Ask the Expert

Hoag for Her Center for Wellness is home to an expert team of Women’s Health Specialists. Our experts offer a variety of subspecialized programs, personalized education, and flexible treatment options to support women through all stages of life.

Christina Nguyen, M.S., L.A.C. – Licensed Acupuncturist

A:  The immune system is a vast and complicated system our bodies rely on to protect us from disease. It is important to make our immune system a priority by giving it rest, feeding it nutrient dense foods, taking proper vitamins, and treating it with holistic preventive remedies. According to Traditional Chinese Medicine (TCM) and acupuncture, late fall and winter is when your body’s defense system is on high alert due to change in weather, school starting, higher stress, and an overall higher intake of inflammatory foods like sugar and alcohol during the holiday season.

One of the best things you can do to increase your body’s defenses is to let it rest with acupuncture. Because acupuncture forces your body’s central nervous system to relax, your immune system is better able to fight off infection. Naturally, acupuncture increases and encourages faster reproduction of the body’s red blood cells, white blood cells and t-cells in your body to fight off disease. 

In addition to acupuncture, you should ask your primary or holistic doctor about the following supplements to boost immune health as well: vitamin C, vitamin D, echinacea, and zinc as well as pre and probiotics for gut health. As we all know, immunity starts with what we put in our body, so making sure we have the correct vitamins and a balanced gut biome is another preventive measure we can take in protecting ourselves from this year’s cold and flu season.

To learn more, call 949-764-7239 or email wellness@hoag.org to schedule an acupuncture consultation.

A:  Acupuncture is an ancient Chinese medicine practice that has been around for thousands of years and is often associated with pain management. By calming the central nervous system, acupuncture helps patients feel relaxed while simultaneously decreasing inflammation. When this theory is applied towards weight loss, it can help control cravings caused by an unregulated central nervous system. With acupuncture, we focus on auricular points on the ear that may help balance hormones and regulate appetite by stimulating ghrelin, the appetite and meal stimulation hormone, as well as leptin, the fat storage and metabolism hormone. When these points are stimulated, patients have noted their cravings decrease and their digestion and metabolism improve. In addition to auricular points, acupuncture points on the stomach can help with healthy bowel movements to stimulate weight loss. 

Research shows that acupuncture needles stimulate the release of endorphins—the body’s natural “feel good” hormones. This can create calming, relaxing effects that counteract the need for stress eating caused by tension, frustration and anxiety.

Paired with good nutrition counseling, acupuncture can help reset your body’s central nervous system and improve weight loss. For sample recipes from our registered dietitians, click here.

To learn more, call 949-764-7239 or email wellness@hoag.org to schedule an acupuncture consultation.

A:

Fertility acupuncture is the integration of ancient Chinese practices with modern fertility protocols to best support a patient’s pregnancy journey. At Hoag for Her Center for Wellness, our lead acupuncturist Christina Nguyen specializes in fertility protocols to regulate menstrual cycles, improve blood flow and circulation to the uterus during insemination, and balance hormones for follicular growth while reducing stress. Because each patient is different, each protocol is individually created to promote optimal health, including cupping and acupuncture. Many studies have now shown the efficacy of acupuncture paired with timed conception. The Hoag for Her team is here to provide the most up-to-date care in the field of fertility acupuncture.

What are the Benefits of Acupuncture for IVF, IUI and Natural Conception?

1. Follicle Growth: Acupuncture improves follicle growth and development to the uterine artery which supports thicker endometrial lining for implantation and pregnancy success.
2. Cycle Regulation: Regular cycles are extremely important for pregnancy support and acupuncture can help regulate your body’s natural hormones after coming off birth control. Ideally, we want your cycle to be between 28-30 days with minimal PMS, healthy flow and no pain.
3. Medication Management: Acupuncture promotes your body’s natural healing system which in turn helps your body process IVF/IUI medication more effectively while simultaneously reducing medication side effects such as hot flashes, constipation, inflammation, mood imbalances, and cramping during the transfer process.
4. Improved Implantation: In one study, acupuncture paired with IVF increased a patient’s success rate by 42.5% compared to a non-acupuncture group that had a success rate of 26.3%. (Paulus et al 2002)
5. Stress Reduction: Acupuncture increases serotonin and dopamine, the happy hormones produced by the pineal gland, which is known for elevating mood and decreasing pain and inflammation. Stress is often the unquantifiable risk factor for many physical and mental health conditions, and overall wellbeing needs to be addressed and managed.

When is the Best Time to Start Fertility Acupuncture?

Ideally, our acupuncturists recommend patients begin incorporating acupuncture a minimum of 3 months prior to the conception cycle to support the reproductive system and regulate hormones.

If you are already in an IUI or IVF cycle, it is strongly recommended to book an appointment right away to begin working on egg and sperm quality, uterine receptivity, insemination and implantation.

If you are in a natural cycle, we encourage our patients to come in a minimum of once a week during the first week of their cycle to help with blood flow to the uterus (cycle days 1-4), the follicular phase to help with egg quality (cycle days 6-14), ovulation to help with conception and intercourse preparation (cycle days 14-16), and the luteal phase to help with implantation (cycle days 16-28). *All cycle days are estimates and based on a 28-day cycle. Cycles may vary from patient to patient and will be evaluated during your acupuncture visit with Christina.*

To schedule an evaluation for acupuncture with Christina, call 949-764-7239 or email wellness@hoag.org.

References:
1. Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril. (2002) 77:3273. 10.1016/S0015-0282(01)03273-3 – DOI – PubMed

2. Hullender Rubin LE, Anderson BJ, Craig LB. Acupuncture and in vitro fertilisation research: Current and future directions. Acupuncture in Medicine. 2018;36(2):117-122. doi:10.1136/acupmed-2016-011352

A:  Facial acupuncture is microneedling focused specifically on the face, neck and hairline to increase blood flow to the epidermis in order to promote collagen production and reduce the look of fine lines and wrinkles. The tiny hair like needles are inserted similar to regular acupuncture in specific meridian channels on the face to create micro-injury to the skin, forcing the body to increase its white blood cell count and naturally heal the targeted area. This results in increasing cell turnover and improving overall skin complexion.

What Does Cosmetic Facial Acupuncture Look Like?

After filling out a comprehensive intake form, your acupuncturist, Christina Nguyen, will do a full facial examination and decide what points to do to support your treatment goals. The needles are placed and left in for 30 minutes to boost collagen, while you take a relaxing “acupuncture nap.” Afterwards, she will go over your diet and lifestyle history as well to best support your skin type.

What Does Cosmetic Facial Acupuncture Treat?

Every treatment is tailored to each client depending on his or her skincare needs, which can include but is not limited to:

  • Improved collagen production
  • Smoothe fine lines and wrinkles
  • Acne reduction
  • Reduced inflammation
  • Jaw tension and TMJ
  • Headaches and migraines

Who is a Candidate for Facial Acupuncture?

Anyone who wants glowing skin is a candidate for holistic facial acupuncture! By increasing collagen production, patients immediately notice improvement and plump youthful looking skin.

To schedule an evaluation for acupuncture with Christina, call 949-764-7239 or email wellness@hoag.org.

A: Acupuncture can lessen allergies by calming the body’s central nervous system to reduce histamine production. I like to look at treating allergies as a two-part process. First, during allergy season, the focus will be to treat the acute symptoms by stimulating the maxillary and frontal sinuses with acupuncture needles to decrease inflammation and reduce phlegm production. Once the symptoms have cleared, I use another set of acupuncture points to treat the immune system. The idea is to treat the person as a whole. The goal of the practitioner is to develop a treatment plan that will alleviate the patient’s acute symptoms, while addressing the underlying immune system imbalance at the root of the allergy. Treatments often include lifestyle and dietary recommendations as well including a decrease in dairy and gluten to help reduce inflammation.

To schedule an an evaluation for acupuncture or cupping with Christina, call 949-764-7239 or email wellness@hoag.org.

Christine King Burke, PT, DPT, MHA, Certified Pelvic Rehabilitation Practitioner

A: It’s often called the “mom sneeze,” the quick-footed dance some women do to cross their legs before sneezing. It’s a telltale sign of stress incontinence, a fairly common pelvic floor disorder that affects an estimated 25% of women.

One of the most effective ways to combat urinary incontinence, if appropriate, is to strengthen the pelvic floor muscles. A person’s pelvic floor works against gravity. Without strong pelvic floor muscles, a patient is at risk of experiencing pelvic organ prolapse, or the drop of the pelvic organs from their normal position. These can include the vagina, cervix, uterus, bladder, urethra, and rectum.

If urinary incontinence is the result of a bladder prolapse, surgery may be recommended. Pelvic floor physical therapy can help strengthen the pelvic floor muscles to prevent prolapse and stop urinary incontinence.

At the Hoag Pelvic Health Program, we often talk to women who believe their incontinence issues are a “normal” function of aging and/or childbirth. While it’s true that age and childbirth can impact the pelvic floor muscles, incontinence is not a foregone conclusion.

Any loss of urine that is not intentional should be investigated and treated. One of the most effective, non-surgical therapies a woman can do to strengthen her pelvic floor muscles are Kegel exercises. Six to eight weeks postpartum, a woman can try basic Kegel exercises to repair damage or muscle weakness caused by delivery.

Kegels are done by repeatedly squeezing and relaxing the pelvic floor muscles. Just as some people find it beneficial to work out with a personal trainer, many women at Hoag find success working with a physical therapist to learn how to maximize the effectiveness of Kegels, using biofeedback and other techniques. Kegel exercises should always include a full relaxation of the muscle afterward and should never be painful.

As with many issues involving the pelvic floor, there is a distinction to be made between “common” and “inevitable.” Many women experience urinary incontinence, but that doesn’t mean that you have to live with it. Pelvic floor physical therapy can be a powerful tool to helping a woman get her life back.

For more information or to schedule an appointment with the Hoag Pelvic Health Program, call our Newport Beach office at 949-764-7277 or our Irvine office at 949-557-0190.

A: Six weeks after delivery, a woman’s obstetrician typically clears her to start working out again. But what does that mean, exactly? 

High-impact workouts early after childbirth may reduce pelvic floor muscle stability and can cause long-term bladder and bowel problems or pelvic organ prolapse. To minimize risk, a woman should ease back into her workout routine, starting with low-impact aerobics and strengthening exercises to build back her core and strengthen her pelvic floor. 

By the 12-week mark, most women can begin to return to running, bootcamp classes, barre, Pilates with modifications – whatever workout regimen they followed prior to pregnancy. There is so much pressure on women to return to their pre-baby bodies overnight that we often see women overdoing it.  

Working out is critical for a woman’s physical and mental health. But it’s important to remember that, just as a typical pregnancy takes 40 weeks, it can take months of healing for a woman to regain the strength and stamina she once had. While every woman is different, it typically takes anywhere between six and 18 months for a woman to fully recover her core strength and be able to safely return to her pre-pregnancy routine. 

Until then the best exercises to follow are lower impact cardiovascular exercises, strength training, and core strengthening exercises that don’t cause separation of the abdominal muscles (that usually means no sit-ups, curls or plank poses). Between three and six months, depending on healing, women can slowly progress back into pre-pregnancy workout routines.  

Many women find this frustrating, as they want to get back to a “flat belly,” postpartum. By slowly strengthening the core, a woman can improve her posture, reduce or eliminate back pain, tighten her waistline and protect her pelvic floor muscles all at once. Easing slowly back into your pre-pregnancy workout routine and taking the time to focus on core and pelvic floor rehabilitation will help to prevent injury and long-term issues.  

For more information or to schedule an appointment with the Hoag Pelvic Health Program, call our Newport Beach office at 949-764-7277 or our Irvine office at 949-557-0190.

Click here to explore Hoag for Her Center for Wellness  classes.

A: Ideally, not a lot. The pelvic floor is an important muscle group that supports the bladder, bowel, rectum and uterus. A healthy pelvic floor is something a person can take for granted, but when weakening, tightening or injury occurs pelvic floor health can become an issue.
So, how often do people think about their pelvic floor? Quite a bit, unfortunately. Pregnancy, childbirth, aging and certain cancers, such as prostate cancer, can damage or weaken the pelvic floor, leading to urinary or fecal incontinence, pain and sexual dysfunction. Nearly 25% of women and many men experience some form of pelvic floor disorder in their lifetimes.
Pelvic floor physical therapy helps to restore the health of these vital muscles. Many times, specialized physical therapy (PT) can reverse an embarrassing or debilitating issue. In other cases, PT can help support the success of surgical or other treatment.
The Hoag Pelvic Health Program uses integrated therapies for women and men with bowel, bladder and sexual dysfunction.
 
For more information or to schedule an appointment with the Hoag Pelvic Health Program, call our Newport Beach office at 949-764-7277 or our Irvine office at 949-557-0190.

A: We all know what it’s like to have to urinate so badly the urge inspires a little dance and maybe some high-pitched squeals of discomfort. But what does it mean to experience that feeling every day – or even multiple times a day?

Outside of pregnancy, a person should be able to wait two to four hours between emptying their bladder. At night, anyone under the age of 60, can expect to get up to urinate no more than one time per night. Over 60, one to two times is normal.

If a person suffers from overactive bladder, they might frequently experience the sudden and urgent desire to urinate or the need to urinate too often (both at night and during the day). This feeling is often caused by involuntary contractions of the bladder. To counter involuntary contractions, pelvic floor physical therapists recommend voluntary pelvic floor muscle contractions that “train” the bladder to minimize the urge to go.

During urine storage, the bladder muscle is in a relaxed, non-contracting state, and the urinary sphincters, which are responsible for urinary control, are contracted. To empty the bladder, the muscles interact in reverse – the bladder muscle contracts and the sphincter relaxes.

By helping “retrain” the bladder to relax, a physical therapist can help patients gain control of their overactive bladders.

Lifestyle changes can also help, such as learning to hydrate appropriately, avoiding irritants such as caffeine or alcohol, and exercising regularly. Through a multidisciplinary approach, the Hoag Pelvic Health Program helps people gain control of these urinary issues.

The trained specialists can even help postpartum. During pregnancy, the normal rules of urinary urgency and frequency go out the window. It’s hard for a woman to control her bladder when there’s someone tap dancing on it. In the postpartum period, however, a woman might still experience an overactive bladder.

That is because bladder habits are like any other habits – they’re hard to kick. Working with a pelvic floor physical therapist can help a woman retrain her brain and body to suppress that urge.

For more information or to schedule an appointment with the Hoag Pelvic Health Program, call our Newport Beach office at 949-764-7277 or our Irvine office at 949-557-0190.

Preeti Soni, M.S., R.D., C.D.C.E.S.

A: 

A Dietitian’s Perspective: Postpartum Nourishment for Breastfeeding Moms

Determining nutrition needs during the postpartum period can be difficult because each woman’s birth story is different. What remains a constant is that your body will require more calories during breastfeeding than prepregnancy.

Early Postpartum – “First 40 Days”

The first two weeks postpartum are considered the acute recovery phase which is the most nutritionally demanding. Just as in pregnancy, lactation places high demands on your energy and protein stores.

After the first two weeks, hunger and appetite are often at peak levels as your body aims to heal itself. During this time, nutrient-dense meals are recommended. Your body needs extra calories and protein for the processes of wound and incision healing, tissue healing and milk production.

Although some moms may feel inclined to reduce calories to expedite postpartum weight loss, calorie counting is not recommended during the first 40 days. Instead, focus on these postpartum guidelines:

1. Listen to your hunger and fullness cues to guide your energy needs. Our bodies are wired to assist us in regulating our intake. It is normal to experience an increase in hunger postpartum. Do not place judgement or a timeline on your larger appetite–your body is recovering!

2. Maximize nutrients and repletion instead of focusing on foods to avoid. Incorporate nutrient-dense foods in your diet to help you heal and recover. Attempting to avoid foods and suppressing your appetite can take away from your body’s ability to repair itself.

3. Adopt a flexible, “all foods fit” approach to eating. “All foods fit” is used to emphasize that no single food has the power to heal or hurt postpartum. Foods should not be labeled “good” vs. “bad” foods. Nutrition is synergistic—combining different foods promotes optimal health.

4. Practice body respect. Body respect involves acknowledging pregnancy and birth without focusing on weight, shape or size. Nourish your postpartum body as it heals and recovers instead of focusing on fixing or controlling your body.

To help meet your nutrient needs, try eating six small meals per day or small meals every two to three hours. Feel free to order food in and accept the generosity of friends and family offering to help with meal preparation. Do not feel pressured to eat perfectly; instead, focus on getting nutrition and rest.

After the “First 40 Days”

After your six-week postpartum check-up, your clinician may allow you to begin gentle to moderate exercise. This timeline can vary based on your birth experience and whether you had a vaginal delivery or C-section.

The Institute of Medicine estimates that breastfeeding women with a healthy prepregnancy weight need 330-400 additional calories per day than prepregnancy. Heavily restricting calories will affect your milk supply.

Postpartum Guidelines and Tips for Meal Planning:

· Plan ahead: Prepare healthy proteins in advance so you can easily add protein to each meal. For example, grilled chicken breast is easy to add to salads, wraps and skillet dishes. Grill chicken breasts to use later in the week or even freeze grilled chicken for the following week.

· Calcium is essential for mom and baby: The daily recommended calcium intake is 1,000 mg. For those who are lactose intolerant, use calcium fortified non-dairy products. Additional sources of calcium include leafy greens, fortified cereals and tofu. Speak with your healthcare provider or dietitian if you have concerns about meeting the recommended calcium intake.

· Aim for variety in your diet! Eat foods rich in nutrients like vitamin C, zinc and selenium to help keep your immune system strong. Choosing different types of fruits, vegetables, whole grains and seasonings will expose your infant to diverse flavors and tastes.

· Add fiber in your diet: Start your day with fiber in conjunction with protein for the perfect combo of energy and sustenance. Fiber is an essential nutrient to help with post-labor constipation. The recommended daily amount of fiber is ~30 grams.

· Stay hydrated all day long: Drink up to three liters of water daily. · Curb your caffeine intake: While the small amount of caffeine that passes from you to the baby through breast milk is not known to adversely affect your infant, the CDC recommends sticking to 300 mg or less per day.

· Minimize empty calories: Minimize foods that are high in added sugar, sodium and saturated fat, including fried foods, soft drinks and desserts. · Avoid high-mercury fish: Some seafood and fish such as tuna, king mackerel, orange roughy, marlin, shark, swordfish and tilefish are high in mercury. Healthier options include salmon, shrimp, cod, tilapia, trout and halibut. · Continue prenatal vitamins: Breastfeeding mothers should continue to take prenatal vitamins or a vitamin specific to postnatal mothers.

· Remember weight loss is ideally slow and gradual: If you’re trying to lose weight while breastfeeding, the Academy of Nutrition and Dietetics says a slow weight loss of one pound per week or four pounds per month is ideal.

· Limit alcohol while breastfeeding: Although many women decide to avoid alcohol while breastfeeding, if you choose to drink, limit it to after breastfeeding or wait two to three hours after having a drink to breastfeed.

Sample One-day Meal Plan

The one-day meal plan below is about 2,200 calories. You can add calories to this by including additional snacks or remove calories by reducing portion sizes. Remember to honor your hunger and fullness cues.

Breakfast

  • 2 eggs
  • 1 slices wheat toast
  • 1 tbsp peanut butter
  • 1 cup strawberries

AM Snack

Lunch

  • 2 cups chicken, lentil, vegetable soup
  • 1 slice toast
  • ½ avocado

PM Snack

  • ½ cup trail mix (think variety – nuts, seeds, dried fruit, granola)

Dinner

  • 6 oz baked salmon or BBQ tempeh
  • 1 cup brown rice
  • 2 cups salad greens with vinaigrette

Bedtime Snack

  • 1 oz dark chocolate
  • 1 medium banana

To modify this meal plan for a plant-based diet:

· For breakfast, eliminate the eggs and enjoy two slices of wheat toast with peanut butter

· Eliminate the chicken in the soup and double the lentils

· Choose BBQ tempeh at dinner

If you are breastfeeding and would like to establish a personalized nutrition plan with a dietitian at the Hoag for Her Center for Wellness, call 949-764-7239 to schedule a consultation.

 

References:

1. NF Butte, A Stuebe, “Maternal nutrition during lactation” March 2022. UpToDate.

2. L Poston, “Gestational weight gain” March 2022. UpToDate.

3. NIH Dietary Reference Intakes – https://ods.od.nih.gov/HealthInformation/Dietary_Reference_Intakes.aspx

4. J Linardon, L Susanto, H Tepper, M Fuller-Tyszkiewicz, “Self-compassion as a moderator of the relationships between shape and weight overvaluation and eating disorder psychopathology, psychosocial impairment, and psychological distress”. Body Image. April 2020. 5. Intuitive Eating – http://www.intuitiveeating.org/ 6. La Leche League – https://www.llli.org/

Elizabeth Whitham, M.D., M.A., Reproductive Psychiatrist  

A:  Maternal mental health can be greatly impacted by sleep and insomnia. Women are prone to insomnia during reproductive transitions. This can include difficulty initiating or maintaining sleep, and early-morning awakening. Symptoms of insomnia can be readily identified by those who are experiencing it and may include: 
  • Sense of poor sleep quality or non-restorative sleep.
  • Daytime sleepiness.
  • Regular difficulty sleeping despite adequate opportunities for sleep. 
It’s important to know you aren’t alone. Insomnia impacts 30-60% of women during pregnancy, particularly during the third trimester, where 98% of women report awakening during the night. There are many causes that contribute to pre and postpartum sleep disturbances, including changes in hormone levels, physiology, metabolism and psychology. In some cases, insomnia can be a sign of underlying illness. 
 
Insomnia in pregnancy and postpartum can be either a sign of a mental health condition, or a trigger for one, or both. Talk to your doctor about insomnia, especially if you have insomnia before pregnancy. Good sleep hygiene can promote better sleep. Some ways to improve your sleep hygiene include: 
  • Prioritizing sleep. 
  • Limiting naps to the early afternoon.
  • Keeping your routine consistent, with the same wake and bedtime.
  • Unplug from electronics 30 to 60 minutes before bed.
  • Allow 30 minutes to wind down with soft music, light stretching, reading and/or relaxation exercises. 
  • Sleep in a dark, cool and quiet space. 
For more information, or to schedule an appointment with a maternal mental health expert, call 949-764-8191 or visit hoag.org/mmh.
 
Visit hoag.org/sleep to learn more about the Hoag Sleep Health Program.
 

Christine Crooks, BS, NCPT

A: Posture can easily be an ongoing challenge for many of us, especially with an increase of time sitting in front of a computer. The first step towards improving poor posture habits is awareness. When we can see and feel the difference between our poor posture versus what proper alignment is then we can instill change in our body. Luckily, the principles of Pilates naturally support the awareness of practicing good posture. Here are some examples of Pilates principles corresponding to posture exercises:
 
  • Control: Becoming more aware of our body can give us more control over our body mechanics, especially our bad habits. 
  • Breath: The natural expansion and contraction of the rib cage and chest during full breath cycles support and improve spinal elongation. 
  • Concentration: Take care and focus while doing postural exercises to receive maximum, lasting benefits.
  • Centering: This refers to the importance of centering of spinal alignment as well as centering the mind and body with the exercises being performed. 
  • Flowing Motion: When the spine has more mobility, suppleness, and strength within proper alignment then our body can move with more flow and ease. 
  • Precision: Practicing good posture frequently with precision on execution will bring forward steady improvement. 
Taking some of these Pilates principles to improve our body awareness may feel a little bit overwhelming. Once we are aware, then it becomes more difficult to “un-see” or “un-feel” our body’s proper alignment. It’s important to remember that practice makes progress, not practice makes perfect when addressing posture.  Each time our awareness pops up while we are sitting in poor posture (head forward, shoulders and back are slumped, etc.) and correct it, we just made a little progress towards improving our posture. Sitting properly isn’t the only way to work on good posture. 
 
With the Pilates equipment, in addition to the mat exercises, we can also further build the strength of the postural muscles. Have you ever felt tired after sitting upright with good posture for even 10 minutes? Well, those postural muscles need some endurance! The spring resistance of the Pilates equipment offers a gradual build of challenge, as well as supportive feedback, to continuously engage the body in integrated movements. Imagine stretching a spring, then trying to not let it “boing” back into a tight coil. When we control (there’s one of the principles again) the resistance springs, we can continue strengthening the muscles in all directions of the movement. This is where the spine SHINES!  Minimize compression, excessive torsion or collapse of the spine, while adding dynamic stretching with strengthening and it is a perfect recipe for delicious movement!
 
To schedule an appointment or learn more about our Pilates services, call 949-764-7239.

Asia Yates, MS, Wellness Program Coordinator 

 

A: While the weather in Southern California is almost always perfect for hiking, now is an especially great time to enjoy physical activity outside. As always, follow your health care provider’s recommendations on the intensity and duration of exercise and be sure to hydrate and protect your skin. Three local hiking trails come to mind as my top recommendations ranging from family friendly to moderate intensity, and all with a beautiful ocean view. Happy exploring!

Hikes in OC with an Ocean View

Bolsa Chica Wetlands, Huntington Beach
If you are looking for a flat trail with ocean views and bird watching, this is the trail for you. The wetlands are right across PCH, so you get an ocean view the entire time! There’s no elevation on this trail. You can make it a family friendly walk or go for a jog. Starting from the free parking lot on PCH the trail runs in between the wetlands providing views on both sides. After about .5 mile, you can either loop around to the park area with benches or follow the trail to the right for an open stretch of trail leading towards the surrounding neighborhoods. Pending your route this can be a 1–3+ mile outing. If you are enjoying a run on the trail and want to extend your time you can always repeat the loop. Be sure to keep your eyes peeled for local birds as they dive into the water to fetch their food – it is quite a show! This flat trail doesn’t offer any shade, so I recommend planning a sunset trip and be sure to bring sunscreen and a hat. The Bolsa Chica Conservancy Team is a great resource for any questions you have about the trail and wildlife. They offer guided tours and events to keep the community connected to this wonderful outdoor resource.

Click here for a map of the Bolsa Chica Wetlands.

Santiago Creek Trail(s), Orange 
This is a choose your own adventure hike! There is ample parking at the trailhead ($5 fee), with restroom access. The hike is both dog friendly and open to mountain bikers, there is also a rattlesnake warning so keep your eyes open. The start of the hike is shaded by oak trees and has a view of one of the first dams in Orange County. After about .5 mile you can choose from one of the incline trails to the top. After about a mile of steady incline you will reach the top to catch a view of the Pacific Ocean. If you look closely, you can even spot Hoag in the distance! Follow the trail to Barham Ridge (another ~1 mile), and you will find views of the ocean on one side and the mountains on the other. Be sure to keep an eye out for hawks soaring overhead. From here you can extend your hike by taking one of the many trails or head back onto the trail to the parking lot. There are a lot of trails leading back to the entrance, so it can be a little tricky. We ended up doing a little exploring on some of the side trails as we made our way back to the parking lot, and our hike ended up being about 4.5 miles, 890 feet of elevation and taking just over 2 hours. Be sure to bring sunscreen and a hat, as after the first .5 mile you are in the sun for the rest of the hike.

Click here for a map of the Santiago Creek Trail(s).

Pacific Ridge Trail (via Crystal Cove), Newport Beach 

For the adventure seekers looking for a challenging hike with great views, this is the trail for you! This hike was referred to me by one of our Hoag Pelvic Floor PT’s, Heather Lapaglia, and is a moderate out and back trail leading to the ocean. You can find free parking at Ridgeline Park, where you will also find a map indicating the start of the trailhead. Start on the main path as you descend and head towards the Crystal Cove parking lots via the Muddy Canyon Entrance. When you are within about a mile of the beach your breathtaking ocean views begin. The trail ends at the Crystal Cove Ranger Station Headquarters, where Ranger Linda recommends you stop in to ask questions before you take the tunnel down to the beach. Be sure to bring snacks and water so you can relax on the beach before you begin your climb to the top. Once you have had your fill at the beach, you can start your climb back to top. This is about a 9-mile round trip hike, with a 4.5-mile descent to start, and a 4.5-mile climb to get back to the trailhead. Be sure to bring your sunscreen and hat, as there is no shade.

Click here for a map of the Ridge Trail.

Danielle Dawson, MA, LMFT, Psychotherapist

A:

6 Tips to Ward Off Holiday Stress

When we think of the holidays, thoughts of fun, joy and happiness fill our minds until the realities of seasonal demands set in. These six tips from Danielle Dawson, M.A., L.M.F.T., will help you manage the stress that comes with extra shopping and running more errands, going to holiday parties and relatives visiting.  

Expectations of a fun, joyful and happy holiday season often add pressure to keep a smile on our face, only to increase our negative thoughts and feelings. But with a few helpful tips to make it through the season, you can feel more prepared and confident to handle what is coming.

  1. Create or keep healthy habits
    Three of the best ways to keep stress to a minimum is eating healthy (even at holiday parties), getting plenty of sleep and staying physically active. If you already have a healthy daily routine, continue what you are doing and add the holiday obligations into your life – do not give up the things that make you feel good. If you haven’t started creating healthy habits, now’s a wonderful time to start a new routine.
  1. Plan ahead
    Between family, friends and co-workers, holiday event commitments start to grow. Make sure to plan so you do not overcommit. If you are hosting a holiday event, organize your party, create a menu and plan for what needs to be done. Getting things done early and asking for help alleviates last minute stress. 
  1. Learn to say no
    Often, you overcommit your time because ‘tis the season. Decide what is most important for you, where you want to go and protect your time. If you have a clear idea of what you want for your holiday season, you can easily say no to the things you do not want to do.
  1. Make a holiday spending budget
    Finances are one of the biggest stressors in your life. Planning early with a financial budget and sticking to it will help elevate stress around purchases for loved ones. Plus, it helps you make informed decisions on gifts, so you are not paying them off the rest of the year.
  1. Take a break
    Don’t forget to take care of what your mind and body need. Take a nap, watch a silly movie, read a good book, take a short walk outside, listen to uplifting music, or light some scented candles. Remember laughter relaxes the mind and body, releasing physical tension and stress. Listening to music and citrus scents boost feelings of well-being. Getting some vitamin D from a walk outside continues to boost happiness.
  1. Enjoy the season
    Be mindful. Once you are at an event, cooking a holiday meal and even shopping with crowds, make sure you slowdown in each of those moments and use all your senses to be present to create memories that remind you of how much you enjoy the season.

Remember the holidays are meant to be enjoyed with family and friends. These tips can help relieve holiday stress and ensure you make the most of this time of the year.

To schedule an appointment or learn more about our counseling services, call 949-764-7239.

A: Great intimacy starts at the beginning of a relationship. It begins with specific attitudes and belief systems around emotional intimacy, physical intimacy and spiritual intimacy.  Each person in the relationship should have a desire to learn and grow in the various forms of intimacy. Addressing intimacy with an attitude that is open-minded, comfortable and honest is important, and some couples can benefit from guidance from sexual health and counseling services to achieve their goals. Maintaining communications around these topics in an emotionally safe space with our partners should be a priority. This safe space will have no judgment and a clear understanding that nothing is right or wrong about our beliefs. The goal is that you and your partner understand and value what the forms of intimacy mean to each of you. You might think different and have different beliefs about intimacy, and that is ok.  Once we understand who each of us are individually, then we can develop what will create lasting intimacy in our relationship. No relationship is the same, and each couple will be able to figure out how to create intimacy that works for their individual relationship.   

3 Relationship Superpower Tips:

1.    Deep friendship: Developing a deep friendship entails a number of things. Couples should strive to know each other intimately, understand each other’s likes and dislikes and appreciate personality quirks and strengths. Couples with deep friendships work together to reach each other’s big hopes and dreams as well as express kindness and love in small ways daily.

2.    Repair attempts: No matter how angry and frustrated each person is while fighting, when one or the other attempts to repair the relationship, they are both open to that repair.  What is going to affect this ability most is the strength and depth of the friendship.

3.   Shared purpose for a committed relationship: Couples who share a deep sense of meaning about their relationship, support each other’s hopes and aspirations and offer comforting support in times of pain and sadness, and build a sense of purpose into their lives together.

Virtual appointments are available with our licensed marriage and family therapist, Danielle Dawson, MA, LMFT, Psychotherapist. Sexual health and counseling services support you in navigating your emotions, while providing proven strategies and counseling to address conditions such as, anxiety, depression, sexual health and relationships. 

To schedule an appointment or learn more about our counseling services, call 949-764-7239.

A: The goal of couples counseling is for you and your partner to experience a connection that can move a static relationship into an evolving and intimate one. Counseling sessions provide psychological education to help you understand the principles of effective communication, talking and listening.

It is crucial to understand who your partner is and how they communicate to be able to fill their needs and effectively do conflict resolution. The dialogue of intimacy, which is the most difficult form of communication, requires developing the skills of talking and listening to negative feelings without criticizing and defending. The dialogue of intimacy can be used to solve any problem in your relationship. An intimate relationship is an interpersonal relationship that involves physical, emotional and spiritual intimacy with your partner.

The skills obtained in couples counseling can help two individuals, while assisting them in figuring out how to create the most loving and fulfilling relationship they can have together.

To schedule an appointment or learn more about our counseling services, call 949-764-7239.

Sandy Yokoyama, LMFT

 

A: When we think of the holiday season, it’s often associated with happiness and excitement, but let’s face it — the reality is that it may bring a level of stress as well. The holidays may be a time of high emotion and demands, which can leave us feeling overwhelmed and exhausted. For some people, particularly during times of Covid-19, the upcoming holidays may look very different. It can be a period of loneliness, sadness, anxiety and depression, which we can refer to as the “holiday blues.” For these reasons, self-care is essential to getting through the season.

You may be thinking “who has time for self-care?” as for many, the holiday season means planning and taking care of others. The thought of self-care may even leave you feeling a sense of guilt, but self-care is not selfish. Self-care is a necessity for our own wellness and ability to care for others. For a lot of people, taking care of yourself doesn’t mean me first, it means me too. That leads to our first tip on how to practice self-care during this holiday season:

1. Prioritize time for you!

Self-care doesn’t have to mean an all day ordeal (but if you need to and have the ability, by all means!). It can just mean taking small moments to prioritize you and your wellness. Some ideas might include sitting in silence for 5 minutes, having a cup of tea, taking a moment to engage in deep breathing, strolling through Target alone for an hour (or two), taking a long shower, asking your partner to take on the morning kid duties so you can sleep for an extra hour, talking to friends or family (in person or video call) or going on a walk with the dog. The list can go on and on and look very different for each person. The point is, carving out time (whether that be a few minutes to a few hours) to do things that feel good for you and replenish your energy and spirit no matter how busy we get.

2. Create healthy boundaries with self and others

Boundaries are a form of self-care and essential for our mental well-being. During the holiday season, it can be helpful (even crucial) to set limitations with yourself and others. In general, we can think of boundaries as setting physical, emotional and mental limits. Sometimes that might look like practicing the art of respectfully saying “no,” taking a break when you are feeling overwhelmed, leaving a conversation when someone is nagging you about your personal life, or allowing yourself to feel gratitude and focus on what’s going right versus what’s going wrong. In addition, you may need to set a boundary with yourself on social media usage as it may lead down an ugly path of comparing yourself and your holidays to others around you.

3. Bring it back to basics

If you are questioning when the last time you ate or took a shower was, chances are you may need to spend time on making sure your basic needs are being met. Sleep, nutrition, hydration and movement are important factors that have a huge impact on mental health. When our basic needs are not being met, all the emotions we’re dealing with can feel even worse. Take care of your physical health, try for adequate sleep (when you can), get your body moving, and aim for a balanced diet. However, self-care during the holidays may also mean indulging on your favorite foods and treats from time to time!

To schedule an appointment or learn more about:

Maternal mental health services for pregnant and post-partum patients with Sandy Yokoyama, LMFT, call 949-764-8191

Individual and couples counseling with Danielle Dawson, LMFT, call 949-764-7239

Tiffany Gunnemann, RD

A: As flu season approaches, it is important to take precautions to keep yourself healthy. Unfortunately, many Americans don’t eat enough fresh fruits, vegetables, and other foods we need to keep ourselves healthy year-round. Healthy foods provide many substances including vitamins and minerals to keep us strong and healthy. You can’t just eat an orange or pop a vitamin C pill and expect it to prevent a cold and to boost your immune system. To keep your immune system truly healthy, it’s important to follow a healthy balanced diet over time.

With a few exceptions, it’s best to get your vitamins and minerals from your food rather than in supplements. Here are some of the top vitamins and minerals your immune system needs to perform at its best:

1. Vitamin C

Vitamin C may help prevent infections or shorten the length of your illness. Citrus fruits are a common go-to Vitamin C-rich food, but there are others as well. Consider trying:

  • Spinach
  • Kiwi
  • Bell peppers
  • Broccoli
  • Strawberries
  • Papaya

2. Vitamin D

Vitamin D is one of the most important and powerful nutrients for supporting the immune system. Food sources are limited but include:

  • Salmon
  • Trout
  • Mushrooms
  • Sardines
  • Vitamin D fortified foods like milk, yogurt, orange juice, and soymilk

In general, it’s best to get most of your vitamins from food, but vitamin D may be the exception. Talk with your doctor and get tested to find out if you need a supplement.

3. Zinc

Zinc helps your body fight germs and helps make protein to repair your body. Most people can get enough zinc from their diet. However if you are vegetarian or over the age of 50, you may need to supplement. Talk to your primary care provider about taking a zinc supplement. Note that taking zinc supplements for a long period of time or regularly taking cold remedies with zinc can cause copper deficiency or anemia. Some foods that are high in zinc include:

  • Oysters
  • Peanuts
  • Lean meats and poultry
  • Baked beans
  • Pumpkin seeds
  • Yogurt

4. Vitamin E

Vitamin E is a powerful antioxidant that helps your body fight off infection. This important vitamin — part of nearly 200 biochemical reactions in your body — is critical in how your immune system functions. Vitamin E is found in plant-based oils, nuts, seeds, fruits, and vegetables as well as:

  • Almonds
  • Peanuts/peanut butter
  • Sunflower seeds
  • Oils such as sunflower, safflower, and soybean oil
  • Avocado

5. Vitamin A

Vitamin A stimulates the production and activity of white blood cells to help boost your immune system. It comes in two forms: preformed Vitamin A (in animal foods such as fish, meat and dairy) or from plant carotenoids. Try to get a mix of both to maximize your benefits:

  • Green leafy vegetables
  • Tomatoes
  • Pumpkin or sweet potatoes
  • Eggs
  • Fish oils
  • Milk

6. Iron

Iron helps your body carry oxygen to cells and plays a part in many of the immune system processes. Your body can absorb heme iron the best (aka iron from animal products), but iron is also found in vegetarian foods. Try adding the following to your diet:

  • Iron fortified cereals
  • Soybeans
  • Lentils and beans
  • Spinach
  • Beef (in moderate amounts)
  • Clams

You can also increase the iron content of your foods by cooking in cast iron cookware.

Choose frozen when you can’t get fresh

When selecting produce and high quality animal protein, fresh food is always a go-to. However, as the winter months approach, you can’t always get your hands on high-quality fresh produce. Keep in mind that buying frozen is a good option and can be quite convenient. Frozen food can still boost your immune system because it is usually frozen at its peak ripeness.

In general, eating a healthy diet rich in fruits, vegetables, whole grains, lean protein, and healthy fats throughout the year will give your immune system the biggest boost. If you haven’t been eating as healthy this summer, now is a great time to change things up and start getting those immune boosting benefits!

Call 949-764-7239 to schedule a consultation with a dietitian to establish a personalized nutrition plan or for more information.

A: Online grocery shopping is a great opportunity to save time and bring nutrient-rich foods into your home environment. Be sure to follow some of these tips when you get started:

  1. Make A Plan – It is important to make a meal plan before beginning to grocery shop online. By being prepared with a meal plan you can save money on groceries and time throughout the week. A meal plan can also ensure that the groceries that you buy don’t go to waste.
  2. Order Early – Orders are on a first-come, first-served basis for many online grocery shopping platforms. The earlier you place your order, the more likely it is to be assigned to a shopper. Most stores let you order at least 24 hours in advance, so take advantage. If your shopper is filling your order earlier in the day, the grocery shelves are more likely to be fully stocked, so you should have less substitutions.
  3. Know How Your Store or App Works – each online grocery store or app works slightly differently. You may need to try a few different options before you find what works best for you and your family.
  4. Be Flexible – some items may be out of stock or unavailable. Be willing to accept a replacement from a different brand. Some apps allow you to choose a replacement option or your shopper may reach out to you for guidance.
  5. Manage Your Time – Online grocery shopping should save you time and money. But, just like in the grocery store, you need to be cautious about getting distracted by foods that aren’t on your list. Stick to your list and be aware of impulse buys.

Start by creating a weekly meal plan for you and your family. When planning meals, it is important to keep in mind The Healthy Eating Plate. Your plate should be 75% plants – fruits, vegetables, and whole grains. Evidence shows that 75% is the minimum percentage of plants to consume to achieve health benefits, but you can have up to 100% of your plate be plants. Plant foods are rich in complex carbohydrates. They have fiber, micronutrients, and sometimes even protein. Protein makes up 25% of your plate and can come from animal or plant sources. We have healthy fats off to the side as they should be used in moderation. All three of our macronutrients – carbohydrates, fats, and proteins are present in balance. Eating in this pattern throughout the day may be the key to eating for a decreased risk of disease.

Call 949-764-7239 to schedule a consultation with a dietitian to establish a personalized nutrition plan or for more information.

A: Weight loss has numerous health benefits, including reducing cancer risk. We know that losing excess weight may reduce the risk of certain types of cancer , such as breast cancer (after menopause) and endometrial cancer, which may be fueled by increased estrogen levels. Because excess fat tissue can produce higher levels of estrogen, weight loss can play a key role in prevention.

In addition to following a healthy diet to achieve weight loss goals, incorporate physical activity to help reduce cancer risk. Activity can help reduce fat mass and increase muscle mass to improve your hormone levels and immune function. Try to practice strength training exercises at least twice per week.

It is important to work with a registered dietitian during your weight loss journey to ensure that you are encouraged, supported, and lose weight in a healthy way.

 

To schedule an appointment, call 949-764-7239

Staphany Lao, PT, DPT, PRPC

A: The miraculous changes your body goes through during pregnancy are essential to accommodate your growing baby, but may cause symptoms such as low back pain, hip pain and pelvic pain. Your pelvic floor muscles, located at the base of the pelvic cavity, are now having to work harder to support you and baby, which can sometimes lead to pelvic pain, urinary frequency and/or urinary leakage. If you are experiencing any of these symptoms, don’t let it linger. Seek help from a pelvic floor physical therapist who can assist you in developing an individualized treatment plan to minimize and control symptoms in order to maintain a comfortable and active pregnancy.

Pelvic floor physical therapy can also help prepare you for labor and delivery. We will go over how to get in tune with your pelvic floor muscles, perineal massage techniques to help decrease risk of tearing, breathing techniques to help with pelvic floor relaxation, and laboring positions for comfort.

To schedule an appointment, call our Newport Beach location at 949-764-7277 or our Irvine location at 949-557-0190. Physician referral is required.

Anusha Wijeyakumar, MA, DIP Mentoring, CPC, RYT, Wellness Coach

A: Practicing Self-Care – 3 Steps to Towards Detoxing Your Mind

Would it not be a wonderful thing to have a calm and serene mind through the ups and downs of our daily lives? Having the ability to learn ways in which to stop the constant cascading thoughts, often negative ones from arising. Do you sometimes feel that you will never be able to change your way of thinking no matter how hard you try? Well you are not alone, many of us feel that we will never be able to slow our minds down or change our negative thinking. Mindfulness and meditation practices are a wonderful way to practice radical self-care and rewire your brain to think in a different way, opening your mind to the beauty in each present moment. Try these three simple steps below to begin the journey towards a calmer more tranquil you!

Step 1 – Bring awareness to your breath

You can practice self-care through mindfulness anywhere and at anytime by bringing awareness to your breath. Our breath, which is our life force brings body and mind together, enabling us to live in the present and not be chained to our pasts or victims of our future. After teaching meditation and mindfulness practices to clients over the years I am struck by how life changing these practices can be for people who have never been able to sit still and fully be with their own thoughts. So take a moment to pause, close your eyes and take a deep calming inhale and a slow releasing exhale. You can repeat this a few times using your breath as a tool to unite body and mind.

Step 2 – Allow your mind to come into the present

By guiding my clients through their journeys with yoga, meditation and mindfulness practices I have seen how much these practices transform their minds. It changes the way they think, which impacts on their lives, their relationships and in turn the world around them. I invite you in this moment to surrender and fully allow your mind to come into the present moment. Become unchained from your past, letting go of your own limiting thought patterns and beliefs that may have been holding you back. Right in this very moment you become fully aware of the now and feel deeply how freeing that can be. This is when the beauty of the present moment can really begin to unfold and the magic can start to happen in your mind and life!

Step 3 – Let go of the past and accept “what is”

I find myself often talking to my clients about the concept of accepting “what is” in our lives. This is something a lot of us struggle with as often we wish things to be different than what they are. Make a conscious decision today to try accepting what is in your life, without fighting, judging or resenting it and just sit with that feeling. Begin to feel all of your emotions that may arise without attachment to them, but simply as a silent, impartial observer of the mind. Rather than letting the past define the present fully surrender to the now and embrace your journey in its entirety without shame or guilt. Use this moment to fully awaken to the knowledge that the past has no power over the present and everything that you need truly lies within you. Allow yourself the opportunity as you drown out all of the internal and external noise to begin the journey of going within to discover lasting inner peace. In this moment embrace the feeling of changing your mindset from within in order to change your life.

To schedule an appointment with Anusha, call 949-764-7239 or email wellness@hoag.org.

Nicole Ervin, Certified Personal Trainer and Nutritionist, Fitness Coach

A: The FDA recommends at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, or a combination of both, preferably spread throughout the week.

How I break this down with a client depends largely on their lifestyle and what they enjoy doing. For a busy parent, spreading out their workout routine into 15 to 20 minute blocks may be more feasible than doing 45 to 60 minutes all at once. Finding out what time of day works best for your workouts is also key. Are you a morning, midday or evening exercise fan?

Being consistent with your days and times can help you stick with an exercise routine. However, if your schedule is like mine where no two weeks are the same, try blocking off time on your schedule at the beginning of your week to fit in a workout.

Lastly, I always encourage clients to listen to their bodies. The body does a pretty good job of trying to tell you what it wants and doesn’t want. It’s just a matter of how well we’re listening. For example, a client with a very high stress job or someone who is going through a stressful period in their life shouldn’t do super intense cardio or a boot camp class everyday. This will elevate their cortisol levels (stress hormones) higher than they already are and will cause fat loss to come to a crawling speed. Working in a proper workout routine with the right work/rest ratios along with some yoga or Pilates classes would be ideal to get the blood flowing without excessively raising cortisol levels.

Another thing I discuss with my clients is working out when sick. Exercising is great for boosting your immune system, but once you have a cold it is best to rest. Your body needs to focus on fighting off the cold rather than using calories for a workout. I can’t tell you how many times I’ve seen a client try and “sweat out the cold” and then hear from them that the cold got worse.

To learn more about individualized fitness and nutrition sessions, click here

Carissa Francisco, PT, DPT

A: Yes, position matters and can exacerbate pain during intercourse. Changing or modifying your position can help to lessen the pain. This applies with pain at any location, whether it’s at the entrance of the vagina, throughout the vaginal canal, lower abdominal area or lower back. We have three layers of pelvic floor muscles that attach from the pubic bone to the tailbone. These muscles have many different functions, one being to stabilize our pelvic girdle. Intercourse positions such as being on all fours (quadruped) and standing in a forward bend activate those pelvic floor muscles, which can lead to pain if your pelvic floor muscles are tight. If you experience bladder pain during intercourse, it may help to allow gravity to move the bladder out of the way during penetration. You can do this by placing a pillow underneath your bottom if lying on your back, or underneath your lower abdomen if lying on your stomach. If you experience pubic symphysis (above the pubic area) or sacroiliac pain (low back and buttocks) during intercourse, having your legs at a neutral position can help prevent aggravation of these joints. These are just a few examples of the ways positioning can play a role in painful intercourse. Each person with dyspareunia may have different positions that work for them depending on why they have pain. Therefore, it’s best to be seen by a physical therapist who specializes in pelvic health. Your pelvic health physical therapist will be able to evaluate what positions are best for you based on why you are experiencing pain with intercourse.

For more information or to schedule an appointment with the Hoag Pelvic Health Program, call our Newport Beach office at 949-764-7277 or our Irvine office at 949-557-0190.

 

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