Depression in Patients with Chronic Illnesses

Depression is one of the most common complications for patients with chronic illnesses like heart disease, multiple sclerosis and diabetes. A chronic illness often introduces major life changes that restrict a person’s mobility, independence and ability to enjoy and participate in regular activities. A physical therapist is trained to identify and address symptoms of depression in patients with these life-altering diseases.

According to an Archives of Internal Medicine review article, exercise can reduce depressive symptoms in patients with chronic illnesses. Based on the authors’ findings, the article concluded that “patients with depressive symptoms indicative of mild-to-moderate depression and for whom exercise training improves function-related outcomes achieve the largest antidepressant effects.”

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Exercise in your First Trimester of Pregnancy

In honor of National Women’s Health and Wellness Day!

By Kristin Anderson, PT, DPT, OCS, CLT

In honor of National Women’s Health and Wellness Day in September, we wanted to remind you of the benefits of exercise!  Health and wellness is important at every stage of life, but today we want to focus on pregnancy since this can be a time of confusion and frustration for many women. Due to the large amount of information (and not always credible information), knowing what intensity and duration of exercise to engage in during pregnancy can be overwhelming. We see graphic images of women doing high intensity work outs, while other sources may tell us to not do any activity. The American College of Obstetrics and Gynecology (ACOG) published research in 2015 on standards of exercise. Remember, these are guidelines and we want to help you walk through them. 

With all women prenatal care is vital to the health of you and your baby!  Please check with your doctor if you have any of these medical conditions so that they can help guide you with your exercise protocol.

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Back to School, Back to You!

By Mara Towne, PT, DPT

It’s back to school time for kids in Colorado!  This is a great time for patients to refocus on self care!  Summer gets busy with vacations and a lack of a consistent schedule.  However, now that the kids are back on a schedule, isn’t it time to put your health back on your schedule as well?

Many of our patients have been mentioning in the last few weeks that they have not been able to be as consistent with their home exercises.  They would like to have better consistency. But, how do we make this happen?

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5 Easy Diet Tips to Help Prevent Bladder Leakage

Bladder leakage (called urinary incontinence or UI), is a common problem. In fact, one in three womenwill experience some form of UI in her lifetime. The physical stress and strain of pregnancy and childbirth, and hormonal changes during menopause, are common contributing factors.

The bladder, uterus, and bowel are held firmly in place by the pelvic floor muscles, which extend across the pelvis like a hammock. These vital muscles can become weakened over time, resulting in bladder leaks when you strain from laughing, coughing, sneezing, or other exertion. This is called stress urinary incontinence, and it’s one of the most common forms of UI.

Kegel exercises with a bladder biofeedback device like PeriCoach can help strengthen the pelvic floor muscles over time, reducing episodes of bladder leakage.

Diet matters, too. Certain foods can irritate the bladder or otherwise increase the likelihood of bladder leakage. Here are 5 diet tips to prevent bladder leakage.

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The Way You POO is Harming You (Seriously!) and Here's Why

This morning I noticed something.  When having a bowel movement, I come onto the balls of my feet while seated on the toilet. I’ve never noticed this habit before the Relaxx Footstool was sent to us for review.

Prior to the inventions of toilets, people squatted outside or used chamber pots to do their business.  


Many experts and doctors have long advised people suffering from constipation and hemorrhoids to elevate their feet on the potty.  Rebekah Kim, “a colorectal surgeon at the Center for Pelvic Floor Disorders at Virginia Hospital Center” told NPR:

Kim says one of the first things she tells patients who struggle on the john is get a stack of telephone books or a stool to rest their feet on…

“Squatting on a stool can reduce the amount of straining on the toilet, which may mean less hemorrhoids, but there are no clinical studies proving that,” she says. 1)

Even medical texts from the 1960s advised squatting.  According to Gastroenterology: The small intestine, absorption and nutrition, the colon, peritoneum, mesentery, and omentum by Henry L. Bockus, “The ideal posture for defecation is the squatting position, with the thighs fixed upon the abdomen.”2)


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Regular Sleep Makes for Happier College Students

The new school year is around the corner!  Get your students off on the right foot with good sleep habits!

SOURCE: Associated Professional Sleep Societies, news release

Between studying and socializing, college students often have crazy sleep schedules, and new research suggests that a lack of regular sleep may dampen students' well-being.

"We found that week-long irregular sleep schedules are significantly associated with lower self-reported morning and evening happiness, healthiness and calmness during the week, even after controlling for weekly average sleep duration," said study author Akane Sano.

A research scientist with the Media Lab Affective Computing Group at the Massachusetts Institute of Technology, she made her comments in a joint news release from the American Academy of Sleep Medicine and the Sleep Research Society.

The study findings were based on a month-long tracking of more than 200 college students between the ages of 18 and 25.

For 30 days, investigators monitored when the students went to sleep and for how long. They also asked participants to keep diaries to assess overall feelings of well-being.

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9 Bladder & Pelvic Floor Mistakes You Might Make Daily

Bladder and bowel control: most of us don’t appreciate it until it’s gone. You may find that loss of control happened suddenly, such as after childbirth. Or it may have sneaked up on you over time: last year you wore a pantyliner to absorb leaks, but now you rely on regular pads to do the job. Learn with Perine the 9 bladder and pelvic floor mistakes you might be making every day to sabotage your ability to control the bladder and bowels.

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Potty-Training Mom Smears Poop on Son's Face: This Doctor Isn't Shocked

Dr. Steven Hodges, MD


“I wiped poop on my son's face tonight. I don’t feel bad either.”

That apparently is how one Oklahoma mom handled (literally) her 4-year-old’s latest poop accident, in an incident she posted on Facebook.

The backlash was so harsh that she closed her Facebook account. I’m glad her post provoked outrage, but in truth, this is just an extreme version of a scenario that plays out all the time: children getting blamed for accidents.

In my decade treating children with enuresis (pee accidents) and encopresis (poop accidents), I’ve seen kids shamed by their parents right in my exam room. “He’s just being lazy” or “She’s old enough to know better” or “He’s doing it for attention. There’s no way a 10-year-old could poop in his pants and not notice.”

But there is!

If you read past the Oklahoma mom’s shocking first sentence, you will see the frustration and lack of knowledge I encounter daily in my clinic. “It’s like he doesn’t care to poop in his pants,” the mom writes. “It literally DOESN’T BOTHER HIM.”

I  know it seems impossible a child could not appear to care that he is sitting in poop, but this is easily explained: The accidents don’t bother this child because he cannot feel them. His rectum has lost sensation, and he does not notice when poop falls out.

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Some Children Don't Outgrow Bedwetting

By Steve Hodges, M.D.

Virtually every bedwetting patient in my clinic was assured by a pediatrician or urologist that on some magical day in the future, he or she wouldwake up dry, never to wet the bed again.

As the mom of a 16-year-old patient told me, “Every year, through age 5, 8, 10, 14, the pediatrician kept saying, ‘Don’t worry, he’ll grow out of it.”

Parents in our Facebook support group report receiving the same “reassurance.”

One mom posted: “Starting when my son was age 6, we were repeatedly told by two different family practitioners, “This happens. Don't worry, he'll outgrow it. A few comments that stand out in my memory: ‘When he really wants to stay dry he will." And: "Just wait till he really wants to sleep over at a friends' house. Suddenly he won't want all this attention anymore."

This boy is now 11 years old and still wetting the bed.

Another mom posted: “We were told every year at our son’s physical that he would outgrow it.

Finally, I took my son’s bedwetting into my own hands. A 15-year-old is not going to outgrow bedwetting!!”

She is right.

In fact, without appropriate treatment, even a 9-year-old is unlikely to outgrow bedwetting, research suggests — especially if the child wets nightly and has daytime symptoms.


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How Did Health Care Get to Be Such a Mess?

Christy Ford Chapman, New York Times

The problem with American health care is not the care.  It's the insurance.  

Both parties have stumbled to enact comprehensive health care reform because they insist on patching up a rickety, malfunctioning model.  The insurance company model drives up prices and fragments care.  Rather than rejecting this jerry-built structure, the Democrats' Obamacare legislation simply added a cracked support beam or two.  The Republican bill will knock those out to focus on spackling other dilapidated parts of the system.  

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Teenage Bedwetting: Everything You've Been Told Is Wrong

By Steve Hodges, M.D.

About 15 percent of my bedwetting patients are teenagers, and lately I’ve received a flurry of email from teens who wet the bed. The common theme:Nothing works. Nobody will help me. How can I go college like this?

From a 17-year-old girl:

“I cannot feel any urine going out, but I wake up wet every day. My mom thinks I'm stubborn and I don't want to wake up at night. I’m a very bright student, I might add. This is the only thing that pulls down my self-esteem. I can’t go to camps, and it’s so embarrassing not even my best friend knows.”

And this, from another 17-year-old:

“I’ve done special diets, alarms, being woken up at all hours by my parents, limiting drinks after dinner, and desmopressin a year now. My doctor isn't the kindest person and says I should just ‘get off’ my medication. If only he knew how hard it is. I try to live a life of a normal teen (sleepovers, trips, etc.) yet I'm always nervous to have an accident. Now college is approaching. I just can't give up on myself as quick as others have.”

Teenage bedwetting isn’t as rare as you might think, affecting about 2% of teens — well

over 800,000 U.S. kids and countless more worldwide. And among children ages 11 to 19 who wet the bed, 48% do so every night, and 29% also have daytime accidents, according to this survey of more than 16,000 children.


Interestingly, about 3% of children wet the bed at age 9. In other words, without treatment, children still wetting in fourth grade are pretty likely to wake up with wet sheets in high school.

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Is Bedwetting a Sign of Bullying?

By Steve Hodges, M.D.

For centuries bedwetting and accidents have been attributed to stress, anxiety, and psychological problems. Even today, you read about this alleged link in the popular media and in the scientific literature. I have countless patients who have been referred to psychologists by their pediatricians or schools. So, I was not surprised when a mom in our Facebook support group posted this question:

My 10-year-old started wetting the bed after 5 years of dryness, other than about 5 accidents per year. Could this be a sign of being bullied? He denies this cause. Nothing has changed in his or our lives except we are planning to get a puppy. My son doesn't like to poop away from home.

In medical jargon, bedwetting that starts after a long period of dryness is called “secondary” bedwetting. I have numerous patients whose bedwetting began “out of the blue,” according to their parents, and these parents, understandably baffled, often assume some hidden stress must be triggering this problem in their otherwise healthy child.

But X-rays demonstrate otherwise. Almost invariably, these kids are severely constipated — same as children who have wet the bed all their lives (aka "primary nocturnal enuresis").

The medical literature makes the unfounded assumption that primary and secondary bedwetting have different causes. For example, a 2016 Turkish study states that "secondary enuresis frequently arises from psychological factors," whereas primary enuresis is caused by "genetic predisposition, biological and developmental factors."

The National Kidney Foundation states, "The later the onset of the wetting, the more likely the cause is due to psychological stress."

But where's the evidence?

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I had terrible groin pain. If I had been a man, they would've figured it out sooner.

It was late spring in 2013 when I frog-kicked in a Maine lake and felt a nauseating tear through the front of my right hip. As I froze in the water and then struggled to climb back onto the dock, I shrugged off my concerns, thinking it was just another sports injury.

But in the week that followed, no amount of painkillers, ice or massaging could ease what I wanted to believe was a temporary strain. Back home in New York City, the pain consolidated into a small spot at the front of my hip that sent a neuralgic burning into my belly, lower back and the outside of my leg.

Often it was bearable, and I could run or do yoga and convince myself that I was fine. The worst days I spent on my back, writhing and mystified: I wanted to seek help, but the pain’s origin felt illusive, the problem not quite mechanical, and I feared the doctors would fail, as I had, to name it.

After a year, I had no choice. My active life had disintegrated, my sleep was fitful, my mind was unraveling. At scarcely 30, I felt ancient.

But doctors’ visits through the fall of 2014 into mid-2015 were as unproductive as I had feared. At a reputable medical group, the nurse practitioner who first ­examined me suggested stress. “Breathing helps” with pain, she advised.

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Urinary Incontinence is Never Normal!

A 2016 study by Silay, et. al found that 50% of women surveyed believed that urinary incontinence (UI) is normal with aging, and more than 15% didn't know that there are medical treatments for this condition.

Patient education is the first barrier to treatment, and pelvic rehab practitioners are working against decades of misinformation about pelvic floor dysfunction. Urinary incontinence in particular is frequently normalized. When 40% of geriatric women studied report UI, and it significantly impacts quality of life, there is a huge need for greater public awareness and capable pelvic rehabilitation practitioners.

Another recent study by Erekson, et. al found that pelvic floor dysfunction in women over 65 creates significant frailty risks that should be taken into account when considering medical procedures. Of 150 women surveyed, 65% were suffering from pelvic organ prolapse, and more than 50% were considered "frail" or "pre-frail". A pelvic rehabilitation practitioner, empowered with the right training, will be uniquely equipped to identify risk factors and advise patients as they consider treatment options.

Article courtesy of Herman & Wallace, Pelvic Rehabilitation Institute

Enjoy Sex: Breath Away the Pain

Posted: March 19, 2017 | Author: erikpeper | 

“After two and a half years of trying, ups and downs, and a long period of thinking it will never happen, it did happen. I followed your advice by only applying pressure with the cones while inhaling and at the same time relaxing the pelvic floor. We succeeded! we had “real” sex in the first time.”

Millions of women experience involuntary contraction of the musculature of the outer third of the vagina (vaginismus) interfering with intercourse, causing distress and interpersonal difficulty (ter Kuile et, 2010) or pain during intercourse (dyspareunia). It is estimated that 1 to 6% of women have vaginismus (Lewis et al, 2004) and 6.5% to 45.0% in older women and from 14% to 34% in younger women experience dyspareunia (Van Lankveld et al, 2010).  The most common treatment for vaginismus is sequential dilation of the vaginal opening with progressively larger cones, psychotherapy and medications to reduce the pain and anxiety. At times clients and health care professionals may be unaware of the biological processes that influence the muscle contraction and relaxation of the pelvic floor.   Success is more likely if the client works in harmony with the biological processes while practicing self-healing and treatment protocols. These biological processes, described at the end of the blog significantly affects the opening of vestibule and vagina are: 1) feeling safe, 2) inhale during insertion to relax the pelvic floor, 3) stretch very, very slowly to avoid triggering the stretch reflex, and 4) being sexual aroused.

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March is Endometriosis Month!

In a study published by the National Institutes of Health,  Dr. Pamela Stratton discussed the need for comprehensive evaluation of the musculoskeletal and nervous systems to look for sensitivity and trigger points in  women with persistent pain  due to endometriosis. (1)

Endometriosis is a condition where the tissue from  the lining of the uterus is found elsewhere in the body.

It is estimated that 10% of all women during their reproductive years from onset of menstruation to menopause are affected by this condition. This is equivalent to 176 million women throughout the world have dealt with this pain during the prime years of their lives. (2) This type of chronic pain significantly impacts the patient's quality of life and frequently results in:  depression, anxiety and   fatigue.  

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Mastering the Mindful Meal

By Kim Oliva, MNT, E-RYT


Root cause why we eat more

Eating while multitasking, whether working through lunch or watching TV while eating dinner, often leads us to eat more. On the other hand, eating "mindfully," savoring every mouthful, enhances the experience of eating and keeps us aware of how much we take in.

Current stats of eating habits

Adults in the United States devote an average of 1 hour and 12 minutes per day to eating, yet spend on average between 5 and 6 hours per day connected to some sort of technology. Our kids are rushed too. Studies have shown that school lunch periods provide an average of 7 to 11 minutes for students to consume their lunch. The speed at which we eat isn't the only problem. As a nation of multi-taskers, we often pair eating with other activities, such as driving or working at our desks. It is rare that we're simply eating when we're eating.

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What is Mindfulness?

We've been hearing the buzzword Mindfulness for quite sometime now but what is it really?

The American Mindfulness Research Association defines it as "the state, process, and practice of remembering to observe moment to moment experiences with openness and without automatic patterns of previously conditioned thoughts, emotions, or behaviors".

The organization continues to describe mindfulness as being able to "be cultivated through mind-body practices; such as focused attention and open monitoring meditation".

Mindfulness Based Stress Reduction (MBSR) seems to be the missing link and the healthcare system to promote a person's own health and healing.

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