I Need PEAK PT

Christmas – tips to reduce the stress

THEPEAKTEAM — Mon, 17 Dec 2012 18:02:21 +0000

Christmas is typically one of the most stressful events of the year. The expense of buying gifts, the pressure of last minute shopping, and the heightened expectations of family togetherness can all combine to undermine our best intentions. Some practical suggestions can help you reduce your ‘Christmas stress’.

Budgeting for Christmas

For many of us, the Christmas aftermath includes massive credit card bills that can take months to clear. Christmas doesn’t have to be a financial headache if you plan ahead. Stress reduction strategies include:

Work out a rough budget of expected Christmas costs as early as possible. This includes ‘hidden’ expenses such as food bills and overseas telephone charges.
Calculate how much disposable income you have between now and Christmas. A certain percentage of this can be dedicated each week (or fortnight or month) to covering your expected Christmas costs. Don’t be discouraged if the amount seems small. If you save $5, $10, or $20 per week over a year, it can provide you with a hefty nest egg.
If your nest egg isn’t enough to cover your estimated expenses, consider recalculating your Christmas budget to a more realistic amount.
If you have trouble keeping your hands off your Christmas nest egg, consider opening a ‘Christmas Club’ account.

Presents

If you have a large circle of extended family or friends to buy gifts for, it can be very costly. You might be able to reduce the stress and cost of Christmas for everyone if you suggest a change in the way your family and friends give presents. For example, you could suggest that your group:

Buy presents only for the children.
Have a Kris Kringle, where everyone draws a name out of a hat and buys a present only for that person.
Set a limit on the cost of presents for each person

Christmas shopping

According to a recent study by Roy Morgan Research, around 60 per cent of Australians dislike Christmas shopping, just 20 per cent plan their shopping expeditions, and the majority of us (nearly 75 per cent) often come home without a single purchase for our efforts.

Stress reduction strategies for successful Christmas shopping include:

Make a list of all the gifts you wish to buy before you go shopping. If you wait for inspiration to strike, you could be wandering aimlessly around the shopping centre for hours. Perhaps you could get to know the interests of family and friends to help you when choosing gifts (remember money is also a great gift as it allows people to choose what they want).
Cross people off the list as you buy to avoid duplication
Buy a few extras, such as chocolates, just in case you forget somebody or you have unexpected guests bearing gifts.
If possible, do your Christmas shopping early – in the first week of December or even in November. Some well-organised people do their Christmas shopping gradually over the course of the year, starting with the post-Christmas sales.
Buy your gifts by mail catalogue or over the Internet. Some companies will also gift-wrap and post your presents for a small additional fee.

The Christmas lunch (or dinner)

Preparing a meal for family and friends can be enjoyable but tiring and stressful at the same time.

Some tips to reduce the stress of Christmas cooking include:

If you are cooking lunch at home, delegate tasks. You don’t need to do everything yourself.
Consider keeping it simple – for instance, you could always arrange for a ‘buffet’ lunch, where everybody brings a platter.
Make a list of food and ingredients needed. Buy as many non-perishable food items as you can in advance – supermarkets on Christmas Eve are generally extremely busy.
Write a Christmas Day timetable. For example, 11.30am – put turkey in the oven.
You may need to order particular food items (such as turkeys) from your supermarket by a certain date. Check to avoid disappointment.
Consider doing your food shopping online. The store will deliver your groceries to your door. (Keep in mind this option is more expensive than visiting the supermarket yourself.)
Book well in advance if you plan to have lunch at a restaurant. Some restaurants may be fully booked for months before Christmas, so don’t wait till the last minute.

Relationships

Stress, anxiety, and depression are common during the festive season. If nothing else, reassure yourself that these feelings are normal. Stress reduction strategies include:

Don’t expect miracles. If you and certain family members bicker all year long, you can be sure there’ll be tension at Christmas gatherings.
Avoid known triggers. For example, if politics is a touchy subject in your family, don’t talk about it. If someone brings up the topic, use distraction and quickly move on to something else to talk about.
Use relaxation techniques, such as deep breathing or focusing on your breath to cope with anxiety or tension.
Family members involved in after-lunch activities (such as cricket on the back lawn) are less likely to get into arguments. Plan for something to do as a group after lunch if necessary.
People under stress tend to ‘self-medicate’ with alcohol, cigarettes and other drugs. Try to remember that drugs can’t solve problems or alleviate stress in the long term.

The little extras

Other ways you might be able to reduce the stress include:

Write up a Christmas card list and keep it in a safe place so that you can refer to it (and add or delete names) year after year.
Plan to write your Christmas cards in early December. Book a date in your diary so you don’t forget.
Christmas cards with ‘Card only’ marked on the envelope can be posted at a reduced rate during November and December.
Overseas mail at Christmas time takes longer to arrive. Arrange to send cards or presents in the first half of December to avoid disappointments (and long queues at the post office).
For great savings, buy Christmas necessities (such as cards, wrapping paper, ribbons and decorations) at post-Christmas sales.

General health and wellbeing

Some other ways to keep your stress levels down include:

Try to be moderate – it may be the season to be jolly, but too much food and alcohol is harmful. Drink driving is a real danger and is illegal. If you can’t (or don’t want to) step off the social merry-go-round, at least try to eat and drink in moderation.
Get enough sleep – plan for as many early nights as you can.
Keep moving – keeping up your regular exercise routine can give you the fitness and stamina to make it through the demands of the festive season.

Where to get help

Your doctor
Financial planner
Your local community health centre

Things to remember

Save a percentage of your disposable income throughout the year to provide a nest egg for Christmas expenses.
Make a list of all the gifts and food you wish to buy and shop early.
Don’t expect miracles – if you and certain family members bicker all year long, you can be sure there’ll be tension at Christmas gatherings.

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Napping: Do’s and Don’ts For Healthy Adults

THEPEAKTEAM — Wed, 05 Dec 2012 17:59:48 +0000

Napping isn’t just for children. Understand the pros and cons of napping and the best way to take a nap.

If you’re sleep deprived or just looking for a way to relax, you might be thinking about taking a nap. Napping at the wrong time of day or for too long can backfire, though. Understand how to get the most out of a nap.

What are the benefits of napping?

Napping offers various benefits for healthy adults, including:

Relaxation
Reduced fatigue
Increased alertness
Improved mood
Improved performance, including quicker reaction time, better memory, less confusion, and fewer accidents and mistakes

What are the drawbacks to napping?

Napping isn’t for everyone. Some people have trouble sleeping in places other than their own beds, while others simply can’t sleep during the day. Napping can also have negative effects, such as:

Sleep inertia. You might feel groggy and disoriented after waking up from a nap.
Nighttime sleep problems. Short naps generally don’t affect nighttime sleep quality for most people. However, if you experience insomnia or poor sleep quality at night, napping might worsen these problems. Long naps might interfere with nighttime sleep.

When should I consider a nap?

You might consider making time for a nap if you:

Experience new fatigue or unexpected sleepiness
Are about to experience sleep loss, for example, due to a long work shift
Want to make planned naps part of your daily routine

Could a sudden increased need for naps indicate a health problem?

If you’re experiencing an increased need for naps and there’s no obvious cause of new fatigue in your life, talk to your doctor. You could have a sleep disorder or another medical condition that’s disrupting your nighttime sleep.

What’s the best way to take a nap?

To get the most out of a nap, follow these simple tips:

Keep naps short. Aim to nap for only 10 to 30 minutes. The longer you nap, the more likely you are to feel groggy afterward.
Take naps in the afternoon. The best time for a nap is usually midafternoon, around 2 or 3 p.m. This is the time of day when you might experience post-lunch sleepiness or a lower level of alertness. In addition, naps taken during this time are less likely to interfere with nighttime sleep. Keep in mind, however, that individual factors — such as your need for sleep and your sleeping schedule — also can play a role in determining the best time of day to nap.
Create a restful environment. Nap in a quiet, dark place with a comfortable room temperature and few distractions.

After napping, be sure to give yourself time to wake up before resuming activities — particularly those that require a quick or sharp response.

By Mayo Clinic staff

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Going the Extra Mile

THEPEAKTEAM — Wed, 28 Nov 2012 18:11:39 +0000

New Jersey physical therapist completes the Ironman Triathlon — and recruits other PTs to work this ultimate test of endurance.

By Jonathan Bassett

Posted on: October 23, 2012

High-level fitness is written into Mike Eisenhart’s DNA. His father was a marathoner, he played contact sports growing up, and now he and his two siblings operate Pro-Activity Associates, a thriving 20-person physical therapy, sports conditioning and workplace rehabilitation operation in Lebanon, NJ.

Still, Mike was never fond of long-distance endurance events until 2008, when his father expressed the desire to complete one final marathon before finally retiring from these grueling tests of physical and emotional staying power.

“I was the anti-runner in the family. To me, running was torture,” said Eisenhart, PT, who has concentrated on workplace rehabilitation during the last few years of his PT career and now works with a large contingent of area employers. “But after the pressure from my father and my brother, I decided to give it a try.”

Before long, Eisenhart found himself entering marathons, triathlons, and most recently, the 2011 U.S. Ironman in Utah and the 2012 U.S. Ironman in New York City.

The Ironman

This year’s New York City event was held August 11, a 140.6-mile race that included a 2.4-mile swim in the Hudson River, a 112-mile bike race along the cliffs of the Palisades Parkway, and a marathon that spanned a 26.2-mile course, crossing the George Washington Bridge and finishing in the heart of Manhattan, at 81st Street in Riverside Park. Participants in Ironman events have a maximum of 17 hours to finish the course.

The U.S. Championship Race is a qualifying event in the Ironman Series, a set of 28 such events held around the globe that qualify top finishers to compete in the Ironman World Championship, held each October on the Big Island of Hawaii.

“When you’re training for something like this, you basically choose one of three goals — to compete, to complete, or to win,” said Eisenhart, whose practice also helped train two other competitors for the U.S. Ironman. While he’s always in a training program of some kind, Eisenhart started training in earnest for the Ironman about eight months prior. Competitors must objectively calculate and track their miles and times for each of the three events, periodizing their training programs, scheduling proper rest breaks and learning their body-specific responses to what Eisenhart calls the “fourth discipline” of a triathlon: nutrition.

“This event is a pinnacle of achievement for triathletes,” Eisenhart said. “It caps months of preparation and the most important thing for participants is to cross the finish line.”

Recruiting other PTs

During his intense conditioning period, Eisenhart was struck by an idea. Since physical therapists are uniquely qualified to treat event-day aches, pains and injuries, why not station one PT alongside a physician and nurse in each medical tent along the route?

“It seemed like the perfect fit,” said Eisenhart, who also serves as membership director for the American Physical Therapy Association of New Jersey. After working with race organizers, he was able to secure 50 physical therapists to staff each medical station along the 140-mile race course.

Going even further, Eisenhart sought approval from the New Jersey state board to educate these PTs in this special practice setting. An educational webinar was followed by hands-on instruction in the finer points of treating endurance athletes, and a state-approved CE course was born.

“It’s a different kind of therapy,” said Eisenhart of the PTs’ medical tent responsibilities. “You have to shift your mindset of ‘we’re going to have this long-term rehab plan to get you back to full function,’ to doing whatever it takes to get the athlete to the finish line.” Most of the work involved hydration, dealing with the intense August heat, and minor injury triage. About 22 percent of competitors dropped out before the race began; another 6 percent had to drop out during the triathlon.

Unexpected Setback

So how did Eisenhart fare during his most recent Ironman challenge? While he was happy he finished, he was less than satisfied with the result. When you spend up to 17 hours swimming, biking and running, it’s often the freak accidents and equipment failures that can derail even the most conditioned and prepared ultra-athlete.

Eisenhart hit a pothole just a few miles into the bike portion of the event, which broke the support that anchored his water bottle to the bike. Because the bottle held about 80 percent of the calories he needed to complete the rest of the course, it was a disastrous development.

“They talk about runners hitting ‘the wall’ toward the end of a marathon,” said Eisenhart. “I hit the wall in mile 2.”

But Eisenhart pushed through the pain and exhaustion to finish in 11 hours and 20 minutes — not bad for someone who’s only been in the long-distance game for 4 years.

“In hindsight, I should have stopped right there,” he said of the water bottle incident. “I should have sacrificed the 10 minutes or so to get it fixed. These are the things that you learn as you go — there’s no real way to prepare for something like that.”

Looking Ahead

While the New York Ironman was a resounding success, the logistics of hosting an event of that magnitude in the congested New York area proved too challenging and expensive for the event to return to the area next year. Still, Eisenhart has his eye on other top-level races in the area that he hopes to continue recruiting physical therapists to staff and to receive CE credit for.

“It’s a concept that I hope to expand on a larger level,” said Eisenhart. “I feel it’s a win-win for the participants and the PT profession. We are doing this out of our love for the sport and our passion for physical therapy. We hope that our efforts help communicate our expertise as motion specialists to athletes and to other physical therapists.”

Jonathan Bassett is on staff at ADVANCE, and can be reached at jbassett@advanceweb.com

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Fall Prevention during Winter Months

THEPEAKTEAM — Mon, 26 Nov 2012 16:01:28 +0000

By Jennifer Rhodes-Kropf, M.D.

November 20, 2012

Let’s face it – winters can be tough. Months of frigid temperatures and heavy snow fall can make daily life difficult and isolation at home even more common for seniors. You can, however, safely maneuver through winter weather by realizing the high risk for falls during icy and snowy conditions and taking proper precautions.

As a staff geriatrician for Hebrew SeniorLife, I regularly see injuries from falls during winter months and urge patients to be extra vigilant when outdoors during the winter season. Fractured ankles and broken hips (especially for those over 50) are two of the most common injuries and can mean lengthy, frustrating recovery periods for seniors.

Before attempting to shovel snow or rush out for that last errand before a storm, consider these tips for fall prevention.

Focus on footwear: Rubber or neoprene soles, especially those with plenty of tread, provide better traction on snow and ice than either leather or plastic soles, making them the best choice for fall prevention.
Careful with cars: Many falls occur when exiting or entering vehicles. Always make sure your footing is clear when you get out of a car.
Beware of black ice: It’s just as slippery as regular ice, but difficult to see, making it a top winter safety concern. Stay on clear pathways or ones that have been treated with sand or salt.
Shovel safely: If you have to shovel, clear a level pathway to stand on so you won’t lose your balance.
Make winter safety a priority: Avoid rushing and allow yourself extra time to reach your destination safely. Avoid short-cuts through snow or over icy areas.

Remember, falls can happen quickly, but lead to long-lasting injuries.

Safety first!

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Thanksgiving Safety Tips

THEPEAKTEAM — Wed, 21 Nov 2012 14:45:44 +0000

Thanksgiving Day has more than double the number of home cooking fires than an average day according to the U.S. Fire Administration. In fact, each year more than 4,000 fires occur on Thanksgiving Day. To help prevent home fires this Thanksgiving, the Red Cross suggests the following tips:

Keep potholders and food wrappers at least three feet away from heat sources while cooking
Wear tighter fitting clothing with shorter sleeves when cooking
Make sure all stoves, ovens, and ranges have been turned off when you leave the kitchen
Set timers to keep track of turkeys and other food items that require extended cooking times
Turn handles of pots and pans on the stove inward to avoid accidents
Follow all manufacturer guidelines regarding the appropriate use of appliances
After guests leave, designate a responsible adult to walk around the home making sure that all candles and smoking materials are extinguished

Even with the best preparation and precautions, accidents can happen. Thanksgiving is high time for cooking related burns. Minor burns can be treated easily if you remember to save the butter for the rolls and not a burn. For a superficial burn, cool the area by running it under cold water until the heat eases and then loosely cover the burn with a sterile dressing.

Another danger that can interrupt a good turkey dinner is choking. The most common cause of choking is talking while eating. If you feel as if food may be caught in your throat, never leave the room, stay where others can see you and help if your airway becomes blocked.

To help someone who is choking, remember “FIVE-and-FIVE Can Keep Them Alive.” First, ask the person if they are able to breathe and if you can help. Once you know the person is unable to cough, speak or breathe, have someone call 9-1-1 or your local emergency number, lean the person forward and give FIVE sharp back blows with the heel of your hand. If the obstruction isn’t dislodged, give the person FIVE quick, upward abdominal thrusts. If you are alone, you can perform abdominal thrusts on yourself, just as you would on someone else. Thrusts can also be administered by pressing your abdomen firmly against an object such as the back of a chair.

Just because we get to take a break from dieting on Thanksgiving, does not mean we can throw caution to the autumn winds. Remember these suggestions and have a happy and safe holiday.

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Cold Weather Raises the Risk of Heart Attack

THEPEAKTEAM — Mon, 19 Nov 2012 15:17:59 +0000

THE FACTS

Looking at the medical literature, it is easy to see that winter can be a dicey season for heart patients.

Anahad O’Connor tackles health myths.

Many studies, some going back decades, have documented climbing heart attack rates during the winter. Some refer to the phenomenon as the Christmas coronary. To what extent winter raises the risk is a matter of debate. But one large study, using data on hundreds of thousands of heart attacks documented in the National Registry of Myocardial Infarction, found that 53 percent more cases were reported in winter than in summer. A pattern of decreasing occurrence of cases from winter to fall to spring and then summer was found across gender, age and geographic area.

The primary culprit, many believe, is temperature. Cold weather narrows arteries and raises blood pressure, stressing the heart. Physical strain and ruptured plaques caused by shoveling snow are also commonly cited.

But in a recent study presented at an American Heart Association conference, two researchers, Dr. Bryan Schwartz and Dr. Robert Kloner, found that the risk increases even in warm climates. Analyzing death certificates in seven regions with different climates — Los Angeles, Texas, Arizona, Pennsylvania, Massachusetts and others — they found that cardiovascular deaths rose up to 36 percent between summer and winter, regardless of climate and temperatures.

Dr. Schwartz, a clinical cardiovascular fellow at the University of New Mexico, said a number of things may be involved, including the spread of influenza and other respiratory infections. Seasonal affective disorder stemming from fewer daylight hours, as well as less healthy eating and exercise habits around the winter holidays, may also play a role.

THE BOTTOM LINE

Heart attack rates climb in the winter, though cold weather may be just one of several reasons.

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PEAK Putting Research Into Action!

THEPEAKTEAM — Thu, 15 Nov 2012 15:16:30 +0000

New Pulley System Aids Shoulder Rehab

BONNEY LAKE, WA — Davidson Therapy Products LLC has released a tool to improve patient comfort during rehabilitation from shoulder surgeries and frozen shoulders.The SLINGPROM™ is a patented shoulder pulley system that provides a more comfortable way to perform passive range of motion (PROM) shoulder exercises and joint mobilizations that can’t be performed with a traditional shoulder pulley.

According to the American Academy of Orthopedic Surgeons, close to 2 million people in the United States went to their doctors because of a rotator cuff problem in 2008. Up to 50% of this population will require surgical intervention to restore function to their shoulders.

In addition, it’s estimated that 3 to 5 percent of the U.S. population suffers from adhesive capsulitis (frozen shoulder) annually.

“I’ve been practicing outpatient orthopedics for over 12 years, and getting a patient to relax their painful shoulder during a physical therapy treatment can be very challenging,” said Rich Klein, a physical therapist in New York. “The SLINGPROM is a great device to achieve optimal patient relaxation, in order to maximize ROM improvements. It is very effective for postoperative treatment after rotator cuff repairs, as well as non-operative conditions such as adhesive capsulitis.”

“My 82-year-old patient sustained a right humerus fracture in October 2011 with very limited PROM using regular shoulder pulleys,” said Dominique Kohlenberger, MSPT. “When I received the SLINGPROM device I used it on her and she was able to increase her PROM immediately by 10 degrees in flexion and scaption because she did not experience any muscle pain while performing the exercise. With the SLINGPROM the rotator cuff musculature action was completely inhibited and the glenohumeral joint was able to move freely throughout its range.”

Visit www.slingprom.com

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Epidural Injections may put you at risk with meningitis

Sasha — Thu, 04 Oct 2012 00:48:42 +0000

Visit NBCNews.com for breaking news, world news, and news about the economy

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WOMEN AND HEART ATTACKS

Sasha — Wed, 22 Aug 2012 17:21:10 +0000

A topic everyone should aware and knowledgeable about.

Visit NBCNews.com for breaking news, world news, and news about the economy

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Sitting…could be harmful to your health!

Sasha — Wed, 11 Apr 2012 02:58:59 +0000

Sitting for just a couple hours has measurable (and negative) health impact

By Travis Saunders, MSc, CEP

Last week a fascinating study was published by SBRN member David Dunstan and colleagues in Australia, which examined the acute (e.g. short-term) impact of uninterrupted sitting on metabolic health. In this new study, individuals with overweight or obesity were asked to perform 3 separate conditions in random order.

Uninterrupted sitting – participants sat for 5 consecutive hours
Sitting plus light intensity breaks – similar to the uninterrupted sitting condition, except that participants had a 2 minute walk break at a light intensity every 20 minutes throughout the day
Sitting plus moderate intensity breaks – similar to the light intensity breaks condition, except that the breaks were at a moderate intensity

The figure below nicely demonstrates the basic protocol for the three conditions.

Dunstan et al 2012 (Diabetes Care)

In all three conditions participants were given a standardized 760 calorie test drink at baseline (for reference, that’s about the same as a medium McDonald’s triple-thick milkshake), and had blood taken every hour to determine the glucose and insulin response. This is pretty similar to an oral glucose tolerance test, except that the test drink included both sugar and fat, while an oral glucose tolerance test involves only sugar. This sort of drink will produce a spike in insulin and glucose levels in the blood, but a healthier person will have a lower spike than an unhealthy person. A big spike in glucose or insulin levels suggests that your body has to work harder to get sugar into your muscles, which is a sign of insulin resistance and a risk factor for diabetes.

So what happened?

Plasma insulin and glucose levels were higher on the day of uninterrupted sitting, in comparison to the days with light or moderate intensity breaks. And not just a bit higher – more than 20% higher! I’ve graphed the average insulin and glucose levels during each condition below.

Glucose response (Dunstan et al 2012)

Insulin response (Dunstan et al 2012)

Even more fascinating is that the groups seem to diverge almost immediately – in the figure below, you can see that the glycemic response to the test meal during the uninterrupted sitting seems to be distinctly higher than the other two conditions even just 1 or 2 hours into the session.

Glucose area-under-the curve (Dunstan et al 2012)

While that may seem surprising, another recent study published in Applied Physiology, Nutrition and Metabolism found that sitting for 2 straight hours (e.g. 120 consecutive minutes) following a standardized meal increased the glycemic response by >45%, in comparison to a combination of 40 minutes of very light intensity walking and 80 minutes of sitting. In other words, these people had a clinically significant increase in metabolic risk simply because of an extra 40 minutes of sitting following the test meal.

What does this mean?

Taken together, these studies strongly suggest that sitting for several consecutive hours has a measurable and negative impact on metabolic health (at least in individuals with overweight or obesity). This could go a long way to explaining the relationship between sedentary behaviour and mortality – if you are engaging in uninterrupted sitting for periods of a couple hours on a regular basis, that could be exposing your body to elevated glucose and insulin levels following every meal, which over the long term could have serious consequences.

On the bright side, these studies also suggest that simply taking an occasional walk break at a very light intensity could substantially reduce the impact of prolonged sitting. In the Dunstan study participants walked at just 3.2 km/h (2 mph), which is a leisurely stroll for most able-bodied individuals. In addition, participants were asked to identify how hard they were walking in the light intensity condition using the Borg scale. The scale goes from 6 to 20, with 6 being “no exertion at all” and 20 being “maximal exertion”. The average rating was 8, which falls between “extremely light” and “very light”. In other words, these participants were not “exercising” in any way – they were just standing up and walking around at a very easy pace, just as you might when walking from your desk to the washroom.

These studies are of particular interest to me since my thesis work is examining similar issues in children. With any luck I will have some data to report from that study later this year. Along with other members of our research group I have also recently completed a systematic review on the acute impact of sedentary behaviour, which found a surprisingly large body of evidence linking short bouts of sedentary behaviour with increased metabolic risk (e.g. reduced insulin sensitivity and increased fat levels in the blood). That review is currently in press, although it is currently available as a provisional pdf for those who don’t mind the formatting.

For those interested in learning more about the new study by Dr Dunstan and colleagues in Australia, I have embedded below a presentation by Dr Neville Owen who co-authored the above paper. Thanks to Dr Owen and SBRN member Ernesto Ramirez for recording the session and making it available online. And if you are interested in learning more about the impact of acute and chronic bouts of sedentary behaviour, be sure to check out the Sedentary Behaviour Research Network.

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