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Solving the Mystery of Headache Pain

There are currently 28 million headache sufferers in the United States. 21 million are female, and 7 million are male (www.americanheadachesociety.org).

People often attribute headache pain to allergies, food or other causes, but some headache pain often originates from the cervical spine. If the source of your headache pain is a mechanical diagnosis, it may be treatable with physical therapy.

If you answer “yes” to ANY one of the following questions, you could be a good candidate for physical therapy to address your headache pain:

  • Headache produced consistently with certain posture or activities (such as when you are propped up in bed reading)
  • Loss of range of motion of cervical spine when headache occurs (more painful/stiffer to turn or look up)
  • Unilateral or headache on one side of your head
  • Headache at base of the posterior portion of your head
  • Headache occurs more often when “still” versus “moving”

During my years as a clinician treating a variety of different patients, I have found alleviating a patient’s headache pain is the most rewarding. One of my former female patients arrived in my office six weeks post cervical spine fusion surgery. Two weeks after the surgery, she received an epidural injection that resulted in a constant headache. She attributed the cause of her headache to the injection. During the course of her mechanical exam, we were able to find a simple sustained head and cervical spine positioning that she could perform easily while sitting. During her first exam, this position decreased her pain from a 9 (on a 10-point scale) to a 2. She was instructed to perform this movement every 2 hours and with the occurrence of headaches. On her second visit, one week later, she reported that her headache had completely subsided within 24 hours from the initial visit. She also reported that when she felt the trace of a headache beginning to start that she could relieve it with the exercise.

If you are suffering from headaches, please don’t hesitate to tell your physician because you may be able to receive therapy as a conservative treatment option. At the St. David’s Spine and Sports Therapy Clinic, we can assess your headache and determine if it is a mechanical diagnosis that can be treated in an average of two to four visits.

-Susan Hennigan, DPT
St. David’s Spine and Sport Therapy Clinic

Successful Green Initiatives and Celebrating Earth Day

Monday, April 22, 2013, is Earth Day—a national program that aims to educate the community on the environmental and economic benefits of waste reduction and recycling.

St. David’s Round Rock Medical Center has continued its dedication to green practices for five years after adopting its recycling program, which has helped manage and reduce waste produced at its campus. Over the past five years, St. David’s Round Rock Medical Center has recycled 610 tons of recyclable materials and saved 4,285,925 gallons of water. Annually, our recycling efforts save about 2,081 trees and divert over 400 cubic yards of materials from being placed in the landfills.

Further awareness and motivational tactics that have helped recycling efforts at St. David’s Round Rock Medical Center include:

  • Pharmacy Waste Recycling – In 2012, St. David’s Round Rock Medical Center implemented a pharmacy waste program. This program helps divert hazardous waste from being sent to landfills and establishes proper disposal practices to meet EPA regulations.
  • Condensation Collection – An average daily collection of 1,800 gallons of condensation run-off that is used to water 3 courtyards on the campus. This helps reduce the impact on the community’s water supply.
  • Utility 4 CP program – This program is vital in providing emergency relief to the electrical power grid as demands in our state continue to stress the electrical grid during severe weather events. Our participation in this program will net a savings of $15,000 in 2013.
  • Filta Kitchen Grease Recycling Program – This program resulted in the recycling of 500 pounds of grease last year. This program converts the grease into biodiesel fuel.

Past projects include:

  • Implementing the use of electronic pay stubs instead of paper versions.
  • Donating over 100,000 pounds of products and supplies to Project C.U.R.E. —a nonprofit organization that takes expired and used medical supplies and products (such as surgery kits, dressings, radiology equipment and defibrillators) and delivers them to third-world countries in need of medical equipment and supplies.
  • Working towards a mercury-free environment over the last 10 years in various ways, including:
    • Retrofitting lighting to remove light bulbs that contain mercury
    • Changing laboratory procedures to eliminate testing equipment that contains mercury
    • Creating a policy that monitors product selection to curtail the use of any new products being brought into the facility that contain mercury
  • Retrofitting over 500 light fixtures throughout the facility, saving 16 watts of power per light fixture (over 8,000 watts per day).
  • Xeriscaping the hospital property by using plants that require little to no water.
  • Using HEPA filter bags in all of the hospital’s vacuum cleaners.
  • Using microfiber mops that use less water to clean the floors.

Colorectal Cancer Awareness Month

(Guest Post via Thiru V. Lakshman, MD)

As a colorectal surgeon, March is an important and exciting time for me (and not just because of March Madness). This is because March is National Colorectal Cancer Awareness Month, and it is a great opportunity to educate our community and the public in general about the very prevalent but preventable disease known as colorectal cancer.

Each year, approximately 150,000 people are diagnosed with colon or rectal cancer, and over 50,000 of those people will die from the disease. Colorectal cancer is extremely preventable if colon polyps that lead to the cancer are detected and removed (via colonoscopy or surgery), and it is very curable if the cancer is detected in its early stages. Since there are very few symptoms associated with colorectal cancer, regular screening is essential. If colorectal cancers are diagnosed at later stages, the prognosis and survival rates significantly worsen.

In order to decrease your risk of developing colorectal cancer, the American Society of Colon and Rectal Surgeons recommends:

  • Get regular colorectal cancer screenings after age 50. Between 80-90% of colorectal cancer patients are restored to normal health if their cancer is detected and treated in the earliest stages.
  • Eat a low-fat, high-fiber diet.
  • If you use alcohol, drink only in moderation. If you use tobacco, quit. If you don’t use tobacco, don’t start. Alcohol and tobacco in combination are linked to colorectal cancer and other gastrointestinal cancers.
  • Exercise for at least 20 minutes three to four days each week.

To learn more, visit the American Society of Colon and Rectal Surgeons website at www.fascrs.org or speak with your colorectal surgeon or primary healthcare provider.

Together let’s flush colorectal cancer down the toilet!

The Battle for a Better Easter Basket

via flickr

via flickr

With childhood obesity on the rise and cavities a constant parental concern, how can the Easter Bunny help families have a healthy and happy Easter holiday?

It is often a tradition to have an Easter basket filled with candy and goodies, as well as for children to search their homes and backyards for candy-filled plastic eggs. Children may even repeat this tradition at school, their grandparents’ houses or a relative’s home. As a result of this fun, children may have pounds of candy and snacks at the end of the Easter holiday, which quickly add large amounts of sugar and fat to their systems, and include hundreds—if not thousands—of calories!

People may think that all candy is created equal, but they are wrong. Depending on the type and size of the candy, calories can range from 65 to nearly 500 per serving.

Screenshot_3_25_13_11_43_AM

Tips and alternatives:

  • Consider using snack-size versions of Easter candy favorites instead of the regular size.
  • Substitute healthier alternatives, such as yogurt-covered raisins, pretzels or sugar-free gum.
  • Fill plastic eggs with small toys or pennies (for children ages five and older only).
  • Other non-food basket ideas include coloring books and crayons, Easter stickers, bubbles, sidewalk chalk, jump ropes and water toys.

Even though Easter only comes around once a year, health and nutrition habits are impacted by choices made each and every day.

—Tarie Beldin is a registered and licensed dietitian at St. David’s Round Rock Medical Center.

4 Steps to Decrease Your Risk For Cancer

(via American Cancer Society)

More than half of all cancer deaths could be prevented by making healthy choices like not smoking, staying at a healthy weight, eating right and keeping active. February is National Cancer Prevention Month. St. David’s Round Rock Medical Center partners with the American Cancer Society (ACS) to provide quality care for our cancer patients and families as well as educating the community on how to decrease the risk for cancer.

1. Stay Away from Tobacco

  • Lung cancer is the leading cause of cancer death in the U.S. for both men and women. (Source: ACS Cancer Facts and Figures 2013)
  • Lung cancer is the most preventable form of cancer death in our society. (Source: Cancer Facts and Figures 2013)
  • It is estimated that there will be 228,190 new cases of lung cancer and 159,480 deaths from lung cancer in 2013. (Source: Cancer Facts and Figures 2013)
  • Besides lung cancer, tobacco use also increases the risk for cancers of the mouth, lips, nasal cavity (nose) and sinuses, larynx (voice box), pharynx (throat), esophagus (swallowing tube), stomach, pancreas, kidney, bladder, uterus, cervix, colon/rectum, and ovary (mucinous), as well as acute myeloid leukemia. (Source: ACS Cancer Facts & Figures 2013)
  • Each year, about 3,400 non-smoking adults die of lung cancer as a result of breathing secondhand smoke. Each year, secondhand smoke also causes about 46,000 deaths from heart disease in people who are not current smokers. (Source: Cancer Facts & Figures 2013)

2. Eat Healthy and Get Active

ACS “Guidelines on Nutrition and Physical Activity for Cancer Prevention” include:

  • Achieve and maintain a healthy weight throughout life by getting regular physical activity and limiting the intake of high-calorie food and drinks.
  • In the U.S., excess body weight is thought to contribute to as many as 1 out of 5 of all cancer-related deaths.
  • Being overweight is clearly linked with increased risk for cancer of the breast, colon/rectum, endometrium (lining of uterus), esophagus, kidney and pancreas.

3. Be Safe in the Sun

  • You don’t have to avoid sunlight completely, but too much sunlight can be harmful.
  • Sun exposure adds up day after day and happens every time you are in the sun.
  • American Cancer Society recommends simply staying in the shade to limit UV exposure, but if you are going to be in the sun, remember to “Slip!”, “Slop!”, “Slap!” and “Wrap!” to protect yourself from UV rays:
    • Slip on a shirt
    • Slop on sunscreen
    • Slap on a hat
    • Wrap on sunglasses to protect the eyes and sensitive skin around them

4. Find Cancer Early

  • Screening increases the chances of detecting certain cancers early, when they are most likely to be curable.
  • Learn what screening tests the American Cancer Society recommends and when you should have them. (www.cancer.org/healthy/findcancerearly/index)

Bonus: Other Ways to Prevent Cancer

  • Visit www.cancer.org to learn about potential carcinogens in your home and environment.
  • Talk to your physician to determine if certain genetic testing is recommended for you.

Sleep: The Underestimated Threat To Heart Health

FB-Teasers-FEB18Year after year, cardiovascular diseases claim the lives of more Americans than any other disease. Despite remarkable advances in medical technology and treatments, over half-a-million people in the U.S. die of heart disease every year. Why? What are we doing wrong? Are we missing something?

It turns out that the answer is, “Yes!” So, what have we missed?

We know about the importance of diet and exercise for heart health, as they contribute to high blood pressure, high cholesterol, diabetes and obesity. We also know about the importance of avoiding exposure to tobacco products. As a medical community, we have implemented many interventions targeting these problems, known as major cardiac risk factors.

However, we have not done enough to address sleep. Compared to the major cardiac risk factors above, our knowledge about sleep is in its infancy. The American College of Cardiology did not publish its first (and only) guidelines on the effect of sleep on heart health until 2008. As a result, many cardiologists nationwide are not fully aware of the dangers of sleep disorders such as obstructive sleep apnea (OSA).

Yet the clinical trials in the past 10 years have shown clearly that OSA not only belongs in the group of “major cardiac risk factors,” it may be one of the most important ones.  Multiple clinical trials have shown that OSA, if left untreated, can:

  • Triple your risk of developing high blood pressure
  • Double your risk of developing atrial fibrillation
  • More than triple your risk of having angina or a heart attack

Worse yet, if you have any of a number of heart diseases, untreated OSA can make things much worse.

  • If you have high blood pressure, OSA can make it much harder to control and can raise your BP by 10 points or more.
  • If you have had atrial fibrillation, OSA can triple the risk that it comes back.
  • If you have congestive heart failure, OSA can more than double your risk of dying.
  • If you have had a stent, OSA can more than triple your risk of having more problems with your arteries and dying of a subsequent heart attack.

The good news is that studies have shown that all of these risks may be reduced (or possibly eliminated!) if OSA is diagnosed and treated. The even better news is that the diagnosis and treatment of OSA are simple and usually do not involve any medications or surgeries.

Although OSA is most often asymptomatic (over 80% of patients with OSA do not realize they have it), clues that you might have it include:

  • Snoring
  • Irregular breathing
  • Morning headaches
  • Trouble falling or staying asleep
  • Unrefreshing sleep
  • Excessive sleepiness during the day
  • Mood disorders, such as depression
  • Difficulty concentrating
  • High blood pressure
  • Obesity
  • Heart disease
  • Stroke

If you have some of these symptoms, ask your doctor about OSA. Testing usually involves an overnight “sleep study” during which you sleep while technicians use external monitors to evaluate many things including breathing, heart rhythm and oxygen levels. Treatment typically involves the use of continuous positive airway pressure (CPAP), delivered with a facial mask that is worn only during sleep.

Not only may treatment help you feel better and improve your job performance, it may save your life by lowering your risk for major heart problems. The Heart Hospital of Austin Sleep Disorders Center is a unique, cutting-edge program that is the only one in Texas to be directed by physicians who are dually boarded in cardiology and sleep medicine. This crossover of expertise allows us to fully evaluate and treat any sleep or heart issues you may face.

-Stan Wang, MD, JD, MPH
Cardiovascular Disease & Sleep Medicine, Austin Heart South
Director of Legislative Affairs, Austin Heart
Chair, Austin Heart Sleep Therapy Committee
Medical Director, Heart Hospital of Austin Sleep Disorders Center

Checking Your Heart Rate With an iPhone

(by David S Abrams, MD)

FB-Teasers-FEB-HeartRateThe heart rate is a very important piece of medical information. An abnormally elevated resting heart rate may indicate the presence of an underlying medical condition. Heart rate response to exercise is an excellent indicator of physical conditioning. Knowing one’s heart rate during exercise is important when it comes to maximizing aerobic benefit or maximizing fat burning. For those interested in an iPhone app that can check heart rate, here are two that I have tried out.

Instant Heart Rate, by Azumio
This free app uses the camera lens on the iPhone 3GS or later to detect pulses from the fingertip similar to what a pulse oximeter does. It detects color changes in the skin which correlate with each heart beat. It is very easy to use. You simply place your fingertip lightly over the camera lens and watch as the app detects your pulse and then displays your heart rate. I did it several times under different circumstances (sitting, after walking, after climbing a flight of stairs) to see how it would perform. I counted my pulse manually and got identical values to what the app displayed. It takes 10 seconds for the app to do this. After it displays the heart rate, it presents you with the option to store the value and to add a note. The five most recent stored values are kept in a timeline feature. You can upgrade to a Pro version ($0.99) which provides unlimited storage as well as charts to show heart rate recovery after exercise. The app’s Help feature is well organized. There is a section on Heart Rate Zones indicating what the heart rate should be for warm up, fat burn, cardio, extreme, and maximum. Settings allow entry of age and gender data to calculate ideal resting and maximal heart rates. This app receives 4.5/5 stars in iTunes. The app is not available for iPad.

Free Heart Rate Calculator, by Carre
This is a free app which requires one to check the pulse manually (e.g. at the wrist) and to tap a heart icon on the phone’s display every time a heart beat is felt. The app will then calculate the heart rate. I found this to be quite cumbersome and not very accurate. The display shows a graph along the top which alternates between Resting Heart Rate and Training Heart Rate. I could not figure out how to switch between the two, and there is no Help feature. When I tried to get to Carre support through iTunes, it took me to a site that wanted me to sign up for Hexoskin Wearable Body Metrics! The app receives 2.5/5 stars on iTunes and is available for both iPhone and iPad.

I clearly prefer Instant Heart Rate by Azumio. It is easy and fun to use, very accurate, and filled with useful information. It can be used at rest or during or after exercise. Those wanting to store data over a longer period of time will need to upgrade for $0.99. Either way, this app is valuable for those wanting to know exactly what their heart rate is at any time.

Happy Valentine’s Day – What Makes the Heart Tick

via flickr

via flickr

In February, we are surrounded by images of hearts—candy hearts, valentines, heart-shaped cookies, heart-shaped jewelry, etc.  But it’s the heart that you can’t see—the one that pumps blood to all your organs and keeps you ticking—that matters most.  Conveniently, February is the month we celebrate that heart, too.

In honor of National Heart Month, I wanted to get back to the basics of what makes the heart tick.  The heart is a big, strong muscle whose systems can be likened to the systems of your home—plumbing, mechanical and electric.  The plumbing of your heart is your coronary arteries, which bring fresh, oxygen-rich blood to your heart muscle to give it the ability to pump blood out to your organs and extremities.  When these arteries get clogged with plaque and other deposits, the blood supply to the heart muscle slows or gets cut off, causing chest pain or even a heart attack.  In the most severe cases of blockage, parts of the heart muscle can die or become damaged, which can affect the mechanical (or pumping action) or electrical systems of the heart.

The electrical system of the heart—what we in electrophysiology study—is the complex system of electrical “wiring” within the heart that tells it when to beat.  The heart’s electrical system determines how fast or slow the heart beats, and whether it beats regularly or irregularly.  When this system is damaged (by a heart attack, heart surgery, excessive drug or alcohol use, stress, obesity, etc.) or is genetically malformed, the electricity in the heart can go hay-wire, causing the heart to beat much too fast or too slow, or to beat so irregularly that not enough blood circulates around the body.

This is where electrophysiologists come in—they fix problems with the heart’s electrical system, either through ablation (“rewiring” the electricity by creating scar tissue in the heart with radiofrequency energy) or implanting a device in the body that can tell the heart when to beat (like a pacemaker) or can shock the heart out of a potentially lethal rhythm (as a defibrillator does).

So, how can you keep your heart’s electrical system healthy and keep yourself out of the electrophysiologist’s office?  Take care of the whole house!  The plumbing, mechanical and electrical systems of the heart are intimately connected to one another, and a problem with one often means a problem for another.  According to the Heart Rhythm Society (HRS), there are many things you can do to keep all of your ticker’s systems healthy, including:

  • Making healthy lifestyle choices, like exercising regularly and maintaining a healthy weight.
  • Quitting smoking and avoiding second hand smoke.
  • Avoiding excessive caffeine, alcohol and other substance use.
  • Developing healthy ways to manage stress and anxiety.
  • Getting regular check-ups and telling your doctor right away about any unusual symptoms.
  • Keeping your risk factors for arrhythmias in check (clogged arteries, heart valve issues, high blood pressure, diabetes, thyroid disease, obesity, high cholesterol, and a family history of heart disease, sudden death or heart rhythm problems).

Happy Valentine’s Day, and Happy National Heart Month!  Here’s to you and your healthy heart!

Chocolate: Health & Happiness

By: Tarie Beldin, RD, LD

via flickr

via flickr

Wait! What? Could it be true….chocolate, healthy? Well, yes, if we are talking about chocolate in a pure form. If you were thinking I was going to tell you that a Snicker’s bar was good for you, you would be mistaken. The goal is to find chocolate that contains a high cocoa content; the higher the cocoa, the less room for sugar and fat.

Now, on to the health benefits. The number one health benefit of chocolate is its antioxidant properties. Antioxidants help rid the body of free-radicals which cause aging and disease. When you think of antioxidants, you probably think of blueberries, green tea or pomegranates. Using the USDA’s Oxygen Radical Absorbance Capacity Unit (ORAC) chart, 100g of blueberries contain 2400 ORAC’s and 100g of dark chocolate contains 13,120! Diets rich in antioxidants have been shown to reduce the risk for heart disease (heart attack and stroke), cancer, high blood pressure, arthritis and asthma. So, if you are looking for something to satisfy your sweet tooth as well as do something healthy for your body, dark chocolate is the way to go. Not a fan of dark chocolate? Try some higher-end brands such as Valrhona, Dagoba or Newman’s Own to name a few.

What about the fat and sugar? Chocolate certainly does have health benefits; however, it is not to be eaten with the same fervor as say wild salmon or broccoli! The portion size is small – only an ounce or two – and should by no means be a replacement for other healthy foods. The fat in chocolate (cocoa butter) is a saturated fat, but is composed mainly of oleic and stearic acids, which have been shown to decrease cholesterol. The sugar in dark, strong chocolate is about 12-15g which is less than a container of yogurt or a glass of orange juice, which are considered healthy foods. Make sure to read the labels of your favorite dark chocolate brands, anything that ends in the word “ose” is a form of sugar. In addition, cane sugar, cane syrup or evaporated cane juice are the same as sugar.

Ways to enjoy dark chocolate:

  • Hot chocolate (made with low-fat or fat-free milk, soy milk or almond milk)
  • Dark chocolate fondue: Dip strawberries, bananas, pineapple, graham crackers, vanilla wafers, pretzels, Rice Krispie treats or Angel Food cake
  • Dark chocolate dipped strawberries
  • Melt dark chocolate over a double boiler until smooth; stir in dried blueberries and pistachios. Drop by spoonfuls onto a parchment-lined baking sheet. Refrigerate until firm and enjoy!

As we celebrate Valentine’s Day as well as Heart Health Month, give up the guilt and enjoy the taste as well as the health benefits of chocolate!

Early Aquatic Therapy Following Total Knee Replacement Improves Outcomes

Screenshot_2_11_13_6_57_AM 2Aquatic physical therapy after a total knee replacement surgery is often used in conjunction with land-based physical therapy to reduce pain and swelling, increase a joint’s range of motion, improve strength and balance, and restore a normalized walking pattern. The principle of buoyancy allows a clinician to adjust the amount of weight bearing appropriate for each client’s particular needs/restrictions. Deeper water could be used for decreasing pain or adhering to a person’s weight restrictions following surgery. A person can also work on improving their walking pattern without an assistive device early on and decrease compensatory movements that may develop on land due to weakness edema and discomfort.

A recent peer-reviewed research study conducted in Germany investigated whether early participation in an aquatic therapy program following a total knee replacement had any effect over later initiation of aquatic therapy. Patients were randomly assigned to start aquatic therapy either 6 days or 14 days after their knee replacement surgery. Validated tests for joint stiffness, pain and physical function were evaluated at 3, 6, 12 and 24 months after the surgery. All measured outcomes in the group that started aquatic therapy early were better than the group that started later. The lead researcher hypothesized that the amount of joint effusion present inside the repaired knee capsule after surgery was less due to the hydrostatic force of the water during pool therapy. Higher levels of joint effusion generally result in more pain and decreased range of motion.

Screenshot_2_11_13_6_57_AMBob Rambusek, Senior Physical Therapist
St. David’s Rehabilitation Hospital

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