In school, I imagined that being a physical therapist would be similar to being an auto mechanic for the human body. “My body is pulling to the left; it must be out of balance.” I could see myself looking at the deep connections and finding the one part to correct, “Ah, yes, well… if you were to just stretch this and move that here while you walk it would fix your problem.” Some days and some problems are simple like that, but usually problems are much more complex. Pain can be a sign of poor overall health and may not get better until the person improves his or her overall health.

Pain is the body’s alarm system, signaling any threats to survival. The body produces pain to move us to action when there is a threat to our health and then get us to change our behavior. For example, if I have been sitting too long, my back and legs will begin to hurt. The pain compels me to stand up and move.

Pain is a vital sign of health, similar to blood pressure or heart rate. It is the result of complex interactions with more than one cause. Persistent or chronic pain can be resistant to change until overall health is improved. When healthy, the body will heal most tissue damage without any special treatment.

New studies on pain have taught us the importance of sleep, nutrition and activity; improving those health factors are essential to reducing persistent pain. Effective pain management strategies may include:

• Sleeping 7 - 8 hours every night
• Exercising 30-60 minutes each day (set a goal of walking 10,000 steps over the course of a day)
• Eating more whole foods, fruits, vegetables
• Consuming less sugar and saturated/trans fats
• Adopting these healthy habits can make a difference in reducing chronic pain and pain that has been resistant to medical treatment.

Chronic and severe pain is a sign that something in the body is out of balance – however, remember that it may not be just a muscle or joint that is out of balance. Sometimes, there are structural or medical issues causing the pain that require treatment.

However, staying healthy does make a difference when it comes to pain; our bodies are marvelously adept at taking care of themselves when we are healthy. Making healthy choices is not always easy, but small changes can make a big difference in your health and pain. It is always helpful to set and track goals, ask for support from friends and family or ask a health care provider about more ways to make the healthy choice easier for you.

Reviewing the previous five-gallon jug metaphor, I think the jug in my last blog post symbolized parents investing in the lives of children, who start out empty and dependent. Parents are like a full five-gallon jug, filled with resources (such as time management, emotional stability, spiritual connection, financial potential, ethics, and so on). Parents act as a resource, “pouring” resources into their children to help them reach adulthood as five-gallon jugs of happy, safe and healthy humans on the planet.

Today, I will be discussing the five-gallon jug and how it relates to time management. Understanding and managing time is a human need. In the past, time motivated people to learn about the Earth’s rotation around the sun, and with that knowledge, that rotation was replicated through the motion of a clock. Understanding time is about more than reciting hour and minute. Before sundials and hourglasses, understanding time helped support human connection. This need drives people to reflect on history, be present in the moment and have a good outlook to the future. Parents “pour” into children a sense of belonging by connecting time to ancestry and pride of “where we came from.” Parents also contribute to a child’s ability to focus and sustain attention by being aware of the current surroundings. They also tip their jug as a way to encourage hope and resiliency for tomorrow. When a child misses this important pour into his or her life, he or she may experience challenges in developing a sense of self, engaging in satisfying interpersonal relationships, planning and making decisions.

Parents can help their children understand time by telling stories that help the child learn about previous generations. Traditions are a fantastic way to underscore this essential principle by bringing the past to the present. To complete the circuit, the parent can guide the child in reflecting on the experience of participating in an activity that has been passed down through the family’s history.

Face time with parents is essential to understanding time and how to be “in the moment.” Simple activities, such as playing “I Spy” and or going on a “discovery” nature walk provide opportunities for children to notice their surroundings.

As children mature and fill their jugs, one of the crucial elements of understanding time includes having a hopeful outlook for the future. While younger children may consider shorter time spans as the future, this early skill leads to planning and decision making later in life. Parents can promote forward thinking through:

• Tracking positive behaviors via behavior charts
• Counting down to an exciting event using a calendar
• Asking the child questions that will help plan a future activity

Time management is about more than being “on time.” Understanding the complexity of time is crucial for good mental health. Understanding time helps us appreciate the past, be mindful and present and anticipate good outcomes for the actions of today.

“If you don’t like the road you’re walking, start paving another one.” This quote by Dolly Parton reminds me that we all have the opportunity to make changes in our lives. Sometimes it’s hard to decide where to start. Let’s begin by looking at the concept of well-being. Achieving wellness requires balancing the various aspects of our physical, emotional, mental and spiritual health. If one or more of these aspects are out of sync, then you can start looking at ways to bring them back in balance.

Physical wellness is probably the aspect that comes to mind first when we think of wellness. According to the 2008 Physical Activity Guidelines for Americans, you need to two types of exercise each week to improve your health–aerobic and muscle-strengthening. Adults need at least 2 hours and 30 minutes of moderate-intensity aerobic exercise (such as brisk walking every week) and muscle strengthening exercises on 2 more days a week that work all major muscle groups (legs, back, abdomen, chest, shoulders, and arms.)

Emotional wellness is the aspect that involves your personal thoughts and feelings. How you handle stress is a big part of your emotional well-being. Improving your emotional wellness involves getting comfortable with who you are by building positive self-esteem and practicing emotional self-care.

Mental wellness can be defined as a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community. Mental wellness can be influenced by medications, illnesses, family history, losses and traumatic events. You can improve mental wellness through healthy habits such as regular physical activity, nutritional meals, adequate sleep, stress reduction and more.

Spiritual wellness deals with how we find meaning and purpose in life, a connection to the universe and a relationship with a higher power. It involves clarifying your beliefs and values so that you can truly live by them. Some questions to ask yourself relating to spiritual wellness include: “Do I make time for relaxation in my day?”, “Do my values guide my decisions and actions?” and “Am I accepting of the views of others?”

If you find that any of the aspects of your wellness are out of sync, look for ways in your daily routine to make improving them a priority. Oftentimes, making an appointment with yourself to walk or return to the moment by turning off distractions such as your cell phone, computer or the TV can be helpful in the process. Remember: if you don’t like the road you’re walking, start paving another one.

Reviewing my previous five-gallon jug metaphor, I think the jug in my last blog post symbolized parents investing in the lives of children, who start out empty and dependent. Parents are like a full five-gallon jug, filled with resources (such as time management, emotional stability, spiritual connection, financial potential, ethics, and so on). Parents act as a resource, “pouring” resources into their children to help them reach adulthood as five-gallon jugs of happy, safe and healthy humans on the planet.

Today, I will be discussing the five-gallon jug and how it relates to emotional stability. Emotions originate in the brain, which is an organ in the body just like the heart and lungs. This biological component is the most tangible part of the process of emotions. However, emotions also involve thoughts and behavior choices, which are social, cultural and spiritual in nature – these last two parts are less specific in location of the brain. For this reason, human emotions are as unique the individual who is experiencing them. At birth, children’s brain functions are mature for bodily functions such as keeping the heart beating and lungs breathing. However, a child’s brain functions are immature with regard to emotions; these social, cultural and spiritual processes have to be experienced in order to promote maturity. Hence, a return to my five-gallon jug metaphor.

Emotions = Thinking + Feeling + Doing

Imagine a large, empty jug – as you pour water into it, it echoes and rumbles as the water hits the bottom and you hear high pitches and swirling. The same is true with an infant. Every new experience is “big” and consumes the child’s entire being. (Think of a baby. When the baby is happy, his or her whole body smiles. When the child is hungry, his or her whole body lets us know!) An explanation for this observation is that the brain is experience-dependent, meaning each event in a child’s life helps form a network, or web, of connections in the brain. Yet, other portions of this web of experiences is determining what events are safe. This is where the parent comes in.

As a child experiences new events, parents can help provide a sense of safety because a child will be determining whether “new” events are okay or not. If the parent provides safety, a child will approach life to experience it. For example, the child will want to try new foods and crawl to reach for a toy. If safety is not provided, a child will avoid experiencing life. A younger child’s brain rewards the body for new experiences that include exploration, curiosity, imagination and discovery. These rewards encourage the child to keep approaching throughout life. This reward matures the brain’s ability to manage emotions.

Present adult safety = child approaches = reward
Absent adult safety = child avoids = no reward

As children grow, their five-gallon jugs may not echo as much, because previous pours absorb the new sounds as water pours in. When children have new learning experiences that are positive, their brains mature and they learn how to manage “bigger” new experiences. Children can learn to manage their emotions when it comes to ongoing change – however, without parental guidance, the echoing in the pour can signal alarm defenses. Without guidance from parents, a school-aged child may feel anxiety and frustration. The child may be reluctant to explore and imagine. Going into adolescence, the result of a low number of positive new learning experiences leads to fewer rewards and thus fewer opportunities to learn how to manage complex emotions and situations in life.

Parents can help their young children prepare for positive new experiences by clearly stating a plan, including start and end times. For example, when going into a car seat, the parent should mention the word “car seat” so that a child can begin to identify the beginning of the process. The adult then says “ready” as the straps and buckling starts. When everything is in place, the adult lets the child know it is “all done.” A child can then begin to predict what will happen with the car seat, approach the process and manage the possible feelings of annoyance at the process. Remember that protest is okay; defiance is not.

Parents can help their school-age children prepare for positive new experiences by sharing control through choices and negotiating a plan. For example, when it is time to review homework, ask “what would work best for you: review homework before dinner or before riding your bike?” Consistency and following through will help a child predict what will happen, approach the process and manage the possible feelings of annoyance. Once again, protest is okay; defiance is not.

Finally, parents can help their adolescent children prepare for positive new experiences by explaining the importance accountability, correcting/building on mistakes and showing fairness. For example, as youths often begin identifying different groups (to belong or not belong to), an adult could “wonder” about various topics to help facilitate conversation. Without making a conclusion, the parent can help the child think about social, cultural and spiritual processes. For example, the parent could ask, “I wonder why it’s important to get a high school diploma?”, “I wonder what would help you get better at being on time for class?” or “I wonder what the outcome might be for such behavior?” These questions help the adolescent prepare for adulthood by helping him or her predict what behavior society expects. Such “pouring” from an adult can help youths approach life and learn to manage the ups and downs in life. Always remember that protest is okay; defiance is not.

With help from parents, children can enjoy learning to experience emotions and all the components of thinking, feeling and doing along the way. While the brain will go through its physical processes, parents have the opportunity to help foster emotional growth through the unique experiences that shape each individual for life. Each “pour” helps a child to reach his or her full five-gallon potential as a happy, healthy and safe adult.

My hobby outside of work is triathlons. This July, I concluded my biggest triathlon adventure yet – I completed 140.6 miles in one day at my first Ironman Triathlon. I learned a lot about my body while training for this race. For instance, I learned just how much I could push the limits. More importantly, I learned the importance of rest and recovery. Even beyond the world of triathlons, the significance of rest and recovery often gets overlooked. It is human nature to think more activity is better and sitting still is counterproductive; I have treated many patients that have this same mindset when it comes to rehabilitation.

Rehabilitating from a surgery or an injury is, in many ways, similar to training for a triathlon. There might be a bit more time commitment with training for a competition, but the end goal is still the same – making the body stronger and healthier, which helps better prepare us for the challenges that life brings.

The human body is amazingly adaptable. It is possible to get stronger and healthier; exercise plays a big role in helping make these changes. It does this by creating positive stress in the body. Exercise, when performed in the right amount and right intensity, can serve as positive stress to the body. Lifting weights can increase muscle size and help reduce the effects of osteoporosis. Running can improve the health of the heart and blood vessels, reducing the risk for stroke or heart attack. Hobbies that increase heart rate can improve brain and nerve health, helping to reduce the risk for disorders such as Alzheimer’s disease. All these examples are “stressors” that can create very positive changes in the body. When done in excess, however, they have the potential to create negative change. At this point exercise adds negative stress to the body. When this happens, the body will respond to exercise similar to what it does with lack of sleep, excessive life stress, poor diet, emotional instability, etc.

When training for my triathlon, I had to really watch how much stress I was putting my body through. I needed to exercise a lot (sometimes up to 20 hours/week) to be strong enough to finish my race. I also needed to make sure I was eating right, getting enough sleep and making time to relax and enjoy activities. I knew that my body could only handle so much stress. More exercise and more training did not always bring me the best outcomes. I think that these same principles hold true for anyone that is rehabilitating from an injury or who suffers from a chronic pain condition. Exercise and medication can help, but they aren’t the entire solution. Any kind of negative stress from life will affect outcomes. Sleep matters. Diet matters. Stress from work matters. It all matters. Don’t overlook the importance of rest and recovery.

After a year of training, I knew I was finally ready for my race. I was strong, healthy and ready for my challenge. On July 27, 2014, I crossed the finish line with a time of 13 hours and 49 minutes after swimming 2.4 miles, biking 112 miles and running 26.2 miles.

Summer barbeques and picnics can offer many tempting food choices that are high in calories and sugar. Knowing how to create a well-balanced meal helps keep your blood sugar level as close to normal as possible. Here are some summer tips to help you keep your cool:

Choose lean, grilled meats. Bypass the fried chicken and go for lean meats such as a grilled chicken breast, turkey burger or fish.

Veg out. Grill up some veggie kabobs or sliced vegetables in foil for a low-carb entrée or side. Raw veggies with hummus or other low-fat dip are great for snacking.

Bring a dish to share. Attending a party? Offer to bring a green salad or fruit salad to share. That way, you can be certain there is something healthy for you to eat, and your host will thank you for helping out.

Drink responsibly. If you decide to drink alcohol, drink in moderation. It is recommended that women with diabetes have no more than 1 drink per day and men are limited to 2 drinks per day.

Drink water, not sugar. It is important to stay hydrated, but many of our favorite summer quenchers are full of sugar and calories. Water is really the best drink to prevent dehydration.

Don't skip meals. Saving all your carbs or calories for a summer outing may make it harder to manage your blood sugar.

Have fun! Making healthy eating choices can make summer gatherings even more fun in the sun.

We have all heard the saying “the family that plays together stays together.” This really holds true, but living a busy life often means it is necessary to cut something out. You may be tempted to cut down on playtime. Yet, cutting out playtime means cutting out an opportunity for the many health benefits that family togetherness provides.

Playing together helps open up the lines of communication in the family. In this day and age, we often communicate through social media and email. It’s important to remember that actually talking to each other is the best and most healthy way to connect.

Spending time together as a family creates a sense of belonging for everyone. Knowing that you have someone who understands and supports you to come home to at the end of the day can get you through a tough day. Additionally, spending time together creates life-long memories that family members will cherish. Try getting the family together this weekend for a fun day in the park or a game of toss football in the backyard.

One of the best things about playing together is that it allows us to get the physical activity we need. We need to get 30 minutes of moderate physical activity most days of the week. So why not make one of those days a family day? Ask each family member to choose the physical activity for a day and alternate each week. You may find yourself doing things you haven’t done since grade school such as jump rope, play hop scotch or ride bikes, which should bring a smile to your kids' or grandkids' faces, and a laugh or two. After all, we've also heard the saying “laughter is the best medicine!”

Is it safe to exercise during pregnancy?
Exercising during pregnancy is safe and recommended. 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. Moderate exercise is recommended for 30 minutes a day, 4 – 5 times each week; strenuous exercise can be performed in pregnancy with physician supervision. Complicated or high risk pregnancies should avoid exercise in pregnancy. As always, talk with your doctor before starting your exercise program. You’ll also need to reassess your exercise program with your doctor on a regular basis as your pregnancy progresses.

What are the benefits of exercise during pregnancy?
Exercise in pregnancy helps you maintain a healthy weight, reduce discomfort and improve sleep. Additionally, it may help decrease your risk of developing diabetes or high blood pressure.

What types of exercises are best for pregnant women?
Most exercises are safe in pregnancy. Yoga, Pilates and stretching exercises can be easily modified for each trimester of pregnancy. Aerobic exercises (e.g., walking, running, swimming or aerobic classes) are recommended to maintain a healthy weight and cardiovascular health. Weight lifting can be performed, typically with the recommendation of more repetitions and less weight. Supine exercises, such as lying on your back for sit-ups, can be performed, but should be used with a hip roll after the first trimester in order to avoid low blood pressure. While sit-ups are okay in pregnancy, as the pregnancy progresses, patients are often so uncomfortable in the sit-up position that it is not reasonable to continue that type of exercise.

Do pregnant women need to consume extra calories on days they're exercising?
Mild increases (200-300 calories) in caloric intake are recommended for all pregnant women, whether they are exercising or not. Pregnant women who are exercising should ensure that they’re increasing their water intake – this is crucial.

What types of exercises should pregnant women avoid?
Exercising in a temperature-neutral environment is important. “Hot yoga,” for instance, would not be recommended for women who are pregnant. Pregnant women should also avoid working out in a gym without adequate cooling mechanisms and running for long distances in the heat of the day. Remember to stay well-hydrated and cool off when needed!

What are the warning signs that a pregnant woman is pushing her body too hard?
Listen to your body! That is the best advice for a woman in pregnancy. If you feel too hot or short of breath, it's time to stop and rest. Other warning signs are: feeling faint, headache, nausea/vomiting, leg pain, chest pain, vaginal bleeding, or contractions/abdominal pains that are painful. Complicated or high risk pregnancies should avoid exercise in pregnancy. For example, patients with a heart condition or high blood pressure may need to avoid certain activities. Consult your physician about your specific condition. Remember: stay hydrated, don’t get too hot and pay attention to your body’s warning signs.

As adults "pour" into the lives of children, adults can serve as a resource to fill children with the capacity to reach adulthood as happy, safe and healthy individuals. We have the explored areas of time management and emotional stability with this metaphor; those blog posts contained a key principle that can be applied in a variety of ways: adult leadership cultivates child followership.

Adults help developing minds track time on a clock, through history and into the future. As long as a child feels safe (due to adult guidance), he or she will feel more secure to learn and approach new experiences. This high-quality role modeling results in young people internalizing a positive view of the world and then living it as they grow up. This key principle – adult leadership cultivates child followership – flows over into other areas of children’s lives as well, such as spiritual connections, finances and ethics.

We can define spirituality as a connection to other people across time and space. Adults can help children develop this important life skill. For example, parents can talk about people who have positively influenced our society as part of that “connection.” For example, simply referring to a picture of a stovepipe hat evokes the connection to Abraham Lincoln for some people. When we are careful to leave the walking path clear of litter, we are demonstrating our connection by considering those who came on the path before us and those who will tag along later. Adults can be considered the best supplier for hope as well; children need to receive frequent doses of hope and optimism in our connection with others.

Children need parental guidance on financial topics, too. This subject holds potential for some uncomfortable life lessons, but parents can help by encouraging children! Just as some would say there is never enough time, some folks say it is also true of money. Thus, this area is a vital “pour” for children!

The obvious benefits of learning to manage finances are learning how to budget, plan and set financial goals. The more subtle advantage is that children will also learn the meaning of money. A simple rule of thumb is to help them distinguish between choices: “Should I save, share or spend?” and “What percentage will I allow for each category?” Adults can help children slow down and discuss the values between the choices of saving, sharing and spending. For example, it may be uncomfortable to wait for the savings to accumulate to the amount needed to purchase an item, but adults can “pour” in patience! Sharing with others can bring a mixture of feelings – children may be glad to help and sad to watch dollars leave. Spending choices help a child practice thinking through cause-and-effect, developing morals and delaying impulsivity. With continued leadership, children will follow their parents’ examples into adulthood.

Moral development can progress when children have caring adults in their lives. Ethics are the “character” that guides a person, group, community, nation and world. Ethics are the center question of credibility, and all else weaves around it. Parents can share valuable customs, beliefs and practices with their children. In adulthood, these manifest as character traits like common sense, moral reasoning and goodwill. For example, I heard an older gentleman explain why picked up loose pennies. He would tell his grandchildren that the pennies were like people and “everyone’s worth picking up.” He also took young people with him during volunteer opportunities. He showed the way during clothing and food drives. As a result, many young people internalized his example.

While children can understand ethics as “right” and “wrong,” adults should remember not to be too rigid or too flexible in the rules. It’s important to learn how to effectively problem solve when dilemmas occur. Ethics help a child know what values to hold firmly, and which ones have some room for negotiation. The older gentleman mentioned earlier poured ethics from his five-gallon jug by showing that his character gave him the energy to help – even when he didn’t feel like it and when the weather wasn’t pleasant. What a “pour” into the young lives in his circle of influence!

In summary, the five-gallon jug metaphor involves valuing caring adults’ contributions in children’s lives. Most importantly, it involves valuing children, who are the needful recipients of such giving. Good mental health is correlated to good physical health. Therefore, adults have significant opportunities to support children’s good mental and physical health through positive contributions.

Enjoy the “pour”!

In 1942, nutritionist Victor Lindlahr published You Are What You Eat: How to Win and Keep Health with Diet. Dr. Gillian McKeith published the book You Are What You Eat: The Plan That Will Change Your Life in 2005. What you eat continues to be just as important today as it was in the 1940s.

Nutritious food is the key to good health. If you exercise but don’t fuel your body correctly, you’re not going to get the physical results you desire. No matter what diet you follow, knowing what is in your food and how it is processed is just as important as the food itself. If you eat whole, healthy and fresh foods, your body, skin and soul will radiate health and you will have more energy!

Take control over what you allow into your body by following these basic clean eating rules:

Eat plants. Eat food that comes straight from nature, as close as possible to the way nature made it. Eat mostly foods that come from a tree, bush, plant or vine, and you’ve pretty much got it covered. Try to stay away from food that has been altered in any way.

Choose meats straight from the farm (and organic if possible). Don’t buy pre-packaged meat products, because you never know what’s in them. When possible, buy whole meats and grind them yourself or ask the butcher to do it.

Enjoy grains. Eat grains that are still complete and haven’t been broken down into “glue”. Stick to brown rice, quinoa, and other whole grains.

Eat fewer ingredients. Try not to purchase foods that have more than 3-6 ingredients in the ingredient list. And be sure you recognize each and every ingredient. If it’s anything other than honest-to-goodness herbs and spices, avoid it! And remember, if you can’t pronounce it, it probably shouldn’t go into your body.

Don’t feel like you have to make all the changes at one time. Pick one area to try to improve for a week and then after it has become part of your healthy lifestyle, make another change. Eating healthy is a way of life, not a diet. So, give yourself some time and enjoy how great the whole foods taste when they are in their natural state.

This blog post was written by Kris Drake RN, CHPD, Freeman Health System Wellness Coordinator, in collaboration with Shelby Allen, RN, BSN, Freeman Prevention and Wellness Supervisor.