Jumping Outside The Box

9/3/14

September has made it!

I know people say that Labor Day marks the ‘end of summer’, but I don’t see it that way. After all, it seems like summer just began!

One of my favorite parts of summer is exercising outdoors. I love that the sun is up early in the morning when I run and is out later in the evening.  It is refreshing being able to get out of my office and apartment to spend time in the fresh air and getting a tan. The downside? The smell of fresh doughnuts at local grocery stores in the morning and grills fired up in the evening. Pick your poison.

One of the newest ‘adventures’ I embraced this summer was teaching an outdoor boot camp class in Jefferson. I never really viewed myself as the epitome of a classic boot camp instructor (yelling at participants to correct their push-up form after seemingly doing hundreds of them), but I thought “hey, I’ll give it a try. What’s another fitness class? Should be easy enough!”

I remember my first night of teaching, shaking throughout the entire hour-long class. Here, I had taught 8-10 classes per week for 3 years and now I was standing in front of a group of 12 and couldn’t formulate a sentence. The hour dragged, it was hot outside, the exercises were hard, and I couldn’t wait for it to be done. I remember getting in my car, humbled, and feeling completely deflated and like a failure. I woke up the next day with a few new aches and pains and wasn’t sure if this was for me.

The next week came around and I was bound and determined to make a better impression and to have fun. You know what? That’s exactly what I did and I was more at ease. The class was better and I smiled the entire time. I woke up with less pain the day after and realized I could do it and that I would be ok.

Flash forward 3 months and I’m teaching boot camp 3x a week and now am a bit hooked. I love the challenge and have become stronger mentally and physically because of it. The class was completely out of my comfort zone, but I am so glad I attempted something different and found a new love.

I think many people share a similar experience when they try a new exercise class or embrace a new exercise program. They may not come in as cocky as I did, however, they may have different expectations or wake up the day after and go “Holy *&#%, I didn’t know I had muscles there!”, which could be a deterrent for the next class or week ahead.

Like any lifestyle change, it will take a few weeks and some potential setbacks before it becomes a habit. Setting goals and making a plan is a way to envision where you see your life going and the steps it will take to make the changes necessary. It may be a good idea to include family, friends, or a significant other in your plan to keep you accountable or to have them join in your efforts. I know class for me is MUCH more fun when my friends are there and I have someone ‘waiting’ on me. It all may be challenging and may not feel comfortable, but keep at it!

I think it’s of utmost importance to prioritize the steps you need to take in order to make your goals a reality. This could include meal prep, exercise time or joining a class, grocery shopping, and even time to unwind and recover. Make time in your calendar and schedule to ensure nothing will get in the way.  For some individuals, this may be more of a challenge with kids, spouses, sports schedules, and laundry, but it is possible when you make it a priority and set your mind to it. The results will not be handed to you; YOU have to be the one to earn every pound lost and make the commitment to yourself.

Stepping out of our comfort zone with exercise is one way to challenge the body and push it to a level that will give it a jump start and eventually produce results. This doesn’t necessarily mean you need to buy new running shoes and go for a 10 mile run or jump into an advanced boot camp class, but you need to be able to expect to work to see the results you want. I can promise it will be worth it and you may even find a new passion.

Until next time!

To sleep or not to sleep? I wish it was up to me.

Hey friends!

Wednesday already?!  End of August?! Summer is FLYING by!

If you’re like me, your weekdays and weekends are crammed full of every activity under the sun.  My weekdays are filled with swim team, work, classes, and the occasional eating and sleeping; even less on the sleeping because I love to eat!

Although eating, exercise, and staying busy are great things, so is sleep. I have had a personal struggle with insomnia for many years, and it does concern me with the scary side effects of only getting a few hours per night.  Anyone who has had a late night with friends, a newborn baby, a sick child, or an excess of stress that keeps them awake at night knows that awful, groggy feeling the next day, like a ‘fog’ that clouds the brain.  Without an appropriate amount of sleep, there are serious health-related concerns that can develop.

I won’t write a novel about the scary side effects of sleep deprivation because, let’s be real, that is my life in a nutshell. I am, however, motivated to change when it comes to my health, realizing what could be coming to me if I do not make changes now.

Some of the side effects that I have experienced and that are listed in many articles regarding sleep deprivation include: forgetfulness, impaired attention and concentration, impaired judgment, and getting sick more frequently. On a more serious note, after an extended period of time, a lack of sleep can increase a person’s risk of heart disease, irregular heartbeats, high blood pressure, diabetes, stroke, obesity, and premature death. Yikes. Seeing a list such as this should be enough to shock you, and make you want to change.

After seeing my doctor for the first time for my insomnia, we made a game plan for a pre-bed routine. I have made changes in the last few years, but I always stick with my routine night after night, and I can say it has helped tremendously.  For me, I always shower, brush my teeth, and read before bed.  I make sure to turn the sound off my phone and put it face down so I don’t see any blinking lights. I also wake up within the same 30-minute window every morning, even on the weekends, which is usually beyond my control because of my ‘internal clock’ (hey, I get my best grocery shopping done at 5a on the weekends! J).

Some other tips I have read include avoiding caffeine entirely, or after a certain point in the day; using soft music or guided imagery/meditation; adding exercise into your routine (but being mindful of the time so it doesn’t keep you racing all night); and using ‘natural’ remedies such a warm milk or valerian root. A cool, dark bedroom will allow the body to ease into sleep easier than a warm atmosphere.

It may take a few days or a week to find something that works for you, but making an effort in the right direction is better than nothing.  Your M.D. can provide you with information regarding medications that may help you get shut-eye and other suggestions to help you overcome this ailment also!

Biggest thing? Try something new or ask for help. Make the effort to change and find a solution that works for you. It took time for me to find a routine that worked for me, and I’m glad I tried. Some nights are better than others, regardless, there are now more good nights that make for even better days.

Until next time peeps!

Giving Circle Grants Announcement

The Giving Circle of Fort Memorial Hospital Foundation is pleased to announce the grants that were awarded from funds raised during its 2013 program year. The grants totaling $14,550 were awarded to three health and wellness initiatives at Fort HealthCare.

A grant for $6,500 was awarded to support the services of Dr. David Rutledge at the Rock River Free Clinic. Fort HealthCare’s commitment to Dr. Rutledge’s service on a full-time basis has allowed the clinic to nearly triple the number of children and families being served in the past year. The Rock River Free Clinic provides preventative care and treatment for at risk and vulnerable children and families who live in Jefferson County.

A grant for $6,500 was awarded to the Community Health & Wellness initiatives of Fort HealthCare in collaboration with the Healthiest Community Coalitions in Jefferson and Walworth Counties. These coalitions improve the health of their local communities through activities and education that fit local interests and needs. Coalitions in Cambridge, Fort Atkinson, Jefferson, Johnson Creek, Lake Mills, and Whitewater are planning activities for the coming year.

A grant for $1,550 was awarded to the Pediatric Wellness Team at Fort HealthCare to combat childhood obesity. Funds will be used to expand opportunities for children and families seeking to incorporate healthier eating and fitness habits into their everyday lifestyle. Programs such as Movin’ & Losin’, Railyard Obstacle Course, and Camp 911 continue to grow due to increased interest from local families.

The Giving Circle invites women who are interested in improving the health and well-being of our community to become members in 2014. A series of four lunches is held each year to educate members about healthcare issues important to the Fort HealthCare service area. Members are asked to contribute a minimum of $100 to participate. At the end of the program year, the membership awards grants to Fort HealthCare to support the healthcare needs of children and families in our community.

If you are interested to learn more about the Giving Circle, you are welcome to contact the Foundation office at (920) 568-5404 or email at foundation@forthc.com.

Cold: Friend or Foe?

grandparents talking to granddaughterMost of us are ready to say goodbye to the ice, snow, and cold.  Icy conditions can contribute to a slip hazard.  When that happens to you, it’s easy to want to stay inside until the Spring thaw.  But inactivity can be equally harmful.  If you or someone you know would like to overcome a fear of falling, the Wisconsin Institute of Healthy Aging offers a variety of instruction to increase your strength and balance.  “Stepping On” is a 7-week course that meets once per week; class members learn from each other as well as from an array of guest experts related to balance, home environment, footwear, vision, and more.  This year I will be teaching “Stepping On” during the summer so that participants will be able to approach the cooler weather with confidence; if you are interested in taking the class locally you will find it at FortHealthCare.com/Classes and in the monthly Health365eNewsletter published by Fort Health Care.  I encourage you to browse the Wisconsin Institute of Healthy Aging webpage to explore the variety of classes available in the counties throughout the state:   http://wihealthyaging.org/.  From the homepage you can click on the “Find a Program” tab to learn more about criteria for each course, or “Find a Workshop” to see the scheduled classes.   You owe it to yourself to stay as active as possible during all four seasons.

When an injury does occur from a fall or other activity, you may consider cold helpful.  Ice is a common component of conservative care, RICE: rest, ice, compression, and elevation.   Whereas sore or tight muscles can benefit from heat, ice can help provide pain relief and minimize swelling from physical strain.  This is especially beneficial in the first 24-48 hours after injury.  You may benefit from using ice longer than that, especially if you have had a more severe injury or surgery; your healthcare provider will let you know after making sure that it is “just a strain.”  When an injury occurs to the fingers, wrists, or hands, a bag of frozen peas can work well to mold around the injured area.  Alternatively, at The Center for Hand Care, we recommend an ice pack recipe you can keep ready in your freezer.  In a secure Ziploc bag, combine 1 part rubbing alcohol with 2 parts water.  Place this mixture inside of another Ziploc bag to prevent leaks.  This will become a gel consistency within a day.  Use a protective cloth between your skin and the ice pack, and keep it on up to 10 minutes (or as soon as area feels numb).   If you are using the ice pack on a larger body area, it may take up to 20 minutes before the area feels numb.  Use ice with caution if you have poor circulation, a previous cold injury, or arthritis.  See, cold can be useful!

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My New Year’s “Health” Resolution

“I will take better care of my diabetes.” Diabetes is a scary diagnosis because it is about more than just blood sugars. It is a disease that affects your blood vessels, and it can lead to a stroke or heart attack. Other than heart disease, diabetes is a disease that affects the eyes, kidneys, nerves and other small blood vessels. The “complications” of diabetes are really complications of uncontrolled blood sugars.

Once a person has diabetes, he or she has to watch lipids (cholesterol numbers) and blood pressure, as well as blood sugars. Medications, lifestyle and diet all affect diabetes, and managing these are the core of diabetes care. One of the tests that help us see how well diabetes is controlled is the A1C test. It is also called hemoglobin A1c ( HbA1c), or glycated hemoglobin test. The HbA1c test shows the average blood sugar levels for the past two to three months. It measures how much of the hemoglobin (red blood cells) is glycated (coated in sugar).

“Statistically, we know people who attend diabetes self-management training (DSMT) and go to yearly DSMT follow-up education manage their diabetes better,” reports Rhonda Perdelwitz, RN, BSN and Certified Diabetes Educator at Fort Atkinson Hospital. “The American Diabetes Association suggests having an A1c of 7% or less is optimal blood sugar control and you can improve, reduce or eliminate complications of diabetes.”

If your A1c test has not been done for 4 to 6 months, ask your doctor to have this test done. This blood test does not have to be done fasting. If the results are 7.0 or higher, ask your doctor to refer you for diabetes education to the nurse and dietitian.

Diabetes education is covered by some insurance plans. Because each insurance plan is different it is recommended that you call your insurance company and inquire on if diabetes self-management training is a paid benefit. If you have Medicare, diabetes education is a preventative program Medicare covers. Medicare pays for 10 hours of diabetes class education the first year of a new diabetes diagnosis and for 2 hours every year after initial diagnosis. To meet the Medicare requirements for DSMT education the patient must have a referral from the doctor. Go to www.medicare.gov to see what kind of coverage the plan you are on has.

So when you think “I am going to take better care of my Diabetes” it may simply mean asking your doctor for a referral to diabetes education.

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What Causes Kidney Stones?

This is maybe the most common question I get. The answer is far from straight forward and usually a combination of patient-specific factors.

Kidney stones form when, if the urine chemistry is just right, substances combine, crystallize, and then those crystals bind together to form stones.

There are many different types of stones: Calcium Oxalate, Uric Acid, Calcium Phosphate, Magnesium Ammonium Phosphate, and Cystiene stones make up the majority of stone types. About 80-85% of stones are calcium based but it is a common misconception that these calcium-based stones are caused by too much dietary calcium (milk, cheese, yogurt, etc.). Usually it is a problem with the way your body handles the calcium. Abstaining from dietary calcium in these circumstances can do more harm than good.

When looking at ways to prevent stones, I focus on common dietary factors that can increase risk. High sodium intake is probably the biggest contribution to stone risk. Excessive sodium from canned foods, processed meats, restaurants, prepared boxed or frozen meals…all contributes to increased stone risk. I try to get my patients to A) recognize where the sodium in their diet is coming from (rarely just the salt-shaker) and B)keep their sodium intake to <2500mg/day.

Sodium is a big culprit, but chronic dehydration is probably the other most common problem. Stone formers should drink no less than 64oz/day of water, ideally with up to 4oz of lemon juice. Lemon juice is high in citrate which is a potent stone inhibitor. Excessive protein consumption can also lead to a more acidic urine, predisposing to certain types of stones.

If a patient has had more than one stone, or if they are young with a strong family history, I usually recommend blood and 24 hour urine testing for a custom stone prevention workup.

If you or a friend/loved one have lived with recurrent stones and haven’t been evaluated for prevention, give us a call.

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Mesh: That sounds bad, right?

I’m sure many readers have seen or heard the commercials featuring law firms that do not have many very nice things to say about “mesh”.

So what is mesh and what should I do about it?

“Mesh” often refers to a web-like sheet of a kind of plastic, polypropylene, that has been used medically for various reasons for many years. This mesh is woven into various shapes and sizes. It is used for large blood vessel reconstruction, hernia repair (umbilical, inguinal, ventral, etc.), incontinence and pelvic organ prolapse.

The controversy surrounding mesh focuses on mesh products that were placed vaginally for pelvic organ prolapse. Prolapse is a condition where the bladder, bowel, or uterus is literally falling out of the vagina, usually causing a prominent bulge. These prolapse-fixing products are often large sheets of oddly-shaped mesh meant to reinforce weakened vaginal tissues. If used properly, they helped many women with their prolapse problems. If used improperly and in the wrong patients, the mesh could erode into structures nearby such as the bladder, the ureter, vagina, or bowel. Usually this requries an additional surgical procedure to remove the mesh. This need for re-operation due to mesh complications led the the Food and Drug Administration (FDA) to issue a “Safety Communication” regarding vaginal mesh for pelvic organ prolapse.

Once again, the mesh “controversy” is regarding mesh used for pelvic organ prolapse. The small pieces of mesh desiged to treat female incontinence are not implicated as problematic and still remain an excellent option for treating stress incontinence. This is a type of incontinence that is often best treated with surgery as no medications are effective. Pelvic exercises (kegels) are often tried first but some women remain bothered by the incontinence and surgery is the next step.

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Are You Troubled by Pain, Numbness or Tingling in Your Hands?

Carpal tunnel syndrome (CTS) is a problem that affects the wrist and hand. The carpal tunnel is a narrow space inside the wrist that is surrounded by bone and ligament. This space lets certain tendons and a major nerve pass from the forearm into the hand. With CTS, the tendon sheaths may thicken and enlarge. This reduces the amount of space inside the carpal tunnel. As a result, the median nerve may be compressed.

Tingling and numbness are the most common symptoms of CTS. Some people also have hand pain or even a weakened grip. At first, symptoms may wake you up at night. Later, they may also occur during your daily routines. Your symptoms may become more severe over time.

The most common symptoms for carpal tunnel syndrome include:

  • Weakness when gripping objects with the hand(s)
  • Pain and/or numbness in the hand(s)
  • “Pins and needles” feeling in the fingers
  • Swollen feeling in the fingers
  • Burning or tingling in the fingers, especially the thumb and the index and middle fingers
  • Pain and/or numbness that is worse at night, interrupting sleep

Treatment may include:

  • Splinting of the hand (to help prevent wrist movement and decrease the compression of the nerves inside the tunnel)
  • Oral or injected (into the carpal tunnel space) anti-inflammatory medications (to reduce the swelling)
  • Surgery (to relieve compression on the nerves in the carpal tunnel)
  • Changing position of a computer keyboard, or other ergonomic changes

Surgery is not always a recommended course of action. I have been very excited about the feedback we receive from patients regarding the outcomes for carpal tunnel surgery. Not only are most patients achieving relief of numbness, tingling, and pain, but with our rapid mobilization program they are experiencing a quicker return to function with minimal down time. Care is coordinated with a Certified Hand Therapist, and our Hand Care Center is set up to provide easy communication.

Carpal Tunnel release is one of the most common surgical procedures. If you are experiencing any discomfort in your hands or wrists, I would encourage you to talk to your doctor or give us a call.

www.FortHealthCare.com/HandCare

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It’s Holiday Cookie Baking Time!

It is the time of year when we dust off the rolling pins, and mix up some cookie dough to roll and cut out cookies. How are your hands feeling while doing this task? Any joint pain? Any hand stiffness? Your friends at the Fort HealthCare Center for Hand Care in Fort Atkinson offer some tips:

 1. Pace your activity. All that gripping and pinching can take its toll on hand joints. Try working for 20 minutes, then rest for 20 minutes. Repeat.
2. Delegate! Have some friends or relatives come over and make it a baking day. My daughters and I are going to have one this Saturday. It’s a lot of fun and you can get the younger ones involved and save your hands.
3. Try wool or cotton gloves at night. Sometimes a glove on the hand at night can help provide neutral warmth that can help hands feel less stiff in the morning.
4. Use your appliances instead of hand mixing. But, if you do hand mix, hold the spoon like a dagger to avoid awkward joint postures in your larger knuckles.
5. When sitting or standing while decorating the cookies, avoid awkward reaching. Keep your supplies at waist level, within easy reach. Watch your posture and avoid sitting or standing for prolonged periods. Get up and walk a bit and then get back at it.
6. Use utensils with wider handles for easier gripping.

Hope your holidays are happy and healthy!

I know where every good bathroom is between here and Sauk City.

If you find yourself emptying your bladder before you leave the house, only to have to stop three times between here and Madison, you have an overactive bladder.  “Overactive Bladder” is a term we use to describe a strong, frequent, bothersome urge to go to the bathroom.  It is very, very common but it is NOT necessarily a “normal” part of aging.  Sometimes the urge is so great folks have trouble making it to the bathroom fast enough.  That’s called Urge Incontinence and it is at the far end of the wide spectrum of overactive bladder symptoms.

It is really important to bring up these symptoms to your doctor.  The symptoms of having to urinate often and urgently could represent a bladder infection.  If you have any blood in your urine associated with these symptoms you should be seen by your doctor right away.  Cancers can develop in the bladder and sometimes the only symptom is the constant urge of having to void. 

Ruling out something dangerous is usually as simple as an office-based urine test.  Once you have ruled out an infection or other trouble, there are many different reasons to look into about why your life revolves around where the next bathroom might be.

You see, the bladder is meant to have a pretty boring existence.  Ninety-nine percent of the day, the bladder should be spending its time filling with urine.  That’s it, just hanging out.  It’s supposed to wait until it is full before giving your brain the signal that “it’s time to go”.  At that point, you should have plenty of time to get the bathroom without having an accident.  Even if you’re 80 years old, you should have plenty of time to get to the bathroom without having an accident.  You might say “Well, I’ve always been rushing to the bathroom”.  If that’s the case, then we really should talk.  Bad habits can seriously affect bladder function and with early intervention, we can prevent permanent bladder damage.

A lot of different things can interfere with normal bladder function:  volume of fluid intake, type of liquid (Coffee caffeinated/decaf), bathroom posture, bowel function (especially constipation), nerve damage from prior pelvic surgery, other neurologic conditions like Parkinson’s Disease…the list goes on.  Although treatment sometimes requires a medication, some patients do really well with some simple exercises and behavioral modifications.

Fort HealthCare Urology Associates