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Achieve Balance in Life Through Fitness and Overall Self-Care

7/31/2018

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Practicing yoga is all about achieving balance -- physically, through asanas, and emotionally, through breathwork and meditation. We practice balance on the yoga mat, but what about achieving that same balance throughout your life? Often, when we are focused on fitness goals, we don’t do enough to care for our overall wellness needs. To find that balance in all aspects of your life, work on incorporating these essential self-care practices into your routine.
 
Start With Quality Sleep
When life gets busy and you feel like you can’t find time for everything, sleep is often the first thing to go. The irony is that sacrificing sleep has negative effects on your body and mind, so we’re less effective at getting all those things done. If you struggle to get quality sleep, focus your self-care efforts on creating a relaxation regimen at night.
 
Start by taking a close look at your sleep habits to see if you can identify problems. Are you waking up in the middle of the night feeling achy? You may simply need better pillows to get comfortable. If you have trouble staying asleep, try using a noise machine to eliminate noise distractions and blackout curtains to make your room dark. Once you troubleshoot obvious problems, Prevention recommends setting a regular sleep schedule and developing a wind-down routine. Most of us don’t have the ability to simply lie down and turn off our minds immediately. Creating a bedtime routine that includes relaxation helps you make that transition and sends the signal to your mind and body that it’s time to rest.
 
Lower Stress
This tip may sound overly simplistic, but it’s amazing just how much stress can pile up, even for those who practice yoga. Self-care that lowers stress is critical when you’re in the midst of a meltdown, but don’t wait for that to happen! Everyday self-care is also preventive, so we’re less likely to reach that point of maximum stress. These are just a few of the many things you can do daily to keep stress in check:
 
  • Stick to your fitness routine. When you feel like you have too much on your plate, don’t let exercise be the thing that slides. According to Shape, exercise is one of the most effective ways to reduce stress, so even if all you can squeeze in is 30 minutes (or less), finding that time is totally worthwhile.
  • Create a space to meditate. Practicing mindfulness through meditation helps you disconnect from all that burdens your mind, which lowers stress and helps you approach life from a more balanced perspective. Create a dedicated meditation space in your home that is free of clutter, comfortable and relaxing. Even when time is short, this will be a retreat where you can go to restore peace in your life.
 
Increase Joy
Everyday emotional self-care is about more than just reducing stress. So often, we get bogged down in our daily must-dos that we forget to do things we want to do. Focus on doing small things throughout your day that bring joy to your life. It may be reading a good book, doing something creative, or cranking up the tunes in your car. Finding time to spend on your hobbies makes you feel happier and feeds your soul, even if all you have time for is a few minutes of listening to music on your commute.
 
Be sure to make time to connect with others too. Social connectedness has been shown to have a strong link to happiness. When we’re busy, relationships can suffer, but that’s also when you need the support of friends and family the most. Get creative about how you find time to nurture relationships - ask a friend to join you for a workout, or plan a weekly lunch date with your partner.
 
All of these tips are geared toward finding balance between physical and emotional self-care. Remember that getting plenty of quality sleep is the foundation that everything else in our lives is based on. With this foundation, reducing stress and finding joy will come easier, and you will see the benefits to your health and get even better results from your fitness routine.

​Jennifer Scott
 
Photo credit: Pexels

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Since Your Baby Doesn't Come with an Owner's Manual:  Chapter 1 - The First Trimester

7/24/2018

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After delivering babies for the last 10 years, I have yet to see the birth of a baby with an owner’s manual, and no matter how prepared new parents try to be, pregnancy and a new baby are undoubtedly a life-changing experience.  What I’d like to do over my next few blogs is cover the time leading up to and just after delivery.  So here it goes, what to expect from you physician’s perspective.

When do I need to start preparing?  The best pregnancy planning begins even before conception.  Prenatal vitamins are generally advised for several months before attempting to conceive to ensure adequate levels of folic acid during the critical time to prevent neural tube defects (essentially spinal problems) in the developing embryo.  As an added bonus, some studies suggest a decrease in the severity of morning sickness for those who have been taking prenatal vitamins for several months before conception.  Win for baby and win for mommy!

More importantly, how soon can I see my baby?  Unfortunately, despite our expectation of instant gratification, our technology hasn’t quite caught up to the demands of anxious mothers-to-be.  While we may be able to see a gestational sac (the sac the baby grows in) as early as 5-6 weeks, we generally aren’t able to see the 3 parts of a successful pregnancy until around 7 weeks.  We want to confirm: 1. Pregnancy inside the uterus, 2. The part that becomes the baby is present inside the sac, and 3. There is a heartbeat.  While we occasionally see moms before 7 weeks, they may leave even more worried than when they came because we can’t always guarantee that the pregnancy appears healthy.  Not to mention, who wants an extra vaginal ultrasound :( It takes until 7+ weeks for the baby to be even a centimeter long, and even though it’s the cutest 1cm you’ll ever see, we want to be able to reassure you that it’s also the healthiest!   Besides, as a doctor, the last thing we want to cause is more stress to expectant mothers.  That’s the baby’s job for after delivery -- “Liam, is that dirt-covered Hot Wheel really that tasty?" ;P

So, what else happens at that first visit?  Your doctor will likely check labs, probably chat with you about pregnancy expectations, possibly discuss genetic testing and may do an exam.  Your provider may also inquire about any medical conditions or previous surgeries that would affect your pregnancy.  He/she will also answer any questions you may have and discuss any symptoms you may be having to determine if those issues are pregnancy-related or require further evaluation/treatment.  Most importantly, it gives you the opportunity to meet the person who will be helping to bring your bundle of joy into the world!

Speaking of symptoms, which ones are common during pregnancy?  The number one complaint in the first trimester is nausea.  Generally, it’s worst during the second half of the first trimester and begins to subside as the HCG (pregnancy hormone) begins to go down towards the end of the first trimester.  Since no one likes to spend all day hugging the toilet, we do encourage notifying your doctor if you aren’t able to keep any food down, even if it’s before 7 weeks.  The one silver lining to all of that nausea is that women with hyperemesis gravidarum (not nearly as cool as the name sounds!) tend to have a slightly less chance of miscarriage.  Other common symptoms include breast tenderness or enlargement, change in skin pigmentation, increased urination, food aversions and of course, missed menses.  Light vaginal spotting or bleeding with pregnancy implantation can also be normal.  That being said, be sure to notify your doctor for abdominal pain that doesn’t go away with Tylenol, heavy vaginal bleeding (more than a pad per hour) and passing large clots or tissue.  These could be signs of either a failing pregnancy or even a pregnancy outside the uterus, which is potentially a life-threatening emergency.  
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There you have it!  A quick look at the first trimester.  We’ll hit the high notes for second and third trimester in future blogs!  For all of those who are pregnant, congratulations, and for those seeking pregnancy, good luck!  Please give us a call at 208-523-2060 if you’d like our help in achieving a healthy, happy pregnancy for you and your baby!

Dr. Nick

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Whooping Cough:  Whoop There It Is!

7/17/2018

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​After seeing a patient whose baby required hospitalization for pertussis, she told me how she wished that she had accepted the tdap booster during pregnancy, but at the time, she didn’t understand how important maternal vaccination was in helping to provide immunity to her baby.  I thought I’d provide a quick review of why we care, especially during pregnancy.

What is pertussis (whooping cough) and who is most likely to get it?  Pertussis is a very contagious bacterial infection that affects the respiratory tract and causes coughing spells.  It is commonly known as “whooping cough” because people with pertussis often make a “whooping” sound when they try to breathe (sounds more like seal barking than Tag Team).   During 2014 there were more than 30,000 cases in the US.  The highest rates of disease were noted to be in babies, and the majority of deaths occurred among babies younger than 3 months old. Half of babies with pertussis will be hospitalized as their immune systems are so fragile and one in one hundred of those who receive treatment in a hospital will die.  

Why is pertussis on the rise?  In 1976 there were only 1,010 cases in the US, but in 2012, there were 48,277 cases nationwide!  What is contributing to this?  Decreased vaccination by parents plays a role, but the primary reason is because the newer vaccine doesn't last as long. In 1997 the US switched from a whole cell to an acellular vaccine to decrease side effects of the older version, but researchers have noticed that the immunity decreases over time with the newer vaccine.  However, this vaccine is still very effective: In 1940, before the vaccine became available 200,000 children/infants became sick and 9,000 died; today the number is 30,000 become infected and 20 deaths a year (way to go science!).  

Why are babies so susceptible to whooping cough?  First, their immune systems are not as developed as that of an adult, and second, they cannot receive their first vaccine against pertussis until 2 months of age (even then, good luck bribing them with a lollipop and sticker!).  This leaves a window of vulnerability for newborns to contract pertussis from family members or a caregiver.  

What can you do to protect your baby from getting whooping cough?  The CDC and ACOG recommend that all pregnant women receive a Tdap booster in the third trimester from 27 to 36 weeks.  First this protects mom from getting whooping cough (30% of babies who contract whooping cough get it from their mother).  Second, the antibodies mom's immune system creates after receiving the vaccine gets transferred through the placenta to baby (mom’s literally taking one for the team).  This will provide your baby with some short term immunity until he/she can begin the vaccination series at 2 months of age.  These antibodies can also protect your baby from some of the more serious complications of whooping cough.  Third, if you are breastfeeding you may pass some additional antibodies you may have made in response to the vaccine to your baby.  Lastly, try to encourage those around baby to be up-to-date on their pertussis vaccines (if you want to hold MY baby, then here’s some hand sanitizer and a tdap).  

Where can I get the Tdap vaccine during pregnancy?  Your OB/GYN office may offer the vaccine, and it is also available at some pharmacies.  If you have any further questions, please ask your provider about pertussis and the Tdap vaccine at your next prenatal visit.

Dr. Pam
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Exercise in Pregnancy:  Too Much, or Not Enough?

7/10/2018

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How much exercise is recommended during pregnancy?
Believe it or not, the American Congress of Obstetricians and Gynecologists (ACOG) still recommends 30 minutes of activity and exercise on most, if not all, days of the week. Why is staying active important? In addition to helping with mood, energy, posture and overall health, exercise also helps to improve sleep quality (best to take advantage now, before your baby gets here). It can also prevent/treat gestational diabetes and can improve back pain, bloating and constipation.

How do pregnancy-related changes in the body affect my exercise routine?
One of the biggest changes is related to hormonal changes that relax the ligaments supporting the joints. This increase in joint mobility may cause a slight increase in the risk of injury. Also, as the baby grows, the extra weight in the front of the body can affect balance, which can make you more likely to fall as your pregnancy progresses. This change in the center of balance is one of the causes of back pain later in pregnancy.

What kind of exercise is safe in pregnancy?
Studies have shown the baby tolerates 30 minutes of even strenuous activity as performed by both active and generally inactive mothers-to-be.  Walking, swimming, aerobics and cycling are all safe during pregnancy, although outdoor cycling should be avoided if you are unfamiliar with the balance necessary to avoid falling. If you were running prior to pregnancy, you can often continue during pregnancy with a few modifications to your regimen. In fact, my mom actually ran all the way into the third trimester while pregnant with me, and she tells me I’m perfect :)

What activities should be avoided?
Apologies to our hockey-playing moms, but contact sports and sports with a high risk of falling such as gymnastics, water skiing and horseback riding should be avoided.  Even more unfortunately, down-hill skiing should generally be avoided not only to reduce the chance of falling but also because of the risk of hypoxia at higher elevations. It is advisable to avoid “hot yoga/pilates” as well.  Lastly, scuba diving should also be deferred until after pregnancy due to concern for decompression sickness that results from pressure changes around the body.

What about strength training?
Lifting and resistance exercise is generally well-tolerated by those who have been participating in strength training prior to pregnancy. As long as the expectant mother understands how pregnancy will affect her body and is able to perform the exercise with safe form, she can often continue her routine while making accommodations as needed.  That being said, lifting that might cause the weights to be dropped on the baby or mom and/or loss of balance should be avoided.

How do I know if I’m doing too much?
We generally advise a target heart rate less than 160 beats per minute.  If you experience regular contractions, vaginal bleeding, rupture of membranes, dizziness and headache, chest pain, trouble breathing BEFORE exercise, muscle weakness affecting balance, and calf pain/swelling.

Generally, speaking activity is well-tolerated by women who are pregnant, and in fact, it should be encouraged for expectant mothers.  However, there are some absolute contraindications to exercise during pregnancy such as heart/lung disease, incompetent cervix/cerclage, twins or higher gestations, persistent vaginal bleeding, abnormal placental implantation, premature labor, ruptured membranes, anemia and pregnancy-induced high blood pressure among others.  To help plan your healthy and active pregnancy, talk to your OBGYN today!

For more information on exercise in pregnancy, check on the link below as a maternal-fetal medicine specialist (high-risk OB) offers further insight.

http://fox13now.com/2016/04/28/this-utah-mom-did-crossfit-until-the-day-before-she-delivered-her-baby/

Dr. Nick
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