Let Food Be Thy Medicine?

I ask my PT colleagues all the time, do you talk about diet and nutrition with your patients? Most of the time I hear, “no it’s not within our scope of practice”. I will give my personal bias (but not really since it is backed by the physical therapy governing bodies), that yes I believe it is very important to discuss the topic of nutrition with patients. However, my opinion doesn't matter, the evidence does.

This post is dedicated to answering the question- is diet and nutrition apart of the physical therapy scope of practice?

Well folks, the quick answer is yes, discussing nutrition is within our scope of practice. In 2015, the American Physical Therapy Association (APTA) provided a document with a statement discussing the role of the physical therapist in diet and nutrition:

HOD P06-15-22-17: Diet and nutrition are key components of primary, secondary, and tertiary prevention of many conditions managed by physical therapists. It is the role of the physical therapist to screen for and provide information on diet and nutritional issues to patients, clients, and the community within the scope of physical therapist practice. This includes appropriate referrals to nutrition and dietary medical professionals when the required advice and education lie outside the education level of the physical therapist. (Link to document here)

The APTA has now taken a stance that nutrition is within our scope of practice since it is a key component to many conditions that we manage. Nutrition can directly affect a patient’s function and recovery from injury. It is considered reimbursable under patient education and self-care. (However, always check your third party-payers). The APTA also states that PTs should refer onto a dietitian when information is outside of information found in public domain. APTA suggests using the dietary guidelines from the US Department of Health and Human Services’ Office of Disease Prevention and Health Promotion. (Summary of guidelines here… this is a really good reference guys)

The Academy of Nutrition and Dietetics provides a resource that can be used to find local Registered Dietitian Nutritionists. (Link here). I suggest finding your local dietitians and building relationships with them. 

In addition to the APTA’s scope of practice, we also need to make sure that we are following our own states practice act.

Here is California’s stance on nutrition:

The Physical Therapy Practice Act does not mention diet and/or nutrition. A document titled Statutes Outside Physical Therapy Practice Act (Link to document here) states:

Division 2- Chapter 5, Article 3, 2068:

This chapter shall not be construed to prohibit any person from providing nutritional advice or giving advice concerning proper nutrition… For purposes of this section the terms ‘providing nutritional advice or giving advice concerning proper nutrition’ means the giving of information as to the use and role of food ingredients, including dietary supplements.

Any person in commercial practice providing nutritional advice or giving advice concerning proper nutrition shall post in an easily visible and prominent place the following statement in his or her place of business: 

(See link for exact wording of “NOTICE” that must be visibly placed on no smaller than an 8 1/2 in by 11 in paper with lettering no smaller than 1/2 in length (except “NOTICE” is not to be smaller than 1 in length)

If you aren’t sure of your states practice act, APTA has a resource that will connect you to your state (click here)

Lastly, remember that we each have our own personal scope of practice. Just because your state practice act says that it is within your scope of practice, if you do not know enough about that topic then don’t practice it. Meaning, don’t practice what you don’t know. 

Here is a link to APTA’s resource on Personal Scope of Physical Therapy Practice. 

We are lucky, we get 30 minutes to an hour with our patients. Most health care providers do not get that time. We have the time. Let’s not side step the topic of nutrition with our patients/clients. It is our job to discuss lifestyle, health and wellness with our patients who are trying to recover from an injury and/or illness. Diet and nutrition have affects on inflammation, obesity, arthritis, autoimmune diseases, diabetes, and chronic/persistent pain. If you still aren’t convinced that you should be discussing nutrition with your patients, check out Dr. Joe Patta's blog post on the APTA website here for additional reasons why pain and nutrition go hand in hand.

Many of the top physical therapy continuing education institutes are starting to add nutrition based courses to their programs. Here are a few examples:

• Herman & Wallace: Nutrition Perspectives for the Pelvic Rehab Therapist. 
• Medbridge: Nutrition in Sports
• Progressive Therapy Education: The Changing Paradigm of Wellness- The Role of Nutrition and Fitness in the Prevention of Chronic Disease

Hopefully you now at least somewhat agree that nutrition isn’t outside of our scope of practice as physical therapists. But you may now be thinking that you don’t want to step on another professions toes, anger your local dietitians that may be sending you patients. I fully believe that PTs discussing general nutrition topics will not in any way take away from the importance or referrals to dietitians or nutritionists. If anything, it may help to open the door between patients and dietitians. In California and most states, we now have direct assess to patients, meaning this may be the first time nutrition has been brought up to a patient in regards to it’s affects on healing the body. We can help assist patients and physicians to find the right dietitian for them. We can be a link between other healthcare providers and patients. I hope that you start asking your patients about their dietary habits, just as I would hope a dietitian would ask their patients/clients about their exercise habits. That way, we can work together as a team to best help our patients.

Additional resources:

Dr. Joe Patta, DPT, CNS is an excellent resource. His focus is treating persistent pain, and you bet nutrition is a part of that. He has a blog and a podcast, and is currently working on a functional nutrition and pain science training for healthcare practitioners. Check out his website here.

Find a local Registered Dietitian here. 

Physical Therapy Board of California laws here.

US Department of Health and Human Services- Dietary Guidelines 8th edition 2015-2020 here. 

Toss Out Those Broken Records

"Watch your thoughts, for they become words.

Watch your words, for they become actions.

Watch your actions, for they become habits.

Watch your habits, for they become your character.

Watch your character, for it becomes your destiny".

- Lao Tzu

It's pretty well known that too much stress isn't healthy for us. When we are stressed, we are more likely to make unhealthy decisions: skip out on that workout, stay up all night to study for that exam, stop at a drive-thru on the way home, have another energy drink.

Being in a stressful situation is one thing, but experts now know that even when we THINK about a stressful event it can affect our body. Meaning I don't even have to go through the physical process of being criticized by my boss to have a stress response in the body, I can merely just play it out in my head and get the same negative response in my body. For example: the big exam is coming up, senior picture day is tomorrow, you have a blind date later in the week. Then, BAM... you get a pimple, you are having a "fat" day, or maybe you even get sick. Why does our body do this to us!? How does it know!

On the simplest level: Our thoughts can affect our immune system. How we perceive our environment is directly related to our health. Where the mind goes, energy follows. It kinda seems like common sense, but think about that. Stress in itself isn't unhealthy for us, in fact it is a vital process necessary for survival. It's how we react to that stress that can be unhealthy.

The good news? When have the ability to tap into this physiological process. As I mentioned above, the mere thought about stress and/or fear can negatively affect our immune system predisposing to disease and illness. However, that also means that positive thoughts and energy can bring about a healthy balance with life stressors. When you are being mindful and positive, you cannot be overly worried and negative. You cannot have both.

Here are four ways to use your mind and thoughts to improve your health: 

PRACTICE DETACHMENT

Often times we are stuck in the past. We make important decisions off of emotions from past experiences. Fear usually comes from a past negative experience that has now left us on high alert. When we hold onto things where it is physical, emotional, mental, etc., we are making it difficult to see new experiences as opportunities rather than stressful events. Always remember the saying, "when one door closes, another one opens." As scary as change may be, rephrase the experience from a disturbance to an opportunity. Now, I'm not saying that we can't live with personal belongs, knowledge, and/or things that provide us with joy- but do not let your possessions define you. It is your responsibility to gain tools/knowledge (possessions), but do not become attached to them. Everything is impermanent. The less baggage we carry around with us, the more able we are to able to enjoy the present moment without blinders.

PRACTICE VISUALIZATIONS

As mentioned above- if you can't visualize it, don't expect it to happen. Visualizations are simply mental images. Studies show that if you imagine crossing that finish line or crushing that presentation, you increase your motivation and cognitive processes in the brain such as memory and attention- thus improving your outcomes! You literally link and strengthen the neural pathways located in your brain. There is a story that a man was in jail for 20 years. Everyday he visualized himself playing his favorite 18 hole golf course, each and every stroke. When he finally swung a club for the first time in 20 years, he pared his favorite course. Visualizations can be very powerful. Again- where the mind goes, energy follows. Many have a difficult time visualizing, I hear it all the time. I understand because I was the same way. It is awkward at first, it takes practice. You can try writing down every step of the process including the outcomes. Imagine/write down situations that may be difficult and how you can will overcome them.

PRACTICE CONTENTMENT

We can practice contentment by writing down three things that we are grateful for each day. We can sit outside with our eyes closed and listen to the life and energy around us. We can slow down, put the phones away, look around. You are who you are right now- no matter how far you are from who/what you want to be, enjoy who you are now. The journey is what is most important. There is nothing truer than this moment. Practice living using intuition rather than instinctually.  Intuition living: Instinctual living: unconscious programing, protective responses- born of the past. 

PRACTICE COMPASSION

We are all human. Humans by nature are imperfect. If you were perfect, then you wouldn't be here. Those Insta-famous moms, models, and movie stars I guarantee you all have their personal struggles. Never judge yourself for taking a step sideways, backwards, or too far forward. Do not judge yourself if you roll down the hill. Care about perfection, but know that it is never the goal. Practice compassion for others- even those who do not share your beliefs, those who are struggling, those who are sick. We are all inner-connected beings. Compassion directly leads to connection. Leave this world better than how you came into it. Be a karmic snail, leave your imprint in this world.


See a common theme? Practice. Practice. Practice. Your thoughts are so powerful. You have the ability to control your thoughts.
Create Space. Envision it. Enjoy the process. When you fail, dust yourself off and try again.

You are who you practice to be.

Motivation Monday- Write down your ideal day.

Let's be real- days, weeks, months fly by. Winter is coming, then all of a sudden we are springing forward, in a blink of an eye it's summer, then it's pumpkin spice latte time, and then we are preparing for the holidays again. Round and round we go. Case in point, it's been over a year since I posted.

Many of us make new years resolutions usually something about health, wellness, and/or improving our lives somehow. I want you to reflect back to what your new years resolution was. Can you remember it? If you remember, have you reached your resolution goal? Are you actively reaching towards it currently? Have your resolutions changed or evolved overtime? To be honest, I don't remember mine. If you are like me and can't remember your goal, make a new resolution today. Don't wait until the new year. If you have obtained your goal, make a new one. If you haven't obtained your resolution yet, use that. Now, I have two activities for you. One you will probably only do once, the other should be performed daily.

Get a piece of paper and I want you to write down your ideal day. Write down what that day looks like to you. Include:
- What time you wake up?
- How many hours of sleep did you get?
- What do you do when you first wake up?
- What do you eat for breakfast? Lunch? Dinner?
- What do you do that brings you closer towards that goal or resolution?

Write it down, do not just think it in your head. Place is piece of paper somewhere that you see it every day. This exercise doesn't guarantee that you will reach your goal or resolution- you must actively do something. But it's a very good first step.

Another equally important activity is self-reflection. Self-reflection is thoughtfulness, meditation, or mindfulness towards one's actions or motives. It takes about 5-10 minutes. Each day, I want you to "grade" yourself; A, B, C, D, F with pluses or minuses if you would like. What grade would you give yourself on your days actions towards reaching these goals and resolutions? No judgements, it's a thoughtful reflection on your day. The point is not necessarily the grade, it's the activity of reflection in itself. The grades may be able to help to show patterns that are helpful, or hinder our ability to reach these goals.

Try it! If you would like to share your goals or resolutions here or in a message, feel free. If you need some help reaching these goals, please don't be shy to ask someone (Ask me!). Also, if you have any self-reflection tools that you use that are helpful, please share! We all are constantly learning from each other.

Remember, you CAN do it, the only thing getting in your way is yourself. 😊

Can You Make It Through This Post Without Yawning? - Hacks on How to Activate our Parasympathetic Nervous System.

"We are what we repeatedly do". - Aristotle.

For those who have read my past blog posts, I talk a lot about our body's natural "fight or flight" reflex. In short, our fight or flight reflex is a primal instinct that is required to survive. The instinct was triggered for our distant ancestors in order to run away from lions and tigers and bears. This reflex caused a quick change in our nervous system in order to win, survive, and procreate. It causes pupil dilation, increased blood flow to our muscles, improved lung capacity amongst many other changes. Once we run away from the bear, our body goes back to it's normal level of homeostasis, the reflex turns off and we can continue our lives, rest, and digest.

The autonomic nervous system is made up of two different systems:
1) Parasympathetic- Rest/Digest
2) Sympathetic- Fight/flight.

I see many patients who have chronic, persistent and intermittent pain that seems to continually crop out of the wood works, again, just as they are going through another life stressor. I usually always discuss how the chronic state of "fight or flight" can wreck havoc on our body, but it wasn't until recently that I also realized it's connection to digestive issues- the rest/digest system. So many of my patients with persistent pain and dysfunction also suffer from bowel and bladder issues including chronic bladder infections, irritable bowel syndrome, constipation, and diarrhea.  In very simple terms, when one system is on and activated, the other system is off. When we are constantly nervous about losing our job, worried about decisions we made in the past, anxious about the future, we are constantly in "fight or flight". So what does that do to the parasympathetic, rest/digest part of our nervous system? Well folks, it can chronically be suppressed. The parasympathetic nervous system allows for fuel storage, sleep, resistance to infection, and you guessed it, motility/digestion. No wonder the more stressed and anxious we are the more unhealthy, tired, and sick we become. 

The word "autonomic" means involuntary making one believe that we do not have the ability to directly influence which nervous system we are in. However, studies have now shown that there are many ways in which we can hack into our parasympathetic nervous system.


1) Breathe.
Lay down or sit in a relax position. Place one hand over your belly, and the other over your chest. Close your eyes. Slowly breath in through your nose for a count of four seconds causing the hand over your belly to rise, while the hand over your chest stays relatively still. If you only feel the hand on your chest moving, than you aren't breathing deep enough. Allow your belly to expand with each inhalation. After the full inhalation, hold for your breathe for a second or two at the top, and exhale slowly through your nose. Repeat this for 60 seconds. During your breathing, visualize what is happening to the heart and lungs with each inhalation- it is widening, and expanding, opening and accepting. With each exhalation, its resting, relaxing and giving.

Why it works: You are expanding your bronchioles, (which are tiny passageways for air to move into the lungs) with each inhalation. The rest/digest nervous system is naturally activated since it's job is decrease bronchial dilation, thus bringing our body back into it's resting state. Bringing awareness and being mindful to what is happening on the inside is a great way to activate the parasymphatic nervous system, replacing our constant thoughts of worry and stress.

2) Relax. 
I don't mean go kick up your feet in front of the TV. I want you to check in with your body periodically throughout the day. Put a timer on your phone to go off every 45 minutes (you can download the Stand Up! App for free. Check out my last blog post on Health/Wellness Apps for more information).
Do this with me right now.
- Check in with your jaw. Are you clinching it? If you are, check in with your tongue. What position is your tongue in? Is it placed up against the back of your teeth? Try this: place your tongue against the roof of your month, now try to clinch your teeth. Was it harder? It's much more difficult to clinch our teeth when our tongue is resting at the roof of our mouth. Now if you haven't done so already, with you tongue gently touching the roof of your mouth, left your jaw gently release with your lips slightly touching.
- Check in with your shoulders. Are they half way up your ears? Are they rolled forward towards your computer? Do 5 slow neck rolls each direction, and 5 big shoulder rolls backwards... Up, back and down. Finish that 5th shoulder roll with your shoulders resting down and back. Quickly re-checkin with your tongue and jaw.
- Check in with your belly. Are you sucking it in like you are trying to put on pants that are too tight? Are you hunched forward making a big "C" curve with your back, sitting on your tailbone? Sit towards the front of your chair, intertwine your fingers behind your neck for support, and gentle extend your back, elongating your belly. Repeat this five times from neutral position and extend your neck, upper back and lower back, maybe even arching over the back of your chair if it is low enough.
- Check in with you glutes. Are you clinching them? Not sure? If your legs are crossed, uncross your legs and place both feet on the floor. Perform 5 slow butt squeezes (contract your butt, don't literally squeeze your butt with your hand), but make sure to relax between each squeeze. After your last glute contraction and relaxation, relax again. That second relaxation is key.
- Check in with your pelvic floor muscles. This one is usually the toughest to relax because they are the muscles we usually have the least knowledge and awareness of. Perform 5 deep breathes like we did above under "Breathe". Visualize on each inhale that the diaphragm is lower and relaxing, and the pelvic floor muscles are lower, lengthening, and relaxing. On each exhale just image those muscles gently going back to neutral position.

Watch this quick video demonstrating this connecting between breathing, the diaphragm and the pelvic floor muscles. You at least have to check out how they made the pelvic organs look like a little piglet.



If you are like most people, you were probably tensing most of those areas we just went through. In fact, studies have found that 70% of individuals who clinch and tense their jaw also have some type of pelvic floor dysfunction (ex. pain with intercourse, pain with urination, etc. See my past blog post Let's Talk About Sex Baby! for more information).

Why this works: Activating the body's relaxation state sends signals to the brain that we are calm, decreasing the brain's natural "alarm system" that is chronically triggered with stress, anxiety, worry and fear.

3) Yawn.

Scientists aren't sure exactly why yawning activates the parasympathetic nervous system. What they do know is that yawning is "contagious", meaning when others yawn, we can quickly and involuntary jump on the bandwagon. They believe it's a way that we show empathy towards others (dogs do this as well to humans). Also, it has been found that when our body gets a little warming than our normal, it is common to yawn, thus putting us back into our normal homeostasis. Tell that to your boss or  teacher next time they catch you yawning!

Can you make it through this video without yawning?




Summary: The sympathetic nervous system is imperative for survival- we see a car coming directly at us full speed, we run out of the way without thinking twice about it. It is when we are unable to get out of this state of fight or flight that it takes a toll on our body. It's important for our health to take the time to activate the parasympathetic nervous system during your day. Set an alarm on your phone and do a quick body scan every 45 minutes. Practice deep breathing for 60 seconds intermittently throughout your day. I would suggest once before getting out of bed in the morning, before lunch, before leaving work, and lastly before you go to bed. We cannot control all life stressors, however we do have control over our body. We have the conscious ability to relax and let go, we must first be aware (hence body checks) of these habits and have the discipline to prioritize our health.

"Little by little, a little becomes a lot". -Tanzanian Proverb

Keep Calm, I Know CPR & First Aid

"If you are prepared, you will be confident, and will do the job". -Tom Landry

As a healthcare provider, it is mandatory to be CPR/First Aid certified. Therefore, every 2 years comes that daunting day that I have to take one of my precious days off to sit in a small, stuffy room, with 10 strangers, renewing my certification.

Well folks, that lucky day… was today. 8:30am-3:30pm. As annoying as it can be to be in a mandatory class on your day off, I really left that room ready to save some lives! Thank goodness I’ve yet to be in a 911 situation, but at least I feel that much more confident if one does occur. (BTW, for those who are freaking out since you forgot the ratio of chest compressions to breaths, it’s still 30:2. But if you read this and forget again, just do chest compressions!)

For those who are required to have CPR/First Aid training, sweet. For those who aren’t, I highly suggest that you take at least a basic course in it. For those mom’s and dad’s who have young kids, without a doubt, become certified. And offer to pay for the course for your child’s nanny or babysitter.  I’m actually pretty surprised during all my years of babysitting, not one time was I asked if I had CPR/First Aid training.

For those who think the ABC's when they hear CPR, that's pretty outdated information. It would be a great idea to go to a class and learn the updates on how to be most effective incase an emergency occurs (You never know!)

Each time I take the course, it has some slightly different (and thankfully more condensed) information. This is because as studies and surveys are being performed, the Red Cross and American Heart Association reconfigure the courses in order to be more affective at saving lives.

I am going to list the things that I learned during the course today. Some of you may think, “well everyone knows that”. I will shamelessly admit that I didn’t know many of these, or not in as much detail.

EPI PENS:

Epi pens (used as treatment for anaphylactic shock) has a predetermined amount of medication for that person. In order words, one epi pen should not be used for another person.

INHALERS:

There are two types of inhalers, (treatment for asthma)- a fast acting and slow acting/long term corticosteroid. For an acute asthma attack, an individual needs their fast acting inhaler.

FIRST AID/AED LOCATION:

For my healthcare professional peers, especially those working in outpatient ortho, do you know where the AED/First Aid kit in your clinic? Admittingly, I do not. I have a pretty good guess since I have seen our First Aid kit, and I have seen my clinic manager change the batteries of our AED in a similar location as where the first aid kit is. But I can’t say I’ve ever seen it/touch it at its resting place and said, “Okay, this is where this is in case of emergencies”. So friends, do what I am going to do the second I get into work tomorrow and find out where the AED is and ask if it is the only one in the clinic. If it’s not, where are they others located?

PACE FOR CHEST COMPRESSIONS DURING CPR:

If you aren’t sure if you are doing the correct pace for chest compressions (which should be 100-120 compressions per minute), then just sing to yourself the Bee Gee’s – Stayin’ Alive (103 compressions per minute to be exact). That song’s beat is the correct pace, and also sending out good mojo into the universe. Another song with the correct pace is Queen’s- Another One Bites the Dust. But, I think we could all agree, who wants that thought going through your head while you are trying to save someone’s life!?

YOU DON’T HAVE TO CHECK PULSE!

New CPR guidelines no longer require you to check the person’s pulse. Studies have found that 1) people where doing it ineffectively, and 2) it’s taking up too much time.

CHEST COMPRESSIONS ONLY IS FINE:

I already mentioned this above, but if you are nervous to give rescue breaths to someone you do not know (not sure if they have any communicable diseases), you don’t have any protective barrier, (or you just can’t remember what the heck you are supposed to do because lets face it, this is an emergency and it’s somewhat normal to freak out), just remember, giving COMPRESSIONS ONLY IS OKAY!

WHAT ABOUT PREGNANT MOMS?

I work with a lot of pregnant moms, so my ears perked up whenever we talked about them in class. Do we treat them any differently? It depends. Can you administer an AED to them? Yep! The same exact way you would administer the AED to anyone else. What if they are chocking?? Yeah, good question. The Heimlich maneuver is modified with your fist positioned at the base of their breastbone, (rather than at their diaphragm) with the same in/upward forceful quick thrusts.

GLOVES!

The single most important tool for you to have for first aid/CPR is… GLOVES. This is something that all men and women can have on them at virtually all times. Even a women like me who has the smallest purse known to mankind, there is room in my purse for two gloves.

COMMON SIGNS & SYMPTOMS:

With more and more people living longer and staying active, it is important to recognize signs of possible distress that needs emergency medical attention.

STROKE. There is a simple acronym used to quickly assess an individual for a possible stroke. Think FAST.

F = Face. Is their face asymmetric? Ask them to smile. Look for drooping of the eyelid, mouth, or look for drooling.

A = Arms. Ask them if they are having any change in sensation of their arms such as numbness/tingling. Ask them to lift up both of their arms to shoulder height and keep them up there.

S = Slurred speech. Have them repeat a sentence, ask them questions.

T = Note the time that symptoms occurred, or if the individual was aware of when the symptoms first began.

CALL 911 or other emergency number! Every second counts.

HEART ATTACK. The signs and symptoms can look completely different with a heart attack. We often think, severe chest pain with radiating pain to the jaw and down the left arm. In men, symptoms often times may look similar to this, or the classic “it feels like there is an elephant sitting on my chest”. Symptoms may radiate down both arms, may look like profuse sweating, shortness of breath, and not relieved with rest or antacids. With women, symptoms may look a lot more subtle,  like dizziness, nausea, and/or indigestion.

CONCUSSION. We commonly think of sports, especially football when we think concussion. Signs and symptoms may include:

-       Behavior changes such as agitation and fear/anxiety

-       Loss of consciousness (not also though!)

-       Changes in vision (double vision, blurred vision, sensitivity to light)

-       Memory problems. Have them answer a few questions like what day and year it is, who is the President.

-       Balance problems.

-       Nausea/vomiting/drowsiness/feeling sluggish.

I remember when my brother got a concussion during one of his lacrosse games. He didn’t even the five minutes before getting hit or afterwards. He was checked out by a medical professional, and was sidelined for the rest of the game. He went out with his friends that night to celebrate the big win against their hometown rivals, and my mom made sure to wake up every few hours that night while he slept. That has long been the “at-home treatment” for a concussion, but with the increase in awareness of long-term and permanent changes that can occur from a head injury, the type of treatment has also changed. If a person is suspected of having a head injury, a doctor should check them out, especially if they are an athlete and planning on continuing to play in contact sports. This is a really big pet peeve of mine, especially when professional athletes put the game ahead of their health. This just puts the pressure on kids to just suck up the pain rather than tell coach that they aren’t feeling right. Sure, maybe that first concussion was “minor”. Did you know that the brain is much more at risk of permanent injury during this critical time period after the first concussion? If you let yourself or a player stay in a game that day or let them return to play before allowing a doctor to medically clear them, you are being negligent and putting yourself or that person into a position of long-term brain trauma. So don’t use the old wives tale of waking someone up every hour to monitor for a significant head injury. Leave the game, work, park, etc., and to go a doctor.

DIABETIC ATTACK. Often times, hypoglycemia or hyperglycemia can look like someone is drunk. They may be slurring their speech, non-responsive, talking nonsense. They may be stumbling around or even worse, swerving on the road while behind the wheel. They may have problems with memory, mental changes, cold/clammy skin.

What my instructor really emphasized in class is that you don’t have to do more than you are comfortable to do. If all you feel comfortable to do is call EMS, then high five, that’s excellent. You are still a superhero. Just try your best to stay calm and comforting as you call 911.

Things to do and purchase in order to be prepared:

-       Get CPR/First Aid training

Red Cross: http://www.redcross.org/m/index.jsp#arcmobile

American Hear Association: http://cpr.heart.org/AHAECC/CPRAndECC/Training/UCM_473167_Training.jsp

-       Purchase a CPR rescue masks for $7-$14 online. They even have keychain masks! Found here: http://www.amazon.com/Ambu-Res-Cue-Mask-Keychain-Pouch/dp/B00BEPQ0KE/ref=pd_sim_121_6/183-9555781-7578840?ie=UTF8&dpID=41DD2RZCqwL&dpSrc=sims&preST=_AC_UL160_SR160%2C160_&refRID=1CXCTPZXD743Q9WSNKN3

-       Purchase gloves to keep in your purse, car, and home. They have a key chain option too! Found here:   http://www.liveactionsafety.com/dixigear-cpr-keychain-kit/?gclid=Cj0KEQjwoYi4BRDF_PHHu6rI7NMBEiQAKZ-JuOP__I8r5-xUAXNdEjy45eQK8ycDa_amxKlYjivaKn8aAoVW8P8HAQ

-       First aid kit.

-       Make an emergency backpack/preparedness kit incase of a disaster. Ready.gov has a “build your own emergency kit” list. The Red Cross has one that you can purchase.

-       Make a plan with your family in case of an emergency, and actually practice that plan (ie. Evacuating the house, where to meet up, emergency contacts).

For those overachievers who feel inspired (by my blog post.. haha), become a member of a local Community Emergency Response Team (CERT). 

Check out the website here: http://www.fema.gov/community-emergency-response-teams

Best Apps for Health & Wellness

There are 100,000 and counting apps for health and fitness on the market today. That's pretty exciting, but very overwhelming at the same time. It's like Netflix, you have so many movie/TV show options at your finger tips, but you end up spending 30 minutes just looking through all the different categories that you just end up giving up on trying to watch anything at all. The endless amount of apps left me searching for hours trying to research which ones were actually good that by the time I downloaded a few, I was over the whole idea. Which is unfortunate, because there is a lot of really good stuff out there.

Jenn's Favorite (FREE... ish) Apps for Health & Wellness

Calm

Calm is an app to calm yo' self. There are 10 minute guided meditations with your choice of background noise (lake with birdies chirping, beach waves crashing, rain drops, etc). If you don't want the guided meditation part, then you can just listen to the waves and chillax. If you are like me and want someone to talk to you, there is a "body scan" option for progressive relaxation (squeeze your muscle, then let it go), and a "calm" option. There are a zillion others, but to get them you must subscribe. Try out the free ones and if you really enjoy it, you can subscribe for $3.33/month.

Swork It 

Swork it's motto is "No gym, no excuses". There are four workout options- Strength, Cardio, Yoga & Stretching. Each option has a type of workout you can select (full body, upper body, lower body, core, etc.) and the amount of time that you have (five, ten, fifteen minutes). Don't have the time to get in a quick stretch, or don't know what to do? No more excuses. You can even have it send you text alerts to stop and stretch. If you sit at a computer desk all day, I recommend to stop and stretch/move your shoulders, neck, back, hips, and wrists for AT LEAST 2 minutes every hour.

Strava 

Strava is an app for tracking athletic performance using your GPS (phone, garmin, fitbit, etc.) It's like facebook, but for runners, cyclists, snowboarders, walkers, & whatever else your heart desires. You can give "kudos" to a friend for their run, you are able to score virtual medals if you finish a challenge (who doesn't love a good pat on the back), and you also get trophies for PRing different routes. I like how I am able to track my performance overtime, and it helps to be motivated by my followers giving me a thumbs up. 

Daily Water


Who else forgets to drink water until all of a sudden its noon and all you've had is two massive cups of coffee? Guilty. Is it sad that there is an app that will text you to remind you to drink water? Maybe. But whatever works to stay hydrated. You can customize how often you want to be reminded, and also keep track of how much water you are drinking.

Rule #76: No Excuses, Play Like a Champion.

"'I don't have time' is the grown up version of 'the dog ate my homework'".

Life is stressful. Student loans, car payments, kids to feed, 50+ hours work, long commutes, boss barking at you, deadlines to meet, etc. Plus, we need to fit exercise into our days in between all the chaos because it's supposed to be good for us right? I've heard every excuse in the book for why one isn't exercise. In fact, I've used every excuse there is to get out of exercising.

Here are some of the common excuses that I hear every day, (and some of which I have used myself) with a rebuttal to challenge these excuses.

Excuse #1: I don't know what to do.
Work out trends are like diet trends, there are so many different types and it can be so overwhelming. How can all these experts have completely different opinions on how to exercise? I get this question from my patients everyday. And as a physical therapist, it is my job to prescribe exercise. Sure there are some extremely general guidelines out there. The Department of Health and Human Services recommends that healthy adults should be getting 150 minutes a week of moderate aerobic activity or 75 minutes a week of vigorous aerobic activity, as well as performing strength training activities twice a week. Moderate aerobic exercise would include activities like brisk walking and swimming, whereas vigorous aerobic exercise includes activities like running and dancing. Use of weight machines, rock climbing, and body resistance type exercises would be considered strength training. That's less than 25 minutes of moderate exercise per day, and 10 minutes of vigorous. Obviously this is very very VERY vague guidelines, but it depends on an individual's goals with their exercise that determines the type/amount/frequency.

Is your goal to:

• lose weight?
• gain muscle mass?
• decrease stress?
• train for an event?
• prevent illness/injury?
• gain flexibility?

Ask yourself, why? What is your goal with exercise? If you don't have one, start brainstorming. It is extremely difficult to get very far without a destination in mind.

Excuse #2: I can't afford a gym membership.
Yes, many gym memberships are super, duper expensive. Especially with the influx of boutique-y type gyms, memberships can easily hit over $100/month with individual 1-hour classes at $15. But here are a few options for those on a budget.

• ClassPass. If you enjoy variety, and I mean everything under the sun, ClassPass may be a good opinion for you. Personal training, cycling, yoga, Pilates, you name it, ClassPass probably has it. It is a monthly membership fee of anywhere from $79-$129 (depending on where you live) which is still a good chunk of change, but if you are going to 3-4 classes per week, you are paying less than $10 per class. You sign up for a class before you get there, so you don't have to worry about there being a spot for you. A con (or a pro based on how you think of it) is that there is a fee if you sign up for a class but don't show up, or don't cancel ahead of time, which could be a con for those who have inconsistent schedules but a pro for those who need the extra motivation to go. Another con (kinda) is that you are only able to go to one gym three times within one month. So if you really like the Monday night Vinyasa Yoga at Yo-Yo-Yogie, you won't be able to go one week out of the month. I do this three is kind of silly, it makes it a little difficult to get into a routine. But it does make it so that you try out various places, different teaching/coaching styles, and new experiences.
• Meet up. The website meetup.com has a lot of different exercise classes, many for free or donation based. You simply go to the website, click "Find" a group, put in your zip code, and there is a search bar if you want to look up "Tai Chai" or whatever it is your heart desires, or there is a "fitness" and "health/wellbeing" page to help if you really don't have any specific interests.
• Various Apps/You Tube Videos. There are a bunch of FREE You Tube videos that have guided exercise routines whether is a quick interval training session or meditation. You only need yourself and probably some space in order to get a workout in. iTunes has an app called "Daily Workouts-FREE" that has videos as well as a listed exercise progression.

Excuse #3: I don't have the time.
I probably hear this one the most. Guess what, no one has the time. You have to make the time. This is your health that we are talking about, how do you not have time for that?

Excuse #4: I've never been an exerciser.
It's never to late to start something new! Maybe brainstorm why you have never been an exerciser. Is it because you never had an exercise goal to strive for, you've tried various types of exercise, but never for long enough to actually give it a shot? Have you been putting everybody else's health/wellbeing before yourself? Time for some self exploring. Everyone had to start somewhere. I was telling a patient the other day that my mom literally forces me to play sports as a kid. My first soccer game at 4 years old, she was standing by my side the entire time or else I refused to get on the field. My first golf tournament at 6 years old,  I didn't want to play. My mom basically dragged me onto the course while I had tears in my eyes. Some make think, "wow that's torture!" or "I would never force my kids", while my mom did and I'm so glad she did. I was a super shy kid, and not very self motivated. So she pushed me quite a bit. But that's how it is with all new things, including exercising, it's scary. I've wanted to quit different exercises classes various times because I didn't feel like I fit in. Me talking to myself in my head: "I'm the only one not wearing Lululemon in the yoga class therefore I must stick out like a sore thumb", or "um.. this is embarrassing, I didn't know you needed socks for Barre, now the teacher just came up to me and told me that I need to leave and go borrow some from the front desk because it's a health hazard without any", or "I cannot keep up with everyone else in this Pilates class, how the heck are they doing the exercises so fast with that much weight!?". My point is, everything is awkward at first, don't give up and just say that your not an exerciser. Do me a favor, try a class/exercise at least 4 times before making an opinion about it. Your future self will thank you for going out of your comfort zone and trying again.

Excuse #5: I already work out because my job involves labor, or I'm on my feet at work, etc.
I hear this one a lot too. When I ask, "do you have a current exercise regime?" and sometimes I'll get back "well no, but I'm exercising all day long at my work when I get up and down to the bathroom (I've literally heard this one), or "Yeah I'm lifting/stocking shelves at Trader Joe's". That's great that your job doesn't make you sit behind a desk all day like a lot of America, but exercise doesn't just have physical benefits, but psychological benefits as well. You rushing to and fro in the chaos of work, or walking 40 times to the fax machine down the hallway does not give you the same benefits as deep breathing in yoga and it doesn't increase your heart rate like cardio activities do. I'm going to emphasis this again, exercise is not just for our physical body, but we are understanding more than ever the benefits of exercise on the mind. And in my opinion, the mental benefits of exercise far outweigh the physical benefits.

Excuse #6: I just really don't enjoy exercising.
Is it that you don't enjoy it? Or is is that you just don't have the motivation? To be honest, this excuse sometimes I can understand. I can understand not wanting to get out of bed an hour earlier to go to that cycle class when my cozied up next to significant other in bed, and I'm warm under this comforter and it's freezing the second my skin touches the air.

Excuse #7: It hurts.
There are lots of reasons why exercise can hurt. Maybe you are performing the activities incorrectly or inefficiently, causing a repetitive type injury. Maybe you have an acute injury that is causing a motion to be painful. Your brain may be so oversensitive to movement that it is sending pain signals to the body, thus causing pain. Pervious injuries, stress, and fatigue are just a few reasons why the brain can be hypersensitive to movements such as exercise. GUYS, PLEASE GO SEE A PHYSICAL THERAPIST IF EXERCISE HURTS!!

Excuse #8: I just eat really healthy.
High-five. Now if you have the drive to eat really healthy, just imagine what would happen if you stopped making excuses to exercise.

So I already mentioned that I myself can be an excuse queen. In fact, it took me two years to finally get back into a solid weekly routine that includes strength training, cardio, flexibility and mindfulness type exercises. After moving to Portland, I pretty much had to start all over again. I had to find the motivation in the miserably cold weather to get up and outside. I was already fatigued from probably lack of vitamin D (no sun for 24 days in a row is rough people, especially for a California beach girl), and I didn't really know my way around town or even how to drive in the dark/cold in an unfamiliar place (see the excuse list just keep growing??) It wasn't until none other than my Uber driver on New Years Eve who really got me thinking about exercise in a different way. When he heard that my boyfriend and I had recently moved from California he said, "the only way you are going to survive this place is if you exercise every day. It is the only way that you will be able to get your body warm the next couple of months, and it's key for getting through the Winter into the Spring". I'm not sure why this reason out of every known benefit of exercise is what finally kicked me in my rear end, but it worked. I was back into a routine within the month and have been keeping with it. It was extremely rough the first few weeks. I was so tired at the end of everyday. I had to literally plan my days around when I could exercise, which was frustrating and annoying. I even had to skip out on plans with some friends, but I set a goal and it was important that I stick to it this time. Even though it's only been about 7 weeks with this new routine, I have more energy at the end of the day than I ever have before. I don't find myself feeling foggy during the day, and I don't just pick up a less health food option on my way home to save time when I have stuff to cook at home. I've had a couple of mornings where I have slept in, but I had the determination to make it up sometime during the week.

Some tips to getting back into the routine.

1. Pick a date. Mark it on the calendar, tell your friends.
2. Find a group. When you know others will call you out for not showing up, it's all the bit more motivating
3. Give yourself external rewards (only at first). The goal is that exercise itself will be the reward to exercising. But when you are first get back into it, exercise my not be all that motivating.
4. Make a realistic goal. The worst is when we set our expectations too high and we fail. Be nice to yourself and make a short term goal, something like "I will run for so many minutes per week", or "I will take yoga 2 times this week". Write this goal down, and put it somewhere that you can see it, so when you are feeling weak you can have the reminder. My gym actually has an app that you can write a goal and it tracks your progress for you. When you reach your goal it gives you a little congrats email, which is silly how satisfying it is. 
5. Get your support system involved. Get them on your team and hey! maybe they will even want to join you. When you are feeling weak, call one of your friends who can help motivate you. Let them know how important this is to you, and that their support is very important to you. Start up #deadlifts4datenight or #crunchbeforebrunch... yeah??? I like the sound of those.
6. Make it excuse-proof. Don't join a gym that is clear across town that has odd hours, or times that don't really work with your schedule. Find something close to work, or your house. Better yet, find something that you literally have to drive by on your commute. Preferably this gym will have showers so you can go before work since we all know that we are dead tired at the end of a work day. Keep an extra pair of sneakers and clothes in your car or at work. Sleep in your running pants and shirt with your shoes and socks right next to your bed- I do this all the time, one less step/excuse to have in the morning.
7. Keep it low and take it slow. Please don't jump off the couch straight into playing tennis four times a week. Too much, too fast, too soon can result in injury and we are right back to where we started from.

A cheviot to my exercise soap box- more doesn't always mean better. An extreme example would be this: Many people have seen the TV show The Biggest Loser where a dozen or so overweight/obese contestants compete to lose the highest percentage of weight in order to win a million dollars. At "the ranch" where the show takes place, they are exercising most hours of the day, and have a professional chef cooking for them. Most of them shed 100's of lbs., but sadly many do not keep the weight off once they get back home. Working out all day, having someone cook for you, and no external stress to worry about except for shedding the weight isn't "real life". So the contestants go back to their daily routines and find it is difficult to keep up exercising and eating the way they were before.

Keep exercise at a level that can be maintained and even enjoyable. This isn't temporary, it's a lifestyle.