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Back Pain in Pregnancy; it’s a Mother... Part 2

3/27/2018

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Given the recent news regarding increased concern for opioid addiction, it seems important to revisit this subject, especially as informed patients are doing research into alternative methods for managing back pain in pregnancy.  Specifically, some questions have come up regarding chiropractors and massage therapists during pregnancy.  After looking into ACOG (American Congress of Obstetricians and Gynecologists) resources, I found very little information on the subject.  Even looking into academic literature shows that there have been very few studies on the subject, but the following is a brief summary of what I found.

What causes back pain in pregnancy?  Spinal dysfunction, displaced load on the spine, stretching of the peritoneum, adnexa and uterus, lordosis and joint laxity are among the main causes.  Huh?  Essentially, unless you typically walk around with your abdomen pushed out in front of you with an extra 25-35 pounds pulling it forward, then your spine won’t be in its usual alignment during pregnancy.  This can compress the usual space between your vertebrae causing pain.  There’s also a constant pulling sensation on all of the structures that usually hold your uterus in place, and even the tiniest added tension can sometimes cause muscle spasms.  The closest thing I can describe would be taking a very non-flexible guy like myself, trying to touch my toes (hello shins!), then having someone come up behind me and push me until my hands are now flat on the floor.  Lastly, progesterone causes the joints to relax (it’s meant to target the pubic bone to allow more room for a baby), and this can lead to easier sprains of any of your joints.

So, that’s really helpful.  Now I know why I feel like crap, but what can I do about it?  Honestly, to some degree back pain is going to be hard to avoid entirely due to the changes above, but there are certainly options to help you feel better.  First of all, stay active.  Women who exercise during pregnancy tend to have stronger core muscles to help offset some of the changes listed above, and they also tend to gain significantly less weight during the course of pregnancy.  Less weight gain generally leads to reduction of back pain symptoms.  Warm and cold compresses are also options, although it’s best to stay away from hot tubs while you’re pregnant.  Topical treatments such as Icy Hot have been given a category B rating, meaning no harm in animal studies but no human studies are available.  Some women find relief with “belly band” or other more supportive undergarments whereas others feel that stretching is more beneficial.  Side-sleeping with a pillow between your legs can often be a more restorative way to rest during pregnancy as this can help keep your spine in better alignment.  Lastly, Tylenol could be used when all else fails.

Can I phone a friend?  Absolutely!  At this time, there are no in depth studies evaluating the safety of chiropractor adjustments or massage during pregnancy.  The limited data available would seem to suggest that this type of intervention can often be helpful in as little as two sessions, and a non-drug treatment option for pain is always a good option to consider.  For women who are able to find relief of their back pain with these sessions, pregnancy can often be much more enjoyable.  Constant contraction of the piriformis and iliopsoas muscles occurs during the new position of the spine during pregnancy, and adjustments that focus on relaxation of these areas have been shown to improve pain in some cases.  If you do book a treatment, be sure your chiropractor avoids unnecessary pressure to your abdomen.

Fortunately, the joint laxity we talked about above can actually make adjustments easier than usual, so if you decide to go for it, your chiropractor may be more likely to achieve the desired effects.  That being said, be sure to discuss your specific pregnancy conditions and concerns with your doctor before scheduling an adjustment (these sessions may not be safe in some scenarios), and if you think you are in labor, that your water has broken, or that you’re having vaginal bleeding, the definitely seek out your ob/gyn first.

Hopefully, you’ll be one of the lucky moms who avoids any significant back pain in pregnancy, but if not, then you could certainly consider the options listed above.  Good luck, and remember that even if back pain makes your pregnancy seem like it takes forever, once your little one here, it will totally be worth it.  In fact, after seeing how cute your little guy or girl is, you may even want to do it again :)

Dr. Nick
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Earn Money While You Get in Shape With These Fun Ideas

3/20/2018

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Picture
(Image via Pixabay)
 
Nearly 70% of American adults are lugging around excess weight. Many men and women struggle to muster up enough motivation to exercise or eat healthy, and they often pass these unhealthy habits down to their children or loved ones. If you find it difficult to drag yourself to the gym or consume nutritious meals, consider finding a method that pays you to get - or stay - in shape. Here are four fun ways to lose weight while padding your bank account.
 
Dog Walking
 
Are you an animal lover who enjoys spending time outdoors? You can earn extra cash while shedding excess pounds as you walk local dogs. A 150-pound person typically burns an average of 204 calories per hour walking dogs, and that number can increase if you weigh more or have active dogs that race around the neighborhood. 
 
People generally lose one pound for every 3,500 to 7,500 calories they burn. The exact formula for weight loss depends on several factors, including your metabolism and current weight. Based on this formula, you can potentially lose several pounds each month just by walking dogs for a couple hours per day. If you want to maximize the amount of calories you burn during dog-walking sessions, consider strapping weights to your ankles or arms. Talk to your doctor first to make sure that your body can safely support these weights.
 
Camp Counselor
 
Tired of doing the same things every summer? Liven up your vacation by becoming a camp counselor. You can work at an overnight camp or help run a local day camp. There are camps geared toward young kids, elementary school students, teens, and disabled adults. Some camps focus on a specific sport, such as horseback riding, while others offer a mix of activities to keep campers - and counselors - busy.
 
As a camp counselor, your primary role will probably be to keep kids safe. You may also have to prepare meals, clean up cabins or tents, create age-appropriate craft tutorials, and lead athletic activities. You can work on your figure as you swim, hike, or play tag with your campers. There’s generally very little downtime at a summer camp, so you’ll probably stay busy from morning to night.   
 
Babysitter
 
Love the idea of working with kids, but not sure you can handle supervising an entire group of them at camp? Consider babysitting for local families instead. You can choose which babysitting jobs you accept, so it’s easy to only commit to gigs you feel comfortable doing.
 
If you babysit toddlers, you’ll burn plenty of calories chasing them around. Older kids may need you to plan fun games and activities before they’re willing to put down their iPads or smartphones. Here are some ways that you and the kids you babysit can get moving:
 
  • Visit a park or playground
  • Run around the track at a local school if the school okays it
  • Play tag, hide and seek, dodgeball, or Capture the Flag
  • Spend the day at a waterpark
  • Visit a kid-friendly museum or aquarium that requires lots of walking
  • Embark on a scavenger hunt
 
You can also ask the kids for suggestions. They may have some outdoor games they enjoy playing.
 
Athletic Coach for a Youth Team
 
Combine your passion for sports with your desire to lose weight when you coach a youth sports team. You’ll burn approximately the same amount of calories coaching a sports team as you might burn walking dogs. If you want to burn more calories, demonstrate athletic techniques whenever possible rather than just cheering your team from the sidelines.
 
Here are some potential sports you can coach:
 
  • Soccer
  • Baseball
  • Softball
  • Basketball
  • Cheerleading
 
When your team warms up during practice or prior to games, join them. It shows your team that you support them, and it also helps you tighten and tone your body.
 
Exercise doesn’t have to be boring. You can get in shape and earn some extra cash by applying for fun gigs like the ones listed above.

Jennifer Scott
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What is the Keto diet and will it help me lose weight?

3/13/2018

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The Keto diet is the newest diet fad that is making celebrities put butter in their coffee and banish all carbs including fruit!  This is the exact opposite of what most of us have been told all these years about weight loss!  So does it work and will it help me lose those extra pounds?

For many years counting calories and focusing on low fat foods was the diet mantra that prevailed.  This was supposed to help you lose weight and help promote cardiovascular health.   As obesity has ballooned, this prevailing theory has been questioned.

First, lets review some basics about metabolism.  The primary fuel of our brain and different organs is sugar, aka glucose.  However, the body stores a limited amount of glucose in the liver.  So, if we are starving or focused on consuming only proteins and fats and eliminate carbohydrates from our diet, our liver will have used up all its glucose stores.  The liver then starts to break down fat into a usable energy source called ketone bodies.  So there are two ways to get the body to start breaking down all its fat stores:  fasting (or starving) is one option and the other is to eat a diet very low in carbohydrates.   In reality, this means eating only meat, cheese, butter, oils and nuts.  All grains, breads, fruits, and sugar are off the table.  Another reason this diet is so effective is because it decreases insulin release.  Increased insulin release promotes weight gain and fat storage instead of breakdown.

This sounds great.  I get to eat greasy food as long as it’s low in carbohydrates and lose weight.  Of course this was the same premise of the Atkins diet.  In the short term, the Atkins diet worked well.  It worked well mostly because it helped control appetite.  However, most studies showed that at the one year mark, it performed equally poorly when compared to other fad diets.  Despite its focus on the science of metabolism, it failed to produce the results desired because people had a hard time sticking to this diet.  Avoiding breads, pastries, and pasta in the long run was more difficult that the dieters had realized.  The average dieter had a hard time maintaining this diet for even six months.

There are two groups of people that have seen a lot of success with the Keto diet.   Neurologists have been using the Keto diet to treat patients with epilepsy.  Researchers noticed in the 1920’s that patients experienced fewer seizures when fasting.  Again we are not sure about the mechanism for why this works.  However, epilepsy patients that are refractory to medication are noted to have fewer seizures on a Keto diet.  Another group that has shown some benefit on a Keto diet are type 2 diabetics.  With type 2 diabetes, the body cannot produce enough insulin to move glucose from the blood into the cells.  By decreasing carbohydrate intake, the body requires less insulin to manage blood sugars.   Type 2 diabetics that have adopted the Keto diet have shown considerable success in being able to not only  reduce their reliance on medication but also decrease their hemoglobin a1c ( a measure of blood sugar).   

If you have type 2 diabetes or epilepsy, talk to your physician about the benefits of the Keto diet.   However, if you are doing the Keto diet strictly for weight loss, your success will really be related to how long your discipline will hold strong- I guess just like any other diet.  No cheating allowed ;)

Dr. Pam
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When to Give Your Man Some Credit, Too:  A Quick Discussion of Male Factor Infertility and Low Sperm Counts

3/6/2018

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Unfortunately, we know that difficulty conceiving among couples isn’t uncommon, affecting as many as 1 in 6 couples.  What we don’t often mention is that men can contribute to infertility, too.  As many as 30% of infertility cases are at least in part attributable to male factors, and in fact, about 20% of all infertility cases are due to male factors alone.
​
So, why is this happening?  The contribution required from men for conception to occur involves an adequate number of sperm that look and move normally, but over the last 40 years, the sperm count in developed countries (yep, that’s us) has declined by roughly 50%.  From 1973 to 2011, sperm counts for men in North America, Australia, Europe and New Zealand declined by 59.3% and sperm concentration declined by 52.4%  Fortunately for Asian, African and South American men, they seem relatively unaffected so far.

How does your partner know if he’s affected?  A semen analysis can answer the question of whether he’s producing adequate sperm and whether or not they have a normal appearance and motility (they’ve got to be able to get where they’re going – it’s a long trip!).  A normal sperm count is at least 15 million sperm per milliliter of semen, and a minimum of several milliliters produced during each ejaculation.

If his semen analysis isn’t normal, what are our options?  Depending on how abnormal the analysis is, lifestyle changes may be the easiest first step.  Known risk factors for a low sperm count are obesity, smoking and excessive drinking, exposure to certain chemicals or radiation, frequent hot tub/sauna use, steroid use, and too tight underwear (yes, seriously-this can increase temperature in the scrotum and damage sperm, no matter how good he looks in them!).  If your partner meets any of these criteria, then lifestyle changes may be a simple place to start for improving sperm count and quality.  Medical history aspects can also play a role, for instance an undescended testicle or varicocele (dilated blood vessel) or lump may require surgical management by a urologist prior to conceiving.  Lastly, a testicular infections should be treated immediately, whether sexually transmitted such as gonorrhea, or simply increase white blood cells noted in the semen analysis.  Vaccination against mumps (MMR) can prevent orchitis, another infection that can affect the testes and may result in male infertility by affecting sperm production or transport.

We’ve tried all of the things listed above, and still no luck.  What now?  For those whose sperm counts are only mildly low, IUI (intrauterine insemination) may be a reasonable option.  Essentially, your ob/gyn takes the sample produced by your partner and places it directly inside the uterus closer to the egg rather than having the sperm make the trek from the vagina.  Kind of a head start on the race for fertilization.  If there’s either severely diminished counts or absence of sperm altogether, meeting a reproductive endocrinologist to discuss IVF may be your best bet.  Sometimes this can involve sperm directly extracted from your partner’s testes (yep, just like it sounds), or sometimes donor sperm may be required.

Infertility struggles can often be a sensitive issue and may even be tough to discuss with your partner.  In many cases, though, involving him not only in the discussion of infertility but also having him participate in the evaluation can help shed some light on why conceiving is hard in nearly 1 in 3 cases.  Involving him now in these difficult conversations will be good practice for involving him in difficult conversations  later (for instance, when it comes time to divide up those late night diaper-changing duties 😉 )

Dr. Nick
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