Health Topics

Managing chronic pain or overuse injuries is challenging for both patients and physicians. According to the CDC, an estimated 1 out of 5 patients with non-cancer pain or pain-related diagnoses are prescribed opioids in office-based settings, and it's well-documented that long-term use of opioid pain medications can be associated with abuse and overdoses. CHI Memorial Integrative Medicine Associates offers acupuncture as part of their use of both conventional and alternative methods of facilitating the body's innate healing response. 

Acupuncture is an effective, non-invasive medical protocol focused on correcting imbalances of energy in the body. It's used to treat a wide variety of health conditions and helps people get and stay well. An acupuncturist activates the body's Qi to improve the body's function and promote the natural self-healing process by stimulating specific anatomic sites, commonly referred to as acupoints. 

Part of my job is to lessen the pain and discomfort people are experiencing - without the need for medication or in combination with medication to provide relief. For someone with back, knee or shoulder pain who doesn't want to be on medication, trying acupuncture is a great option. It's also proven helpful in my practice for people who are working with their physician to get off or lessen their medication dependence.

What is Qi (Pronounced Chee)? 
In Chinese medicine Qi, or vital energy, flows throughout the body and protects it from pain, illness and disease. It circulates through specific pathways called meridians. The quality, quantity and balance of Qi influences a person's health, and it can be affected by physical or emotional trauma, stress, lack of exercise, overexertion, seasonal changes and diet. Acupuncture is recognized as an effective treatment for a range of conditions, including: 

• Abdominal pain
  
• Allergic rhinitis
  
• Anxiety 
  
• Bell's palsy
  
• Chronic gastritis
  
• Diabetes
  
• Earache or headache
  
• Facial pain or spasm
  
• High blood pressure
  
• Morning sickness and induction of labor
  
• Insomnia
  
• Knee or shoulder pain
  
• Nausea or vomiting 
  
• Neck, spine or low back pain 
  
• Plantar fasciitis
  
• Post-operative pain
  
• Prostatitis 
  
• Rheumatoid arthritis 
  
• Sciatica
  
• Smoking cessation
  
• Sore throat 
  
• Stroke
  
• Tennis elbow
  
• TMJ dysfunction 
  
• Ulcerative colitis
  

What Patients Can Expect
After taking a full health history including symptoms and lifestyle, an acupuncturist completes a physical exam of a person's pulse and tongue. This helps the practitioner create a structured treatment plan and detect any imbalance of Qi that may contribute to health problems. 

Once the imbalances are detected, hair-thin, solid, surgical stainless-steel needles are inserted to unblock the obstruction and balance Qi. The insertion creates micro tears in the tissue, sending signals to the body to send elastin and collagen to that specific location to aid in healing. Patients may experience a heaviness, tingling or dull ache where the needle is inserted. This is known as the 'Qi sensation' and is a completely normal sign that the treatment is working. With Qi freely circulating throughout the body, adequate nourishment is reaching the body's cells, organs, glands, tissues and muscles. This can eliminate pain and restore balance and the body's ability to heal itself.

Personalized Treatment 
The number of treatments and frequency is customized for each person and depends on several factors: constitution, the severity and duration of the person's condition, and the quantity and quality of a person's Qi. Some people experience immediate relief, while others require a longer treatment plan. A minimum of one month is expected to see significant changes. 

Each person has a different medical history, and that's why it's important to offer a variety of solutions based on that individual's needs. Wear and tear injuries, degenerative conditions, lifestyle, exercise level and age are all important factors I consider when developing a personalized treatment plan.

Liza Mercado, MSOM, Dipl. Ac. (NCCAOM), L. Ac.

In this year of uncertainty, an increasing number people are living with anxiety – many due to the stress from changes that have come with COVID-19. Stress is multilayered and is often accompanied by pain felt throughout the body. With changes in our normal work environment, anyone working or schooling from home is likely to feel the effects. The home computer isn’t always ergonomically friendly, causing neck, shoulder, forearm, wrist and back problems – not to mention the stress from not knowing what will happen next with jobs, schools or the economy.

Stress can result in many physical symptoms like headache or digestion problems. Sometimes stress and worry make the neck, shoulders and back tight, resulting in headaches or body pain that ultimately hinders a person’s ability to fall asleep or stay asleep. Other physical manifestations of stress and anxiety include migraines, Bell’s Palsy, TMJ, carpel tunnel, depression, panic attacks, constipation, pain and tightness everywhere, and unregulated menses.

One effective and minimally invasive option for addressing stress and anxiety is acupuncture, a practice that aims to correct imbalances of energy in the body. CHI Memorial Integrative Medicine Associates offers both medical and traditional Chinese acupuncture to treat a variety of health conditions and help people get and stay well.

How does it work?
The goal of acupuncture treatment is to activate the body’s Qi (pronounced "chee") to improve the body’s function and promote the natural self-healing process by stimulating specific anatomic sites, commonly referred to as acupoints. Acupuncture treatment begins by lying on a massage table either face up, face down, seated if hip problems are present or on the side if you’re pregnant.

A selection of acupuncture points are needled with whisker thin, sterile, stainless steel, one-use acupuncture needles to help create change or balance. The number of needles and how long they remain in place – from five to 45 minutes – depends on an individual’s needs. The first session typically lasts longer, and it’s where we discuss and review a person’s medical history and identify what benefits they hope to gain from acupuncture. In most cases, treatment is administered in this first meeting. Subsequent visits are up to one hour, where we touch base on how you’re doing before treatment begins. 

Personalized Care
Many people wonder how long the benefits of acupuncture ‘last,’ particularly related to their level of stress and anxiety. Because each person is different, the benefits, how long they last, and the number of treatments needed vary as well. Everything from a person’s medical history, age, diet, lifestyle, constitution or level of stress at the time of the session are factors that impact the longevity of each treatment.

My goal is to meet every person where they are at each session – finding ways to improve their quality of life by addressing stressors and offering tools to help live a calmer and more peaceful life.  

COVID 19 Precautions
CHI Memorial Integrative Medicine Associates follows strict protocols to keep patients safe, including masking, daily temperature checks, handwashing and sanitizing throughout the day. Social distancing is practiced at all times, and patients are screened for COVID symptoms over the phone before being escorted to a treatment room. Any person without a mask will be provided one. The acupuncture room is disinfected between each patient – including new linens and a thorough cleaning. After the session, checkout, payment and scheduling is available via telephone if preferred.

Liza Mercado, MSOM, Dipl. Ac. (NCCAOM), L. Ac.

Cholesterol is one of the building blocks of human cells – it occurs naturally in the body and is present in certain food products like meat and dairy. Not only is it essential for human tissues, it also aids in the production of sex hormones and fosters bile production in the liver. Cholesterol isn’t all bad, but if cholesterol levels are elevated, it could lead to coronary artery disease, stroke, peripheral arterial disease, Type 2 diabetes, and hypertension.

There are two types of cholesterol – HDL and LDL. HDL stands for high-density lipoproteins. We commonly call HDL your “healthy cholesterol.” HDL helps to remove other forms of cholesterol from your blood and takes it back to the liver where it is ultimately broken down and removed from your body. Having high levels of HDL helps lower your risk of heart attack and other health problems. The National Institutes of Health report that HDL levels of 60 mg/dL and higher may help keep your cardiovascular system healthy. But lower levels of HLD (think under 40 mg/dL) put you at increased risk for heart disease.

LDL stands for low-density lipoproteins, and we often refer to this as “bad cholesterol.” High levels of LDL can increase your risk of heart disease and stroke. This is the cholesterol you want to keep low – ideally less than 100 mg/dL. Triglycerides are a fat-like substance that can be found in the blood and can be used to give your body energy. These are commonly found in foods like butter or oil. Excess calories in the body can be turned into triglycerides and stored in fat cells around the body for later use.    

When it comes to cholesterol, men and women aren’t the same. According to the Centers for Disease Control, men tend to have higher LDL and lower HDL cholesterol levels than women do. However, after menopause, total and LDL cholesterol increase, while HDL decreases in women. This has to do with female sex hormones that can impact cholesterol levels.

Many people incorrectly believe that in order to have high blood pressure or high cholesterol you must be overweight. The reality is that you don’t have to be overweight to have high cholesterol. In fact, the risks for high cholesterol include family history of heart disease or high blood cholesterol, diabetes, older age, male gender, and previously having high cholesterol. Being overweight or obese is also a risk factor, but it is not uncommon to have elevated cholesterol in a patient who is not overweight.  

Why is it important to have your cholesterol checked? Simply put, lower cholesterol levels help reduce the risk of developing coronary heart disease, stroke, peripheral arterial disease, Type 2 diabetes, and hypertension, all conditions that can hinder your quality of life and lead to premature death. The CDC recommends checking cholesterol once between ages 9 and 11, once between ages 12 and 21, and every 4 to 6 years in adulthood. However, based on your family history or personal medical history, your physician may choose to check this more often.

Several factors come into play when aiming to lower LDL numbers or boost HDLs. In addition to cholesterol lowering medications, choosing foods that are low in cholesterol and saturated fats, managing your weight and getting regular exercise are all part of keeping cholesterol levels in check and minimizing your risks for cardiovascular disease.

Chelsea Ryan, DO

Behavior change is the concept that lies at the foundation of almost everything related to our health. It’s unfortunate but true that the default in the U.S. and many other developed countries is unhealthy behaviors. Poor diet choices, low activity and excess sedentary behavior, constant and overwhelming stress, and poor sleep with very little understanding of just how important it is for us is all too common. You can’t function day to day and address these roadblocks to health without paying conscious daily attention. This brings us to the key problem – most people already have too much on their plates before adding in shopping, planning, cooking healthy meals, 30-60 minutes of exercise, time to destress and then seven to nine hours of sleep!

We all fight the same daily battles. But in my job, I’m reminded every day of the consequences of not investing the time in these things. I see first-hand the ravages of the Standard American Diet (SAD), sedentary lifestyle and too much stress with too little sleep. It’s my job to work with people to help them make better choices. Sometimes that means fine-tuning their diet or finding ways to incorporate more exercise. And sometimes that means a lifestyle overhaul is necessary to get a person on the right track. Most of the time, it’s somewhere in between.

Addressing your health and wellness is not all or none – it’s a marathon that starts with a single step. Whether you are walking or running for that first step is up to you, but you have to make a commitment to take that first step, and the next and the next.  You also need to understand a few backward steps is also part of the marathon. You will have setbacks, but how you handle those setbacks separates those who are successful from those who aren’t.

The definition of health and wellness is not simply the absence of disease – it’s a very personalized and individual definition. It won’t be the same for an 80-year-old as it will be for someone who’s 30, and it won’t be the same for me as it is for you. But working together as a team – with the emphasis on preventable diseases – we help you strive for optimal health. This is living at your fullest potential, physically, mentally and emotionally. It doesn’t mean a life without disease, but it does refer to a life without preventable disease and to maintaining the highest level of function possible throughout your lifetime and in the face of illness. In real life, that means having the energy and strength to the things you want to do and spend your time on your own terms.

Most of us live below our optimal level of health – not due to disease or illness, but due to the lifestyle choices we make. Not only do these choices keep us from feeling our best, for many, they will lead to early onset of preventable diseases like diabetes, heart disease, stroke and cancer.

If you’re ready to make some big behavioral changes and take a more active role in your health, we’re here to help guide you. Whether it’s changes to your diet and nutrition, increasing your daily activity, addressing issues with sleep or more effectively managing stress, we partner with you in all areas of your lifestyle to help you live longer, keep disease at bay, and improve the quality of life in your years.

Patrick Wortman, MS, RD, LDN, NSCA 

When it comes to eating healthy, the first and most important thing to say is that there is no perfect or correct diet. There is no one size fits all, and despite what you hear from all the “experts” on social media, the news, your favorite magazine, a google search or wherever else you may find recommendations, everyone needs an individualized plan. They don’t know you or your relevant medical, genetic, social or cultural history. What worked for them may or may not work for you. This doesn’t mean you can’t use an eating plan as a template (Paleo, Mediterranean, DASH, plant based, etc).  Just know that you will need to make some tweaks and changes to make it work for you.

The next question you might be asking is, “what will actually work for me?” First, we talk about what is universally accepted and then share several different strategies that work for most people, most of the time. From there, we determine what works for you and fine tune it to continue working in the long-term. Take weight loss as an example. Americans often struggle with weight loss, but even if those who successfully lose weight often regain it later (plus a few pounds). There are several reasons for this, but it’s largely tied to the survival mechanism programmed into our biology.

If what you did to lose weight isn’t sustainable for the rest of your life, then you will eventually revert back to the same patterns that allowed or facilitated the weight gain in the first place. Your metabolism will have slowed down due to the weight loss (biology), you gain back the weight plus some for the next “famine.” Here are some things to consider when it comes improving your health through thoughtful diet choices.

1. Any changes you make to improve your eating to assist in weight loss must be behavior/lifestyle changes and made permanent. Small permanent changes are better than drastic but temporary ones. This applies to nutrition changes for ANY reason, not just weight loss. Cholesterol, blood sugar, blood pressure, or any other condition impacted by nutrition will get worse within days or weeks of reverting back to poor eating.  
2. The current food environment in the U.S. can work against you. Most of the food that’s in our normal diet is engineered to drive consumption. Food scientists and research laboratories are working to find the perfect combination of taste, texture and mouth feel to make food irresistible, leading to overconsumption.  
3. All the experts agree – you must significantly decrease your reliance on processed, refined and convenience food. Make eating real food a priority! Almost any of the popular diet plans will work to help you lose weight and improve health if it means lowering your intake of processed foods and sustaining that particular way of eating for the rest of your life.

Small Changes Add Up

When it comes to creating a healthy diet, small, manageable changes are the best place to begin. If you don’t cook much, try cooking one day a week. Make sure the meal includes lots of colorful plant foods and make a double recipe you can have for leftovers for lunch. Keep your favorite recipes – those that everyone likes or are easy to make – and increase the number of days you cook over time.

Another simple but effective idea is to “eat the colors of the rainbow.” This goes a long way towards eating a more plant-based diet and helps you be mindful about what you’re putting in your mouth. The six basic color families (red, blue/purple, orange, yellow, green, and white/tan) each contain their own powerful antioxidants and are great sources of the vitamins and minerals your body needs to function at its best.

Lastly, create an environment that will help you succeed – make your home a nutritional fortress! If your home isn’t free from foods that tempt you when you’re hungry or cause you to overeat when you consume them, clean out your refrigerator and pantry today. If it’s a food that you can eat one serving and stop, it’s probably fine in small amounts. But if you eat one serving and find yourself going back for more or finishing the package, it needs to go. Stock up on the foods that will help you meet your goals. This doesn’t mean you can’t enjoy your favorite treats in moderation – just don’t keep them in the house!

Patrick Wortman, MS, RD, LDN, NSCA 

When we think about exercise, it’s easy to overlook the cumulative benefits of activity, or not being sedentary (what I call wasting calories). Researchers have studied individuals who start an exercise program, and an unexpected thing happens. Individuals who start exercising regularly often do a little less during the rest of the day. They might park closer to the store, use the stairs a little less, or use email to communicate with a co-worker instead of walking over to their office. On average, people who started an exercise program decreased their activity enough the rest of the day to cancel out some or most of the calories they burned during their work out!  

If you’re an athlete and are already at your optimal body weight, then this pattern is fine and justified. But if you’re not at your optimal weight, then you’re negating some of the benefits you should be getting from your exercise. Even if you are exercising regularly, you still have to park farther away from the store, take the stairs, and do everything you can to burn calories whenever possible to ensure you maximize your exercise benefit.

The next important question is, “what should I do, and how much should I do it?” Just like with your diet and nutrition, there’s no black and white answer. The answer depends in large part on what your goals are, how much time you have to devote to exercise, and any medical issues you have. Since most of these are very individual, I discuss basic recommendations and encourage you to discuss the particulars with a physician or someone with the proper training to help you with the details.

If you’re looking to optimize your health and start feeling better and more energized, following current guidelines is the best place to start. This means some form of cardiovascular exercise for a total of 150 minutes per week. Most recommendations state 30 minutes 5 days per week, but you could just as easily do 50 minutes three days a week if that works better for your schedule. This exercise should be at moderate intensity, meaning you can carry on a conversation with someone but might need to take an extra breath or two every three to four sentences. If you can talk away for the full 30 minutes unhindered, you aren’t working hard enough. 

If you’re taking an extra breath every other word or can’t talk at all, you’re working at a high intensity. It’s a great strategy once you have a good base fitness level, and generally 20 minutes at high intensity is equal to 30-45 minutes at moderate intensity for cardiovascular exercise. If your primary motivation is general fitness, the type of exercise you choose isn’t as important as long as it gets your heart rate up. Each mode of exercise has advantages and disadvantages, but it’s most important to choose the things that you enjoy doing.  

Strength Training Matters 

Many people neglect the area of strength training, but it becomes critical as you age to slow down muscle loss. Starting in your late 40s to early 50s, men and women begin to lose muscle at approximately 1% per year. By your 70s, that rate of muscle loss accelerates to 1.5% per year. That’s why it’s important to include strength training two times per week for 20 to 30 minutes. You can’t stop muscle loss completely, but you can slow it down so it doesn’t impact what you want to do. No matter how old you are, your body will respond favorably to resistance training! 

You don’t have to go to the gym and lift weights to build your strength. If you don’t like the gym, elastic bands and body weight exercises will produce improvements in strength if used regularly. Keep things simple to start – spend 20 to 30 minutes doing eight to 10 difference exercises (upper body, core, lower body). Start with two to three sets of 12 to 15 repetitions of each exercise. If you’re able, consider purchasing a few personal trainer sessions to learn which exercises to do and how to do them safely. 

Consistency Is Key

If time is short and you don’t have 45 minutes for cardio, do what you can do. Even 10 minutes provides some benefit while reinforcing the exercise habit. Skipping one workout increases the likelihood that you’ll skip the next day’s work out as well. Although there’s no perfect time to work out, those who are morning exercisers tend to be more consistent, which is the key to success! Reasons to work out tend to accumulate during the day, so getting it done first thing eliminates that issue. 

Patrick Wortman, MS, RD, LDN, NSCA 

Menopause is a natural phase in every woman's life. It is the time when a woman stops having monthly periods, and the ovaries stop releasing eggs and making the hormones estrogen and progesterone. Most women are between the ages of 45 and 55 when menopause occurs. The average age is 51. Some women in their 30s can experience symptoms of early menopause, or perimenopause.

Most women start to wonder about menopause when their periods start to change. Common signs menopause has started include:

• having periods more or less often than usual (for example, every 5 to 6 weeks instead of every 4)
  
• bleeding lasts for fewer days than before
  
• skipping 1 or more periods
  
• symptoms of menopause, such as hot flashes
  

If your uterus has been removed, but you still have your ovaries, it might be tough to tell when you are going through menopause. Still, women who do not have a uterus can have menopause symptoms.

Those symptoms vary from woman to woman but most women have one or more of the following symptoms.

• Hot flashes - Hot flashes feel like a wave of heat that starts in your chest and face and then moves through your body. Hot flashes usually start happening before you stop having periods.
  
• Night sweats - When hot flashes happen during sleep, they are called "night sweats." They can make it hard to get a good night's sleep.
  
• Sleep problems - During the transition to menopause, some women have trouble falling or staying asleep. This can happen even if night sweats are not a problem.
  
• Vaginal dryness - Menopause can cause the vagina and tissues near the vagina to become dry and thin. This can be uncomfortable or make sex painful.
  
• Depression - During the transition to menopause, some women start having symptoms of depression. That's especially true for women who have been depressed before. Depression symptoms include: sadness, losing interest in doing things and sleeping too much or too little.
  
• Trouble concentrating or remembering things - This might be caused by lack of sleep that often happens at menopause, or by the lack of estrogen. Some experts suspect estrogen is important for good brain function.
  

Many women who experience these symptoms often wonder if they should see a doctor. If your periods start changing, you are 45 or older and you have symptoms that really bother you, see your doctor. For instance, you should see your doctor if you cannot sleep because of night sweats, or if you start to feel sad or blue and don't seem to enjoy things anymore.

You should also see your doctor if you:

• Have your period more often than every 3 weeks
  
• Have very heavy bleeding during your period
  
• Have spotting between your periods
  
• Have been through menopause (have gone 12 months without a period) and start bleeding again, even if it's just a spot of blood
  
• Menopause symptoms can be treated in a variety of ways. Options include hormone replacement therapy (HRT), antidepressants, and plant-derived estrogens.

The hormone estrogen is the most effective treatment for menopause symptoms and prevents osteoporosis (thinning of the bones). You should not take hormones if you have had breast cancer, a heart attack, a stroke, a blood clot or smoke.

Women who have vaginal dryness without other symptoms of menopause can try vaginal estrogen. This is a form of estrogen that goes directly into the vagina without systemic effects. It comes in creams, tablets, or a flexible ring.

Antidepressants can ease hot flashes and depressions. Even women who are not depressed can take them to ease menopause symptoms.

Plant-derived estrogens, or phytoestrogens, have been marketed as a "natural" or "safer" alternative to hormones for women with menopausal symptoms. Phytoestrogens are found in many foods, including soybeans, chickpeas, lentils, flaxseed, grains, fruits, vegetables, and red clover. Isoflavone supplements are phytoestrogens as well. Phytoestrogens have not been proven to help reduce hot flashes or night sweats. Most studies have not reported benefit. In addition, some phytoestrogens might act like estrogen in some tissues of the body. Many experts suggest women who have a history of breast cancer should avoid phytoestrogens.

Herbal treatments have also been used to relieve menopause symptoms, but studies have yet to demonstrate efficacy better than placebo. There are also some safety concerns. Some herbs, including black cohosh, might stimulate breast tissue, similar to estrogen. Like phytoestrogens, herbal treatments are not recommended for women with high risk for breast cancer. It is best to discuss treatments options with your doctor to ensure the safest, most effective therapy.

Osteoporosis is a big concern for women going through menopause. Women may take calcium and vitamin D supplements to help strengthen bones. Be active. Exercise helps keep bones strong. And ask your doctor when you should start having bone density tests. Your doctor can prescribe medicines to help keep your bones strong, if needed.

Mary McKenzie, DO