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.

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

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

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.

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.

Christina Nguyen, Licensed Acupuncturist

A: Cosmetic acupuncture is an extension of traditional Chinese acupuncture that has grown increasingly popular over the years. Unlike Botox or chemical facials that inject the face with neurotoxins, facial acupuncture does NOT inject anything into the body but instead uses the body’s natural healing system to promote blood flow and increase collagen to the surface of the skin, thus reducing fine lines and wrinkles. While being equally relaxing as a normal facial, it is also fertility and pregnancy safe!

How does it work? Similar to micro-needling, a licensed acupuncturist inserts hair-thin needles into the dermis of the skin to promote collagen production as well as target bags under eyes and wrinkles. The needles are left on the face while the patient rests for a minimum of 30 minutes and generally six treatments are suggested to begin seeing results. Every treatment is custom and tailored to each client depending on his or her skincare needs, which can include but is not limited to: acne scarring, wrinkle prevention, smile lines, laugh lines, bags under eyes, crow’s feet and bunny lines. 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.

Danielle Dawson, MA, LMFT, Psychotherapist

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.

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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