Better Health - May 2023

Better Health

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Depression is twice as common in women than in men, and the initial onset tends to peak during the reproductive years.

By C ORI U RBAN Special To The Republican

“So, it is not surprising that depression during and after pregnancy is one of the most common medical complications that a pregnant or postpartum woman may face,” said Dr. Elizabeth A. Rottenberg, chief of obstetrics and gynecology at Mercy Medical Center in Springfield and director of the Family Life Center.

Perinatal depression is defined as any major or minor depressive episode that occurs during pregnancy or the first 12 months after delivery.

Depression during pregnancy or within 12 months postpartum affects approximately 10-15 percent of mothers annually; 8-10 percent of men also experience symptoms of pregnancy- related depression, she added.

Some risk factors for pregnancy-related depression are history of anxiety and/ or depression, life stress, unplanned pregnancy, lack of social support, domestic violence or poor relationship quality.

Some risk factors for postpartum depression also include traumatic birth experience, neonatal intensive care unit admission and breast-feeding difficulties. Thus, “history of depres-

sion, whether postpartum or otherwise, is a risk factor for depression in subsequent pregnancies,” Rottenberg said.

If you or someone around you notices any of these symptoms, she recommends you make an appointment with your OB/GYN. “But do not feel like it is only up to you to recognize symptoms and seek help. We are here to help navigate the normal vs. abnormal mood changes of pregnancy and post-partum.”

Her practice screens for postpartum depression at the beginning of pregnancy, at around 28 weeks, immediately post-partum and again at six weeks post-partum using the Edinburgh screening tool.

The Edinburgh screening tool is the one most frequently used in research and clinical practice. It has been translated into more than 50 languages; it takes about five minutes to complete the 10 questions that prompt “recognition of depressive and anxiety-related symptoms but excludes some constitutional questions about things like sleep which are common … during pregnancy and post-partum,” Rottenberg said. “This tool is effective at its core, but also needs to be used in clinical context. In other words, if a patient’s score is normal, but they are tearful in the office and/or have a flat affect that is different from baseline, these are symptoms that still need to be addressed.”

If based on answers/results

healthcare providers believe someone is experiencing abnormal mood changes or is at risk for depression, there

can be a conversation in the privacy of the medical office.

But the doctor pointed out that the “baby blues” are normal for new parents to experience over the course of the first several weeks after delivery. This can include mood swings, crying and anxiety.

“Bringing home a new baby

pears as though everyone else “has it together,” she added. “Anyone who has not spent moments crying or feeling inadequate after delivery or bringing a child home has had a different experience than most of us. This is normal!”

Being that the baby blues are such a normal part of pregnancy — specifically

been a complete loss of joy or motivation to get up and face the day, despite knowing that there may be challenges to overcome.”

And she emphasized that it is never normal to have thoughts of hurting yourself or others.

For those suffering from postpartum depression, medication is an option. The most common medication used to treat mild-to-moderate symptoms of pregnancy-related or postpartum depression is a selective serotonin reuptake inhibitor — a type of antidepressant — that, according to Rottenberg, are safe and effective for pregnant and/or breast-feeding women.

“There are other medications that may be useful that aren’t as common, so it is important to discuss with your OB/GYN or mental health care provider to establish which may be best suited for you and your situation,” she added. “Referral to mental healthcare providers is important; medication and therapy together have been shown to have more benefit than either of the two alone.”

not get the help that they need to ensure that they are able to safely care for themselves; one cannot care for anyone else if they are not able to care for themselves.”

She advised that if something feels “off,” say something. There are tools to help detect pregnancy and postpartum-related anxiety and depression, “but this is an art as much as it is a science,” she said. “We are here to help navigate the vast spectrum of emotions involved with being pregnant and then supporting a newborn and your family at home. We can listen and provide advice/referral to non-obstetrical providers that can help with things like mental health and lactation, and we are proficient and knowledgeable about when it is important to suggest that we get involved medically. You can be a masterpiece and a work in progress at the same time.”

is a huge lifestyle adjustment that comes with changes in things like roles and responsibilities, sleep, appetite and libido. It is common to feel vulnerable, overwhelmed or ill-equipped for, arguably, one of the hardest jobs which is parenting and caring for another human,” Rottenberg said. Social media can be a “dangerous place” where it ap -

post-partum — recognizing true postpartum depression can be difficult. Less than 20 percent of women diagnosed with postpartum depression outwardly report symptoms. “We start to worry that the baby blues are becoming true depression when there becomes an inability to care for oneself or their baby,” the doctor said. “We worry when it appears that there has

In more severe cases of depression, or certainly psychosis, inpatient hospitalization may be necessary to ensure safety, she said. “Untreated adults with pregnancy-related or postpartum depression may have difficulty making sure that their newborn and/or other children in the household are appropriately clothed, fed and in safe spaces for sleep. The biggest risk to infants of women with postpartum depression is that their mother (or father) does

Most depressive symptoms that are truly pregnancy and/or postpartum related improve after 6-12 months, Rottenberg emphasized that it is important to be mindful of longer-lasting symptoms that may be an indication of a more chronic anxiety and/ or depression: “This is not something to ignore or be ashamed of, and treatment can safely continue beyond the 12- month mark.”

For more information, go online to massppdfund.org/ general-resources or ppdcommission.com

Depression is the most common mood disorder in the United States.

Above: Dr. Elizabeth Rottenberg, Chief of Obstetrics and Gynecology and Director of the Family Life Center at Mercy Medical Center, holds newborn A’layah Hollins. (PHOTO COURTESY OF MERCY MEDICAL CENTER)

How to pair Food with Exercise

Food pairing is often discussed in terms of which wines best complement particular dishes. But pairing food with exercise merits consideration, as it can create the balance needed for overall health. Food plays an important role in workouts, giving individuals the energy necessary to perform at their peak. Timing meals appropriately and knowing what to eat before or after a workout can make a difference.

Creatine benefits weight lifting

Creatine is an organic acid that is an important ingredient for short duration, high-intensity exercises, such as weight lifting. According to Kelly Pritchett, Ph.D., RDN, director of the nutrition graduate program and assistant professor of nutrition and exercise science at Central Washington University, foods rich in protein from meat, poultry and fish can help optimize stores of creatine.

Creatine also may be found in foods and beverages targeted to athletes, like protein shakes and snacks.

Pre-workout mixes include protein and carbohydrates

A snack or mini meal one to three hours before a workout is ideal so that digestive issues don’t occur during a workout when the body directs more blood to muscles than digestion. Food pairings that include a high quality carbohydrate, like whole grain bread or oatmeal, with a protein source, such as peanut butter or milk, can be key. Blood sugar will stay steady with whole grain carbs, and the protein will help you to feel full and avoid overeating after a workout.

Glucose, glycogen and running

Distance running or other exercises that require endurance, such as skating or biking, require ample energy stores. Although low-carbohydrate diets are popular for people looking to lose weight, they’re not ideal for people who engage in endurance sports and need carbohydrates for energy, states Johns Hopkins Medicine. Endurance athletes need more carbs than those who aren’t training. These activities use both glucose in the blood and glycogen, which is sugar stored in the liver

and muscles. Eating plenty of healthy carbs helps bolster energy stores. Whole fruits and grains are good sources of carbohydrates.

Benefits of bananas

For those with limited time to grab a bite before a workout, bananas might be the perfect option. According to WebMD, bananas have easily digestible carbs that will not weigh you down. The potassium in bananas also may help prevent muscle cramps during and after workouts.

Power up with potatoes

Potatoes are whole foods, meaning they contain a balance of all the essential amino acids, despite being low in whole protein. They’re also rich in vitamin B6, which is critical to protein metabolism, says Mark Anthony, Ph.D., adjunct professor of science and nutrition at St. Edwards University, Austin. Potatoes also contain the right mix of sodium and potassium to maintain an electrolyte balance in the body.

Recover right

A mix of carbohydrates and lean proteins also is ideal for exercise recovery. Mix in good fats like avocado and olive oil. Carbs will help replenish depleted levels of glycogen and high-quality protein will help build and repair muscle. Don’t forget to drink plenty of fluids to replace what was lost while working out.

Food and exercise go hand in hand. It’s important to eat well to keep the body in top form.

Women’s Health Issues

Diabetes:

significant and less publicized women’s health issues, recognition of which could potentially save lives.

Heart disease:

Though preventive care is often discussed in terms of diet, wellness checkups and physical activity, recognition of various threats to long-term health is equally important.

Certain women’s health conditions garner more attention than others. For example, efforts to raise awareness of breast cancer are extensive and widely known. But other women’s health issues have a tendency to fall off the radar, even if their prevalence merits greater consideration. The following are four

A 2020 report from the American Heart Association indicated that, in 2009, 65 percent of women were aware that heart disease is their leading cause of death. By 2019, that figure had dropped to 44 percent. In addition, in its 2019 Global Burden of Disease Study, the Institute for Health Metrics and Evaluation estimated there are 275 million women around the world with cardiovascular disease. Often and incorrectly considered a disease for men, heart disease poses a significant threat to women as well. Women can speak with their physicians about their heart disease risk and what they can do to maintain their long-term heart health.

The Centers for Disease Control and Prevention reports that African American, Hispanic/Latina, American Indian/Alaska Native, and Asian/Pacific Islander women are more likely to have diabetes than white women. But any woman can get diabetes, and the U.S. Department of Health & Human Services reports that type 2 diabetes is more common in adults who are 45 and older. The CDC also reports that diabetes increases the risk for heart disease in women by about four times compared to two times for men, which underscores how great a threat the disease is for women. Women can speak to their physicians about the significance of checking their blood sugar and the role diet and exercise can play in reducing diabetes risk.

Urinary tract infections:

The Office on Women’s Health notes that women get urinary tract infections up to 30 times more often than men. In addition, a 2016 report in the journal American Family Physician indicated that between 30 and 44 percent of women will have a second UTI within six months of an initial infection. The OWH indicates urinating when the need arises, drinking between six and eight glasses of water per day and additional hygiene measures are some ways to potentially prevent a UTI. Women can discuss more specific measures with their physicians.

Alzheimer’s disease:

The Alzheimer’s Association¨ notes that almost two-thirds of Americans living with Alzheimer’s are women. Figures are similar in Canada, where data from the Alzheimer Society indicates that just under 62 percent of those living with dementia in 2020 were women. The life expectancy of women is still longer than it is for men, which may explain the greater incidence rates of Alzheimer’s among women. However, women can still speak with their physicians about lifestyle choices that could reduce their risk of developing Alzheimer’s.

Recognition of less publicized issues that affect women’s health can be the first step toward reducing the risk for many conditions.

Preventive care is vital to maintaining overall health throughout adulthood.

Bite Back against Lyme disease

Among the tall grasses and wildflowers that sprout each spring and summer lies a stealth predator just waiting for its chance at an easy meal.

Ticks may be small in stature, but their impact on bite victims is potentially significant. Preventing Lyme disease and other tickborne illnesses comes down to following some key steps.

· Learn how common Lyme disease is. Lyme disease affects an estimated 476,000 people each year in the United States alone, according to the Center for Disease Control and Prevention’s Division of Vector-Borne Diseases. Lyme disease is most common in New England, the mid-Atlantic states and the upper Midwest. Between 2009 and 2022, the Government of Canada

Exercising

to promote healthier bones

Osteoporosis is a condition that affects both men and women, but aging women are notably more susceptible than men. The Mayo Clinic says osteoporosis causes bones to become brittle or weak, and overall bone loss can occur. While bone tissue is constantly being broken down and replaced, osteoporosis occurs when the creation of bone does not keep up with the loss of old bone. This makes bones susceptible to fractures and breaks more readily, particularly in the event of a fall or injury.

Good nutrition that includes calcium and vitamin D intake through natural foods and sometimes supplementation may help alleviate osteoporosis risk. But exercise is a key component, too.

Harvard Medical School reports that exercise reduces the risk of falling and also fracturing a bone if a fall occurs. According to an analysis published in the journal BMJ, programs of balance, strength and resistance training reduced the odds of falls resulting in fractures by more than 60 percent. The Mayo Clinic says exercise can increase

muscle strength and improve balance. It also can maintain or improve one’s posture, all factors that are vital to bone health.

Like muscle, bone is living tissue, so it can be strengthened with exercise. Here’s a look at the best bone-building techniques through exercise.

Weight-bearing exercises

While swimming and cycling can build strong muscles and offer cardiovascular benefits, they don’t do as much for the bones because these activities don’t involve weight-bearing.

Weight-bearing exercises force a person to work against gravity, and include walking, jogging, climbing stairs, dancing, and more, says the NIH Osteoporosis and Related Bone Diseases National Resource Center.

Muscle-strengthening exercises

Harvard Medical School suggests using the body’s own resistance to work against gravity and to build muscle strength. Using weight machines, free weights, resistance bands, and lifting one’s own body weight are some ways to do so.

Flexibility exercises

Engage in activities that help improve flexibility. Yoga has been known to improve flexibility across various age groups. Additional activities that move joints through their full ranges of motion may include acrobatic exercises like gymnastics, Pilates and simple deep stretching. The Mayo Clinic warns against stretches that flex the spine or cause a person to bend at the waist for people who already have been diagnosed with osteoporosis.

Balance exercises

Certain regimens will help improve balance to prevent falls. While yoga also incorporates balance, tai chi is another effective balance strengthening activity. Also, practicing standing on one foot at a time and tilting from side to side can help improve balance.

Osteoporosis does not have to be an inevitable part of aging. Engaging in bone-strengthening exercises can reduce the risk of developing this condition.

reported 17,080 human cases of Lyme disease across Canada. However, instances of Lyme disease are likely underreported due to undiagnosed cases.

· Know which ticks carry Lyme disease. The blacklegged deer tick and the Western black-legged tick carry the Lyme disease spirochete. The black-legged tick is native to the northeastern, mid-Atlantic and north-central U.S., while the western black-legged tick is found on the Pacific coast.

· Wear light-colored clothing outdoors. When traveling in areas where ticks reside, it is important to wear light-colored clothing. Long pants and tall socks, long-sleeved shirts, and hats also should be worn. It is easier to spot ticks on light-colored clothing, and covering up prevents ticks from gaining easy access to skin.

· Know where to expect ticks. John’s Hopkins Medicine says black-legged ticks live in moist and humid environments, particularly in and near wooded or grassy areas. Walking through leaves and bushes or through tall grasses can disturb ticks and enable them to jump onto people or pets.

To avoid ticks, walk in the center of trails and avoid tall vegetation.

· Be mindful of pets. Even if you do not venture outdoors into tick-laden environments, your dog may. He or she can carry ticks into the house where they may end up on you or other family members. Prescription tick repellent products are available from veterinarians, and there are topical solutions and collars that can keep ticks away.

· Remove ticks quickly and correctly. The CDC says if a tick is removed in less than 24 hours from when it first attached, the chances of getting Lyme disease is very small. Remove a tick with fine-tipped tweezers as soon as it is noticed, being cautious to remove all mouth parts. Try not to squeeze the tick, as it can regurgitate saliva and other fluids when squeezed.

· Repel ticks when possible. Create less favorable conditions for ticks. Use a product containing DEET or permethrin on clothing to repel ticks. Some people use chemical-control agents on their properties to reduce the number of ticks in the yard. Discourage deer from the property, as they can carry many ticks, by erecting fences and removing vegetation that deer eat.

Various strategies can help people reduce their risk for Lyme disease.