neither me nor dairy products. he's been on this diet since two thousand and six what's the secret of his success. in the kind of nothing is heated so that means the food retains all its vitamins this contains iodine and vitamin c. in the form of the lemon juice there's also linseed oil which has omega three fatty acids all of these foods are part of a typical vegetarian diet. but arnold's a vegan so that means eggs and dairy products to leaving fruit and vegetables. food don't cook anything so that eliminates all the foods that aren't palatable when their own cooked potatoes and old machines contain solon e.

which is difficult to digest. contain lecterns which can cause nausea and vomiting when eaten so they're no good either. just leaves nuts. and poses to provide the body with the nutrients it needs. as a. food and a vegan is difficult you really have to know what you're doing and then stick to a very very strict diet. and you cannot say i don't like algae so i'm not eating that because algae contains nutrients your body needs. last. year and a half ago since then he's continued to train regularly but less intensively he puts his impressive fitness down to his diet for the dr believes there's another reason. the surprises me is that your fat metabolism is very very

good and it's not just good for someone who runs one hundred kilometers or does ultra triathlons it's remarkable. so when you're pushing the limit in endure and sports your metabolism is still at nearly eighty percent well so it takes a long time before you draw on your carbohydrate reserves. put on old reconstruct metabolism has always been unusually good he said before he switched to a role food diet the medical exam shows he has no nutritional deficiencies. so could this kind of diet be an option for everyone. you couldn't just go from zero to one hundred percent raw food even specialists tend to incorporate some cooked food in their diet which is important and fish fish well and. there are also some tricks like curating raw vegetables and fruit to make them

easier to digest. after ten years of eating only real fruit and vegetables on old reagan has now also added a small amount of cooked food to his diet. that's it for today next week.

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