Dispelling Common Myths about Cosmetic Procedures

By: Denise Baker, RN, Plastic and Reconstructive Surgery

There comes a time in every woman’s life when she looks in the mirror and wonders, “When did that wrinkle get there?” Plenty of us have spent dollars upon dollars on products or procedures that we hope will make us look and feel younger. But with such a wide variety of treatments available, how can you be sure what’s best?

A fear of the unknown prevents many from trying a new procedure. I never imagined I would try Botox, but once I did, I realized it provides me the results I’d been hoping for.

As someone who helps to administer a wide variety of cosmetic procedures every day—and has tried them personally—I’d like to offer some advice and dispel some common misconceptions that might be stopping you from getting a non-surgical cosmetic procedure.

Myth: Non-surgical cosmetic procedures are not as transformative as cosmetic plastic surgery.

Non-surgical procedures often address many of the same issues that surgical procedures address. In fact, Juvéderm, for example, can treat facial hollowness more effectively than surgery. Results vary depending on the procedure, but most results last months or years. Some may even last a lifetime. Additionally, non-surgical procedures cost significantly less than surgery, require little to no recovery, and have a very low risk of side effects, which are usually mild and only temporary.

Myth: Botox and Juvéderm work the same way.

While it’s true that both decrease the appearance of wrinkles, dermal filler Juvéderm fills and Botox relaxes. Botox relaxes the muscle that’s creating the wrinkle, diminishing the appearance of lines and creases, while also helping to prevent the development of new wrinkles. Juvéderm is frequently used to fill in wrinkles and restore volume to the folds around the mouth and hollowness under the eyes. In some patients, pairing the two treatments together will provide the best results. Many women will have Juvéderm injected into their lips to give them a fuller pout.

Myth: Botox isn’t safe.

Clinical use of Botox is the result of more than 100 years of studying botulinum toxin type A. Botox is one of the world’s most widely researched medicines, with approximately 2,300 publications in peer-reviewed scientific and medical journals.

When administered by a skilled physician, it is one of the quickest and safest treatments for smoothing wrinkles. The most common side effects after receiving a Botox treatment are minor pain at the injection sight and headaches. Cases with individuals experiencing more serious side effects are extremely rare.

Myth: Botox injections are a painful.

There is very little pain associated with a Botox procedure. You will experience the pricking sensation of the needle, but the procedure is so quick, it’s over before you know it! As someone who doesn’t like needles, I promise you I can hardly feel the injections.

Myth: Botox injections should be administered only to persons above age 40.

I’m 29 and I have wrinkles–everyone is his or her own worst critic. A trained professional will advise you on whether Botox is appropriate for you and what areas of your face or neck would benefit.

The most common areas where Botox is administered are the forehead, between the eyes (known as the glabella), and the outer corners of the eyes to treat “laugh lines” or “crow’s feet.”

Myth: Juvéderm isn’t safe.
Juvéderm is safe for a majority of people. It is made from hyaluronic acid, which is a naturally occurring substance found in all biological organisms, including humans. It is produced without any animal substances and is FDA-approved for use in people of all skin tones and types.

However, Juvéderm is not recommended for use by women who are pregnant or breastfeeding, those with a history of multiple or anaphylactic allergic reactions or individuals under the age of 18.

Myth: Dermal fillers wear off after less than a year.

Some fillers can wear off in less than a year. However, JuvédermVoluma gives patients a subtle lift, restoring contour and a more youthful profile for up to 2 years. It is the first injectable gel filler to receive U.S. Food and Drug Administration approval for the purpose of increasing fullness and firmness and decreasing sagging and loose skin in the cheek area in patients over the age of 21.

Deciding to get a non-surgical or surgical cosmetic procedure can be nerve-wracking, but it is also exciting and empowering. Learn even more about your options for feeling beautiful and confident by joining my colleagues and me for Ladies’ Night Out at Olbrich Gardens on April 24th at 6 p.m. Everyone who attends will receive 25% off Botox® Cosmetic, Juvéderm® XC, Juvéderm Voluma™ XC, and cosmetic vein care treatments at Meriter!

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Meriter Children’s Center Celebrates The Week of the Young Child

Martha Harrison, manager of MCC, read to the children as part of the week long celebration of The Week of the Young Child.

This week Meriter Children’s Center has been celebrating The Week of the Young Child. This annual celebration is an opportunity to focus public attention on the needs of young children and their families.

To celebrate, the children have participated in several activities including chalk the walk, breakfast on the go, beach/bubble party and story time with Martha. The week will end with a 5th Quarter Celebration on Friday, April 11 at 10:45 a.m. Members from the UW Marching Band will lead the kids in a parade to Meriter Hospital horseshoe for the final celebration! If you are at the hospital on Friday, please stop out to the horseshoe area to participate in the exciting event!

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Industry Experts Assess the ACA

In a recent InBusiness article, Dr. Robert Turngren, president of Meriter Medical Group, joined a panel of local industry experts to assess the Affordable Care Act’s long-term impacts.

Click here to read the complete article.

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Seven Ways to Better Manage Your Allergies

Suffering from seasonal allergies? Be sure to avoid allergic triggers to manage your seasonal allergies.

By: Dr. Jeremy Bufford, Allergy/Immunology

If you suffer from seasonal allergies, you may have started to notice a runny nose or itchy eyes. From avoiding allergic triggers to options for preventing and treating symptoms, here are several suggestions to manage your seasonal allergies.

  1. Common misconceptions about allergies. People often assume their nasal and respiratory symptoms are due to the common cold, when, in fact, the symptoms are manifestations of seasonal allergies. Seasonal allergies often bother patients the same time each year and last for several weeks at a time; whereas the common cold should be short-lived and resolve within 7-10 days.
  2. Diagnosing, managing or curing allergies. Allergists can diagnose allergies through skin testing, blood testing or challenge testing. They will discuss avoidance measures with patients, including environmental changes that can be made in and around the home to avoid particular allergens. Allergists will prescribe over-the-counter and/or prescription medications to help control symptoms, but at this point there is no true “cure” for allergies.
  3. Avoid your allergic triggers. This could include avoidance of environmental allergens such as pets, dust mites, molds and pollen, or avoidance of food allergens, stinging insects or drugs.
  4. Prevent or control symptoms during allergy season. In terms of environmental allergies, including seasonal allergies, patients can use OTC and/or prescription medications to prevent or control symptoms during their allergy seasons. These medications include antihistamines, nasal decongestants, nasal steroid sprays and allergy eye drops. Allergy immunotherapy or “allergy shots” can be considered as well.
  5. Presentation of allergy symptoms depends on the type of allergen. The initial symptoms may be mild, moderate or severe and potentially life-threatening. Seasonal and other environmental allergies can present as runny nose, sneezing, nasal congestion; itchy, red, watery eyes; or cough, wheeze and shortness of breath in patients with asthma.
  6. Practice avoidance of indoor allergens at home. If you have seasonal allergens, avoid outdoor exposure in the early morning hours, keep your windows closed, run your air conditioner and don’t hang clothes or bed linens outside to dry.
  7. People and allergens can coexist. As long as people obtain the proper diagnosis, recognize and respect their allergic triggers and practice avoidance measures, people can coexist with allergens. Patients with environmental allergens can avoid triggers and prevent and control symptoms with medications.

If you have concerns about allergies or allergic disorders, please arrange to see an allergist for an appropriate work-up, definitive diagnosis and avoidance recommendations. Learn more about Meriter’s allergists and immunologists.

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Meriter Launches Interactive Experience for JointCare Program

Meriter Health Services announced today a new experience for their JointCare program, allowing total joint replacement surgery patients to access and interact with their care plans online.

The interactive care plan, designed by Madison-based Wellbe, is fully integrated with all aspects Meriter’s existing patient program — pre-admissions testing, JointCare class, and physical therapy — to create a single, streamlined experience. The new program is offered to all hip or knee replacement patients at no extra charge.

“The program helps us engage with patients in a new, innovative way, empowering them to be educated and involved in their care,” said Phil Swain, Director of Orthopedics and Rehabilitation at Meriter. “From pre-operative preparation to post-operative rehabilitation, the program will provide patients with the information they need to achieve the best possible outcome.”

A patient’s online care plan is accessible 24 hours a day via the web on any device. Meriter Hospital staff enroll patients when they are scheduled for surgery, and the program guides patients step-by-step through preparation, hospital stay and recovery from surgery. Everything patients need to know, do, and keep track of is conveniently provided to them at just the right time.

Enrolled patients get convenient online access to all the information they need right when they need it along the journey of care, including:
• Checklists and reminders to make the surgical journey less stressful
• Convenient access to important educational materials regarding total joint replacement
• Informative videos, including follow-along exercises
• Ability to do planning and complete forms online to simplify paperwork
• Surveys to provide the surgeon and orthopedic team with important feedback
• Updates delivered to family members as patients progress through the program

“Guided patient engagement throughout the care cycle can help improve outcomes, reduce risks of setbacks, and speed up recovery,” said James Dias, CEO of Wellbe. “We are excited that our friends, families and neighbors in Dane County will be able to benefit from the use of this new tool.”

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Dr. Dana Johnson: Many Choices for a Safe Night’s Sleep

A trip to the baby store will quickly show you there are numerous options available for infant sleep locations. Some are recommended and some are not.

Originally published on March 27, 2014, in the Wisconsin State JournalDr. Johnson is a pediatrician practicing at the Meriter McKee clinic.

Dear Dr. Johnson: I am expecting and trying to plan where my baby will sleep. What is your recommendation?

Dear Reader: A trip to the baby store will quickly show you there are numerous options available for infant sleep locations. Some are recommended and some are not.

The first step is to determine what room or rooms where your baby will sleep. The American Academy of Pediatrics (AAP) recommends room-sharing where infants sleep in the same room as their parents until 6 months of age. The advantage of this is that it is easier to respond to a newborn’s needs during the night when in the same room. Studies also show a reduction in SIDS (sudden infant death syndrome). Babies should, however, have their own area for sleep outside the parents’ bed.

I have found that most parents know if room sharing is a good option for their family and when it is time to transition their infant to his own room.

In the infant’s room, most parents find a crib to be the best sleep location. Some basic safety components are to make sure the crib slats are no more than 23/8 inches apart and that the mattress fits snugly with less than 2 finger widths gap around the edge. Avoid bumper pads and drop side cribs. If using an older crib, check the Consumer Product Safety Commission website at www.cpsc.gov to ensure it has not been recalled.

If you have a large master bedroom, a crib may fit in your room and be a good option there as well. Many people choose smaller beds for the baby, however, when room sharing. Some of these options include a bassinet, a bassinet with a drop side, or a pack ’n play (some with a bassinet option).

When comparing these various options, the AAP recommends babies sleep on a firm, flat surface to reduce SIDS. I have found it advantageous to be able to have my babies close to the bed so I can touch them without getting out of bed. Sometimes a gentle touch, rocking side to side or replacing a pacifier is all an infant needs to be soothed back to sleep. If I don’t have to leave the comfort of my own bed, even better. Having them close can also benefit breast feeding and overall bonding.

It is not recommended that babies sleep in swings, car seats, bouncy seats or other places where they are in an inclined, sitting position.

You may find that a combination of sleep locations works best. Some babies will nap in their crib in their own room and sleep in a bassinet in their parents’ room overnight. No matter which option you choose for your baby, make sure the mattress and sheets are snug-fitting, there are no heavy blankets or stuffed animals in the bed, and your baby always sleeps on his back until he can roll onto his stomach on his own.

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Fifteen Tips for a Healthy Pregnancy

By: Sara Babcock, Clinical Nurse Specialist at Center for Perinatal Care

During your first visit, your provider will ask you many questions to help guide pregnancy management. You will discuss the time of your last menstrual period and ultrasounds for the pregnancy. It is important to have accurate dating for the pregnancy, so an early ultrasound can help determine your due date; however, a baby’s due date is only an estimate. In fact, women don’t usually deliver exactly on their due dates. Most babies are born between 38 and 42 weeks after the first day of a woman’s last period. Your provider will also discuss many important things for you to consider during your pregnancy. These may include:

1. Take a prenatal vitamin. They can be prescribed by your practitioner or you can buy them over the counter, and you should ensure it contains 0.4 mg of folic acid.
2. Avoid chemicals that could possibly harm your baby. This would include avoiding fumes often associated with paint and wall paper.
3. See your dentist before you get pregnant and brush your teeth daily.
4. Stop drinking alcohol, smoking and using street drugs. Smoking, drinking alcohol and using street drugs can cause many problems during pregnancy for a woman and her baby, such as premature birth, birth defects and infant death
5. Get help for violence. Violence can lead to injury and death among women at any stage of life, including during pregnancy. The number of violent deaths experienced by women tells only part of the story. Many more survive violence and are left with lifelong physical and emotional scars.
6. Stop changing cat litter.
7. Rest when you can—nap!
8. Weight gain recommendations.
9. Review the signs of premature labor and warnings signs for when to call.
10. Take a childbirth class. Sign up early to ensure you get the class and dates that you want.
11. Take a breastfeeding class to help prepare you for breastfeeding.
12. Write a birth plan. Develop a plant to help you clarify what you want or need for your birth experience. Share this with your practitioners and those you have invited to your birth.
13. Have film and cameras ready!
14. Practice relaxation whenever you can. Try for at least once a day.
15. Do pelvic tilts to help with late pregnancy back pain. It will help relieve your pain and even encourage the baby to assume a good birth position.

Taking Medicine during Pregnancy
There may come a time during your pregnancy when you’re feeling under the weather and aren’t sure if you can take your regular over-the-counter (OTC) medication. Some medications are safe to take during pregnancy, but other medications are not or effects on your baby may not be known.

When you meet with your provider, ask what medications you can take and what medications to find alternatives. Generally, you should not take any OTC medication while pregnant unless it is necessary.

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How to Choose Your Obstetrician

There are several types of health care providers who can care for your needs during pregnancy and childbirth. Be sure to explore your options and evaluate what is most important to you before making a decision.

By: Sara Babcock, Clinical Nurse Specialist at Center for Perinatal Care

If you’ve decided to have a baby, the most important thing you can do is take good care of yourself!

When planning for a pregnancy it is always a good idea to have a preconception health visit with your provider. Together, you will review your current health and discuss certain aspects that may impact you or your baby’s health. This visit can help ensure that you are physically ready for pregnancy and that your baby will be as healthy as possible.

Once you are pregnant, see your provider as soon as possible to begin getting prenatal care. Choosing who will help care for you during your pregnancy, labor and delivery is very important. There are several types of health care providers who can care for your needs during pregnancy and childbirth. Be sure to explore your options and evaluate what is most important to you before making a decision.

Some obstetric health care providers to consider include:

Obstetrician-Gynecologist (OB/GYN): A medical doctor who is specially trained to provide medical and surgical care to women, OB/GYNs spend four years after medical school in a residency program studying pregnancy, reproduction and female medical and surgical problems. To verify the credentials of an obstetrician, contact the American Board of Obstetrics and Gynecology. Specialists who mainly provide pregnancy care are obstetricians while gynecologists primarily provide female reproductive system care.

Certified Nurse Midwives (CNMs): Specially trained, licensed professionals experienced in providing obstetric and newborn care, CNMs provide comprehensive, family-centered maternity care from the first prenatal visit through labor, delivery and after the birth of your baby. Midwives are registered nurses who have earned their master’s degree in nursing, with a strong emphasis on clinical training in midwifery. Midwives work with obstetricians who are always available to assist if complications occur during pregnancy, labor or delivery.

Family practitioner (FP): A medical doctor who specializes in the health care of all family members. FPs provide normal OB/GYN care but will refer high-risk pregnancies and other problems to an OB/GYN. All family practitioners are trained to perform cesarean births in an emergency and also to assist other specialists in doing the procedure.

Perinatologist: Also called maternal-fetal medicine specialists, a perinatologist is an obstetrician who specializes in the care of women who may face special problems during pregnancy. These include young women under age 18 and women over age 35; women with certain medical conditions such as diabetes, hypertension and sexually transmitted diseases; women with inherited (genetic) disorders; and women who have had problems with previous pregnancies. Perinatologists manage high-risk pregnancies, preconception counseling and sophisticated prenatal diagnosis and treatment.

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Meriter Receives Recognition from Salvation Army

L to R: Tobi Cawthra, Community Relations Manager; Jim Woodward, President and CEO of Meriter Health Services; Chris Ziemba, Development Manager at The Salvation Army

Meriter is pleased to receive recognition from the Salvation Army for its involvement in the Red Kettle campaign. Meriter staff participated by ringing bells at several locations.

The Salvation Army has been an excellent partner to Meriter in the development of the Helping Educate and Link the Homeless program, developed by Meriter hospitalist and current Chief-of-Staff, Dr. Cate Ranheim. The Salvation Army also is the home base for another non-profit organization supported by Meriter, the Madison Dental Initiative. The Madison Dental Initiative provides free dental care to those who are homeless or at risk of homelessness.

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The Truth about Colonoscopies

By: Dr. Gary Griglione, Gastroenterology

Each year, March is recognized as Colon Cancer Awareness Month. Colon cancer is the third most common cancer in the United States and the second leading cause of cancer-related death that affects both men and women, behind lung cancer. But it doesn’t have to be this way; educating the public about the importance of screening for the disease can save lives.

The purpose of a colonoscopy is to ensure you’re healthy and stay healthy. Talk with your doctor today to learn more about colonoscopies and find out whether one is right for you.

Below are a few things you need to know about colonoscopies.

1. Colonoscopies can PREVENT colon cancer.
Colonoscopies allow a physician to examine the inside of your large intestine (colon). We’re looking for small growths of tissue on the wall of your colon, called polyps. Most of these polyps are precancerous in nature and, when left to grow, will turn into cancer. Finding these polyps during a colonoscopy allows us to remove them before they can become cancerous.

2. Colonoscopies can DETECT colon cancer while it’s still in an early stage.
Polyps left to grow develop into cancer over time. Individuals most often do not experience any symptoms until the cancer is large. Unfortunately by that time, the cancer may not be curable. Some common symptoms of colon cancer include blood in or on the stool, stomach pain, alteration in bowel habits, aches or cramps that do not go away, and unexplained weight loss. If you have colon cancer, a colonoscopy is the best way to find it in an early stage, making it easier to remove and hopefully cure.

3. You should schedule a colonoscopy if you are age 50 or older, or at an increased risk for the disease.
Although the disease can occur at any age, the majority of individuals diagnosed are over the age of 50. A healthy adult should first get screened soon after his or her 50th birthday and approximately every 10 years after that, until the age of 75. Some individuals may need a colonoscopy at a younger age or more frequently (every 3-5 years), including those with certain gastrointestinal conditions, those with a family history of colon cancer or polyps, or those who were found to have polyps on prior colonoscopy. The disease affects men and women equally.

4. They’re just not that bad.
Colonoscopies save lives. Still, many people avoid them for as long as possible – or entirely. I can promise you, most of my patients tell me that their colonoscopy wasn’t that big of a deal.

  • The day before the procedure, you will need to completely empty your colon. Historically, that involved drinking practically gallons of sometimes rotten-egg-tasting fluids. This is not the case anymore. In fact, at Meriter, standard procedure involves mixing flavorless Miralax into a low-volume (approximately half the amount used in the past) clear liquid of your choice, like Gatorade or fruit juice.
  • The actual procedure takes typically 30 minutes or less. Many people sleep through their exam and have no memory of the actual test at all.
  • When you’re done with the procedure, you will likely feel a little sleepy, groggy or confused. After a friend or family member drives you home, you will spend the rest of your day relaxing.
  • Even following a polyp removal and biopsy, you should feel only minor discomfort after the exam. Because we insufflate air into your colon to allow us to see during the exam, many people experience some slight cramping due to residual gas. This generally lasts just a few hours.
  • The great news is if no abnormal growths or polyps are found, you will not need another colonoscopy for 10 years.

The purpose of a colonoscopy is to ensure you’re healthy and stay healthy. There is a lot of hype, but the procedure isn’t nearly as bad as many might have heard or expect. I encourage you to talk with your doctor to learn more about colonoscopies and find out whether one is right for you.

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Best Tips for Flying with Your Children

Make sure that each child has an activity bag for the flight. It can include items such as books, washable markers, a blank composition notebook and a favorite stuffed animal.

By: Dr. Kristin Millin, Pediatrics

Wisconsin in the winter makes all of us question why we have chosen to live in the Midwest.  My survival tool is to think about vacations in warmer climates.  I love to fly in an airplane, but flying in an airplane with small children brings on other emotions.  I have learned over the years that there are several survival skills that help when flying with children.

Make sure that each child has an activity bag for the flight.  I always pack washable markers, a blank composition notebook, 1-2 books, a favorite small stuffed animal, and not infrequently scotch tape or painters tape.  Kids love tape and even if they stick the tape all over the seat in front of them, it won’t stain and it is easily removable.  We always check into the airline we are traveling with 24 hours earlier from our home computer as well as print our boarding passes from home.  This saves time waiting in the check-in line and if you are not checking luggage, you just have to go through security.  Make sure to follow the Transportation Security Advisor guidelines on what you can and cannot bring for carry- on items (see website below).  There is quite a lot of variability on what is required by the TSA so checking ahead can save having your child’s favorite bug catcher thrown away as you start your vacation (happened to my son 2 years ago).

You can bring a stroller all the way to the gate of your airplane and in busy airports is it much safer to keep your child restrained at least part of the time.  We also bring our own water bottles and after we have gone through security with the empty bottles, we can fill them at the water fountains (many airports, including Chicago O’Hare, have stations to fill water bottles for free).

As one last tip, although airlines will allow families with small children to board first, I recommend waiting to board the plane.  As soon as a toddler has to stay in a small space, havoc begins.

I love to travel and spend   time with my family.  Making some small changes to keep us mentally and physically healthier during our travel experience is even better.

Websites to check out for traveling with children:
http://www.cdc.gov
http://www.tsa.gov/traveler-information/traveling-children
http://www.travelforkids.com
http://www.parenting.com/gallery/50-ways-entertain-kids-plane

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Allergy and Pediatrics Groups Achieve Best in the Nation

We are proud to announce that our patients have rated the Allergy and Meriter DeForest-Windsor clinic pediatrics groups Best in the Nation (on National Research Corporation’s Fourth Quarter 2013 Survey) for being able to get an appointment as soon as they needed and getting answers to their medical questions the same day. We thank our patients for their loyalty!

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Celebrate Healthy Baby Month

March is Healthy Baby Month. Our staff works tirelessly to ensure every baby born in Meriter Hospital receives personalized attention and support. Each year at Meriter, we care for over 400 babies in our newborn intensive care unit. If a child is born premature, we offer programs to help families to be successful.

Meriter is proud of our commitment to family-centered care provided by highly qualified staff and providers. We create a foundation that helps families build a lifetime of health, growth and happiness.

Once your baby is ready to head home, Meriter offers compassionate, knowledgeable pediatricians and family medicine physicians who focus on your family’s needs – and schedule. To find the perfect doctor for your little one, visit meriterdoctormatch.com

Meriter is there for your family every step of the way.

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March 7 was Dress in Blue Day

On Friday, March 7, in honor of Colon Cancer Awareness Month, Meriter’s doctors, nurses and staff showed up to work dressed in blue to raise awareness and encourage discussion about the importance of screening for colon cancer. View the photos.

Colon cancer is the second-leading cause of cancer related death for both men and women in America. Through screening, colon cancer is one of the most preventable diseases.

The Colon Cancer Alliance launched the National Dress in Blue Day in 2009 to bring attention to the importance of screening for colon cancer.  Beginning at age 50 (or earlier if you have a family history or are at a higher risk), talk to your doctor about getting screened for colon cancer. The most effective screening is a colonoscopy

To make a donation toward life-saving research, prevention education and patient support services, visit Colon Cancer Alliance. Support Meriter’s Digestive Health Center by donating through the Meriter Foundation.

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How to Set Exercise Goals for Success

You don’t have to run a 5K every day just be active, a brisk walk would do the trick.

By: Lisa Sanborn, Lead Exercise Physiologist

Are you already frustrated and discouraged that you have not kept up with your New Year’s Resolution to exercise more or lose weight? Most likely you probably set too grand of a goal and gave up because it wasn’t attainable and you didn’t see results.

When setting goals for exercise and a healthier lifestyle you should set attainable goals. Making the decision to exercise more, lose weight, or lead a healthier lifestyle is applauded; Exercise provides significant benefits for both mind and body. And with that, comes time. Don’t be discouraged that you aren’t seeing change overnight. It’s important to make both long-term and short-term goals. By setting small goals with rewards along the way, you’ll have more success achieving your ultimate goal. This helps keep you on task and decreases potential frustration and discouragement.

The American College of Sports Medicine recommends 30 minutes of physical activity most, if not all, days of the week. However, if you are just starting an exercise program this might be too much to achieve. You don’t have to run a 5k every day just be active, when a brisk walk would do the trick. When starting an exercise program; you should start with 30 minutes each day, 3 days per week and gradually build up as you are physically able. Also, start with a type of exercise that is easy for you, such as walking. Exercise should not feel hard or hurt your body.

If doing 30 minutes at a time is too hard, break that up into 2 bouts of 15 minutes. Once this gets easier, start by adding more time to your workout, then eventually add another day each week. As the exercise starts to feel easy, start increasing your intensity. Our bodies adapt to exercise, so we need to continue challenging it over time.

For your first month, set a goal of exercising 3 days per week. Once you achieve that goal, reward yourself with a new pair of shoes, a massage, a pedicure or something else to pamper yourself. If you miss a day, or a few days, don’t get discouraged just start over the next day or the next week. Set a new goal each month, a small goal leading up to the ultimate goal. The best thing is to make time for yourself to achieve your goals. Find a friend or exercise buddy that has similar goals because this can help you stay honest and you’ll motivate each other to keep your goals.

Keep in mind that change doesn’t happen overnight. You are making a lasting lifestyle change for a healthier you!

Meriter Women’s HeartCare offers a comprehensive cardiovascular program designed especially for women by women. To learn more, call 608.417.6447 or visit meriterheart.com.

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Register to Improve your Golf Game

Has the polar vortex given you the winter blues? Have you been dreaming about this year’s golf season?

If you want to improve your golf game and your health, then join Zac Lefel, Dave Bollig, Adam Malm and Ben Armstrong, physical therapists, and the PGA Pros from Vitense Golfland for this interactive seminar – Training and Injury Prevention for Golfers. We will discuss the fundamentals of a basic golf swing as well as tips and strategies on how to improve your strength and flexibility allowing for a smooth, efficient golf swing. You will also get a chance to put this into practice on the range under the guidance of a PGA professional from the George Vitense Golf Academy, 5501 Schroeder Rd, Madison, WI 53711.

Date: Saturday, March 22
Time: 8:00-11:00 am
Location: George Vitense Golf Academy, 5501 Schroeder Rd, Madison, WI 53711
Cost: $25

Register for this class today!

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12 Tips from Meriter Women’s HeartCare

  1. Know your numbers. High cholesterol, high blood sugar and high blood pressure are major risk

    Making small life changes with the help of Meriter Women's HeartCare can drastically improve your heart health.

    factors for heart disease. Optimal total cholesterol should be under 200, fasting blood sugar under 100 and blood pressure under 120/80.

  2. Stop smoking cigarettes. Get counseling, nicotine replacement or drug therapy (if needed) and find a group program to help you stop. Check out Meriter’s Smoking Cessation Program.
  3. Pay attention to signs and symptoms of heart disease. Report any chest pressure/discomfort (including back, neck, jaw) along with shortness of breath, fatigue, nausea or stomach upset at rest or with activity to your health care provider. If these symptoms are severe, call 9-1-1.
  4. Avoid the “all-or-nothing” mindset. Instead, try the “something is better than nothing” approach. So, if you can’t fit in your 30-minute workout routine, take a 10 minute walk instead. Remind yourself that even small changes can lead to significant improvements in health.
  5. Simply pay attention. Most of us operate on autopilot a lot of the time. To make yourself more aware, find an inexpensive, brightly colored bracelet, even a rubber band will suffice. Each time you catch sight of your new accessory, ask yourself if there is something that you could do to positively influence your health.
  6. Get a pedometer. These gadgets are a great way to get an objective measure of your physical activity. Start recording your total daily steps to get a sense of your baseline activity level. Figure out what you need to increase your total number steps each day. Competition, even with yourself, is a great motivator!
  7. Consume a more plant-based diet. Continue to enjoy the healthy and delicious Mediterranean diet by filling up 2/3 of your plate with vegetables, fruits, legumes and whole grains. Incorporate more meatless meals, starting with one meal each week and gradually increasing from there.
  8. Choose liquids over solids. Replace solid fats, such as butter and cheese, with heart healthy fats, such as nuts, seeds and oils. Limit fat portions due to high caloric content. An example of this would be to add 1 Tbsp. of nuts to a salad or drizzling 1 tsp. of olive oil over your vegetables.
  9. Practice portion control. Small changes over time really add up. Some suggestions include: switching to a smaller plate at meals, taking ½ your meal home when dining out at restaurants or leave a few bites of food on your plate at meals.
  10. Exercise. Regular exercise can help you lose or maintain weight and can reduce your risk of heart disease. Strive for 30 minutes of exercise most days of the week. You can do the 30 minutes all at once, or break it up into 10 or 15 minute increments. Walking, bicycling, swimming and other activities that increase your heart rate are best.
  11. Move more, Sit less. Find ways to build activity into your day. Instead of the elevator, take the stairs. Get up from your desk every hour or so, and try standing while you are on the phone or working on the computer. Park farther away. Keep a set of small weights next to your favorite chair and pump iron while you watch TV.
  12. Breathe. There is a relationship between your emotions, high stress and heart disease. Ever notice that when you are angry or upset you breathe faster and less deep? Simply slowing your breathing down can calm you down.

To get started on your path to wellness, contact Meriter Women’s HeartCare – a comprehensive heart program designed for women, by women. Call 608.417.6447 to schedule a heart health risk assessment or visit meriterheart.com.

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Understanding the Risk Factors for Heart Disease in Women

If you have a blood relative with heart disease, your risk significantly increases. The more you know about your family health history, the more you can do to protect yourself.

By: Dr. Melissa Grimm, General Internal Medicine

Cardiovascular disease is the leading cause of death among U.S. women.  In fact, for women the average lifetime risk for some type of cardiovascular disease is high, approaching 1 in 2 women. But what can we do to prevent cardiovascular disease and how do we know if we are at high risk?

The presence of any one or more of these risk factors constitutes a high risk of future cardiovascular events such as a heart attack or a stroke:

  1. History of coronary heart disease, such as a previous heart attack or stent placement or history of coronary bypass surgery
  2. History of cerebrovascular disease, such as a previous stroke or TIA (mini-stroke)
  3. Peripheral artery disease, which may cause pain in the legs with walking due to lack of blood flow through the arteries
  4. Abdominal aortic aneurysm
  5. Diabetes mellitus, type 1 or type 2
  6. End stage kidney disease
  7. 10-year risk of cardiovascular disease  ≥ 7.5%, based on other risk factors such as blood pressure, cholesterol, and smoking status

If you have any of the above, controlling other risk factors is known to decrease future risk.  Therefore, keeping blood pressure and cholesterol under control using medication and lifestyle modifications is very important.  Smoking cessation is extremely beneficial. Also, daily aspirin therapy (either a baby aspirin or full dose aspirin) should be used unless it is not tolerated due to a history of gastrointestinal bleeding.

If you do not have any of the above, you still may have a high lifetime risk of cardiovascular disease.  This is dependent on the number of other risk factors that are present and they tend to have a cumulative effect.  These include:

  1. High blood pressure: Defined as BP ≥120/80, or if being treated for blood pressure with medication. Even a slightly high level doubles the risk of heart disease.
  2. High cholesterol, or being treated for cholesterol. About one-third of American women have high enough cholesterol to pose a serious heart disease risk.
  3. Cigarette smoking: Almost as many women smokers die from heart disease as from lung disease.
  4. Sedentary lifestyle
  5. Poor diet
  6. Poor exercise capacity on treadmill testing
  7. Obesity: At 20% or more over ideal weight, particularly in abdomen, the risk of heart disease increases.
  8. Family history: if you have a blood relative with heart disease (men < 55 years old or women <65 years old), your risk significantly increases. The more you know about your family health history, the more you can do to protect yourself.
  9. Metabolic syndrom
  10. Inflammatory arthritis: Such as lupus or rheumatoid arthritis
  11. History of pregnancy complications of preeclampsia, gestational diabetes or pregnancy-induced hypertension

How these risk factors are approached can make a difference in the success of improving your health.  Knowing which of these risk factors can be modified by lifestyle changes and to what extent is important. Work with your provider and health care team to guide you as lifestyle modifications are always important, but may not always be enough.

In regards to lifestyle changes, it is often problematic when people try to make “all-or-nothing” changes searching for a “perfect” solution to eliminate their risk of disease.  This can become overwhelming and can be a set-up for failure.

It can be more helpful to think of making changes as a lifelong process, setting small reasonable goals that are easily accomplished and can be maintained.  These changes become habits and can be motivating to make further changes.

Meriter offers many different wellness options to guide individuals in making healthy lifestyle changes. This includes our Women’s HeartCare Program which provides the multidisciplinary guidance of a nutritionist, exercise physiologist, health psychologist and physician to support women to better heart health. Meriter also offers a very successful Smoking Cessation Program and interdisciplinary Diabetes Care Team among many other resources. For more information, visit meriter.com/wellness.

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Ten Tips for a Heart-Healthy Diet

Try using olive oil as the principal fat, replacing other fats and oils (including butter and margarine).

By: Susan Brueggemann, Registered Dietitian

The Mediterranean Diet was based on the dietary traditions of Crete, Greece and southern Italy circa 1960 when the rates of chronic disease among populations were among the lowest in the world and adult life expectancy was among the highest even though medical services were limited.

As time passed by, this eating pattern was thought of as the “poor” diet for the people of the southern Mediterranean region.  By default, this population resisted all the modernization of foods in most industrialized countries which led to an increased consumption of more meat and processed convenience foods.

Research has shown that the Mediterranean Diet reduces the risk of heart disease.  It has also been shown to reduce blood pressure and “bad” LDL cholesterol as well.

The Mediterranean Diet is plant-based. It favors olive oil loaded with heart healthy unsaturated fats while limiting saturated and trans fats. The Dietary Guidelines for Americans also recommends the Mediterranean Diet as an eating plan that can help promote health and prevent disease.

One major difference between the Mediterranean Diet and other diets is  the frequency and amounts of foods are very non-specific, which is intentional.  The reason for this is dietary variation is considered ideal; encouraging individuals to eating a variety of healthy foods.

Other vital elements of the Mediterranean pyramid that are different from most food pyramids include incorporating daily exercise and emphasizing the importance of sharing meals with others.

As with any diet, portion control is still important. Excess calories, even from the healthiest foods, can result in weight gain.

One final note is that even though olive oil and nuts are heart healthy, they are also high calorie.  Limit portions to control calories; no more than ¼ cup of unsalted or lightly salted nuts and 1-2 tablespoons of olive oil daily.

Ten Tenants of the Mediterranean Diet Guidelines:

  1. An abundance of food from plant sources, including fruits and vegetables, potatoes, whole grains, beans, nuts and seeds.
  2. Emphasis on a variety of minimally processed and, wherever possible, seasonally fresh and locally grown foods.
  3. Olive oil as the principal fat, replacing other fats and oils (including butter and margarine).
  4. Total fat ranging from less than 25-35 percent of energy, with saturated fat no more than 7 to 8 percent of calories or 16 grams on a 2000 calorie diet.
  5. Daily consumption of low to moderate amounts of cheese and yogurt (low-fat and non-fat versions are preferable).
  6. Twice-weekly consumption of low to moderate amounts of fish and poultry (recent research suggests that fish be somewhat favored over poultry); up to 7 eggs per week (including those used in cooking and baking).
  7. Fresh fruit as the typical daily dessert; sweets with a significant amount of sugar (often as honey) and saturated fat consumed not more than a few times per week.
  8. Red meat a few times per month (recent research suggests that if red meat is eaten, its consumption should be limited to a maximum of 12 to 16 ounces per month; where the flavor is acceptable, lean versions such as the loin and round cuts are preferable.
  9. Regular physical activity at a level which promotes a healthy weight, fitness and well-being.
  10. Moderate consumption of wine, normally with meals; about one to two glasses per day for men and one glass per day for women. From a contemporary public health perspective, wine should be considered optional and avoided when consumption would put the individual or others at risk.

We invite you to attend ladies night out on Feb. 20. The event features Mediterranean cuisine and wine paired with inspiring discussions about keeping yourself heart healthy. Visit meriterheart.com to register.

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How to Protect Yourself from Stress

Feeling stressed? Manage it by using deep breathing techniques to redirect your attention and take a few, slow deep breaths.

By: Gretchen Diem, PhD; Women’s HeartCare

These days stress is almost a fact of life. It creeps into our lives in a variety of ways from angst-inducing news about natural disasters and economic woes to daily stressors like looming deadlines and icy roads.

The effects of stress may go beyond what you think.  Even though you might feel that you are dealing with your stress, it can still wreak havoc on your body.  Stress triggers a cascade of stress hormones that produce physiological changes in almost every organ system including your heart and blood vessels, immune system, lungs, digestive system, sensory organs and brain.

We’ve all experienced it —  a stressful incident that can make the heart pound and breathing quicken. Our muscles tense, our stomachs churn and beads of sweat appear.  These changes occur automatically in response to stress.  It is estimated that our stress response is triggered 50 to 100 times per day. Over time, prolonged and repeated activation of the stress has been shown to adversely affect our health, both physical and emotional. Many well-respected studies link stress to heart disease, the number one cause of death of both men and women in the United States.

You may not be able to avoid stressful situations, but you can counteract the damaging effects of stress by calling upon your body’s unique potential for self-healing. The first step is recognizing the connection between your mind and your body. You can learn how to use your mind to elicit the exact opposite physiological response to the stress response — a calm, relaxed state called the relaxation response.

Harvard cardiologist, Dr. Herbert Benson, was the first to scientifically document that the relaxation response can reduce central nervous system activity by lowering blood pressure, decreasing muscle tension and lowering respiratory rate in addition to other beneficial physiological changes.  The relaxation response is not difficult to invoke.  It can be done anytime or anywhere by simply focusing your attention on the breath and slowing it down, breathing in for a count of 5 or 6 and breathing out for a count of 5 or 6.  Do this for as long as you have the time to do it.  Believe it or not, it does not take long for it to work and your physiology will start to shift in beneficial ways in just a matter of seconds.

So, if you believe the experts who estimate that your body is going to get revved up 50-100 times per day, then go ahead and turn on your relaxation response 50-100 times per day (by focusing on your breath and slowing it down) to buffer against the negative physiological effects of stress. No one will even know that you’re doing it!

Deep breathing as a stress management technique is not new, but perhaps you can now better redirect your attention and reduce stress by taking a few slow, deep breaths.  It’s pretty easy and it might just protect your heart and improve your health.  If you are interested in experiencing other ways to elicit the relaxation response, check out the recorded relaxation exercises at  www.meriter.com.

Come enjoy a four-course Mediterranean dinner to learn about women and heart disease on February 20 at 6 p.m. Click here to learn more!

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Welcome Dr. Craig Dopf to Meriter Deming Way

The Meriter Medical Group would like to welcome Craig Dopf, MD to Meriter Deming Way located at 2275 Deming Way, Suite 220, Middleton, WI 53562. We are pleased to offer spine services through the Meriter Medical Group.

Dr. Dopf prides himself on not leaving an exam room until all of his patients’ questions are answered. He uses common language when explaining diagnosis and treatment options, and takes minimally invasive approaches to surgery whenever possible. He finds the best outcomes come from having a relationship of mutual respect with patients who are willing to do what is necessary to reduce their pain. Having experienced broken bones and back pain in the past, Dr. Dopf believes he has some ability to relate to his patients’ pain and problems. He also understands how important family support is for the healing process.

Dr. Dopf works with patients of varying ages experiencing disabling pain and numbness or weakness in their neck, arm(s), back or leg(s). He treats the following spinal conditions: adult degenerative spine conditions, cervical thoracic and lumbar spine disorders, disk herniations, spinal stenosis, spinal fractures and spondylolisthesis.

During his free time, Dr. Dopf enjoys spending time with his wife and five children. He enjoys a multitude of leisure activities including snow and water skiing, fishing, hunting, motorcycling, hiking, photography and attending concerts. For the last five years, he has also volunteered in Haiti performing surgeries with the Community Health Initiative-Haiti.

Please join Meriter in welcoming Dr. Dopf!

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Seven Indoor Activities to Try With Your Kids

Looking for indoor activities to try with your kids? Have a dance party! Kids love music, and it is always fun to get a groove on with Mom and Dad.

By: Dr. Carleen Hanson, Meriter Monona

February is American Heart Month, and while many people think of heart disease as an adult medical issue, it’s important to remember that having a healthy heart starts in childhood. I try to remind my young patients that their heart is a muscle, and just like the other muscles in their body it needs exercise to be strong. However, this time of year, it can be a challenge to keep kids active. I know my own children love to play outside in the snow, but this winter has been particularly brutal. There have been lots of days that even the hardiest kids (and their parents) haven’t wanted to venture out for even 10 minutes.

So what can you do if you’re stuck inside? There are plenty of options – sometimes it takes a little creativity. Remember, it’s always more fun if mom or dad join in too, so be a good sport and get your heart rate up as well. Also, while it’s recommended that kids get a minimum of 60 minutes of physical activity per day, it doesn’t need to be all at once. Break it up and do 10-20 minutes at a time. It all adds up and sometimes it’s helpful to actually keep track. Kids love charts and accomplishments, so feel free to make a sticker chart for being active.

Here are some ideas to get you started:

  • Have a dance party. Kids love music and it’s always fun (and often funny) to get a groove on with mom and dad. Pull out some of your old favorites for dancing to change it up a little.
  • Follow the leader. Explore the whole house and mix it up. Add in some exercises in between those funny walks and use those stairs if you have them. Be sure to take turns with who gets to be the leader.
  • Balloons. There are so many fun things to do with balloons and they are safer, and less likely to damage anything, than balls for indoors. Play the “keep the balloon up” game and try to prevent the balloon from hitting the floor. Add extra balloons to make it more challenging. Write mini-challenges, such as “Do 30 jumping jacks” or “Run up and down the stairs 5 times,” on little slips of paper and slide them into the balloon before you blow it up. Let your kids pick a balloon to pop and then they have to do what’s inside.
  • Scavenger Hunts. These are my kids’ all-time favorite indoor activity. You can adjust your clues to be more challenging for older kids and feel free to add in some “exercise” clues (Run in place for 60 seconds, then …). The American Heart Association has a fun “Healthy Challenge Scavenger Hunt” on their website if you’re looking for inspiration.
  • Hot Spot stations. Set up stations in a larger open area for your kids to rotate through every 30-60 seconds. Have instructions at each station telling them what to do such as run in place, sit-ups, dance, jumping jacks, hula hoop, etc. You can use old milk jugs filled with some water for weights if wanted. For older kids, encourage them to keep track of repetitions and aim to improve.
  • Use your garage. If you have a garage, leave the cars parked outside for a few hours and use the open space for activity. Use empty boxes to set up goals for a mini soccer game or try to throw balls into the boxes for points. You can use chalk to make hopscotch or even blow bubbles for your kids to run around and pop.
  • Ask your kid for ideas. Sometimes, they have the best ideas for fun and are more likely to want to participate if it’s something they helped with. Try to keep an open mind and as long as it’s safe, give it a try.
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Dr. Dana Johnson: Plenty of Ways to Stay Active This Winter

 

The best way for children to be physically active is through play, and this is often best done outdoors.

Originally published on January 22, 2014 in the Wisconsin State Journal. Dr. Dana Johnson is a pediatrician practicing at the Meriter McKee clinic.

Dear Dr. Johnson: My children are starting to get cabin fever. Do you have suggestions on how to address this?

Dear Reader: Children and adults of all ages benefit from physical activity no matter the time of the year. Lack of physical activity can be especially evident in young children, who tend to become more rambunctious and display more behavior problems when physical activity is limited.

While I find it easier in the warmer months to stay active myself and keep my son active, for our overall physical and mental health, it is important to get regular physical activity year round. Many adults will do this by going to the gym. While some gyms offer fun classes for kids, most children would not and shouldn’t get their exercise on a treadmill.

The best way for children to be physically active is through play, and this is often best done outdoors. While there have been a few days recently where it was not safe for anyone to be outside for more than a few minutes, most days it is a good idea for children to play outside as long as they are appropriately dressed. Dressing in layers with waterproof snow gear including a coat, snow pants, hat, gloves and boots should keep them warm and dry. With snow on the ground, children can have fun building forts and snowmen — and don’t forget about sledding. The walk up the hill burns energy, and the ride down is just plain fun.

While I am not a huge proponent of video games, on the days that it is too cold to venture outside, or for additional activity, video games that require physical activity can be used. There are also several indoor play and gymnastic facilities around town that allow children to burn off energy indoors. The Madison with Kids website has a good list of many of them at http://madisonwithkids.com/open-play.

We are also fortunate to have many other opportunities for outdoor activities for the whole family. My family has enjoyed trying several new winter activities in recent years. Having grown up in the south, cold weather activities were not common. We have taken advantage of the Madison Parks cross-country ski trails. They offer ski and ice skating equipment rental at some of the parks for a nominal fee. We have also ventured onto the Elver Park ice rink. I need quite a bit of practice at both, but we had fun as a family spending the day outdoors. There are also several downhill ski places nearby.

Here are some other resources and events that your family might enjoy.

Madison Parks: Ice skating, sledding, cross-country skiing. www.cityofmadison.com/parks
Shoe the Zoo: Snowshoe lessons with 50 percent of the fee benefitting the zoo, Jan. 25 and Feb. 9. http://www.vilaszoo.org (click on “Events”)

Read more: http://host.madison.com/news/local/ask/dr-johnson/dr-dana-johnson-plenty-of-ways-to-stay-active-this/article_2785434d-ab3a-56d8-9da2-d132f71be51c.html#ixzz2rKrJf11Q

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Stop by Polar Dash Today

Yes the weather outside might be frightful but Polar Dash will be delightful!

Most of the outdoor activities have been moved inside due to the cold and windy weather. But children can still fun around one snowy course pulling a sled before going inside to warm up. Stop by for this FREE event from 10 am to noon today!

Join us for a fun-filled morning at Polar Dash!
• Race around a snowy course pulling a stuffed bear in a sled
• Enjoy outdoor hula hooping and bean bag toss
• Warm up inside with treats
• Visit the Bear Clinic: Bring your favorite bear (or stuffed animal) from home for a head-to-toe check-up by Meriter doctors.
• Compete in fun games inside!

Polar Dash is free and open to the public. Bring a friend!
Recommended for Kids 12 and under. All are welcome.

Date: January 25
Time: 10 am to noon
Location: Meriter Monona, 6408 Copps Avenue
Cost: FREE

Download the registration form

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Five Foods to Consume, Limit for a Healthier You

Be sure to eat before going grocery shopping because going on an empty stomach will leave you more likely to buy on impulse.

By: Gena Van Kirk, Registered Dietitian/Diabetes Educator

Have you ever gone on a diet in hopes of losing weight, only to go off the diet a short time later? Did you wonder, “Why didn’t this work for me?” Most diets only modify behaviors temporarily which often leads to short-term success and long-term disappointment.

Let’s take a closer look at the word diet. It can be defined in two very separate ways. Definition one, my favorite, is the usual food and drink of a person or animal. That doesn’t sound so bad, does it? The second definition is the one we often think of first, a regulated selection or restriction of food for a specified outcome such as weight loss or other medical reasons. Sounds a little less appealing, doesn’t it?

My challenge to you is to break the “diet” mentality that we have become accustomed to and replace it with a nutrition consciousness that works for life. You can feel better, have abundant energy from morning to night, and look healthier. You may need to take a second look at your eating habits, but with your newfound knowledge about nutrition you should never have to diet again!

Are you ready? Here we go! By following the health conscious guidelines listed below in your everyday food intake, it can happen.

Foods to Include:
It is recommended that you make half of your grains “whole grains”
Examples include: oatmeal, barley, brown rice, whole grain pasta, whole wheat and corn
Lean Meats
Examples include: chicken or turkey without the skin, round or loin cuts of beef and pork, and fish high in omega 3 fats (salmon, lake trout, mackerel, and herring)
Include a large variety of deeply colored fruits and vegetables
Examples include: spinach, carrots, peaches and berries
Enjoy frozen vegetables and fruit, and shop for seasonal produce. Fruits and veggies are less expensive during their peak growing times. Grow a garden! Not only will you save on vegetables like cucumbers and tomatoes, but you’ll stay active with this new hobby. A few ways to eat more fruit include adding it to your cereal, your salads or even your dinner.
Sneak in more veggies by adding a tomato on your sandwich, peppers on your pizza or extra veggies in your pasta sauce. Keep precut or canned/frozen veggies ready for quick snacks.
Heart-healthy fats and oils
Examples include: olive oil, canola oil, nuts and tub margarines
Eat low-fat or fat-free dairy.
Switching to skim milk or fat free yogurt is another simple way to decrease calories.

Foods to Limit:
Sweets and added sugars
Examples include: table sugar, sucrose, glucose, fructose, maltose, dextrose, corn syrups, high- fructose corn syrup, concentrated fruit juice, honey, soda, fruit drinks, candy, cake and jellies
Foods high in sodium
Examples include: many canned and processed food items, pickled or smoked food items
Saturated fats
Examples include: butter, whole milk, 2% milk and cheese, fatty meats and hydrogenated oils
Alcohol
Females should limit to one drink/day; males limit to two drinks/day

Other suggestions:
-Bring a healthy lunch and snacks to eat throughout the day because this will help you stick to healthy food options.
-Keep a bottle of water handy to drink throughout the day to stay hydrated.
-Eat in more frequently. Many restaurants come with extra large portions, and options at fast food restaurants are typically higher in fat, salt and sugar.
-Eat before you go shopping. Going to the grocery store on an empty stomach will leave you more likely to buy on impulse.
-Make your own pre-packaged snacks by buying a large container of raisins, unsalted nuts or popcorn (low salt and fat) and separating them into individual portions yourself.
-Plan your meals each week. By planning ahead, you can check the nutrition facts of a meal before you decide to make it and create a detailed grocery list for easy shopping. Planning also helps avoid impulse shopping.
-Make some substitutes. Look through your cabinets or fridge and pick three foods you eat every day. Write down the nutritional content. Then, the next time you’re at the store, find lower calorie substitutes for just those 3 items.

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