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Author: Tucson Medical Center

Pregnancy and Back Pain – Tips from an Expert

The waddling gait, the hands pressed into the small of her back, mama-to-be is uncomfortable.

An aching back is such a common part of pregnancy that the waddling and back clutching is a stereotype of late-term pregnancy. But backaches can start much earlier in pregnancy. The vast majority of pregnant women will experience backaches during pregnancy. For many, it persists after the birth of the baby.

Tim Evens PT of Agility Spine & Sports Physical Therapy gave us the lowdown on why back pain is an issue during pregnancy and what to do to prevent and to treat back pain.

Why do so many pregnant women experience backaches?

As the baby grows and mama’s belly grows, the increased weight, shift in center of balance, and the increased mobility of some of the joints of the pelvis (hypermobility of the sacroiliac joint) all contribute to extra strain on the lower back. This added strain and resulting distorted movements with joints locked at the end range of motion can make daily life painful.

What can you do to prevent backaches during pregnancy?

A strong core and upright posture before and during pregnancy can help prevent backaches.

  • Squats help strengthen legs, abs and pelvic floor, and require balance and can be performed during pregnancy.
  • Balancing exercises, such as through yoga, can provide core strengthening
  • Avoid over stretching
  • Limit how much sitting you do each day
  • Exercise 30 minutes every day

When to contact a physical therapist?

Evens suggests that if back or pelvic pain is limiting daily function do not wait to seek help. Often it is an issue that can be easily addressed. The first port of call is your primary care physician who can rule out other issues. If this is a second or third pregnancy and this is a familiar pain you may wish to check in with your physical therapist’s office.

How can a physical therapist help you if you experience backaches?

A physical therapist can help you return to fully functional movement, and address tissue healing and trauma of back and pelvis pain. As many of these issues can be addressed simply, Evens encourages women to seek help if the pain is limiting their daily function. Don’t let it linger for months when it is easy to fix and can help reduce stress during a time that can be fraught with stress anyway.

At your appointment the physical therapist will evaluate your flexibility, strength, balance and posture. The therapist may manipulate or move your body to address immediate tissue issues, and almost always will provide you with at-home daily exercises to increase strength, mobility and flexibility.

How to perform a squat

Tips on how to perform a squat from Tim Evens Physical Therapist. Particularly important for pregnant women to maintain/develop core/pelvic strengthEvens provided these tips for performing an effective squat:

Hold your lower lumbar spine in a neutral position. As you squat the low spine should not flex (tail should not tuck under)

Make sure your knees do not move in front of your toes. This ensures that the majority of motion is coming from the hips

Remember good squats require good hip strength and flexibility.

 

This post was first shared on May 1, 2014 on TMC for Women

Smoothies – Not all are created equally healthy

Smoothies can be a tasty and healthy way to get more fruit and vegetables into your daily diet. Unfortunately, many of the smoothies you find in grocery stores make it easy to consume more calories than you really want. By making your own instead, you can control what does and does not go into them.

The Smooth Basics

healthy smoothie basicsTry one of the following recipes for a nice breakfast or afternoon snack. Or get creative and come up with your own recipe:

  1. Start with a liquid base, such as milk, orange juice or even yogurt.
  2. Add a couple of servings of fresh or frozen fruit. Aim for at least 1 cup of fruit per smoothie.
  3. Try adding a vegetable or two. Someone who doesn’t usually love vegetables may enjoy them more when they are blended with other foods.
  4. Blend the ingredients until well mixed and creamy. Don’t worry if your smoothie isn’t completely smooth. A little texture makes it more interesting.

Smoothie Tips

  • Make a smoothie with yogurt, milk or calcium-fortified soymilk to boost your calcium and protein intakes. If using Greek yogurt, you may have to add a little milk or juice to get the right consistency.
  • For easier blending, pour the liquid (or yogurt) into your blender before adding fruit and vegetables.
  • Peel and slice bananas, then store them in the freezer for a convenient addition to your smoothies. Bananas not only sweeten but also thicken a smoothie.
  • Try a dash of nutmeg or allspice to add a little extra flavor to your smoothie.
  • To add volume without adding calories, toss in some ice cubes before blending. This will give your smoothie a slushier texture.

Smoothie Recipes

Blue Garden Smoothie

1/2 cup skim milk (or soy milk)
1/2 cup nonfat vanilla yogurt
1/2 cup blueberries
1 cup baby spinach leaves, loosely packed
1/2 medium banana, sliced
1/2 cup shredded carrot
dash of cinnamon
dash of nutmeg (optional)
1 tsp cocoa powder (optional)

Makes two 3/4-cup servings. Nutrition information per serving (using dairy milk):
calories 125, fat 0.5g, carbohydrates 25g, fiber 3g, protein 6g, calcium 190mg

Blushing Mango Smoothie

1/2 cup nonfat plain yogurt
1/2 cup orange juice
1 medium banana, sliced
1/2 cup frozen mango chunks
1/2 cup frozen strawberries

Makes two 3/4-cup servings. Nutrition information per serving:
calories 150, fat 0.5g, carbohydrates 35g, fiber 3g, protein 4.5g, calcium 110mg

Strawberry Chia Smoothie

Courtesy of The American Institute for Cancer Research

3/4 cup skim milk
4 tsp chia seeds
1 cup fresh strawberries
1 Tbsp strawberry fruit spread, or to taste
2 tsp orange zest
1/2 tsp chopped fresh ginger
1/2 tsp vanilla extract

Directions:

Place milk and chia seeds in blender and allow to sit while measuring other ingredients.
Add strawberries, preserves, orange zest, ginger and vanilla to blender. Whirl on high speed until smoothie is blended and creamy, about 1 minute. Pour into a tall glass and let sit to thicken for one minute before serving.

Makes one large serving. Nutrition information:
calories 249, fat 5g, carbohydrates 44g, fiber 9g, protein 9g, calcium 340mg

TMC babies providing life-saving stem cells via cord blood

Not so very long ago, two families welcomed babies into the world at Tucson Medical Center – and made an important decision. They chose to make a public donation of umbilical cord blood to give the gift of life and provide hope for others in need.

The donations of cord blood, which are rich in stem cells and used to rebuild immune systems, were matches for a child in Australia who was struggling with acute myelogenous leukemia – a cancer of the blood and bone marrow. The most recent match helped a child being treated at the University of Minnesota facing acute lymphoblastic leukemia, the most common type of childhood cancer.

Tucson Medical Center wants to thank everyone who makes the choice to provide life-saving cells so that others may have treatment options. The matches are made possible because of the Arizona Public Cord Blood Program, which TMC joined in October 2014. Those who do not intend to privately bank their baby’s umbilical cord blood have the opportunity to donate it to others. Donated cord blood is listed on the Be The Match national registry.

Since the program’s inception in 2011, 43 life-saving matches have been made including these donations– the second and third match for TMC.

“As we celebrate the ways we can make a difference in the world, we want to thank everyone whose generosity allows other children the opportunity to grow and thrive,” said Kristen Wilt, TMC cord blood coordinator. “That includes the families who provide the cord blood, as well as the providers whose expertise and commitment has such a tremendous impact on patients and families they will never meet.”

The procedure is painless, the program is free for patients, and everything is kept confidential.

The latest match was collected from baby born at TMC in May, 2016 by Dr. Jennifer Reinhart and Annie Reiners, RN.

For more information on cord blood donation, please visit the Tucson Medical Center website and these blog posts.

Arizona Public Cord Blood Program

Osteoporosis: “The most important factor is prevention”

May is Women’s Health Month, a great time to celebrate and promote stronger health and a perfect time to discuss the latest information about preventing and treating health challenges like osteoporosis.

More than 44 million American women experience the debilitating effects of the bone disease, and many women fear aching joints and brittle bones are an inevitable part of aging. It is important to know the risks, and engage opportunities to maintain optimum bone-health.

Dr. Lawrence R. Housman is an orthopaedic surgeon who specializes in musculoskeletal disease at Tucson Orthopaedic Institute. He sat down with us to discuss the best ways to prevent and treat osteoporosis.

osteoporosis, know your risksWhy are women at greater risk for osteoporosis?  

Women start with a lower bone density than men. They also lose bone mass more quickly as they age. Between ages 20-80, women will lose about 1/3 of her bone density compared to men who lose only 1/4 of their bone density in that time frame. Estrogen levels also affect bone density, and women lose bone mass more quickly in the years immediately following menopause than at any other time of their lives.

What can accentuate this risk?

Alcohol in moderation is not a risk factor, however more than four drinks per day results in a twice the risk of hip fracture. Steroids can also increase this risk. Long term use of steroids will double the risk of fracture in women.

It should be noted that proton pump inhibitors (e.g. Nexium/Protonix used for stomach disorders such as acid reflux) decrease the absorption of calcium from the stomach.

While increasing fiber, phylates (beans, wheat bran), oxalates (spinach, beet greens, rhubarb) and phosphorus (colas) can provide other health benefits they can also interfere with calcium metabolism.

What are the most effective means of preventing osteoporosis?

Regular exercise is one of the most effective means of preventing osteoporosis. Thirty minutes per day – walking is excellent, and Tai Chi reportedly decreases falls by 47 percent and hip fracture by 25 percent.

Nutrition is another import part of maintaining healthy bones. Fruits and vegetables are important. Women ages 19-50 should take in 1000 mg of calcium daily and women older than 50 should get 1200 mg per day.

Vitamin D is another vital nutrient the body needs to prevent osteoporosis. An individual can get their vitamin D through measured exposure to sunlight or through supplements. A diet with dairy, protein or calcium fortified foods (e.g. orange juice), fish (salmon/sardines) and yogurt (6 ounces has 300 mg of calcium) will go a long way in getting vitamin d to the bones.

What are the warning signs of the disease – and when is it time to see a doctor?

There are usually no warning signs before a fracture occurs; therefore, the most important factor is prevention.

A primary care provider (PCP) is the best person to monitor bone health. Most physicians recommend a DEXA (bone density test) after the age of 50.

The DEXA scan is the bone density test done most frequently and is predictive of fracture risk. The scan will also show whether you have normal bone density, osteopenia (bone is becoming weaker) or osteoporosis (bone is at high risk for fracture).

If a fracture occurs, then an orthopaedist would enter the picture to advise on treatment concerning the spine or extremity fracture.

If diagnosed with osteopenia or osteoporosis – what’s next?

With treatment patients can live normal, active and happy lives.

There are many types of medications that are now available – which work to reverse and then rebuild the bone loss. With treatment, the risk of a vertebral fracture drops from between 30-70 percent and the risk of a hip fracture drops by up to 40 percent.


Dr. Housman is an orthopaedic surgeon who practices at the Tucson Orthopaedic Institute. He earned a medical degree from the University of Alberta in Edmonton, Canada and completed an orthopaedic surgery residency at the Montreal General Hospital and McGill University. Dr. Housman is fellowship trained in several orthopaedic pursuits and is a past chief of staff at Tucson Medical Center. He has also served as president of the Western Orthopaedic Association and Arizona Orthopaedic Society.

 

What is your breast cancer risk? How do we tell and why you should know.

You might be tempted to dismiss your risk of developing breast cancer due to a lack of family history. Or perhaps, to worry incessantly about it because of some family history. However, as women, we are all at risk of getting breast cancer. Yes, men are also at risk. But simply being a woman is the number one risk factor. We talked with Dr. Michele Boyce Ley, board-certified breast cancer surgeon and medical director of the TMC Breast Health Program about assessing your risk.

What factors play into breast cancer risk:

  • being female
  • getting older
  • family history
  • not having children or having children after age 35
  • receiving hormone replacement therapy
  • obesity
  • lack of exercise
  • more than four alcoholic drinks a week

Dr. Michele Boyce Ley explains the key here is if multiple people from multiple generations in your family have been diagnosed, then you’re considered high-risk. “If your aunt had breast cancer when she was 65, for example, it’s probably not as important as if your mom had breast cancer at age 45,” she said. However, most women with breast cancer do not have a family history. Don’t ignore other factors because your family has no history of breast cancer.

Online high-risk assessments

Additionally, there are some easy-to-use scoring methods online to help you figure out if you’re high-risk or not. We have an online health risk assessment tool you can use and connect you with our nurse navigators if it appears that you’re at high risk. Still not sure? It’s best to get established with a breast specialist to assess your risk and what to do about it. A breast specialist can also help you figure out your breast density, which oftentimes can be another risk factor.

What about genetic testing for breast cancer risk?

Genetic testing is also an option, but proceed with caution. It’s not for everybody, and there are lots of caveats. Dr. Boyce Ley said it really needs to be done by a breast health specialist. Testing used to be limited to just testing for the BRCA 1 and 2 genes. Now there are numerous companies which offer genetic testing for up to 25 different markers. Certainly good information to have, but oftentimes it turns into a case of “We have this info. Now what do we do with it?”

While these mutations have been identified, it takes a highly trained team of clinicians to know how to interpret the results. Genetic testing can make a big difference in the treatment planning but it’s not a one-size-fits-all approach. “The testing can be helpful, but it’s not helpful in the same way for every person,” said Dr. Boyce Ley.

“I always tell my patients who want to pursue genetic testing this: Let’s think this through. If you get the testing done, and you get these results, what are you going to do about it? Your motivation might be to protect yourself or simply to help your children figure out their risk.”

Dr. Boyce Ley warns, however, that testing can have implications for an entire family. “Sometimes there is guilt associated with it if people realize they have passed this gene onto their kids. This isn’t like getting a blood test and finding out you have high cholesterol. It’s a bit more complex than that,” she said. That’s why it’s important to sit down and talk with an expert. Insurance coverage of genetic testing has gotten measurably better with the exception of Medicare, which is more restrictive in covering the cost.

Bottom line: Have a plan before you get genetic testing done.

Doctors continue to develop a better understanding about what characteristics constitute a high-risk patient, and there are an assortment of new drug therapies in the pipeline that work to reduce a patient’s risk. “Just because you’re identified as high-risk doesn’t necessarily mean you need an invasive procedure,” Dr. Boyce Ley said.

Something super simple you can do to reduce your risk of breast cancer that isn’t talked about much? Exercise and manage your weight. “It’s been shown over and over again that maintaining a healthy weight and exercising more than four times a week reduces the risk of breast cancer. Those are things where you don’t need to see a doctor. They’re not easy, but they’re free!” she said.

The TMC High-Risk Breast Clinic is at 2625 N. Craycroft Road, #201. Call (520) 324-BRST (2778) to make an appointment

Sit. Stay. Bad human! 9 tips for the office worker

As an office worker you may be bound to a desk and a computer. For most of us this means that we may sit most of the day. You might think staying seated is one of the safest things you could do, but too much sitting can hurt your body in a number of ways:

How sitting too much can hurt your body:

  • Increases your risk of heart disease
  • Increases your risk of diabetes
  • Causes poor circulation in your legs, which could lead to varicose veins or blood clots
  • May lead to fatigue and food cravings
  • Less activity leads to weight gain
  • Weakens your abdominal and gluteal (butt) muscles
  • Contributes to other structural problems in the spine and hips

We checked in with Laurie Ledford RD, our very own Nutritionista, for her tips to help us escape the chains of our desks.

What is a desk-bound office worker to do?

Here are a few tips to get you out of your chair.

  1. Don’t rely on an hour or less of exercise to make up for a whole day of sitting. You need to get up and move more often than that to offset the bad effects of sitting.
  2. If you have a sit-to-stand desk, alternate positions throughout the day.
  3. If you don’t have a special desk, stand up whenever you don’t need to be touching your keyboard or your desk – e.g., when answering the phone, while reading, while talking with a coworker.
  4. Sit on an exercise ball or a stool with no back, so that your core muscles will have to do some work. Always sit with your feet flat on the floor.
  5. Hold walking meetings.
  6. Drink lots of water (or other unsweetened beverage) throughout the day, so that you will have to get up to relieve yourself of this fluid frequently.
  7. Get away from your desk every 30-45 minutes to give your eyes a break and do something active – e.g., pushups against your desk, wall sitting (back against the wall with legs bent at 90 degrees), squats, calf raises, brisk walking, stretches or yoga poses.
  8. Keep a resistance band in your office. Use it to perform squats, lunges and upper body exercises during your breaks.
  9. Park far away, in a shady spot. This gives you a nice little walk to and from work, plus a cooler car in the afternoon.

For more information on how just a little more standing for office or around the home can make all the difference check out this post on how to burn more calories without adding a workout. 

The Nutritionista (aka Laurie Ledford)  is a Registered Dietitian at Tucson Medical Center who uses her knowledge and experience every day to support patients making healthy nutrition choices and prevent or combat the major killers of our time. Have a question about something you’ve heard or seen about nutrition or diet? Send your question to the Nutritionista at tmcforwomen at gmail dot com. Check back on TMC for Women for Nutritionista’s blog posts.

Holistic Heart – Your Health Coach Molly Griffis

If only you could have your own health coach! Someone who could cheer you on and support  you in achieving your healthy best…but that’s only for celebs and the fabulously rich, not mere mortals like you and me, right?

Not so! Tucson Medical Center’s satellite wellness center, The Core at La Encantada, offers individual health coaching with Molly Griffis RN.

As a holistic health coach trained at the Institute for Integrative Nutrition and a University of Arizona Nursing School graduate, Molly is a health care advocate and consummate cheerleader. She’s your wellness ally working with you to become the best, most healthy and happy versions of yourself.

Molly’s experience includes acute-care nursing and stroke program coordinator at Tucson Medical Center. Inspired by the amazing potential of disease prevention and health maintenance through lifestyle choices, Molly made the switch more than a year ago from hospital and sick care to wellness and preventive care.

Make an appointment with Molly – Call 520-324-2673

Why meet with a health coach?

“There are simple changes people can make toward health, but often these simple things are extraordinarily difficult to do on your own, without adequate information and consistent support. This is precisely where health coaches like myself come in! ”

Molly’s Healthy Dozen – to prevent stress, excess, inflammation and illness:

Recently Molly spoke with Gina Murphy-Darling of Mrs. Green’s World and shared her top 12 healthy living tips:

1. Let food be thy medicine!

Eat a RAINBOW of real whole foods including green leafy vegetables, cruciferous vegetables, fruits especially berries, whole grains, nuts, seeds and legumes. On the other hand, reduce your consumption of conventionally raised animal meat and dairy products, commercial baked goods, fried foods, highly salted foods and white sugar.

2. Drink more water

Drink more water and less sugar-laden beverages, soda, caffeine and alcohol.

3. Just keep moving!

Participate in regular physical activity that you enjoy.

4. Get in those zzzzzz’s

Get consistent quality and quantity of sleep.

5. Plan and prioritize

At the beginning of the day create a list of things you need to do, set reasonable priorities, ask for help when necessary and, if possible, say “NO” to tasks that will overwhelm you.

6. Take time to slow down

Find your personal peace and calm. Lessen your stress by turning off large and small gadgets (TVs, computers, phones, etc..).

7. Just breathe!

Focus on your breath, and find your personal calm & relaxation through meditation, prayer, music, art, journaling, cooking, gardening, reading a good book, yoga or tai chi.

8. Nature

Go outside, enjoy a healthy dose of sunshine, savor the fresh air and touch the earth.

9. Dogs, cats and children

Dogs, cats and children are three of the BEST stress reducers. Connect with them as often as possible.

10. Channel your inner child

Smile, laugh, sing, dance & play more

11. LOVE!

Love yourself and others. Take time to connect with positive relationships on a daily basis. Share your achievements as well as your disappointments with your good family/friend. Minimize time spent with negative individuals.

12. Aromatherapy

Try stress reducing essential oils: lavender, ylang ylang, frankincense, clary sage, bergamot, lemon, grapefruit, tangerine, peppermint, rose, aroma life, patchouli, sandalwood, Roman chamomile, valor, spruce, palo santo, cedarwood and geranium.

Soothing complementary therapies made possible through TMC Mega Raffle

Meaningful and compassionate hospice care is more than meeting complex medical needs. 

Thanks to the support from the TMC Mega Raffle, Tucson Medical Center offers soothing therapies that provide comfort, joy and peace for hospice patients – from the calming melodies of a harp, to the therapeutic knead of massage, the ease of a paintbrush stroke, and  the warm friendliness of a pet. 

Music, massage, art and pet therapies are only a few of the meaningful complimentary services offered at Peppi’s House, TMC’s inpatient hospice program.  

“It made a noticeable difference,” said Krista Durocher, the volunteer services coordinator at Peppi’s House. Massage therapy made a significant difference for Durocher’s grandmother, a hospice patient who struggled with pain and discomfort. “She was so relaxed after her massage. It was so wonderful to see her more comfortable and calm.”

The complimentary services at Peppi’s are carefully and thoughtfully chosen, from reflexology and aromatherapy to reiki and craniosacral therapy. 

“Each service has supportive data and is evidence- based,” said Director of Hospice and Palliative Care Alicia Ferguson. “We care very deeply for the patients and we provide the most effective complimentary services, assured to make a positive difference in a patient’s comfort and quality of life.”

Peppi’s House is a special place for many reasons, and one of them is the pediatric inpatient program. The complimentary therapies have an even stronger impact on children and their families. 

“It is simply wonderful to see a child’s face light-up when a pony walks in; the child and their family are all smiles – forgetting the seriousness surrounding them,” said Ferguson. Plans are in the works to grow children’s hospice services, and the Mega Raffle will be an important part of making the expanded services a reality.

Each TMC Mega Raffle ticket sold is helping hospice patients when they need it most.

 

 

This is the last in our six-part series of blogs to show the meaningful impact the TMC Mega Raffle funding has for patients and the community.

Outpatient lactation services receiving support from TMC Mega Raffle

Little Kailey Nowak decided to enter the world five weeks ahead of her due date. Her mom, Kelly, experienced difficulties with breastfeeding almost immediately. “She wouldn’t latch on, or if she did, it would only be for a few seconds,” she said. “It was awful. I cried every single day for six weeks as I pumped and fed my baby through a bottle. My plan was to breastfeed, and when I couldn’t, it truly felt like I was failing as a mother. People were

The family lives in Sierra Vista and with few lactation support services available there, Nowak’s pediatrician suggested she seek expert advice from the lactation specialists at TMC, where she had previously rented her hospital-grade breast pump. “I didn’t know what to expect, but the lactation specialists solved my problems and had Kailey successfully breastfeeding just two minutes into my session. It was the most magical moment of being a mom. I finally felt like I was doing a good job for her, and I wish I would have pursued this help sooner.”

The Mega Raffle provides funding for new moms to visit the outpatient breastfeeding clinic even if the service is not covered by their insurance or if they cannot otherwise afford it.

 

 

 

This is the fifth of our six-part series of blogs that show how the TMC Mega Raffle is making a difference for patients and the community.

 

TMC receives $25,000 grant from Avon Breast Health Outreach Program

Avon Breast Health Outreach Program in Tucson

The Avon Breast Health Outreach Program has again awarded a $25,000 one-year grant to Tucson Medical Center to increase awareness of the life-saving benefits of early detection of breast cancer.

Breast cancer is the most common form of cancer in women in the United States and early detection still provides the best opportunity for successful treatment .

Tucson Medical Center created the TMC Breast Health and Education Program to educate Tucson-area women and refer them to low-cost or free mammograms and clinical breast exams in their own communities. The vital program provides services to women who would not otherwise seek a screening mammogram.

Avon Breast Health Outreach Program

Denise Navarrete, TMC breast health and education program coordinator

 

The fund’s national advisory board selected The TMC Breast Health and Education Program as one of 56 new grant recipients nationwide in the 2017 cycle of Avon Breast Health Outreach Program grants. Programs were selected based on their ability to effectively reach underserved women in the communities they serve.

It is the nineteenth year that TMC has received funding from the Avon Breast Cancer Crusade to support its work on this important health issue, and in recognition of the program’s excellence.

Since May of 1998, the TMC Breast Health and Education Program has reached more than 50,000 women with information about the importance of early detection and has referred almost 7,000 women for mammograms and clinical breast exams.

The TMC Breast Health and Education Program helps ensure that all women have access to early detection information and options.

“We are proud that the Avon Breast Cancer Crusade shares our mission and has chosen to support our program. With these funds we will be able to reach women with breast cancer information and resources to Early detection saves lives at TMC Breast Center Avon Breast Cancer Crusade help overcome factors that keep them from practicing good breast health,” said Denise Navarrete, TMC breast health and education program coordinator.

For more information on the TMC Breast Health and Education Program at Tucson Medical Center please call (520) 324-1286. To learn more about the Avon Breast Health Outreach Program, visit www.avonbhop.org