The following items are approved menu items:

• Steamed edamame (with no salt added)
• Fresh basil spring rolls (without the dipping sauce)
• Steamed bowl with chicken and brown rice (sauce not included)
• Ginger sesame salad with chicken

(*Sauce options are: low-sodium soy sauce and gluten-free soy sauce)

In addition to the above items, Mama Fu’s offers ancient words of wisdom that should serve as a mantra for any healthy diner:

• Go gluten-free by substituting our new Mama Fu’s Gluten Free-Sauce* on almost any dish.
• Lighten up any rice dish, noodle bowl or salad by requesting your chicken, beef, shrimp or tofu be prepared wok-seared (cooked in broth).
• Brown rice options on any dish.
• Pile on the veggies. Try broccoli, red bell pepper, yellow onions, green beans, carrots, snap peas, bean sprouts, spinach and cabbage.
• Go green! Add a garden salad made of mixed field greens topped with carrots, tomatoes and wonton chips. (Ask for any of our dressing choices on the side).
• Calorie counting? Request a portion of your entrée “to go.”

The House has spoken, so take your wiser self to one of their many area locations today, and start the path to becoming a stronger and healthier you.

• Mama Fu’s― Austin – mamafus.com
  • located at 100 Colorado St.
  • 4615 N. Lamar Blvd.
  • 9600 S. IH-35
  • 11301 Lakeline Blvd.
• Mama Fu’s―located at 5400 Brodie Lane in Sunset Valley – mamafus.com
• Mama Fu’s―located at 1003 West University Ave. in Georgetown - mamafus.com

Orders can be placed either over the phone or online by visiting https://orders.mamafus.com

–St. David’s HealthCare Healthy Dining Program

via Facebook

Any Austinite will tell you where to head for “legendary bar-b-q”― the “Hill” or the “Lake.” County Line on the Hill, aka “the original County Line,” is located in a historic “speak-easy;” this location offers “tourist worthy” views and deliciously grilled items. The County Line on the Lake lives up its name, set in an old lake lodge, and surrounded by a large redwood deck over-looking Lake Austin.

County Line’s two Austin locations are still branded in the minds of Austin foodies for their bar-b-q, but they have now added a new notch to their “legendary” status by becoming the only bar-b-q restaurant in town that serves menu items approved by the St. David’s HealthCare Healthy Dining Program.

The following approved menu items are available at County Line on the Hill:

• Grilled Norwegian Salmon Platter―served with a grilled veggie kabob, baked potato (includes a teaspoon of Smart Balance Spread). *Optional addition: side salad with roasted pecan balsamic vinaigrette
• Grilled Chicken Breast Platter―served with a grilled veggie kabob, baked potato (includes a teaspoon of Smart Balance Spread). *Optional addition: side salad with roasted pecan balsamic vinaigrette
• Grilled Veggie Kabob Platter―served with a baked potato (includes a teaspoon of Smart Balance Spread). *Optional addition: side salad with roasted pecan balsamic vinaigrette

(Complete menu for County Line on the Hill)

The following approved menu items are available at County Line on the Lake:

• Grilled Norwegian Salmon Platter―served with a grilled veggie kabob, baked potato (includes a teaspoon of Smart Balance Spread)
• Grilled Chicken Breast Platter―served with a grilled veggie kabob, baked potato (includes a teaspoon of Smart Balance Spread)
• Grilled Veggie Kabob Platter―served with a baked potato (includes a teaspoon of Smart Balance Spread)

(Complete menu for County Line on the Lake)

So whether you are feeling like the “Hill” or the “Lake,” this Austin institution offers healthy
options in a historic bar-b-q setting.

• County Line on the Hill, located at 6500 Bee Cave Road in Bee Cave - countyline.com
• County Line on the Lake, located at 5204 Ranch Road 2222 in Austin - countyline.com

–St. David’s HealthCare Healthy Dining Program

As we begin the month of May…let us reflect back on April, on Earth Day, where we examine ways to conserve energy and take steps to save the planet….perhaps you have wondered – “does what I eat have an effect on my carbon footprint?”

To refresh your memory…a carbon footprint is defined as the amount of carbon dioxide (a greenhouse gas) that is given off from burning fossil fuels for lifestyle activities. Honestly, our society sometimes makes eating a recreational activity, so if we are concerned with reducing our carbon footprint, we need to educate ourselves about where our food comes from and how it is produced.

Research suggests that the more greenhouse gas produced, the higher the temperature at the lower levels of the atmosphere. This “global warming” can lead to extreme shifts in temperatures, droughts, blizzards, hurricanes and eventually a lower crop yield.

So just what is it about our food choices that increase the production of greenhouse gases, and what can we do about it?

• We throw out about 1/3 of the food we buy… which is approximately 400 lbs. per year. Most of this is due to overbuying. Rotting produce and leftovers decay in landfills; this is second only to paper waste in terms of volume.
• Think of how far your food travels and how it is produced. The more processed it is, the more energy used to produce it. The more paper/cardboard packaging it has, the greater the strain to forests. The farther away your food has to travel to get to your plate, the more fuel used for transportation and energy used for refrigeration.
• Eating a diet that contains a lot of animal products can also have a negative impact. Animals consume far more food than they produce and also strain the environment by consuming large amounts of water, and their waste products can pollute the air and water supply.

Here are just 2 suggestions that will not only help the planet, but improve your health as well.

• Eat more of a plant-based diet. Plants require less energy to produce and they can also help protect against disease.
• Buy local. Whether it is meat or melon – visit local farmer’s markets or become part of Community Supported Agriculture programs. Buying whole, unprocessed foods that are grown or produced close to home are better for you and the environment.

Small changes can make a difference, and if we all made these changes – each day…not just Earth Day… in time, we could make an impact in our environment.

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

Last month, news coverage about the fertilizer plant explosion in West included a story that resonated with me. A nurse who worked at a nursing home that had collapsed from the explosion was at home, 20 miles from the plant at the time of the blast. However, when she heard the massive noise from so far away, she rushed to the nursing facility to help evacuate residents. Similar stories abounded about the heroic work of nurses during the aftermath of the bombing at the Boston Marathon. As do so many nurses every single day, these nurses went beyond their traditional call of duty and saved lives.

According to the U.S. Department of Labor’s Bureau of Labor Statistics, the employment of registered nurses (RNs) is expected to increase 26 percent from 2010 to 2020. The Bureau of Labor Statistics attributes this growth to an increased emphasis on preventative care, technological advancements and the fact that the aging baby-boomer population continues to require healthcare services as they live longer and more active lives.

The U.S. Census Bureau reports there were 3.5 million employed nurses in 2011. Of those nurses, 78 percent were RNs—64 percent of whom worked in hospitals.

There’s a reason people are moving more and more to this wonderful profession. Studies indicate that nurses are among the most trusted healthcare professionals in the country. A nurse is usually the first person a patient sees when he or she falls ill and the last one they see when they leave the hospital. Every day, nurses leave indelible impressions on their patients. Their worth is truly immeasurable.

On behalf of St. David’s HealthCare, thank you to all nurses for your compassion and commitment. Whether you serve right here in Central Texas, or in Boston, in West, or anywhere else in the country, you truly are making a difference.

–

David Huffstutler is president and chief executive officer of St. David’s HealthCare, which employs more than 3,100 nurses in Central Texas.

We all know that everyone benefits from physical activity, and it’s important to remember the same is true for persons with MS. However, some individuals may have more barriers than others, so activity must be individualized to fit your specific needs. I tell my patients to focus on three areas of activity—flexibility, strength and cardio. All three are needed for optimal health. My advice to all MS patients is to find some activities you enjoy that will address one or all of the above areas. Physical activity may be the key to maintaining cognitive sharpness and keeping weakness and spasticity at bay.

Below are some recommended exercises for MS patients:

• Swimming (or just walking in a pool)
• Walking (on the ground or a treadmill, even short durations are ok)
• Stationary bike or rower (if your legs are not working well, an upper body ergo meter is another option)
• Yoga
• Pilates
• Resistance training (either with weights or resistance bands)

The key is to keep moving, while staying cool and managing your fatigue. This could mean 10-minute workouts, several times a day. Some alternatives may include keeping up with regular daily activities that can also provide exercise, such as: gardening, vacuuming, sweeping or practicing standing from a variety of seat heights.

Overall, remember to keep moving, stay cool (especially as the summer months approach), and manage fatigue by shortening workouts or increasing daily activity frequency.

Below you can find some other resources that may be helpful:

Visit the Multiple Sclerosis Association of America for information on the following resources:

• My MS manager application for phones
• My MS Resource locator
• S.E.A.R.C.H. program for navigating various medications/therapies

The National Multiple Sclerosis Society has a great online community with resources and information including:

• National MS Society Online Community – Facebook, Twitter, YouTube, Personal Stories
• MS Connection – online community
• MSWorld – website, message boards, chat rooms

Consortium of Multiple Sclerosis Centers is another good resource.

• NARCOMS (North American Research Committee on Multiple Sclerosis)

If you don’t have MS, but know someone who does, consider fundraising for research via an MS walk or bike ride! Check out the National Multiple Sclerosis Society for more information.

- Kathy Bolstorff, PT, NCS, MSCS

What do Occupational Therapists do for their patients?

• Find ways to help clients improve their abilities
• Help people do the things they want or need to do
• Restructure environments for optimal success to participate in daily life tasks
• Re-educate movement patterns, improve cognitive skills and educate to modify task requirements
• Specialize in creating customized splints to minimize deformity and improve functionality
• Teach the use of adaptive equipment to simplify task performance and maintain independence with life skills
• Use a holistic and individualized approach with all clients
• Provide education and guidance to clients, family members and caregivers
• Promote maximizing independence in all areas of life

The Occupational Therapists at St. David’s Round Rock Medical Center help patients participate more actively in life!

• Work in the acute, inpatient, outpatient and Day Program settings
• Treat a range of diagnoses and illnesses
  • Traumatic brain injury (TBI)
  • Upper extremity fractures and injuries
  • Total hip, knee or shoulder replacements
  • Stroke
  • Rotator cuff injuries
  • Traumas
    • Car or bicycle accidents
    • Falls
• Help people across the lifespan – from neonates to the elderly
  • Work with children with special needs to help them participate in school and social situations
  • Work with people recovering from injury or illness to regain skills
  • Work with elderly adults who experience physical and cognitive changes

Help us celebrate our Occupational Therapists this month during National Occupational Therapy month!

There are several types of omega-3 fatty acids. The fatty acids EPA and DHA are primarily found in fatty fish and fish oil. Sources include: sardines, mackerel, salmon and halibut. A source of the fatty acid ALA can be found in the flax plant. Supplements provide an alternative to adding these foods to your diet, but you should always discuss adding supplements into your diet with your healthcare provider since some have been associated with side effects such as bleeding.

Here is a recipe that will help you easily incorporate fatty acids into your diet. Zucchini, banana and flaxseed muffins are one of our favorites: Martha Stewart’s Zucchini, Banana, and Flaxseed Muffins

Source: Journal of Nutritional Biochemistry, January 3013

Brenda Baumann, RN, MSN

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.

The University of Texas Club

Designed to meet the high culinary expectations of its members, the Club’s innovative menu draws on the executive chef’s experience and talent. Not only does the menu offer the finest selections, but all menus are created daily featuring the freshest seasonal ingredients.

The St. David’s HealthCare Healthy Dining Program currently approves the following menu item:

• Pork Tenderloin with Cherry Port Sauce and Vegetable Cous Cous

This delicious but healthy menu item includes succulent pork medallions drizzled with a tangy, semi-sweet port wine cherry sauce accompanied by a vegetable cous cous with fresh onions, tomatoes, zucchini and yellow squash. This entrée packs jumbo-tron sized taste with a healthy onside kick. (Insert stadium cheers here!)

While the Club is the only private club that is a participant in the Healthy Dining Program, this tasty pork dish may give you one more reason to don your burnt orange, become a member and join in on an Austin tradition.

http://www.clubcorp.com/Clubs/The-University-of-Texas-Club/Amenities/Dining

-St. David’s HealthCare Healthy Dining Program

What does it mean to be a Certified Comprehensive Stroke Center?

• Recognition by one of the leading accrediting agencies in the United States.
• Comprehensive Stroke Centers offer the most advanced stroke treatment available in a given geographic region.
• The hospital has met the nation’s highest standards in stroke care, an accomplishment that is a genuine team effort.
• The hospital can provide services such as neurosurgery, neurocritical care and endovascular therapies for cerebrovascular diseases.
• The level of certification determines where EMS providers will transport patients for the most appropriate medical care within state health department guidelines.
• DNV Healthcare is the only hospital accreditation program approved by the U.S. Centers for Medicare and Medicaid Services (CMS) that integrates the ISO 9001 Quality Management System with the Medicare Conditions of Participation. DNV’s National Integrated Accreditation for Healthcare Organizations (NIAHO) accreditation program requires hospitals to evaluate the continuum of patient care and take measured steps to improve, if warranted.
• The DNV Comprehensive Stroke Center Certification incorporates elements from its NIAHO hospital accreditation standards, as well as requirements from the Guidelines of the Brain Attack Coalition and Recommendations of the American Stroke Association.
• In order to earn and maintain a Comprehensive Stroke Center Certification, the hospital must participate in the Medicare program and be in compliance with the conditions of participation, which may be demonstrated by maintaining accreditation with DNV or another CMS-approved accreditation organization.
• The hospital will be visited annually to monitor the hospital’s adherence to patient safety criteria established by CMS and to evaluate processes that impact patient care across various departments and facilities of the hospital.

Congratulations to St. David’s Medical Center and NeuroTexas Institute on this outstanding accomplishment!

DNV Healthcare Inc. is based in Cincinnati, Ohio, and is a part of Det Norske Veritas, a global independent foundation dedicated to safeguarding life, property and the environment. For more information about DNV Healthcare and its NIAHO hospital accreditation program, visit DNVAccreditation.com.

SNAP Kitchen

All of Snap Kitchen’s menu items are portion controlled and labeled with full nutritional content. Approximately 99% of the menu is Gluten Free. SNAP also caters to customers with specific dietary needs by offering menu categories including: Carb Conscious (lower carb), Sodium Conscious, Non-Dairy, Plant Powered (vegetarian and vegan) and Paleo.

With the motto of: “Eat right. Feel great. Live well!” SNAP was destined to be a St. David’s HealthCare Healthy Dining Program restaurant partner.

The St. David’s Healthcare Healthy Dining Program currently approves the following items:

• Baked Vegetable Quiche
• Spinach and Goat Cheese Scramble – Egg Whites, Sun Dried Tomatoes, Caramelized Onions, Baked Sweet Potatoes
• Vegan Scramble – Non-GMO Tofu “Eggs,” Avocado Coulis, Baked Sweet Potatoes
• Asian Beef Noodle Bowl
• Chicken Tikka Masala
• Vegetable Lasagna (gluten-free) – Eggplant, Zucchini, Summer Squash, Portabello Mushroom, Oven Roasted Marinara, Herbed Cheese Sauce
• Mediterranean Spaghetti Squash – Tomatoes, Pitted Kalamata Olives, Feta Cheese, Green Onions, Capers, Greek Vinaigrette
• Chimichurri Salmon or Chicken- Spinach, Sautéed Mushrooms, Roasted Carrots
• Crispy Scottish Salmon or Chicken – Roasted Carrots, Roasted Zucchini

*Stay tuned for more items from SNAP’s menu. Please note that with a seasonal menu, not all approved items will always be available.

With their multiple locations in Austin and Houston, online ordering, curbside pickup and grab and go mantra, eating healthy on the fly, is.… a SNAP!

Visit a SNAP location today and get started on your way to healthy eating! www.snapkitchen.com

-St. David’s HealthCare Healthy Dining Program

Quality Seafood Market is Austin’s premier retail seafood market and wholesaler, providing Central Texans with the freshest and highest quality seafood since 1938.

Quality Seafood offers fresh seafood fare and several healthy items approved by the St. David’s HealthCare Healthy Dining Program, including:

• Grilled Texas gulf black drum
• Grilled gulf shrimp
• Grilled Atlantic salmon
• Grilled ruby red trout
• Grilled rainbow trout
• Grilled Texas catfish
• Broiled Greenland flounder
• Broiled Icelandic cod
• Broiled sea scallops
• Grilled chicken breast
• Sides: garden salad (with Italian or vinaigrette dressing), steamed green beans or steamed broccoli
• Grilled fish taco (with grilled mahi mahi) with corn tortilla and mango pineapple pico de gallo, or avocado pico de gallo or roasted tomato salsa
• Salmon burger (no bun) on a bed of lettuce or with 2 veggie sides
• Seafood salad- with grilled salmon or trout (omit the fried onions) and Italian or vinaigrette dressing

Pick a delectable protein above, and add a crisp garden salad, steamed broccoli or green beans to complete your healthy seafood meal.

Craving something different? They also offer a deliciously healthy fish taco, salmon burger or seafood salad to satisfy any appetite.

Check out their website for weekly market and chef prepared specials, www.qualityseafoodmarket.com, and stop in today to get coastal seafood in the heart of Austin.

-St. David’s HealthCare Healthy Dining Program

You probably have a friend, mother, sister or a friend of a friend who has had a thyroid nodule discovered on imaging for an unrelated issue, or a health provider who discovered a thyroid nodule on their physical exam for an unrelated visit.  But do not panic!  Thyroid nodules are actually quite common, discovered in 4–7% of the population by palpation and in up to 60% of patients on postmortem examination.

Do not panic!  Although thyroid nodules are very common, thyroid cancer is still fairly rare.  Palpable thyroid nodules have a reported malignancy rate of around 5%.  Malignancy rates of incidentally-discovered thyroid nodules vary, ranging from 8% to 29%.

The key is to have these thyroid nodules appropriately worked-up according to the American Thyroid Association Guidelines.  This entails:

• getting a lab test
• a thyroid ultrasound
• and possibly an ultrasound-guided biopsy of the nodule, if indicated.

This is a simple procedure that can be done in the office and takes about 10 minutes.  There is a good chance that you will never require thyroid surgery, but you will need to have the thyroid nodule(s) followed with yearly ultrasounds.

Teresa Kroeker, M.D., Fellowship-Trained Head & Neck Surgeon
St. David’s Medical Center

Mobility Garden at St. David’s Rehabilitation at North Austin Medical Center

Stroke Facts
Strokes, also known as cerebrovascular events or brain attacks, are a leading cause of death in the United States. The most common types of strokes are classified as ischemic and hemorrhagic. An ischemic stroke occurs when a blood vessel in the brain is occluded by a blood clot and accounts for 87% of all strokes. A hemorrhagic stroke occurs when a blood vessel in the brain is torn or bursts, leaking blood into the surrounding brain tissue and causing damage.

According to the CDC, every year close to 800,000 people in the United States suffer from a stroke. Approximately 34% of those occur in adults under the age of 65. Although adults over age 65 are generally considered to be most at risk for stroke, they do occur in children and younger adults as well.

The three primary risk factors for having a stroke include

1. high blood pressure
2. high LDL (“bad”) cholesterol
3. smoking

The CDC finds that half of all Americans have at least one of these three risk factors. Other serious risk factors include heart disease, diabetes, obesity, poor diet, physical inactivity and excessive alcohol use.

Life After a Stroke
During a stroke, blood is cut off from a certain area of the brain causing damage to that area. After a stroke, a patient may be left with residual problems, including: difficulty walking or performing physical activities, impaired muscle tone, difficulty speaking, sensation changes including pain or numbness, paralysis and an overall decreased independence in life.

However, having a stroke does not necessarily mean one must forego his or her interests and hobbies. Physical, occupational and speech therapists specialize in treating individuals who have suffered strokes and work with patients to regain lost functions. Rehabilitation provided by an interdisciplinary team provides the resources stroke survivors need to return to everyday life and interests such as: cycling, running, gardening – even skateboarding and driving.

Remember!
It is important to recognize the warning signs of a stroke and act immediately. The National Stroke Association urges you to act FAST.

F: Does one side of the Face droop?
A: Does one Arm drift downward?
S: Is their Speech slurred or strange?
T: Time is essential.

If you observe any of these signs, call 911 immediately.

- Deanna Hall, Physical Therapist
- Christine Jacobson, Student Physical Therapist
St. David’s Rehabilitation Neurological Day Program

Resources:

http://www.cdc.gov/stroke/facts.htm

http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/docs/fs_strokesigns.pdf

http://www.ninds.nih.gov/disorders/stroke/poststrokerehab.htm

http://www.stroke.org/

Risk Factors include:

• People with a personal or family history of benign colorectal polyps.
• People with a personal or family history of colorectal cancer.
• People with a personal or family history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease).
• People with a personal or family history of ovarian, endometrial or
• breast cancer.
• People of African American and Hispanic descent, who are often
• diagnosed at a later stage of the disease.
• Men and women over the age of 50.

Colorectal cancer is preventable and often easy to treat and cure when found early. To learn about screening recommendations and to learn more about the disease, visit the American Society of Colon and Rectal Surgeons website at www.fascrs.org.

March is Colorectal Cancer Awareness Month. Talk to your colorectal surgeon or other healthcare provider to learn more.

Together let’s flush colorectal cancer down the toilet!

Thiru V. Lakshman, MD
Board Certified Colon and Rectal Surgeon

Colorectal cancer is preventable and often easy to treat and cure when found early. To learn about screening recommendations and to learn more about the disease, visit the American Society of Colon and Rectal Surgeons website at www.fascrs.org.

March is Colorectal Cancer Awareness Month. Talk to your colorectal surgeon or other healthcare provider to learn more.

Together let’s flush colorectal cancer down the toilet!

Thiru V. Lakshman, MD
Board Certified Colon and Rectal Surgeon

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!

Many pregnant women with low back pain feel they will have to suffer with the pain until their baby is born.

At St. David’s Spine and Sports Therapy, we advocate starting physical therapy for pregnant women as soon as symptoms commence. Injections and medications are not an option for this population; therefore, physical therapy is often their only attempt at conservative treatment. Many pregnant women respond very quickly to mechanical therapy and require no more than 6-8 visits to resolve their problem. Furthermore, most of these patients display directional preference which dictates the treatment plan giving these patients immediate pain relieve with just a few simple exercises. Often, these patients are fearful of exercise worsening their symptoms or harming the baby, so guidance from their physical therapist is essential to their recovery. By increasing awareness that early intervention is an option, these patients can avoid chronic problems and be able to enjoy their new baby without having to suffer from back pain or sciatica. A specialized therapist can also help the post-partum mother with more chronic problems. Consulting a therapist with advanced training in spine care can help alleviate back pain and allow you to focus on your new baby. 

Kim Greene, PT Dip. MDT
St. David’s Spine and Sports Therapy
Diploma in Mechanical Diagnosis and Therapy

3000 N. IH-35 Suite 530
Austin, TX 78705
Phone: 512 544-5092

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.

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.

Myth #1: Colorectal Cancer is a man’s disease.
Truth: Colorectal cancer is just as common among women as men. About 150,000 Americans are diagnosed with colorectal cancer each year. More than 50,000 die from colorectal cancer each year.

Myth #2: Colorectal cancer cannot be prevented.
Truth: Colorectal cancer can be prevented in many cases. Colorectal cancer almost always starts with a small growth called a polyp, and if the polyp is found early, doctors can remove it and stop colorectal cancer before it starts.
Tests that can find polyps: double contrast barium enema, flexible sigmoidoscopy, colonoscopy or CT colonography. Talk to your doctor about which test is best for you.

Myth #3: African Americans are not at risk for colorectal cancer.
Truth: African American men and women are diagnosed with and die from colorectal cancer at higher rates than men and women of any other US racial or ethnic group. The reason for this is not yet understood.

Myth #4: Age doesn’t matter when it comes to getting colorectal cancer.
Truth: More than 90% of all colorectal cancers are found in people who are 50 years of age or older. For this reason, the American Cancer Society recommends you start getting checked for this cancer when you are age 50. People who are at a higher risk for colorectal cancer (like those who have colon or rectal cancer in their families) may need to begin testing when they are younger. Talk to you doctor about when you should begin testing and how often.

Myth #5: It’s better not to get tested for colorectal cancer because it’s deadly anyway.
Truth: Colorectal cancer is often highly treatable. If it’s found and treated early while it is still small and before it has spread, the 5-year survival rate is about 90%. But because many people are not getting tested, only about 4 out of 10 are diagnosed at this early stage when treatment is most likely to be successful.

Other ways to help lower your chances of getting colorectal cancer include:

1. Get to and stay at a healthy weight throughout life; stay lean without being underweight.
2. Be physically active; limit the time you spend sitting, lying down, watching TV, etc.
3. Eat at least 2 ½ cups of vegetables and fruits each day.
4. Choose whole grains over refined grain products.
5. Limit the amount of red meat and processed meat you eat.
6. If you drink alcohol, limit the amount to 1 drink per day for women and 2 per day for men.
7. Don’t use tobacco in any form.

Located at 2201 South First in Austin, TX, Bufalo Bob’s keeps a few important words near and dear to their South Austin hearts—tasty, healthy, fast and fun! Bob doesn’t serve unhealthy food, including no hormone laden beef or genetically modified vegetables; only the finest, freshest ingredients, and a large selection of vegetarian and gluten-free entrees are available.

Given Bob’s staunch commitment to healthy eating in Austin, his food was a prime candidate for the St. David’s HealthCare Healthy Dining Program.

The following items are approved menu items by the Healthy Dining Program:

• Blueberry smoothie with honey
• Hummus
• Refried beans
• Texas hummus (spicy pinto bean dip)
• Buffalo taco meat
• Shredded chicken
• Salsa

(*the above items cannot be eaten with fried chips or fried chalupa)

The next time you are in South Austin and have the hankering for some healthy, tasty eats; saddle up and trot on over to Bufalo Bob’s Chalupas. You are guaranteed to have a good time partner!

• http://bufalobobschalupas.com/
• https://www.facebook.com/pages/Bufalo-Bobs-Chalupa-Wagon/113640422052100

-St. David’s HealthCare Healthy Dining Program

The issue of heart screening for athletes prior to participation in competitive sports has been in the news lately. Perhaps you have heard of Star Lotulelei the standout defensive lineman from the University of Utah who is projected to be selected in the first few picks of the upcoming NFL draft. At the recent NFL Combine, Star and the other draft hopefuls underwent heart screening tests such as an electrocardiogram (EKG) and a heart ultrasound or echocardiogram. Star was found to have mildly abnormal heart function due to a weakened heart muscle. He was sent home from the Combine to have further testing which will determine if it is safe for him to pursue a career in the NFL or if playing football would be too high risk for him. It is possible that his heart condition could prevent him from playing ever again.

Star’s case is just the latest in a string of athletes with heart conditions. Many will remember the case of Hank Gathers who was a college basketball player in the early 1990’s who suffered a cardiac arrest on the basketball court during a game and subsequently died. There have been many other athletes at all levels of sport, from high school to the professional ranks, who have had cardiac problems which put them at increased risk from intense physical exertion. Most of these athletes have a condition called hypertrophic cardiomyopathy which is an abnormal thickening, or hypertrophy, of the heart muscle. This abnormal thickening is associated with cardiac arrhythmias or abnormal heart rhythms which commonly will occur in situations of physical exertion. Some of these arrhythmias can be extremely dangerous and can lead to sudden cardiac death. Since hypertrophic cardiomyopathy can occur in up to 1 in 500 young adults, and since it is the leading cause of sudden death among athletes, there has been a push to identify young athletes with hypertrophic cardiomyopathy and other heart problems.

St. David’s HealthCare, the Heart Hospital of Austin and the physicians of Austin Heart have partnered with The University of Texas at Austin to bring state-of-the-art cardiac screening to the varsity athletes of The University of Texas. We have instituted a three-step process designed to identify hypertrophic cardiomyopathy or other heart problems before they result in more severe consequences.

1. The athlete completes a questionnaire regarding family history and any symptoms he/she might have such as chest pain or shortness of breath or passing out when exerting.
2. An EKG is performed to identify any heart rhythm abnormalities and look for evidence of hypertrophic cardiomyopathy.
3. A brief screening echocardiogram is performed. An echocardiogram is a painless ultrasound examination of the heart that allows the cardiologist to identify any heart muscle or heart valve problems. The echo is accepted as the best way to make a diagnosis of hypertrophic cardiomyopathy.

If normal, this screening panel is powerful evidence that participation in competitive sports should be safe for the athlete. If abnormal, it allows the athlete to undergo further testing to assess the safety of strenuous physical exertion similar to the situation of Star Lotulelei. St. David’s HealthCare and the physicians of Austin Heart are proud to bring this service to The University of Texas at Austin and its athletes.

The vestibular (ear) system is the first sensory system to develop. It is visible at two months gestation and fully formed by the fifth month of gestation. The semi-circular canals, the saccule and utricle are housed in the inner ear. The semi-circular canals, utricle and saccule provide information on head rotation, position and body direction, and speed of movement to assist the brain’s processing of our orientation in space and to coordinate associated eye movements. As we age, beginning at approximately 55 years old, the number of vestibular nerve cells and blood flow to the inner ear decreases. This may manifest as slow, gradual changes in the quality of balance. One may start to notice imbalance with standing or walking in various conditions, such as, dim or dark lighting, across thick carpet, grass or sand or on uneven surfaces like gravel, cobblestone, ramps and stairs.

What can you do to combat these age-associated changes in the inner ear?

• Have hearing and vision check-ups regularly. If hearing and vision are impaired, important cues that help maintain balance can be lost.
• Hearing tests can be used to detect inner ear disorders that affect both balance and hearing.
• Keep your contact lenses or eye glasses prescription current. An article from the Journal of Physical Therapy stated that a visual acuity of 20/40 can cause imbalance. For those who have presbyopia (where you experience blurred near vision), you may want to consider having a specific pair of glasses for reading and a separate pair for intermediate/far distances to minimize conflicts in depth perception (that affect balance) that can occur with bifocal or progressive lenses.
• Take care of your feet. Remember the feet also provide information to the brain on position in space. Have your primary care physician or podiatrist assess your foot health, especially for diabetics. They can monitor your feet for any changes in sensation. If you notice any numbness or tingling in the feet, for instance as seen in peripheral neuropathy, contact your doctor to perform a comprehensive sensory examination to the feet.
• Stay Active! Join a T’ai chi, Yoga, dance class or activities designed to promote flexibility, sharpen coordination and balance. Many of these activities can be modified for individuals of various physical levels and ability. According to the British Journal of Sports Medicine, a regular exercise program may improve protective responses in case of a fall. Being sedentary may not only put you at risk for obesity, heart disease and a whole host of other diseases, it prevents stimulation of the vestibular system, and it may also lead to decreased flexibility and strength, which are necessary for having good balance.

If you suspect difficulties in maintaining your balance, speak to your doctor about prescribing vestibular rehabilitation, a type of therapy specific to balance and dizziness disorders.

-Natasha Johnson, Sr. Physical Therapist
Certified Vestibular and Vision Specialist
St. David’s Rehabilitation Hospital

Two key things distinguish a food from a “super food”—a “super food” is real (unprocessed), and it is packed with higher nutrients per calorie as compared to other foods. Rich in minerals, vitamins, antioxidants and other nutrients, these familiar, affordable and readily available healthy foods (you can find them at your grocery store or farmersmarket) can be used in easy-to-cook recipes or eaten raw.

“Super foods” fall into one of five categories—vegetables, fruits, proteins, calcium-rich foods, grains—or miscellaneous.

Here are a few examples of “super foods”:

• Blueberries: Blueberries are rich in fiber and vitamin C, as well as contain high levels of antioxidants and important phytochemicals believed to destroy cancer cells in the liver. Related foods include purple grapes, cranberries, boysenberries, raspberries, strawberries, currants, blackberries, cherries and all other varieties of fresh, frozen or dried berries.
• Oats: Look for the word “whole” listed as the first ingredient. Bread products should have at least three grams of fiber per serving. Related foods include wheat germ, ground flaxseed, brown rice, barley, wheat, rye, quinoa, yellow corn and couscous.
• Omega 3 fatty acids: Omega 3 fatty acids help lower heart disease and alleviate arthritis symptoms, and they are high in monounsaturated fats (which can lower cholesterol). They are most prevalent in fatty, cold-water fish, such as wild salmon, herring, sardines and mackerel. Others forms of Omega 3 acids include eggs, flaxseed and walnuts.
• Raw cacao: Raw cacao can be found in dark chocolate—before it’s been processed and sweetened. It is filled with iron, magnesium and fiber, and it is abundant in antioxidants and neurotransmitters (these elevate your happiness level).
• Red wine: Red wine is rich in antioxidants and has high levels of resveratrol, a plant phytoalexin linked to a decreased risk for breast and prostate cancers.
• Soy: Soy lowers cholesterol as much as statins, the most widely prescribed cholesterol medicine. However, extra soy is not recommended if you have a history of breast cancer. Soy can be found in tofu, soy milk and edamame.
• Spinach: Spinach is a good source of fiber and calcium. The darker the greens, the better, as they contain more bioactive phytonutrients. Related foods include kale, collards, mustard greens, turnip greens, bok choy, romaine and orange bell peppers.
• Sweet potatoes: Sweet potatoes are high in fiber and have a lower glycemic index value than white potatoes. This helps slow the breakdown of glucose in the bloodstream.
• Tea: Both black and green teas have antioxidants. Green tea also has ECGC, an antioxidant that may help lower cholesterol. Brewed tea is better than instant.
• Tomatoes: Tomatoes are a good source of fiber, beta-carotene and vitamin C. When cooked, a tomato is also an excellent source of lycopene, and it can potentially reduce the risk of developing prostate, breast, lung and colon cancers. Related foods include red watermelon, pink grapefruit, red-fleshed papaya and strawberry guava.

Remember, no single food can provide you with everything you need to be healthy. It is important to choose a variety of “super foods” from each category to meet your daily nutritional needs.

How would a woman know if she had endometriosis? Pelvic pain symptoms (painful periods and painful deep intercourse, for example,) which affect a woman’s quality of life, may increase suspicion for the presence of endometriosis, but laparoscopic day surgery with tissue biopsy is the gold standard for the diagnosis of any stage of endometriosis.

Endometriosis can adversely affect fertility at many levels. Not only can endometriosis distort the pelvic anatomy and make egg pick-up by the fallopian tube more difficult, but this disease can also adversely affect egg quality, egg numbers, fertilization rates, embryo development and implantation rates. While women in the general population have been reported to have a 15-20% chance of pregnancy per month, those with endometriosis may have a 2-10% chance of pregnancy per month. The time to pregnancy is increased in women with endometriosis who are trying to conceive with natural cycles.

Fertility treatment options are available for couples with endometriosis-associated infertility. These can range from ovulation induction medications (for example, clomiphene citrate, letrozole, gonadotropins) in conjunction with timed intercourse or intrauterine insemination (IUI), laparoscopic treatment of endometriosis, and in vitro fertilization (IVF). Success rates vary depending on the degree of endometriosis and the various other fertility factors. It is important for women with endometriosis to discuss their fertility potential with a fertility specialist in order to optimize the chances for a successful pregnancy.

Shahryar K. Kavoussi, M.D., M.P.H.
Board-Certified Reproductive Endocrinology & Infertility Specialist

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.

Top 3 Things to Know about Cord Blood Donation:

1. Cord blood donation is free and does not interrupt the normal birth process. Privately banking your cord blood can cost thousands of dollars, which many families don’t have at the time of birth.
2. By donating your baby’s cord blood, you can help treat life-threatening diseases such as leukemia, aplastic anemia or genetic blood disorders. Blood is drawn from the umbilical cord and placenta after the baby is delivered and does not cause any discomfort to mom or baby.
3. Cord blood is found to be a rich source of stems sells and is currently being used as an alternative to bone marrow in treating the life-threatening diseases listed above.

Celebrate with us today as the work of St. David’s Medical Center and our amazing patients goes on to positively affect the lives of others!

-Meghan Frazier

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

The 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.

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!

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!

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.

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

via Flickr

February 1st was National Wear Red Day. The Red Dress Campaign started in 2002 to raise heart attack awareness in women. Heart disease is the number one killer of women, and women may experience different cardiac symptoms than men. The focus of the Red Dress campaign is to share the specific symptoms women report.  A study completed by the National Institute of Health titled “Women’s Early Warning Symptoms of AMI” reported the following information from women who experienced Acute Myocardial Infarction (AMI):

Out of 515 women, 95% reported new or different symptoms a month or more before their cardiac incident.

The symptoms reported before having a heart attack include:

• Unusual Fatigue – 70%
• Sleep Disturbance – 48%
• Shortness of Breath – 42%
• Indigestion – 39%
• Anxiety – 35%

The symptoms reported during a heart attack include:

• Shortness of Breath – 58%
• Weakness – 55%
• Unusual Fatigue – 43%
• Cold Sweat – 39%
• Dizziness – 39%

Less than 30% of the women in this study reported chest pain prior, and 43% never had chest pain.

Be aware of your body and seek immediate medical assistance for all medical emergencies including AMI. Time matters.

How are women different from men when it comes to heart disease? The heart and arteries in women are smaller. Hormonal changes throughout life affect the cardiovascular system in unique ways. Women most often present with atypical symptoms. On average, women tend to present about ten years later than men with heart disease. Women are more likely to die from a heart attack than men.

The higher death rate in women vs. men after a heart attack is alarming. The reason appears to be because women have atypical symptoms . This can lead to misdiagnosis by healthcare professionals. Often patients will ignore the symptoms themselves or present much later for a medical evaluation. Typical symptoms of angina are chest pressure, shortness of breath and pain in the left arm. Atypical symptoms are fatigue, throat tightness, jaw pain, back pain, nausea and dizziness. These latter symptoms are much later in women.

How to make a diagnosis of heart disease? There are a variety of tests that can be helpful. Some include EKG, Echocardiogram, Stress testing (stress test, stress echocardiogram and nuclear stress test), CT scan of the heart and heart catheterization. It is also important to have the blood pressure, weight, glucose and cholesterol checked regularly.

The development of heart disease is multi-factorial. We must recognize which ones are within our power to change and develop a game plan to do so.

Risk factors for cardiovascular disease that are non-modifiable include:

• advanced age
• postmenopausal status (Women are postmenopausal about a third of their lives.)
• positive family history of heart disease

Risk factors for heart disease that are modifiable are:

• smoking
• diabetes
• hypertension
• abnormal cholesterol levels
• obesity
• physical inactivity

Complete smoking cessation is recommended for all women. Counseling and drug therapy have both been shown to be effective. However, for any smoking cessation program to be successful, the smoker must be motivated to quit. Avoidance of passive or second-hand smoking is important as well.

Blood pressure should be maintained at less than 140/90. Ideal blood pressure is less than 120/80. Anything between 120-140/80-90 is considered pre-hypertension. Medications are often needed to lower the blood pressure to the target range. Avoiding excessive caffeine intake, limiting alcohol usage, following a low-sodium diet, exercising regularly, maintaining an ideal body weight and limiting certain medications such as decongestants can assist in lowering the blood pressure as well. Remember that high blood pressure may be completely asymptomatic and requires periodic monitoring.

Diabetes is considered to be an independent risk factor for heart disease. All women with diabetes need frequent follow up with their physicians approximately every three months. Goals for treatment include maintaining blood glucose in an acceptable range, Hba1c (three month average blood sugar) < 7%, LDL or bad cholesterol < 70mg/dl and triglycerides < 150 mg/dl.

Following a heart healthy diet is recommended for everyone. Further restriction of dietary fats and drug therapy are considered depending on the lipid levels and cardiovascular risk factors. Generally, goals are total cholesterol < 200, HDL or good cholesterol >50, LDL or bad cholesterol optimally Maintaining an ideal body weight is recommended. The goal is BMI or body mass index between 18.5-24.9 kg/m2. For women with BMI’s between 25-34.9, the waist circumference should be less than 35 inches.

Nutrition guidelines include a well-balanced, low-fat/ high-fiber diet. Reduced sodium options are generally better. Five servings of fruits and vegetables are recommended on a daily basis. The DASH diet is a good example to follow. Alcohol intake for women should be limited to no more than one glass per day.

Exercise is a major key to managing one’s cardiovascular risks. One should strive for 30 minutes of moderate intensity exercise most days of the week. This can be broken into as little as 10-minute segments. Exercise is very helpful in managing depression and stress as well.

One out of every four women die from heart disease. Remember that women are more likely to have atypical symptoms, and it is better to get atypical symptoms checked out rather than ignore them.

PREVENTION is the key to preventing heart disease in women. It is up to you.

Stacie Bush-Veith, MD
Executive Wellness Physician at Heart Hospital of Austin

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Heart disease is the #1 killer of women. Start by taking care of yourself and reducing YOUR own risk by living heart healthy.

A great way to start is by learning the symptoms of a heart attack. According to the American Heart Association, the following can serve as common symptoms of a heart attack:

• Uncomfortable pressure, fullness, squeezing or pain in the center of the chest lasting more than a few minutes
• Pain in the chest that spreads to the shoulders, neck or arms
• Chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath

Women often experience less common symptoms, such as:

• Atypical chest pain, stomach or abdominal pain
• Shortness of breath and difficulty breathing
• Unexplained anxiety, weakness or fatigue
• Heart palpitations, cold sweat or paleness

***If you experience any of these symptoms, please call 9-1-1.

In the United States, it is estimated that close to 550,000 people die each year from coronary artery disease (CAD). CAD is the most common type of heart disease and is the leading cause of death in the United States. St. David’s Medical Center is spreading awareness about heart disease prevention and maintenance. Please join us this month and throughout the year at the following free offerings:

• Heart Disease Management Class “Living Well with Heart Disease” – February 21, 9:00am–noon at St. David’s Medical Center, Medical Office Building (3000 North IH-35, 5th floor, classroom D). Validated parking in Garage #2. This class is held monthly on the third Thursday of every month. To reserve a space, please call 512-544-2663.
• Monthly Cardiac Support Group Meetings – February 18, 6:00pm–7:00pm at St. David’s Medical Center, Medical Office Building (3000 N. IH-35, 5th floor, classrooms). Validated parking in Garage #2. This class is held monthly on the third Tuesday of every month. To reserve a space, please call 512-544-4263.

St. David’s Medical Center is also proud to offer a Fit Heart Consultation for $130.00. This is a comprehensive screening and consultation designed to educate individuals on heart disease prevention. The consultation is intended for those with positive cardiac risk factors such as high blood pressure, diabetes, high cholesterol, smoking, obesity and a sedentary lifestyle. The consultation provides personalized guidance for lifestyle modifications, and participants will receive an individualized, goal-oriented exercise program. For more information, please call 512-544-4263.

Take care of your heart in February and throughout 2013!

-Laura Raymond, RN, BS, FAACVPR

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Losing weight and exercising more are very popular New Year`s resolutions. It is commonly known that exercise has cardiovascular benefits, but there is another great reason to hop on that treadmill in 2013. Research has shown that women who exercise regularly and maintain a healthy weight can decrease their risk of breast cancer. Researchers at the University of North Carolina at Chapel Hill found that women who exercised 30 minutes per day (10-19 hours per week) experienced greater health benefits, with a 30% reduced risk of developing breast cancer, than inactive women who gained a significant amount of weight, particularly after menopause.

Regular exercise is crucial to reap these health benefits, but staying on track all year can be daunting. There are many ways you can become more active.

• Try to incorporate simple changes such as taking the stairs or selecting a parking spot requiring you to walk further.
• Other exercise options include: team sports, classes, joining a gym, investing in home exercise equipment, or aerobic activities, like walking, running and dancing. Before exercising, always begin with a warm-up that includes adequate stretching.

Follow this with 20-30 minutes of aerobic activity, and end your session with a cool down combined with more stretching. If you have a medical condition, you should speak with your healthcare provider prior to participating in any vigorous activity.

Stay healthy in 2013! Get moving and reduce your risk of developing breast cancer!

-Brenda Baumann, RN

(Resource: Cancer, online edition, June 21, 2012)

1. 

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   More than 12,000 new cases of cervical cancer will be diagnosed this year and about 4000 will die as a result.

2. Cervical cancer is the second most common cancer world-wide.
3. Cervical cancer is highly preventable. In the United States the death rate attributed to cervical cancer is declining secondary to wide spread use of preventive strategies.
4. Cervical cancer is typically a slowly developing cancer. There are tests available that diagnose precancerous changes and those at risk of developing cervical cancer. These tests include the cervical pap smear and human papilloma virus.
5. Infection with Human Papilloma Virus (HPV) is closely linked to the development of cervical cancer.
6. There is a vaccine that decreases your risk of infection with Human Papilloma Virus.
7. There are lifestyle changes you can make to decrease your risk of developing cervical cancer:
   1. Limit number of sexual partners
   2. Practice safe sex
   3. Exercise regularly
   4. Eat a healthy diet
   5. Don’t smoke
8. Other factors associated with increased risk of developing cervical cancer include:
   1. Human immunodeficiency virus (HIV) infection
   2. Weakened immune system
   3. Exposure to diethylstilbestrol (DES) during your mother’s pregnancy
9. Screening for cervical cancer should begin at age 21. Your provider will help you determine types of tests and interval of testing that is appropriate for you.
10. In summary:
    1. Minimize risk factors for developing cervical cancer.
    2. Screening for cancer of the cervix is important.
    3. Talk to your health care provider about screening for cervical cancer.

To combat that stress in 2013, consider taking a break from the hustle and bustle by giving yoga a try. The controlled breathing, gentle stretching postures and the mindfulness (meditation) exercises can be very restorative. Hatha yoga in particular may be a good choice for stress management. Hatha is one of the most common styles, and beginners find it easier to practice due to its slower pace and easier movements. However, people can benefit from any style of yoga — it`s all about your personal preference. Yoga is generally low impact and safe when practiced appropriately under the guidance of a well-trained instructor. Yoga should not be used to replace conventional medical care, and those with medical conditions should talk to their healthcare provider prior to starting. Affordable classes are available virtually everywhere, and you should consider enlisting a friend for support and motivation. Not up for yoga? An alternative is meditation.

Meditation can help patients undergoing cancer treatment stay healthy and energized. Multiple research studies have reported that patients demonstrate improved sleep and decreased fatigue when yoga is incorporated into their cancer treatment. M.D Anderson has research in progress which utilizes imaging technology to pinpoint the changes taking place in women’s brains, who practice yoga, while undergoing breast cancer treatment. Researchers hope to confirm tangible results that will confirm the benefits of mind body interventions such as yoga.

Make 2013 the year of mindfulness, positive thinking and improved health through successful stress management!

If you live in the Austin area use the link below to find your perfect yoga spot:

http://www.yelp.com/search?find_desc=Yoga+Classes&find_loc=Austin%2C+TX

Sources:
Bertisch, S.M., et al, ”Effects of Yoga on Depression and Anxiety in Women”, Complimentary Therapies in Clinical Practice,2009,15;102.
Distasio, S.A., “Integrating Yoga into Cancer Care”, Clinical Journal of Oncology Nursing,2008;12:125 Laino,Charlene,”One Particular Type of Customized Yoga Found to Improve Sleep, Lessen Fatigue among Cancer Survivors”, Oncology Times,July,2010.
www.mdanderson.org/newsroom/news-releases.
wwwyogaalliance.org

These monitors can be helpful with any type of aerobic exercise such as jogging, biking, elliptical training and even swimming (find one that is waterproof not water resistant).   To use your heart monitor effectively you first need to know your maximum predicted heart rate.   This is estimated by subtracting your age from 220 for men and 226 for women.  You then know your theoretical maximum heart rate in beats per minute.  Now pick your sport and set up training zones.  These can help you achieve your goals and prevent both under and overtraining.

I’ll share how I use this.  I like running.  At 42 years of age, my maximum heart rate calculates to 178 bpm (beats per minute).  My training goal is to prepare for half/full marathons.  This requires endurance training (ability to go long distances with moderate energy expenditures).  So for most of my training I will want to be in the ‘aerobic zone’.  In this zone, the body’s primary energy stores are in the form of glycogen.  When you do aerobic exercise the body does not have to go into ‘back up stores’ to create energy.  Higher intensity training for long periods of time forces your body into the ‘anaerobic zone’ where the body then has to look for alternative sources of fuel which could result in muscle break down.

So if I go out on a training run I will want a target heart rate between 125 to 142 bpm.  Typically I will find a pace at which my heart rate remains around 135 bpm, and I feel comfortable.  Once I find that pace, it is amazing how constant the heart rate remains.  Because my main goal is endurance training, this is where the bulk of my exercise focuses, but say I want to work on speed.  This can help me finish a race or help on hills when the ‘extra push is needed’.  I will mix it up by running ¾ of a mile at a lower heart rate goal of say 120 bpm (67% or 2/3 of maximum) and then finishing the remaining ¼ mile at 160 bpm (90% of maximum), then repeating this for several miles.  This gets my heart rate into the anaerobic zone and allows me to work on speed but not long enough that I start to tear down my own muscle.

If just starting an exercise program, you will want to start with a lower target heart rate like 50-60% of maximum and then build upwards as your body gets in better shape.  For weight loss, you can target 60-70% of maximum heart rate with exercise 4-5 days, per week 45 minutes at a time.  Then as you get hooked on fitness, you will want to increase to the aerobic zone at 70-80% of maximum to gain endurance and strength.  As I previously explained, pushing into the anaerobic zone at 80-90% can be helpful in building speed/finishing power.  But if you see yourself constantly in that zone, you will want to pull back a little to avoid overtraining, injury, or breakdown of muscle.

As you get in shape, you should also notice your resting heart rate decrease as your heart is now more efficient.  It may also take more effort to get in the right training zone which is a sign that your body is ready for more vigorous physical exercise.

All of this heart rate monitoring can lead to some compulsiveness.  I recommend 1-2 times per week that you just go out and exercise with the monitor off.  Exercise at a level where you feel good, and forget about the heart rate.  Enjoy staying healthy!

Jeffrey N. Whitehill, M.D.

There is a chill in the air; and whether you have a cold, want to lose those extra holiday pounds or are trying to keep your resolution to eat healthier, one food fits the bill…SOUP! Grandma was right! Soup has been proven to ease the symptoms of respiratory illnesses. The warm liquid and the steam can ease congestion, thin mucus and soothe a sore throat. In addition, research has shown the chicken and spices used in soups contain anti-inflammatory properties. Soup contains a lot of water, and if you add beans or a variety of vegetables, you also increase the fiber content making you feel fuller, helping you to eat less and lose weight. Soups are also a great way to increase the nutrient content of your diet. Soup ingredient possibilities are endless making it a great way to add a variety of vegetables and lean meats. If you have a slow cooker, making soups, stews and chili couldn’t be easier…make some soon!!!

Chicken & Spinach Soup with Fresh Pesto

• 2 tsp. olive oil
• ½ cup chopped carrot
• 1 large boneless, skinless chicken breast (~8 oz.) – cut into quarters
• 1 large clove of garlic, minced
• 5 cups reduced sodium chicken broth
• 1 ½ tsp. dried marjoram
• 6 oz. baby spinach, coarsely chopped
• 12 oz. can of Cannellini beans, rinsed and drained
• *Fresh store bought pesto, or could make from scratch
• Salt and fresh ground black pepper to taste
• Multigrain croutons for garnish (optional)

Heat oil in a large saucepan or Dutch oven over medium-high heat. Add the carrot and chicken; cook turning once and stirring frequently, until the chicken begins to brown ~3-4 minutes. Add garlic and cook, stirring for 1 minute more. Add broth and marjoram; bring to a boil over high heat. Reduce heat and simmer, stirring occasionally, until the chicken is cooked through ~5 minutes. With a slotted spoon, transfer the chicken pieces to a clean cutting board to cool. Add the spinach and bean to the pot and bring to a gentle boil. Cook for ~5 minutes to blend the flavors. Cut the chicken into bite size pieces. Add the chicken, the pesto and black pepper to the soup and heat until hot. Serve and garnish with croutons if desired. Makes 5, 1 ½ cup servings.

Per serving: 204 calories, 8 g fat, 16 g carbohydrate, 18 g protein, 6 g fiber, 529 mg sodium

Black Bean Soup

• 1 Tbsp. olive oil
• 1 small onion, chopped
• 1 Tbsp. chili powder
• 1 tsp. ground cumin
• 30 oz. canned black beans, rinsed and drained
• 3 cups water
• ½ cup salsa
• ¾ tsp. salt
• 1 Tbsp. lime juice
• 4 Tbsp. reduced fat sour cream
• 2 Tbsp. fresh chopped cilantro

Heat oil in a large saucepan over medium heat. Add onion and cook until softened ~2-3 minutes. Add chili powder, cumin cook while stirring, 1 minute more. Add beans, water, salsa and salt. Bring to a boil, reduce heat and simmer for 10 minutes. Remove from heat and stir in lime juice. Transfer half of soup to a blender and puree, add back to saucepan. Place in bowls and garnish with sour cream and cilantro. Makes 4, 1 ¼ cup servings.

Per serving: 191 calories, 4 g fat, 22 g carbohydrate, 9 g protein, 9 g fiber, 408 mg sodium

(Guest Post: Lynelle Evans, PT Supervisor, St. David’s Rehabilitation Hospital)

How to equip your home to be a NO FALL ZONE – This is an issue for all generations whether you are in your 20s and thinking of your grandparents, or you are in your 70s and thinking of your own safety. Here are 10 things that will make your home a NO FALL ZONE:

1. Make sure you have rails or grab bars for any steps or stairs.
2. Remove all throw rugs in all rooms and your bath rooms. If you have one in your bathroom, put it away when you are not bathing.
3. Do not allow any electrical cords to stretch across walk ways.
4. Clear pathways throughout the house.
5. Leave a night light or the bathroom light on at night.
6. Phones – either carry one with you at all times or have voice mail on your home phones, so you do not have to rush to answer a phone.
7. Be aware of your pets – those that might get between your feet and cause a fall or that might be big enough to knock you off balance.
8. Toys – if you have young children or grandchildren in your home, be aware of their toys on the floors; also pet toys.
9. Be aware of raised thresholds that may cause you to trip if you catch a toe.
10. Place grab bars around your bathtub or shower areas.

This is by no means an exhaustive list on how to prevent falls, but this is a start to having a NO FALL ZONE in your house or a house of a loved one.

The following 10 tips can make that climb a bit easier:

1. As a beverage choice, ask for water or order fat-free or low-fat milk, unsweetened tea, or other drinks without added sugars.
2. Ask for whole-wheat bread for sandwiches.
3. In a restaurant, start your meal with a salad packed with veggies, to help control hunger and feel satisfied sooner.
4. Ask for salad dressing to be served on the side and opt for a vinegar/oil-based dressing rather than a creamy one.
5. Choose main dishes that include vegetables, such as stir fries, kebobs or pasta with a tomato sauce.
6. Order steamed, grilled or broiled dishes instead of those that are fried or sautéed.
7. Choose a “small” or “medium” portion. This includes main dishes, side dishes and beverages.
8. Order an item from the menu instead of heading for the “all-you-can-eat” buffet.
9. If main portions at a restaurant are larger than you want, try one of these strategies to keep from overeating:
   • Order an appetizer-sized portion or a side dish instead of an entrée.
   • Share a main dish with a friend.
   • If you can chill the extra food right away, take leftovers home.
   • When your food is delivered, set aside or pack half of it to go immediately.
   • Resign from the “clean your plate club” — when you’ve eaten enough, leave the rest.
10. To keep your meal moderate in calories, fat, and sugars:
    • Ask for salad dressing to be served “on the side” so you can add only as much as you want.
    • Order foods that do not have creamy sauces or gravies.
    • Add little or no butter to your food.
    • Choose fruits for dessert.

If you live in the Central Texas area, you can visit a restaurant that has partnered with St. David’s HealthCare as a participating partner in the Healthy Dining Program. This program provides healthy menu options for people who want to eat healthy while dining out. Participating restaurants offer approved menu items that have passed the Healthy Dining Program nutritional guidelines.

For more information about the program, including a list of participating restaurants, approved menu items as well as how to become a restaurant partner, click here.

-St. David’s HealthCare Healthy Dining Program

(Source: http://www.choosemyplate.gov/healthy-eating-tips/tips-for-eating-out.html)

The article highlighted a recent study to assess the benefits and risks of aerobic exercise during pregnancy, using a fitness regimen based on the 2002 American College of Obstetricians and Gynecologists (ACOG) guidelines. Inactive women were randomized at 12-14 weeks gestation to a group which remained sedentary, or to a group which performed moderate aerobic exercise for 45-60 minutes, 4 days per week, for 36 weeks.

The results were that active women displayed improved aerobic fitness and muscular strength, experienced less premature labor, less incidence of gestational diabetes, delivered comparable size infants with significantly fewer Caesarean deliveries and recovered faster postpartum. Active women did not display gestational hypertension or experience injuries related to the exercise regimen. It was also determined that previously sedentary women who began exercising at 12-14 weeks showed improved fitness and delivery outcomes.

Dr. Price will be speaking further about this subject at an upcoming free community seminar:
Get Fit Pregnancy!
Wednesday, January 23
6:00-8:00 p.m.
St. David’s Medical Center, Medical Office Building, Fifth floor

A free pregnancy fitness consult will be offered to attendees as well. To register or learn more about this seminar please call 512.478.3627 or download the event flyer.

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A new year…time to start over with your health and fitness goals that got away from you during the holidays! Most New Year’s resolutions have something to do with becoming healthier, losing weight or exercising, and even though excitement and motivation is high now, many resolutions will be abandoned by February!

I believe the main reason for people not being able to keep their resolutions is that they try to make too many dramatic changes all at once. Many people cannot go from sedentary to running 5 miles a day or from eating a high-fat/junk food diet to becoming a vegetarian.

Here are some tips that can make it easier to reach your New Year’s goal – without pain or starvation!

1. Set a REALISTIC goal. You should have a main goal and several small “mini” goals that support your main goal. Goals should be doable and measurable.
2. Write it down. When you write down your goals and make plans on how to achieve them, you are more likely to be successful. Also, keeping food and activity records have been shown to shape behaviors to help you reach your goals.
3. Make small changes. Try substituting water for soda or mustard for mayonnaise or cooking at home 3 nights a week vs. eating out. As you feel comfortable with the changes you have made, then you can implement others.
4. Reward yourself (not with a hot fudge sundae!). As you reach your “mini” goals, reward your hard work. Take a healthy cooking class; buy a new pair of running shoes; get a massage…something to look forward to and to help keep you motivated.
5. Make mistakes! You are going to eat birthday cake, go to happy hour, catch a cold and not make it to the gym for a week – that’s life! Each time one of these situations happens is a time for learning and problem solving.
6. Educate yourself. There is so much information on nutrition and fitness it is difficult to make sense of it all. Whether you do the research yourself or seek the expertise from a qualified professional….know how many calories you need each day, how many calories are in your favorite foods and what exercises are best for you.
7. Get support! Having support from family, friends and co-workers can give you extra accountability! Find groups and classes so that you can surround yourself with people that share your same goals and passions.

Tarie Beldin, RD,LD
St. David’s Round Rock Medical Center

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With the season of over indulgence upon us, it is important to remember that increased estrogen levels in the bloodstream resulting from alcohol consumption can increase women’s risk of developing breast cancer and that this risk is directly related to the amount consumed. In the November 2, 2011 edition of the Journal of the American Medical Association it was reported that:

• Women having 3-6 drinks per week have a 15% increased risk of invasive breast cancer compared with non-drinkers.
• The American Cancer Society also recommends that women have no more than one alcoholic drink per day, which may be a bit more difficult to do in the holiday season.

Despite this recommendation there could be a light at the end of the party tunnel; ingredients in red wine may help combat heart disease and some forms of cancer such as breast, prostate, thyroid and leukemia. While red wine is not considered a “health food,” a small amount can be part of healthy diet for some individuals. We encourage you to consult your health care provider about what is appropriate for you.

In December 2011, the online Journal of Women`s Health reported a study of pre-menopausal women who were asked to add 8 oz. of red wine to their daily diet for one month. A lowering of estrogen levels was seen as well as elevated testosterone levels. These changes are believed to be protective against breast cancer. More research is needed to determine whether the benefits arise from the alcohol or from the grapes themselves. Red grapes contain chemicals called polyphenols and while their action is not well understood, we know they have antioxidant properties that may help prevent the formation of cancer or suppress cancer development.

While a small amount of red wine may provide some health benefit, avoid overindulging this holiday season. A daily multivitamin with 400 micrograms of folic acid every day is often recommended to offset the effects of alcohol on the body. Foods such as blueberries, red grapes, grape juice, peanuts and cranberries offer the beneficial effect of antioxidants without the risk of alcohol. A diet rich in a variety of fruits and vegetables also offers many protective disease fighting benefits.
Most important please remember that the key is balance during this busy holiday season. Strive to keep up a healthy diet and regular exercise.

If you are planning a celebration, making party appearances or even just staying in tonight, keep it merry with one of your healthy friends: merlot, cabernet, pinot noir or zinfandel.

Cheers, Brenda

Sources:

Chen WY, etal”Moderate alcohol consumption during adult life, drinking patterns and breast cancer”JAMA ,2011;306:1884-1890.

Branunstein and Shufeil,” Moderate red wine drinking may help cut women`s breast cancer risk”, Journal of Women`s Health, Dec 7,2011( online journal). Published in print  April 2011.

Cucumber-Shrimp Bites

• 2-3 cucumbers
• Guacamole
• 
Boiled shrimp (medium)
• 
Fresh Dill

Wash cucumbers and cut into ¼ inch thick slices. Spoon or pipe guacamole onto each cucumber slice. Top with a boiled shrimp. 
(*Can squeeze lemon juice over each piece to prevent browning
 * Top with snipped fresh dill.)

Toasted Ravioli with Marinara Sauce



• Pre-made, frozen cheese ravioli
• Italian style bread crumbs
• 
Parmesan cheese
• 
Non-stick cooking spray
• 
Marinara sauce – for dipping

Cook ravioli according to package directions. Drain and place on a wire rack, plat or baking sheet. In a shallow bowl mix together bread crumbs and parmesan cheese. Spray ravioli with non-stick cooking spray and press into bread crumb/cheese mixture coating both sides. Place on a foil lined baking sheet that has also been sprayed with cooking spray. Bake at 350 degrees for ~20 minutes or until golden brown. Cool slightly and serve with marinara sauce for dipping.

Low Fat Red Velvet Cupcakes with Eggnog Frosting

• 

1 box Red Velvet cake mix
• 
1 can (15 oz) pumpkin puree
• 
1 container of Fat Free Cool Whip
• 
1 small box of Fat Free/Sugar Free Instant White Chocolate Pudding
• Rum extract to taste
• 
Nutmeg to taste

For cupcakes: Place pumpkin in a bowl and add cake mix. Mix with electric mixer until smooth. Batter will be thick. Spoon into 12 muffin tins that have been sprayed with cooking spray. Bake at 350 degrees for 18-20 minutes. Let cool completely.

For frosting: In the tub of Cool Whip, add the pudding mix, rum extract and nutmeg and stir until well combined. Frost cupcakes right before serving.

Holly Krivokapich
Health and Wellness Coordinator
St. David’s Round Rock Medical Center

1. Balsamic Spinach Salad Picnic Box
2. Turkey, Cream Cheese & Avocado Sandwich Picnic Box.

The Balsamic Spinach Salad is made from fresh spinach with juicy, ripe strawberries, goat cheese and tangy balsamic dressing. It comes with a side of fresh fruit for a healthy satisfying meal.

The Turkey Sandwich is made with hand carved turkey breast on honey whole wheat bread. The sandwich comes with fresh green leaf lettuce and ripe tomato slices. Reduced fat cream cheese and avocado add an extra kick to this tasty sandwich and a side salad completes this well-rounded meal.

If you feel the urge to take your healthy meal to a local picnic-friendly spot, check out some of their “local picnic spots.”

Urban picnic is open Monday – Friday, 11am – 8pm & Saturday, 11am – 3pm and is a one stop shop for planning your healthy, gourmet picnic outing.

-St. David’s HealthCare Healthy Dining Program

HDYR is committed to a “better you” and offers one particular combination that is officially approved by the St. David’s HealthCare Healthy Dining Program:

• Fresh Tuna Roll, with a side of unsalted edamame. This roll is wrapped in seaweed and filled with super healthy brown rice, fresh tuna, avocado, sprouts, cucumber and sesame seeds. For 265 calories and 7g of fat, this is a great protein-packed lunch, dinner or snack! Need a side of protein with that protein? Well step on up and order a side of unsalted edamame for 254 calories and an extra 22g of protein!

In addition to having a clean, well designed establishment HDYR has a friendly staff to boot. Roll on over to one of these great little sushi spots asap for a healthy, satisfying experience!

-St. David’s HealthCare Healthy Dining Program

It’s that time of the year when all the parties, shopping and preparing for the Holidays takes over your life.

Holly Krivokapich
Health and Wellness Coordinator
St. David’s Round Rock Medical Center