Turn Your Frown Upside Down!

By Riva Preil

Seasonal Affective Disorder, also known as SAD (pun intended), is a subcategory of major depression connected with one season only (varies per person).  These symptoms include lethargy, hopelessness, social isolation, irritability, increased appetite and sleep, and decreased libido. The season most commonly associated with SAD is the winter, hence the condition’s nickname “winter depression” or “winter blues.”  A proposed theory behind the pathophysiology is that exposure to light (or lack thereof) plays a huge role in the development of SAD, especially the winter version.  In fact, many have benefitted from bright white light therapy treatment with a lightbox that emits 10,000 lux (a much higher amount than a typical incandescent bulb).  Treatment includes sitting 30-60 cm away from the lightbox (but not staring directly into the light) and is recommended for 30-60 minutes/day. Alternatively, light exposure mimicking sunrise (“dawn simulation”) has proven very effective as well. (See link to article below for evidence-based research about the positive effects of light therapy from BMS Psychiatry.) Other forms of treatment for SAD include medications (SSRI and Modafinil), talk therapy, adequate sleep and exercise, and healthy eating. In addition, Dr. Alfred Lewy of Oregon Health and Science University suggests that SAD is associated with an altered circadian rhythm.  Therefore, he recommends daily afternoon melatonin supplements to help re-align the sleep-wake cycle.  Proper diagnosis and treatment of SAD is crucial because an estimated 20% of SAD sufferers have or will go on to develop bipolar disorder.  Therefore, if you or someone you know can relate to the symptoms described above, please speak with an appropriate health care provider to help alleviate symptoms.

Feeling the Burn?

By Riva Preil

Burning pain with urination (dysuria)…urinary urgency and frequency…sounds like a urinary tract infection (UTI), right? Not necessarily!  Even though UTIs are one of the most common reasons for women to visit their doctor (an estimated seven million visits per year, in fact!), they are not always the culprit.  When a urine culture’s results are negative despite the classic symptoms described above, it is believed that the individual has urethral syndrome.

Urethral syndrome can be subcategorized as follows:

  1. “Pure” urethral syndrome- this is believed to be a type of vulvodynia.  The individual may report a spasm sensation surrounding the urethra or near the vagina as well as a burning or stinging sensation with urination.
  2. Interstitial Cystitis (IC)- inflammation of the bladder due to unknown cause. Unfortunately, antibiotics do not help treat IC. IC is diagnosed through a test called cystoscopy, which is involves filling the bladder with fluid while under anesthesia to assess its integrity. IC is strongly correlated with vulvar vestibulitis, and the two often accompany each other.
  3. Certain sexually transmitted infections (such as chlamydia, herpes, and gonorrhea) may also urethral irritation.

Please talk to your doctor if you think you may be experiencing any of the above. Burning and irritation may not be what you think it is, and your health care provider can help you with proper diagnosis and treatment. As with all pelvic floor disorders, physical therapy is a wonderful tool to treat the musculoskeletal related changes associated with any of the urethral syndromes.

Let’s Review: Pelvic Floor Muscles


By Mary Hughes, PT, DPT

Urogenital Triangle

Primary Sexual Function: Obstructs venous return and maintains erection of clitoris

Primary Sexual Function: initiates erection of the clitoris, also functions as a vaginal sphincter in females

Superficial Transverse Perineum: Stabilizes and strengthens the perineum

Levator Ani: functions as a unit.
Deep Pelvic Floor Muscles: Pubococcygeus,  Iliococcygeus, Puborectalis
Supports Pelvic Organs, assists with core stabilization, assists in orgasm in both men and women, moves the tail bone.
Inappropriate length tension relations or strength between any or all of these muscles can lead to pain, bladder/bowel dysfunction and or sexual dysfunction.

The WHY of the THYroid

By Riva Preil

Happy Thyroid Awareness Month!  The thyroid gland is an important component of the endocrine system which is located in the front of the neck.  The thyroid gland itself is regulated by the hypothalamus, which releases thyrotropin releasing hormone (TRH).  TRH acts on the anterior pituitary gland and causes it to release thyroid-stimulating hormone (TSH).  TSH in turn controls the release of two important hormones from the thyroid, triiodothyronine (T3) and thyroxine (T4).  Iodine and tyrosine are required for T3 and T4 production.  These hormones are responsible for metabolism, protein synthesis, and the body’s sensitivity to other various hormones.  They are also crucial for brain development in the growing fetus.

Too much of anything is never good, including thyroid hormones.  Grave’s Disease, an autoimmune disorder, can result in hyperthyroidism (overactive thyroid) and an overproduction of T3 and T4.  The symptoms of hyperthyroidism include an enlarged thyroid gland (goiter), exophthalmos (protruding eyes), heart palpitations, increased sweating, involuntary weight loss, diarrhea, increased appetite, and muscle weakness.  Beta blocker medications are often prescribed to help treat the symptoms, and others may decide to undergo radioactive iodine-131 to treat the overactive thyroid.  On the flip side, decreased thyroid activity, also known as hypothyroidism or Hashimoto’s Disease, is also detrimental to one’s health.  Iodine deficiency is also linked with hypothyroidism, and it is therefore recommended to use iodized salt in one’s diet.  The symptoms of hypothyroidism include fatigue, weight gain, decreased heart rate, and poor tolerance to cold temperatures.  Hormone replacement therapy with levothyroxine often corrects for this disease.

It is interesting to note that hypothyroidism is associated with sexual dysfunction (refer to abstract from The Journal of Sexual Medicine: http://www.ncbi.nlm.nih.gov/pubmed/20412428).  Therefore, it is important for health care providers to address any and all issues that an individual with hypothyroidism may be experiencing, including pelvic floor muscle dysfunction.

Lymphedema Risk Reduction

Risk Reduction Practices For People With Lymphedema According to the National Lymphedema Network

By Roseanne Cruz

It is not known why some people with the same risk factors develop lymphedema and some do not. People at risk of lymphedema are individuals who have not yet displayed the signs and symptoms of lymphedema but have a known insufficiency of their lymphatic system. This includes people who have undergone removal of lymph nodes or radiation therapy, which increases the risk for developing lymphedema. At-risk individuals have altered lymphatic function that may impede the body’s ability to take up excess fluids in the tissues.

For those with a confirmed diagnosis of lymphedema or at risk for developing it, consider the following:

  1. Routine medical check-ups
  2. Report changes- such as increase in size, change in sensation, color, temperature, or skin condition
  3. Body Weight- maintain normal body weight and seek help to lose weight if needed
  4. Exercise- incorrect or unsafe exercise may exacerbate lymphedema
  5. Compression garments- wear for air travel, exercise, and exertion
  6. Infections (cellulitis)- be aware of any signs of redness, warmth, pain, fever, or flu-like symptoms
  7. Skin care- maintain proper hygiene and use a moisturizer regularly
  8. Trauma- avoid trauma; protect against falls, fractures, and burns; use non-involved limb for venipunctures; proper nail care
  9. Constriction- ensure properly fitting compression bandages and clothing; avoid tight stockings or bras
  10. Avoid exposure to extreme heat or cold
  11. If you are having surgery, inform your surgery of your lymphedema condition
  12. Stasis- move, change position, and exercise periodically throughout the day
  13. Varicose veins- treating varicose veins may help to reduce lymphatic load and improve lymphedema
  14. Air travel- it is imperative to wear compression garments for the duration of the flight. It is also important to move around and exercise the affected limb and hydrate well to lower the risk of venous thromboembolism

Frolic with Folic (Acid)!

By Riva Preil

This week marks National Folic Acid Awareness Week. Folic acid (also known as folate or Vitamin B-9) is an essential nutrient whose name is a derivative from the Latin folium (leaf) because it is found in many leafy vegetables such as lettuce, asparagus, spinach, and turnips.  Folic acid can also be obtained by eating lentils, egg yolks, Baker’s yeast, fortified breads and cereals, and sunflower seeds.  Folic acid is required for DNA synthesis and repair, and it is also required for many chemical reactions to occur.  Furthermore, folic acid enables mitosis (cell growth and division) to occur properly and efficiently, especially in developing fetuses and infants.  In addition, it is involved with producing red blood cells which is important for proper delivery of oxygen throughout the body.

Clearly, folic acid is involved with many basic life functions, and it is no surprise that folic acid deficiency has many detrimental effects. One of the most notable results is neural tube defects (ex. malformation of the brain, spine, and skull) in a developing fetus.  Therefore, the Reference Daily Intake suggested for pregnant women is 600 micrograms of folic acid per day (compared to the recommended 400 micrograms for non-pregnant woman above age 14 and the recommended 500 micrograms for lactating women).  Folic acid is important for men as well, and it is believed to be linked with decreased chromosomal abnormalities in sperm.  Fortunately, most people have a folic acid reserve ranging between 500 and 20,000 micrograms, therefore it is rare to develop a folic acid deficiency.  Nevertheless, it is important to recognize the signs and symptoms which include peripheral neuropathy (numbness and weakness in the extremities due to nerve damage), diarrhea, shortness of breath, and cognitive deficits (ex. confusion and forgetfulness).  An ounce of prevention is worth MORE than a pound of cure, especially when it is so easy!  Take a moment to reflect this week upon your folic acid intake.  If you don’t think you are consuming adequate amounts of folic acid, please speak with your health care provider about an appropriate supplement for you, especially if you are considering becoming pregnant.