I believe the most under-prescribed thing in medicine is exercise. I suspect the reason is because it is not something simple to do – it is not a prescription that can be written, nor is it a pill that can be taken. Exercise involves dedication, hard work and prioritization in your life schedule to make sure you have time to do it.

Exercise has clearly been found to prolong people's lives and to combat disease when disease arises. People who exercise live at a different level as they age into their 40s, 50s and 60s than those who do not. Multiple studies have shown that exercise, even to a moderate degree, combats heart disease and cancer, and prevents diabetes and obesity. Additionally, it has a significant effect on people’s cognitive function and overall well-being as they age.

So the questions are, “How much should I exercise?” “How should I exercise?” and “When should I exercise?” First of all, you must make exercise a priority. It must be as important as everything else in your life and a schedule must be set up that you are going to stick to on a regular basis so that excuses are not made. Otherwise, days and weeks can go by without exercising.

It’s important to try to exercise at least four days a week, 30-40 minutes at a time. If you want to get into really good shape, then my recommendation is for six days a week. The exercise should be a mix of both aerobic exercise, such as treadmill, bike, or walking, and some strength training, which is not quite as important, but is important for overall core strength and muscle development.

The intensity of the workout is also important. If you go to work out and only get your heart rate up to 40-50% of what it should be, you are not going to get the benefit that you will get at 85% of maximum predicted heart rate. A heart rate monitor and careful guidance from your physician is critical to make sure that you push your workout, particularly the aerobic side, to the point where you are going to get benefit and you are not just wasting your time. Therefore, I would recommend four to five days a week, 30-40 minutes of aerobic workout, with a heart rate at 85% of maximum predicted heart rate. Also include one to two days a week of muscle-training for overall strength and core strength.

If you can dedicate yourself to this type of workout, the benefits from a health standpoint and a heart standpoint are huge. It takes discipline and time, and the value is far worth what you put into it!

Many mothers worry about having enough breast milk when they return to work and want to get started pumping right away. Don’t worry – feeding your baby as often as he or she wants will help build your milk supply the first few weeks. Below are a few common questions many mothers ask when needing to start pumping for work.

What kind of pump should I get?
A double electric pump will help remove more milk than a single pump or manual pump. Many insurance companies reimburse for the purchase of a pump when you are away from your baby.

How soon should I start pumping to prepare for returning to work?
Start pumping one or two weeks before returning to work. Gradually add pump times when you would normally be pumping at breaks during your work day.

How often do I need to pump?
Usually, three times in an eight-hour period is sufficient to provide milk when away from your baby. Feeding more often at home can decrease the amount of milk needed when away as well. Decrease the time away from your baby by feeding just before leaving and as soon as you return. For further information on calculating your estimated pumping frequency, we recommend this online tool to calculate your magic number.

How do I get my milk to “let down” when I am stressed at work?
Bringing pictures of baby or something that reminds you of your baby will help. Massaging your breasts before pumping will also help release the milk. It is also a good practice to manually express after pumping to ensure the breasts are well drained.

How should I store my breast milk?
Breast milk can last six months in the refrigerator’s freezer and twelve months in a deep freezer. If the milk will be used the next day, storing in the refrigerator is fine. It can last as long as four to six days at refrigerator temperature. For long-term storage, it is best to store your breast milk in individual servings in BPA-free containers in the freezer. Store in the back of the freezer to avoid temperature fluctuations.

Questions?
Please feel free to contact Freeman Lactation Services with any questions or problems. Our services are free and open to everyone – including women who did not deliver their babies at Freeman. Our phone number is 417.347.1067. We are available for outpatient consultations by appointment as well.

One of the great things about exercise is that it works. Our bodies are designed to improve, with time and effort, to meet the demands placed on them. It is always amazing to see someone go from running for only a block or two to racing for 3-5 miles in a few short months. The body is marvelous at adapting to the demands we place on it, but the effect of exercise is very specific to the demands needed for any activity. The disadvantage of this adaptation is that our bodies also adapt to sedentary positions, which can sometimes cause problems and pain.

If our jobs require us to do a lot of sitting, we will gradually stretch out our backs until sitting becomes more tolerable. If we run for 40 minutes a day, our hamstrings – muscles in back of our legs – will get stronger and shorter to adapt to the distance trained. This is a normal occurrence, but it has some practical implications.

Our overstretched sitting muscles and stronger running muscles create an imbalance of movement. If the desk worker who runs on the weekends has developed an overstretched back and short hamstrings, when the worker moves to bend over, the body will move in the path of least resistance. Most of the movement would then occur at the worker’s low back, and this is not optimal. Ideally, when someone bends forward, much of the movement happens at the hips and legs. However, when our desk worker bends forward, the low back moves excessively due to changes from posture and exercise. After multiple times of bending forward, a strained back is possible.

So, you may be wondering if this person stop exercising. The answer is absolutely not. I would simply recommend this person makes sure to undo any unintended effects of his or her lifestyle and exercise. In this case, spending time sitting with the leg stretched out while at the office and adding some back strengthening exercise could allow all the benefits of exercise without the possible problems. Our bodies will give us exactly what we train for.

If you are like many of us who have lost weight, you find losing the last 5 to 10 pounds seems to be the most difficult. At the beginning of your diet, the weight seemed to come off fairly easy by watching what you ate and exercising on a regular basis – but now, what worked before doesn't work at all. Well, don't give up! There are ways you can get past the dreaded weight loss plateau. Try these tips!

Make sure you’re getting enough calories daily. Never go below 1200 calories because your body's metabolism may slow down at that point. I understand that it's hard to make yourself eat more calories when you are not losing weight. But, this may be exactly what you need to do. Visit ChooseMyPlate.gov SuperTracker to learn how many calories and exercise you need to lose weight safely. As always, check with your primary care physician or a registered dietitian to make sure your weight loss plan is customized to your specific needs.

Change up your exercise routine. If you have been working out on a regular basis, your body may have adapted to your routine, which means you’re no longer burning as many calories as you were before. If you have been strength training, make sure that you are challenging your muscles by doing more repetitions per session or adding a higher weight. If you have been exercising aerobically by participating in exercises such as walking, stair climbing or biking, switch things up by trying a different machine at the gym, adding an incline to your treadmill workout, or even participating in a circuit training routine. A certified personal trainer help you ensure your physical activity plan is safe for you.

Document your food intake and physical activity. If you aren't already doing so, log your daily food intake and physical activity. There are a variety of free apps to use such as Super Tracker, noted above, or you can keep track on paper if you prefer. You may find that you are actually consuming more or less calories that you thought. The same is true of calories you burn through physical activity.

Drink at least 64 ounces of water each day. Our bodies are 60-70% water. If we don't have enough water, many of our bodily functions don't work as well, thus slowing down our weight loss efforts. Water also helps curb our appetite. If you aren't already drinking your daily quota of water, add that in and see if that helps you shed the last 5-10 lbs.

I hope that by trying some of the suggestions above you find that your weight loss efforts are worth the hard work. Enjoy the sense of accomplishment that comes at the loss of those last few pounds. It really is worth the effort.

What are the signs of breast cancer?
Because breast cancer can present in many ways, and every woman's breasts are different, I tell patients to look for anything new or changing in the breast. Common signs and symptoms are:

• Mass or lump felt in the breast
• Change in the color or texture of the skin on the breast
• Dimpling anywhere on the breast
• Changes in the nipple, for example, becoming inverted or developing a red scaly patches on the nipple or areola
• Discharge from the nipple when not breast feeding

What should I do if I find a lump?
Most often, it is not breast cancer, but if you notice anything new or changing in your breast, let your healthcare provider know as soon as possible.

What steps can I take to help prevent breast cancer?
Although you cannot prevent cancer, you can take steps to reduce your risk:

• Maintain a healthy weight
• Stay physically active
• Eat fruits and vegetables
• Don’t smoke
• Limit alcohol consumption

Which exams detect breast cancer, and how often do I need each exam?
The gold standard for breast cancer screening is mammography. The American Cancer Society recommends women over age 40 have a mammogram every year. If you have a first-degree relative (mother, sister, daughter) with breast cancer, then you should start screening mammograms 10 years prior to the age she was diagnosed (but not before age 25).

Ultrasound is used to give more information on something found on mammogram. It can determine if an area is glandular tissue or a mass, if a mass is solid- or fluid-filled, and if there is blood flow to the mass.

Does a family history of breast cancer put a woman at a higher risk for breast cancer?
Having a family history of breast cancer can be a risk factor. If you've had one first-degree female relative (sister, mother, daughter) diagnosed with breast cancer, your risk is doubled. If two first-degree relatives have been diagnosed, your risk is five times higher than average. If your brother or father has been diagnosed with breast cancer, your risk is higher, though researchers aren't sure how much higher. In some cases, a strong family history of breast cancer is linked to having an abnormal gene associated with a high risk of breast cancer, such as the BRCA1 or BRCA2 genes. A test can be performed to see if you carry the BRCA gene mutation. Please contact your healthcare provider or call me at 417.347.4512 if you would like more information on testing.

How does breast density affect breast cancer? How does it affect mammogram exams?
Dense breasts have less fatty tissue and more non-fatty tissue compared to breasts that aren't dense. Dense breasts have more gland tissue that makes and drains milk and supportive tissue that surrounds the gland. Breast density can be inherited, so if your mother has dense breasts, it's likely you will, too.

Research has shown that dense breasts can be six times more likely to develop cancer. It can be harder for mammograms to detect breast cancer in dense breasts – breast cancers (which look white like breast gland tissue) are easier to see on a mammogram when they're surrounded by fatty tissue (which looks dark on the mammogram).

Referenced from breastcancer.org

For me, the quote above, a fun little quip nestled within the pages of a children’s book, has sparked a whole series of integrated metaphors. These metaphors all revolve around the idea of a traffic light as applied to children’s mental health issues. The subsequent blogs will include the following topics, with each able to stand on its own but also work together with the other blog segments.

Here is the foundation of the metaphor: traffic lights signal to the drivers what to do with their cars – go, stop or yield. The behavior traffic light, likewise, is a metaphor for how children and families can manage thinking, feeling and doing, i.e., behavior choices. The purpose of this mental health symbol is to help your family understand and manage a range of emotions, which often drive behavior choices. The ability to manage thinking, feeling and doing is important because what happens in the body affects the mind, and what happens in the mind affects the body. Teaching children about steering their bodies and emotions is good for the health of both body and mind.

From a clinical perspective, as children and adults practice this metaphor, it reinforces internal processes that then help with external change. Using the behavior traffic light is a great way to explain the concepts of cognitive behavioral therapy to those not familiar with the language of mental health, potentially replacing jargon and sterile terminology that is sometimes used.

Both adults and children can benefit from the behavior traffic light metaphor. One benefit of using this metaphor is that children and adults can easily internalize the lessons because they are already familiar with traffic lights. Lesson after lesson with positive experiences releases reinforcements via feel-good hormones. These electrical and chemical processes act like the glue to keep the body and mind connected in a healthy way.

Just as traffic control signs send messages to drivers about what to do with cars, it’s important for parents to communicate to their children in a way that promotes receptivity. Caregivers can encourage learning about managing emotions and explain how everyday living includes experiencing a range of comfortable and uncomfortable feelings. These messages from caregivers have benefits for the children, and adults benefit as well by responding intentionally. Such deliberate leadership cultivates child followership. With this relationship intact, progressing through the lessons of the behavior traffic light can embody the message “you are important and your life has purpose.” A caring but firm approach is calming for the child and adult, and feel-good hormones from the brain reinforce this strategy, acting like dabs of glue.

By glue, I am referring to the connection the brain makes between the inside and the outside world. The brain – an organ in the body just like the heart and lungs – is the control center of the internal and external signals of the body. Inside, the brain needs feel-good hormones to be aware and connect what is happening with thinking, feeling and doing. The brain pays attention to what is happening; the mouth, hands and feet simply do what the mind says. It is amazing how the exterior body is available to express the interior thinking and feeling. Using the behavior traffic light is one way to make sure the brain and its feel-good hormones stay in control at all time.

Otherwise, feelings try to take over traffic control. Feelings are healthy when they stay in the role of letting us know we have some internal thoughts and/or we've got some external action choices to make. Just as the engine of a car burns fuel to travel, feelings are temporary bursts of energy that give fuel for people to act. So, if a person has high octane feelings going on, they will burn hot and make decisions based on those heated bursts of energy. That can lead to difficulty with psychosocial functioning. Equally, a person running on empty in the feelings department might make feelings-based decisions that lead to underachieving, which is another type of psychosocial functioning problem. Feelings go up and down, and so do the levels of energy that go with them. These impulses can try to take over traffic control; those temporary bursts of energy do not make for good glue. Yet, with a strong internal behavior traffic light in place, children and adults can react appropriately when feelings of importance and purpose are challenged. This type of good mental health results helps us problem solve and become resilient, thus helping us make appropriate behavior choices during times of emotional distress.

The bottom line of the behavior traffic light: action choices should be based on a mind that is fully active with both thinking and feeling processes. The goal is to respond to life rather than reacting with impulses. The plan is to have the light be constantly “on” so responding in situations is standard practice as compared to having to resist the impulses as if a light switch is flipped on suddenly. Just as children need help with the learning process of driving a car, they need help with learning managing emotions.

I’d like to end this introduction of the behavior traffic light metaphor with a caveat: children start out with a “permit” to drive. As such, it is necessary that adults guide children in the process of becoming happy, healthy and safe participants in the adult world of good mental health and psychosocial functioning.

March is National Social Worker Month. Chances are, a social worker has impacted the life of someone you know – a patient, a friend or a loved one. Social workers provide our patients with emotional support, help them find solutions to difficult situations and connect them with vital services and resources. Freeman has social workers in a variety of departments at Freeman. For instance, dialysis social workers connect patients with resources that help make their dialysis experiences better, such as transportation, food, medical equipment and in-home services. In other departments, social workers may help ensure a patient’s discharge from the hospital is safe by connecting him or her with home care providers, medical equipment, rehabilitation and more. Today, we're interviewing Kim Bernot, Freeman Dialysis Social Worker, to learn about her experiences as a social worker.

Tell us about your career in social work – how you got started and what you do now.
I have been a social worker for the past 25 years. I obtained my bachelor’s degree in social work at Pittsburg State University and my master’s degree in social work at Kansas University. I started my social career with Ozark Center in 1991, working with people with mental illness and substance abuse issues. This truly got my feet wet in the field as this population has so many needs. Next, I worked at the Joplin Regional Center as a case manager for people with developmental disabilities. I continued to work with people with developmental disabilities in Kansas City for Pathways Supports while I finished my master’s degree. I oversaw in-home support for people with disabilities and also facilitated an autism support group.

Then, I went to work at Lansing State Prison to counsel sexual offenders. I continued to counsel sex offenders out of the Kansas City, KS parole offices until I went to work as a hospital social worker at Independence Regional Hospital near Kansas City. Most of my time at Independence Regional was spent as a social worker in the emergency room and on the geriatric psychiatric unit. I liked the hospital setting, and remained there until my family made a big move to Florida. I worked for nine years as a trauma social worker at Baptist Hospital in Pensacola, FL, a major trauma center. I spent most of my time in the intensive care unit and ortho-neuro floors, and the majority of my patients suffered from head and spinal cord injuries. This was probably the most challenging and rewarding position of my career. Currently, I work in the outpatient dialysis unit at Freeman East. I have so much respect for the patients and staff at this unit. The sacrifices that our patients make daily is amazing, and I am honored to help them along their journey.

Why do you like being a social worker?
I have always wanted the world to change for one reason or another – social work was a career where I felt I could actually make a difference. Instead of sitting back and wishing people or systems would change, I can actually help them along the way. Sometimes, that person or group just needs a little support and social work has allowed me to provide that. Most of the heroes in my life came in the form of patients or clients whom I've had the opportunity to meet because I was their social worker. In reality, they have probably blessed me much more than I did them.

Why did you choose Freeman?
What I love most about my current position is that I have the freedom to just jump in and make things happen. I can think outside the box and connect my patients with the things they really need to succeed while on dialysis. The team I work with shares my goals and genuinely cares about our patients. I want to make a difference and I can do that in my own way at outpatient dialysis. I've been given the opportunity to partner with a local food pantry and this has helped meet the nutritional needs of some of my patients. It’s nice to work in a place that supports me and my sometimes not-so-conventional ideas.

People around the world – drivers and nondrivers alike – can relate to the meaning of the colors red, yellow and green in terms of traffic control. Traffic lights help drivers determine whether to go, slow or stop. This understanding of a traffic light can be applied to good mental health interactions with children so well.

As I discussed in my last blog post, the benefit of using the behavior traffic light metaphor is that children see traffic lights in everyday activities and understand how the lights apply to car behavior. For example, children learn from adults about how “running a red light gets you a ticket” or “the yellow light means slow down.”

However, the messages of go, slow and stop as applied to mental health are not always as clear – there is wiggle room for what each of those terms means. For example, “control” does not have to have a negative meaning attached to it. The meaning a child attaches to the colors gives us clues to his or her perception of power, control and authority (of his or her own and with others). Adults can help cultivate healthy perceptions of self-control.

Children may hear the messages of go, slow and stop only as external forces that manage their thinking, feeling and doing (i.e., behavior choices). For good mental health, children must also develop the use of internal strengths to manage their behavior. Regularly exercising inner strength builds resiliency – the ability to face challenges. Resiliency helps children grow into adulthood with healthy perceptions of power, control and authority.

If the messages of go, slow and stop only come from the outside, the child’s capacity to face adversity may become compromised. One way that this can impair resiliency is the potential contempt for force of any kind – including the child’s own force. A child may direct resentment for outside forces inward and, therefore, not see himself or herself as important or having a purpose. The result is a child who could become dependent on external decision-makers. Contempt can also be directed at others, and the child may become too independent in his or her own sense of importance and purpose. Some children cycle through the objects of contempt, so it depends on whose importance and purpose they resent most in the current situation.

Summary:

• Contempt for self: too dependent
• Contempt for others: too independent
• Revolving contempt: cycles depend on direction of contempt

Thus, interactions about the colors of go, slow and stop can show how a person interprets navigating issues of power, control and authority.

Check back next week for more information about the colors of the traffic light as they apply to children’s mental health!

This quote reminds me of my hike in the Grand Canyon last summer with 23 other women. We set out on our journey to hike the Grand Canyon, rim to rim, on Friday June 13, 2014. The last set of switchbacks on the trail seemed never-ending by the end of day. One day had a heat index of 125 degrees Fahrenheit. Just when we thought we were near the end of the trail, there would be another set. Our group made it to camp with only a few hours to sleep before waking up to begin our climb out of the canyon.

The next morning, upon awakening with aching muscles, I thought for a moment, “I don’t think I can hike out of here.” I prayed for a mule to come by and take me out, or a helicopter to pick me up – even if it cost $1,000! I shared this thought with my friend who encouragingly said “You are going to get out of here and on your own two feet.” She mixed me an electrolyte solution that I drank and then I began feeling better.

The nine mile hike out for my group was difficult as well. The heat continued and even with stopping for water and snack breaks, there were times when it seemed that our hike would never end. But, it did. I cannot explain the feeling of joy, relief, accomplishment that I felt all at the same time as I took my last step out and was greeted with hugs from those who had come out before me.

I share this experience to let you know that you can reach your goals and you can overcome any challenges that may be in the path of your success. Don’t let your moments of weakness or doubt keep you from accomplishing your dreams or marking something off your bucket list. The straight stretches and the switchbacks will end, and you will cross the finish line and have a sense of accomplishment like none other!

When babies are born prematurely, their mothers’ bodies automatically begin to produce breast milk that is specifically designed for the baby’s stage of development. The breast milk aids the fragile early baby in developing the immune system, stomach, lungs and brain to catch up to their full term counterparts.

The first breast milk called colostrum is a thick yellowish liquid filled with antibodies, which help build the immune system. Colostrum is easy for the baby to swallow and digest – it has a natural laxative to aid in stooling which helps prevent jaundice. The colostrum also coats the intestines to prevent foreign substances from entering the body, lowering the risk of allergies and kills disease causing germs.

As mother continues to provide mature breast milk, she gives the baby antibodies and probiotics to build the immune system preventing serious infections such as necrotizing enterocolitis, (NEC), meningitis and RSV, a serious respiratory infection. It also helps develop the gut maturity and improve feeding tolerance.

The brain receives DHA and ARA, 2 fatty acids, as well as the milk sugar lactose from breast milk, which enhances brain and nerve development as well as the development of the retina of the eye. Studies show the more breast milk the infant receives, the more benefit the baby will receive. Many of pre-term babies are on a ventilator and oxygen, and statistics show that babies who breastfeed tend to have fewer days of oxygen therapy.

There are many benefits of providing breast milk to any baby, but these benefits are even more significant for premature babies. Breast milk protects these babies from harmful and in some cases, deadly, infections and helping the baby develop more quickly and thus go home sooner.