Varicose veins are the seemingly unsightly, swollen, twisted and bulging veins found on the legs. They are caused by blood pooling up in the vein when a defective or damaged valve no longer pushes blood back up to the heart. Developing these veins may be more than just a cosmetic issue.

Here's why. Pain, swelling and leg fatigue can readily discourage an active lifestyle. Severe cases can even cause chronic infections and skin ulcerations. Gender, family history, age, pregnancy, obesity and prolonged standing all contribute to this condition.

For many seniors, varicose veins are an unfortunate rite of passage. Nearly 50% of all Americans over the age of 50 and 2 in 3 women over 60 suffer from them, but it’s a common problem at any age. I have treated patients younger than 20 and older than 90.

Hippocrates and the ancient Egyptians wrote about the condition, and until the 21st century, the only surgical treatment was stripping the greater saphenous vein (the primary leg vein). This was a painful, even barbaric procedure requiring a general anesthetic and weeks of recovery. Understandably, most patients avoided this treatment. I still see many patients who have suffered for decades, believing that vein stripping was their only alternative. These same patients are delighted to discover that medical technology has finally caught up with the treatment of varicose veins. Now, we are able to offer a minimally-invasive procedure that treats the condition in minutes.

Breakthroughs in catheter technology, the same type as used for heart interventions, provide physicians with a safe and effective solution in treating varicose veins. Using a local anesthetic, the doctor threads a catheter, about the thickness of a spaghetti noodle, into the vein, heating it from within and sealing it off. The catheter is pulled through the vein using radiofrequency energy (RFE) or laser to heat the vein walls, causing them to collapse inward. Once the vein is sealed, the body automatically re-routes blood through healthier vessels, thus restoring normal circulation. Varicosity symptoms quickly dissipate and the sealed vein is absorbed by the body.

Considered a medical necessity, not cosmetic surgery, this procedure is generally covered by Medicare and most insurers, thus clearing away the final barrier to longtime varicose vein sufferers seeking treatment. We are seeing many new patients.

No longer considered unmanly, we are treating more men than ever before. We’ve seen a rush of interest from active seniors well into their 80s. Many of these have middle-aged children who’ve undergone the treatment, and upon seeing the results, want the treatment for themselves. I’ve had patients tell me they are wearing shorts for the first time in 40 years!

Studies have found volunteering leads to improved physical and mental health because it provides a sense of purpose and accomplishment. Volunteering can be a very rewarding experience. If you ask Freeman volunteers why they volunteer, you may get a variety of reasons. Some of the reasons I have heard from our volunteers include:

“I enjoy the new friends I have made.”

“It brings me joy, and I feel good about myself.”

“I work in a positive atmosphere.”

“I love the challenge of learning something new.”

“It gives me a sense of pride, knowing I am helping others as well as giving back to my community.”

“It gets me out of the house, and Freeman offers great benefits to their volunteers.”

To get started, simply call me at 417.347.4603 or send an email to ldmcintosh@freemanhealth.com. You are welcomed to job shadow in a couple of areas before deciding which area fits you best. We work to get you on a day and time slot that works best for you. Some of the areas available to volunteer are ICU, surgery check-in desk, information desk, Freeman Gift Gallery, Freeman Cancer Institute, and Freeman Heart & Vascular Institute. We can accommodate a busy schedule – most Freeman volunteers work one 4-hour shift a week, so volunteering doesn’t have to be a big time commitment. We also offer an easy process for taking time off.

We hope this opportunity is just what you are looking for, and we are anxious to hear from you!

As we begin a new year, we often reflect on the things we didn’t accomplish last year and set a resolution or goal for the coming year. “The start is what stops most people” is true for many of us. We want to reach our goals and make positive changes in our lives, but often don’t know where to begin.

The first step in setting a health-related goal is to determine why you want to develop healthier lifestyle habits. Maybe the reason is that you have a strong family history of heart disease or stroke, or maybe you are a parent and want to be in the best possible health so you can care for your family. Once you have established the why, then you can follow the goal setting process to reach your objectives.

Goals should be SMART: Specific, Measurable, Action-based, Realistic and Time-oriented. Try these tips to set SMART goals:

• Set three-month and weekly goals based on your wellness vision.
• Focus on one goal at a time.
• Create a plan that is flexible, fun and appropriate for you.
• Start a journal and include goals, desires, barriers, obstacles, excuses and solutions.
• Plan for obstacles and determine how you will overcome them.
• Reward yourself for reaching the small goals to help you stay motivated for the long-term results.
• Remember small steps become lifestyle changes. Take it one step at a time and don’t be afraid to get started.

The moment you announce your pregnancy, advice begins to pour in. It can be hard to decide which advice to take to heart. Old wives tales are often the most entertaining – some examples include, “Carry low and the baby is a boy,” “Heartburn causes the baby to have a lot of hair,” “If you dream of a fist, you are pregnant,” and “Sleeping with your arm above your head causes the umbilical cord to wrap around the neck.” Of course, none of these are true, but some of these myths can cause women to limit their activities or keep them from staying as healthy as possible.

Myth: Exercise in pregnancy should be avoided.
Fact: Nothing is further from the truth. This subject has been studied and exercise is safe in pregnancy. The rule of thumb is in a normal healthy pregnancy, the exercise that you did before becoming pregnant can usually can be continued throughout the pregnancy, with modifications as the pregnancy progresses. Staying active is good for your flexibility and strength. Exercise also helps with basic aches and pains of pregnancy and labor. Always talk with your doctor first, but in most cases, exercise is encouraged.

Myth: Flu vaccine is not safe in pregnancy.
Fact: I highly encourage you to get vaccinated against influenza while pregnant. The vaccine does not cause influenza or any of the symptoms. Pregnant patients with the flu are more likely to have complications with respiratory distress and pneumonia – these complications can be avoided by getting vaccinated.

Myth: Sex in pregnancy is not safe.
Fact: Intercourse can cause contractions and uncomfortable pain, but typically does not increase risk of infection or preterm labor. As long as you are not in a high-risk relationship or having unprotected intercourse with a new partner, then the risk of infection is very low. Sexually transmitted diseases can cause pregnancy complications to both you and your unborn child if severe. If unsure, talk with your doctor.

Myth: Hair dye is not an option.
Fact: There is very little, if any, hair dye that is absorbed into the blood stream when you dye your hair. The smell of hair products may not agree with you in pregnancy, so make sure to dye your hair in a ventilated area.

Myth: Pregnant women are eating for two.
Fact: Unfortunately, it’s a myth that women are eating for two. You only need about 200-300 more calories per day when you are pregnant. Healthy eating and a healthy weight not only affects your pregnancy, but it may affect your child’s future. There is some research that suggests babies of obese moms are more likely to be overweight as an adult. Additionally, the more weigh you gain in pregnancy, the harder it is to lose after. Splurge now and then for those pregnancy cravings, but keep your diet balanced to keep you and your baby healthy.

Myth: Caffeine is off-limits.
Fact: You don’t have to be caffeine-free in pregnancy! There is a threshold of 300 milligrams of caffeine, which may contribute to miscarriage. If you have high blood pressure, heart problems or anxiety, caffeine may worsen those issues. Overall, a little caffeine is safe if you just can’t let it go completely. Read the labels and know how much you are really drinking or eating daily.

Myth #7: Flying is not allowed.
Fact: Whether you’re planning a trip or travelling for work, you are safe to fly. It’s safe to walk through airport body scanners, but if you want to play it safe, feel free to ask for an alternative method of screening. Just know if you are running late for your plane, a trip through the scanner will not harm your baby.

Myth: Fish is off-limits during pregnancy.
Fact: I encourage my patients to eat fish while pregnant – omega-3 fatty acids, found in fish, are chock-full of health benefits and helpful for brain development. Before consuming, just ensure that the fish or shellfish is cooked. Please note that large fish, such as swordfish, mackerel, shark, tilefish, are high in mercury must be limited. You’ll also need to avoid sushi, unless it is cooked.

Myth: Cocoa butter helps prevent stretch marks.
Fact: I hate to tell you this, but stretch marks are a genetic issue. Some women just don’t have stretch marks. We don’t like them, but unfortunately, that is just the way it is. Using a moisturizer is helpful as the skin stretches, but it won’t prevent stretch marks.

Myth: Hot dogs and lunch meat are not permitted.
Fact: You can eat hot dogs and lunch meat, but be sure they are well-cooked/heated through and that they’re not a mainstay in your diet.

Myth: Sleeping on your back is off-limits.
Sleeping on your left side does optimize the blood flow to your uterus (and to you), but this is not an absolute. If you wake up on your back or any side, no harm done. Sleep how you are comfortable; both you and your baby will be just fine.

There are many other very entertaining myths out there – but, before you change your life, starve yourself, don’t leave your house during an eclipse, or never raise your arms above your head, talk with your doctor! Enjoy your pregnancy and know that within reason, most day-to-day activity is just fine.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Referenced from breastcancer.org

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

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

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

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

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

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

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

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

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