Better Health - Women's Health - March 2019

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Better Health D

SLEEP WELL: Good sleep is critical to good health, D2 DEPRESSION: Clinical depression in women, D2 WOMEN’S DENTAL HEALTH: interview with James Dores, DMD, D4

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The essence of pelvic health is to

EMPOWER women & men through education and sound clinical rationale/treatment with the tools needed for good self-care so they can

live a worry-free and pain-free life,”

- Patricia J. Young, Physical Therapist

By Anne-Gerard Flynn

Special to The Republican

Physical therapist Patricia J. Young believes in health care that treats the whole person and that is the approach at Restore Physical Therapy and Wellness Center that she founded and owns in Hadley. The center’s staff helps patients dealing with a variety of musculoskeletal and orthopedic conditions, but Young’s specialty focuses on what is called the pelvic floor where muscles work to support organs related to sexual performance and childbirth as well as bodily functions related to waste elimination. Problems such as incontinence of the bladder and bowel, organ prolapse and separation of the abdominal muscles are among common pelvic floor disorders. Causes may include disease, hormonal changes, injury as well as aging, pregnancy and childbirth and participation in high impact sports. It is estimated that one-quarter of women face pelvic floor disorders. Physical therapists like Young specializing in pelvic floor disorders evaluate and treat patients through protocols that do not involve surgery or medication. Young refers to her practice as an “integrative pelvic health center.” “It is integrative because we treat the whole body in terms of evaluation - not just a body part - and consider nutrition, mindfulness, acupuncture, pain management and lifestyle as part of the plan of care for everyone who comes

for care,” Young said. flags/concerns we might have health is to empower women A. The pelvic floor muscles “We have an interdisciplin- during exam or course of and men through education ary referral source to support treatment, we know whom we and sound clinical rationale/ provide support for the uterus, bladder and bowel. These our work when needed such can send them to.” treatment with the tools muscles are formed in a slingas psychotherapists, family Pelvic-floor related conneeded for good self-care so practice primary care provid- ditions treated at the center they can live a worry-free and like fashion from front to back ers, naturopathic doctors, ur- include organ prolapse, and side to side. You can look pain-free life,” Young said. ogynecologists, obstetricians/ diastasis recti and dyspareuat this muscle arrangement A graduate of the University gynecologists, midwives and nia, that is, painful sex due as scaffolding for the weight of Massachusetts-Amherst, doulas. We also have referrals to a variety of causes such as of the insides of your pelvis, a Young earned her master’s with urologists and gastroen- vaginal dryness, weak pelvic degree at Springfield College foundation if you will. There terologists.” muscle support or a history of and her doctorate of physical are openings in these muscles: The center’s clients are abuse. therapy at Philadelphia’s Tem- the vagina to the uterus, the predominately women, but Organ prolapse occurs when ple University. urethra to the bladder and the She was asked in the follow- anus to the bowels. However, Young said men are also seen weakened pelvic muscles for “pelvic pain, digestive cause one of the pelvic organs ing interview further about in an even broader picture, the pelvic health and its treatment pelvic floor is a group of musdisorders, urinary and fecal to drop down and diastasis cles that work in conjunction in women at her center. incontinence and post-surgi- recti is when the abdominal cal for prostatectomy.” with the rest of your pelvic muscles separate often as a Q. What do the pelvic floor muscles, such as your gluteals She added the center’s staff result of pregnancy. muscles support and how do “can treat most of the patients (buttocks), low-back and abThe center offers ongoing dominal muscles, and are also they become weakened after we see.” wellness classes as well. affected by your knees and childbirth or as women age? “Patients/clients come “The essence of pelvic ankles. either by self-referral or from When you standanother provider. up and walk you Sometimes they need all of these come with a dimuscles to work agnosis,” Young together. So, you said. need to consider “However, the how the pelvic physical therafloor functions pist has to do an in relationship evaluation which to your posture, involves clarifyweight, how you ing the root of breathe, your hormones, how you the problem not walk, how you lift looking at the and carry, as well symptoms. For as your diet and example, asking Young said. stress levels. why is the person If you address having incontinence or pelvic pregnancy and pain and how childbirth specifically, you have and why the therapist approach to note the many treatment is our changes a woman’s body goes approach.” Physical therapist Patricia J. Young is founder of Restore Physical Therapy and through. There She added, Wellness Center in Hadley. (PHOTO COURTESY OF MARY ELLEN KELLY) is a tremendous “If there are red

“Patients/clients come either by selfreferral or from another provider. Sometimes they come with a diagnosis,”

increase in pelvic floor stress with the growth of the baby. This causes pressure on bowel and bladder as the woman’s center of gravity shifts. She may experience pain in low back, groin and in the pubic bone area. During pregnancy she may also have increased urinary frequency and incontinence or constipation due to this pressure on bowel and bladder and of course the pelvic floor can become fatigued. During vaginal childbirth, the hormone relaxin causes the joints and ligaments of the pelvis to slacken in order to accommodate the descension of baby. The pelvic floor muscles are also relaxed and stretched during this time. How much so really depends on the individual and her circumstances. Women do heal well but have to remember it takes a few months to initiate the healing process and up to two years if the woman is breastfeeding or if there are other factors to consider. With regard to the aging process, not only do women have changing hormones and loss of muscle mass but they also have established both supportive and not-so-supportive habits/behaviors. It is important for women to have proper exercise and diet. Both are necessary for pelvic floor health because proper core strength and ease of bowel movements are essential in avoiding stressing the pelvic floor. SEE PELVIC, PAGE D4

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Sleep well Clinical Depression

in women

“It takes a village to raise a child,” is one of my favorite African proverbs as it succinctly embodies the value of belonging to a supportive community - reminding us of how impactful a group of us are in a child’s life when we put forth the effort and commitment. This idea of living in active community with one another is also essential to women’s health, particularly as it relates to depression. As much primetime as depression has received over recent years, many of us still are mistaken about what it truly means to be clinically depressed. And understandably so. When we hear the word depression we think of that sad, lousy feeling that comes on as a result of some disappointment or hurt that may linger for a few days, even for a week or two, that eventually passes as all emotions do. And while that depression is never a pleasant occurrence, it is not the same thing as experiencing clinical depression. Clinical Depression or Major Depressive Disorder is a serious, sometimes devastating mood disorder that persists beyond two weeks. It often robs you of your energy, your focus, your desire to be around others, and your ability to concentrate and remember. It can affect your sleep and eating

habits, your libido and your ability to feel any sort of pleasure, can cause excessive guilt, hopelessness, worthlessness, a lack of motivation and even thoughts of suicide. Put metaphorically, clinical depression is the hurricane, not the rainy day. It is not a disorder that one simply snaps out of or gets over. Ignoring it doesn’t work.

own 10 million businesses, and comprise 15 % of the military. But despite our undeniable value, many of us are severely depressed. It is estimated that more than half the women who experience clinical depression will not seek care. These are women in our everyday lives. They are our aunts. Our friends. Our coworkers. And they need us to step in and connect with them in a meaningful way. As our lives become busier, we seldom take the time to check in with each other anymore, especially face to face. Look around you and you’ll find that a lot of us are busy looking at our phones instead of at each Like all serious illnesses it other. This lack of connecrequires treatment. According to the National tion is taking its toll on our Institute of Mental Health village. I encourage you to 12 million women in the reach out to that aunt or that United States experience friend. Invite her to take a clinical depression each year brisk walk with you a couple and one in eight women will times per week. Invite her experience depression in her to do a fun activity with lifetime. Clinical depression you. Offer her a little more occurs most frequently in of your time, even if it women ages 25 to 44 but can amounts to being just a five develop at any time. Women minute call to share something light-hearted. It is experience depression at roughly twice the rate of men, okay to offer her the number to a doctor’s office or mental a point that experts in the field believe is due to genetic, health facility. It is okay to reproductive, hormonal, and offer to accompany her to the visit. social factors. As women, our contriThe good news is that butions to the planet have depression is a treatable been absolutely phenomeillness, even in severe cases. nal despite the challenges Let’s make ourselves and our that are unique to us. We village stronger by staying are essential to the success better connected and looking out for those who need of our families, constitute 47% of the U S Labor Force, our support.

Put metaphorically, clinical depression is the hurricane, not the rainy day.

Yejide Bell Lorenzo

received her undergraduate degree from Cornell University and her graduate degree from Springfield College. She is a licensed Marriage and Family Therapist and a licensed Mental Health Counselor at Behavioral Health Network Inc. where she practices individual, couples and family therapy.

Good Sleep is Critical to Good Health. Here’s your guide to healthy habits. You’ve no doubt heard the expression “You snooze, you lose,” but when it comes to your health, it’s quite the opposite. Your life’s quality depends on your alertness, and alertness depends on getting a good night’s sleep. “We all need sufficient and restful sleep to optimize our physical, emotional and cognitive well-being, as well as our daytime functioning and overall safety,” says Kristie Harrington, FNP-BC, a nurse practitioner at the HMC Sleep Center. To best understand how critical sleep is to our overall health, we need to appreciate the effects of not getting enough of it on a routine basis. “For an adult who sleeps less than seven hours per night,” says Harrington, “there’s increased risk for many adverse health outcomes.” These include an impaired immune response, increased pain response, headaches, diabetes, weight gain, stroke, heart disease, high blood pressure and even death. “In addition,”

says Harrington, “there are elevated risks of cognitive dysfunction, mood disorders, increased risk of errors and increased risk of accidents, especially workplace and motor vehicle accidents.” According to the Centers for Disease Control and Prevention, more than a third of American adults aren’t getting enough sleep, though it’s clear that sleep deprivation can cause catastrophe. It’s thought to have contributed to the errors that led to the 1989 Exxon Valdez oil tanker disaster, the 1986 Space Shuttle Challenger explosion and the Chernobyl nuclear meltdown that same year. Some 90,000 auto accidents yearly are linked to nodding off at the wheel, causing an estimated 800 fatalities and 41,000 injuries, according to the National Highway Traffic Safety Administration. However, there’s broad agreement that this is an underestimate of the impact of drowsy driving. Of course, good sleep takes time—at least eight hours. The body needs that time to complete all phases of sleep for muscle repair, memory consolidation and the release of hormones regulating growth and appetite. If it doesn’t get enough, weight and blood pressure rise along with the risk of depression, while resistance to illness, mood, judgment, reaction time, logic and creativity stumble. “Good sleep hy-

giene is critical to developing and maintaining an optimal sleep pattern,” says Harrington. Suggestions to make that happen include:

• Cutting caffeine from your diet after 2 p.m. • Limiting naps to 30 minutes. • Stop drinking liquids three hours before you go to sleep. The need to urinate disrupts sleep in 28 percent of adults, rising to 41 percent of those over 60. • Schedule 8 hours for sleep, and head to your bedroom an hour before that to begin releasing your day. Shut off TVs, laptops, cell phones and other flickering or blue light-emitting devices. To learn more or schedule an appointment at the HMC Sleep Center, call 413.534.2557.

“For an adult who sleeps less than seven hours per night there’s increased risk for many adverse health outcomes.” - Kristie Harrington

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The right foods can

fight inflammation The human body and its immune system excels at fighting foreign invaders like bacteria and viruses. Signaling chemicals called interleukins tell cells whether they are needed to fight illness or they should wait in the wings. While these immune defenders are doing their jobs, soreness, fatigue and swelling can occur - the natural side effects of an immune system response - but will soon dissipate. However, many people deal with immune systems that are consistently revved up, even when no invaders are present. This is the problem with many chronic diseases and immune system dysfunction. Unfortunately, the inflammation that is a hallmark of immune de-

fense becomes a daily problem that may result in chronic pain and other complications. What many people may not realize is that the foods that they are putting into their bodies may exacerbate inflammatory responses, while others may help keep inflammation at bay. People with rheumatoid arthritis, Crohn’s disease, Hashimoto’s, and other chronic illnesses may find that turning to the right diet can tame inflammation and other symptoms. Recently, many health experts, including Dr. Barry Sears, founder of the Inflammation and Research Foundation and author of the “Zone Diet,” and Dr. Andrew Weil, who offers the Anti-Inflammatory Food Pyramid, have begun to tout certain

foods that are purported to reduce inflammatory response over an extended period of time. As beneficial as some foods can be, it’s important to note that individuals are unique and certain foods may produce a particular response in some but not in others. Systematically isolating certain foods can help paint a picture of foods that can be problematic. But generally speaking, refined carbohydrates, sugar-sweetened beverages, fried foods, and processed meats may increase inflammation, advises Harvard Health Publishing. Conversely, certain foods and beverages that have been identified as reducing inflammation for many people.

These include:

· tomatoes · olive oil · green leafy vegetables and cruciferous vegetables · nuts, like almonds and walnuts · fatty fish · berries · avocados · green tea · peppers · grapes · turmeric · dark chocolate

Including these foods in one’s daily diet may help to relieve the pain, bloating and fatigue associated with inflammation. It is important to speak with a doctor before making any dietary changes. Discuss any inflammation issues you have been having and which foods might help. Generally speaking, a diet full of diverse, antioxidant-rich foods can provide relief for those with various levels of inflammation.

EMPOWERING

WOMEN

IN HEALTHCARE

Nancy Shendell-Falik, RN, MA became the first female president of Baystate Medical Center and senior vice president for Hospital Operations at Baystate Health in 2015. At right, the first class of nurses at Springfield Hospital in 1892.

For nearly 150 years, this community has entrusted Baystate Health with its health and wellbeing. From our earliest beginnings at Springfield Hospital, to the modern-day Baystate Medical Center, to today’s continually evolving integrated healthcare system, Baystate Health has grown alongside the many lives it serves. Throughout our progression, the women of Baystate Health - starting with our first class of nurses in 1892 to our current president of Baystate Medical Center - have been a constant force in transforming healthcare in western Massachusetts. To the 9,476 female employees who today comprise over 77% of our workforce – we thank you. Your purpose, passion and power have made our legacy of quality, compassionate care possible. Join our efforts as we advance care and enhance lives. Visit BaystateHealthJobs.com. CS10641

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THE REPUBLICAN | MASSLIVE.COM

manual work a therapist can do to help a woman feel more comfortable during this time. Having a good prenatal exercise program helps a woman be more in touch with her body and how to support the pelvic floor. All my pregnant clients come back for postpartum care to restore and replenish their bodies.

Q. What are some of the other most common issues that you help women address at your center? A. I also treat people who

have pain with sex, pelvic organ prolapse, diastasis recti, digestive issues, bladder pain, pubic and coccyx pain, low back and hip pain. My colleague Paul Warner focuses on the athlete in the 40s- to 60s- age range who wants to stay in best shape without injury. Carla Becker, a former dancer, loves to work with people who have movement challenges and uses Pilates as part of her physical therapy treatment. We can co-treat with patients who would really benefit from another physical therapist’s approach.

Hormones

and dental health

What every woman needs to know Keith O’Connor

of progesterone go up, which could cause swelling in the Women and men have difgums. redness, and bleeding ferent needs when it comes gums may happen more than to their heath and preventive usual. It is not normal to have medicine, and that applies to bleeding gums. This can dental health as well. usually be avoided with good “It’s all about hormones,” flossing and brushing and said Dr. James Dores of regular dental visits,” Dores Dores Dental in East Longsaid. meadow, noting women He noted dental visits can have hormonal cycles that vary depending on how your differ greatly from men and dentist assesses your risk for that vary throughout their oral health problems. It is lifetime. usually recommended to visit “Throughout a woman’s the dentist at least two times lifetime there are changes in per year. However, if your hormones, and during each dentist feels you are at higher stage there are risks for inrisk, than more visits could flammation of gums and gum be recommended. disease,” he added. Dores explained that When hormones change pregnancy can affect dental during pregnancy and menhealth in several ways. strual cycles, it can cause an “With changes in hormonal levels during pregnancy, increase in inflammation in oral tissues and gums. Often inflammation can occur, increasing risk for gum this can be prevented with disease. It can also result in regular checkups with your dentist and proper home care painful and irritated gums. Gum disease, or periodontiwith flossing and brushing. tis, causes weakening of the Menopause can cause dry supporting structures that mouth, which can increase hold your teeth in place and risk for tooth decay, such as cavities, as well as painful or keep them strong enough for chewing food. In late sore gums and osteoporosis. Osteoporosis is caused stages of periodontitis, tooth by decreasing estrogen movement occurs leading to levels which weaken bone. tooth loss, a process that may This happens throughout be painful for some. Morning the body including the jaw sickness can lead to vomiting, which results in acid bone. Decreasing jaw bone being attached on the teeth. strength can lead to loss of supporting structures for the This can weaken the enamel, teeth, increasing risk for gum which is the strongest outside layer of your teeth. It can also disease and possibly lead to cause an increased risk for tooth loss. “Specifically, during a cavities,” Dores said. woman’s period, swings in He noted that during preghormones occur. During ovu- nancy, some women may not lation and a few days before a be able to tolerate certain woman’s period starts, levels flavors of tooth paste. “I would recommend Special to The Republican

changing your tooth paste to one that is more neutral flavored or one that is more tolerable for you. The fluoride in toothpaste is the key ingredient that will help protect the outside enamel layer of your teeth. If you can’t tolerate any tooth paste, than try brushing without tooth paste. It is just as effective in that it removes the harmful plaque bacteria. To reap the benefits of fluoride, you can rinse after brushing and flossing with a fluoride mouth wash such as ACT fluoride rinse,” Dores said. Dores noted both women and men should talk with their dentist early on about any concerns they may have. “Concerns such as your fear of dentistry, post-traumatic stress, or a past traumatic event in your life can affect how you feel about coming to the dentist. Take time to establish a communication system with your dentist. So, if you feel anything uncomfortable during a procedure, then you can let your dentist know by raising your hand, for example. Once I know you are uncomfortable, then I can stop and make adjustments to make your experience better. This will put you in the driver’s seat in terms of taking control of your dental experience,” Dores said. “The best advice I can offer to women, as well as for men, is do not avoid going to the dentist at any stage of your life. This is important because conditions can be detected early on and prevented from progressing,” he added.

James Dores, DMD,

graduated from the University of Connecticut School of Dental Medicine and completed his residency at the UCONN Health Center. Dr. Dores has been practicing dentistry in western Massachusetts since 2006 and opened his own practice, Dores Dental, in 2010. Dr Dores and his team participates in the annual Dentistry From The Heart, providing local people with basic dental care who otherwise may not afford to receive.

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CONTINUED FROM PAGE D1

Q. Many women are said to

have urinary incontinence as a result of weakened pelvic floor muscles and Kegel exercises are often recommended. How difficult is it to strengthen these muscles?

A. It is often believed that women leak because they have weak pelvic floor muscles. That is not always the case. Yes, sometimes a woman is weak throughout her buttocks, hips, back and abdominals and the pelvic floor as well. However, there are other times when the pelvic floor is actually in high tone or too tight. In this case, it is her other pelvic muscles that are not supporting the pelvic floor. Consequently, the pelvic floor has too many demands on it and leaking occurs. These women may also have pelvic pain in addition to leaking. This is why Kegels should not be go-to exercises for all women who leak. The whole picture has to be assessed. Just doing Kegels for a weak pelvic floor is not the answer which is why so many women get frustrated when they don’t see results from doing just these exercises. If the exam reveals that these contraction exercises of the pelvic floor are also needed, then patients are taught how to properly do the contraction. Often times people cannot connect with the pelvic floor muscles or only do so partially which is not effective. Q. What are some of the

treatment options you offer at the center for this condition?

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Pelvic

A. When treating women for urinary incontinence we use a whole-body approach. A client will first have an orthopedic physical therapy exam where posture, walking, balance, reflexes, sensation and muscle strength are checked in standing, seated and lying down. Then a pelvic floor exam is done and carefully explained. A patient always has the option of declining the internal part of the exam that is done to assess muscle volume as

well as the muscles’ ability to contract and relax, joint movement, pain points, sensation and skin integrity. In gathering all this information, we then have the ability to decide how to approach a woman’s problem. Is it stress? Is it weakness or a challenging walking pattern? Is she extremely weak in one area? The approach to treatment always incorporates manual therapy, that is, bodywork, exercises/stretching, as well as discussion of diet and self-care. In other words, it is not usually one factor that contributes to this problem. The pelvic floor physical therapist clarifies the factors contributing to the patient’s concerns and empowers her to make positive changes.

Q. Once a woman has weakened pelvic floor muscles how long does it take to correct this problem and is there a need to continue to address their strengthening in an ongoing way?

A. There are many factors

that play into correcting this problem but with consistent attention to the exercise program and lifestyle changes one can see improvement in several weeks and know what factors in her life exacerbate the problem.

Q. What advice do you give women to avoid the issue of weakened pelvic floor muscles, and is there something that pregnant women can do to lessen this issue? A. Keeping an active life-

style with attention to your pelvic floor is important. There are women who love to run and some have no problems with it but others I recommend walk uphill. Get your heart rate up for a good cardio workout without the pounding of running. Learn basic core stability exercises that do not put extra pressure on the pelvic floor. Maintaining a healthy body weight is important as increased weight puts more pressure on the pelvic floor. Don’t get constipated. Pushing and straining also puts adverse forces on your pelvic floor. Pregnant women need to have access to pelvic floor physical therapy to help with low-back and pelvic pain or other concerns they may have. There are exercises and

Q. When did you open your center and what inspired it? What need do you feel you were meeting in the community in terms of women’s health care and why a trauma-based approach to some issues?

A. I opened my clinic a

little over six years ago. I was inspired to do so based on some of the events I experienced during my child-bearing years and in talking to other women about the challenges they have had in health care. Every person wants to be heard and have a choice about how to best resolve their impairment. I want to offer health care without the use of drugs, injections, or surgery for those who seek that avenue. Most importantly, I want to work collaboratively with the patient. I also work with other disciplines I can refer out to if needed such as psychotherapy, nutrition and acupuncture. A trauma-based approach is essential in working in pelvic floor physical therapy as often times a person’s source of pain is from an earlier traumatic event or events in their lives. Trauma can also make physical therapy challenging or limited. If this is noted, we ask that if the patient is not currently working with a psychotherapist, that she connects with one. Doing pelvic floor work can trigger people with a trauma history and we want a woman to have all the support she needs while participating in treatment so she can receive her best possible outcomes.

Q. How has the center

grown and has it grown in any ways that you did not expect?

A. The center has grown organically in that we have made an amazing network of incredible people in the community. We have so many family members, friends and colleagues of patients who are an important part of Restore. The doulas and midwives in the Valley have been invaluable resources for prenatal and postpartum clients. Our interdisciplinary colleagues are supportive and insightful, allowing us to provide the best care for our clients. The next step is to train the new generation of pelvic floor physical therapists in our integrative approach to women’s health. I am hoping to mentor a new physical therapist over the next several months to be able to offer more help to women who need this type of care. We need to demystify what pelvic health is, provide support to women in a way they choose, and focus on wellness.


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