To Medicate or Not to Medicate?

By Riva Preil

Perhaps this would have been Shakespeare’s question had the medical technology at our disposal been available to him. The questions we are able to ask nowadays far surpass those asked even one generation ago thanks to the vast amount of research performed since. One such question many women  “at risk” of developing breast cancer (ex. family history or personal history of the disease) may find themselves asking is whether or not they should prophylactically take tamoxifen or raloxifene, medication that decreases the likelihood of developing breast cancer.  The upside of these medications is that they interfere with effects of estrogen, which is associated with the growth of breast cancer tumors. However, the downside of these medications is that on rare occasion, they can result in stroke, blood clots, and endometrial cancer.  Scary, no?  Wouldn’t it be great if doctors could predict for each person, on an individualized case by case basis, how they are likely to respond to medications?  Absolutely, because if that were the case, then women with an extremely low likelihood of developing the negative side effects could breathe a sigh of relief if they decide to take preventative measures by opting for the medication.

Well, thanks to Dr.  James N. Ingle of the Mayo Clinic along with his international team of researchers, the answer to the question may be within reach.  Dr. Ingle discovered two single-nucleotide polymorphisms (SNPs), ZNF423 and CTSO, which presented amongst the more than 33,000 high-risk participants in two different versions, a “good” version and a “bad” version.  These two genes have never been linked to breast cancer in the past, however this study revealed that women with a “good” version of both genes were SIX TIMES LESS LIKELY TO DEVELOP BREAST CANCER than women who had the “bad” versions.  With this promising research, doctors will hopefully have the ability to guide their patients in informed decision making to promote optimal health.

Lymphedema and Diet

By Roseanne C. Schoen, PT, DPT, LLCC

There is no specific lymphedema diet, but there are some general guidelines to follow:

Limit salt intake– try to avoid processed foods or foods with high sodium content which can cause fluid retention and increased swelling

Adequate water intake– proper hydration is essential, especially following lymphedema treatment sessions, to remove waste products from the body

Balanced diet– it is suggested to a balanced diet of fruits, vegetables, lean proteins, whole grains, and healthy fats in order to maintain a healthy weight and lifestyle



The National Lymphedema Network-

Dawson R and Piller N. Diet and BCRL: facts and fallacies on the web. Journal of Lymphoedema, 2011, 6:1. 36-42

Vaccine Provides Dual Protection!

By Riva Preil

Approximately 70% of cervical cancer is caused by two types of human papillomaviruses (HPV), HPV 16 and HPV 18.  In addition, it is believed that many cases of oropharyngeal cancers, especially amongst heterosexual males, are caused by sexually transmitted viruses which are transmitted through oral sex.  The past thirty years have demonstrated a huge rise in throat cancers due to oral sex, and the rate was only 16% in the 1980s compared to 70% nowadays!

Fortunately, GlaxoSmithKline recently produced Cervarix with the support of the National Cancer Institute.  Cervarix is a vaccine that protects against HPV 16 and 18, the two types of the virus that are strongly associated with cervical cancer.  The vaccine works by creating antibodies that protect against the virus.  Fortunately, a recent study performed by Dr. Rolando Herrero (head of prevention for the World Health Organization’s International Agency for Research on Cancer) with 5,840 women in Costa Rica revealed that Cervarix ALSO helps protect against oropharyngeal cancers.  Although the research was only performed with women and future research with men is still required, it is suggested that the vaccine produces similar antibody levels amongst both genders.  Further research is also indicated to explore how long the protection lasts and whether or not re-vaccination is required.  For additional details about the study, please refer to this link in the New York Times.

Beat the Heat!

By Riva Preil

During these hot and humid summer days, it’s important to be mindful of taking appropriate precautions to stay healthy. Unfortunately, hundreds of deaths occur in the United States annually due to extreme heat. Taking the proper precautions to ensure summer safety is crucial.


Sweating is our body’s natural cooling process.  Heat is carried away from the surface of the body as sweat evaporates from the skin which decreases one’s body temperature.  When sweating alone is not able to restore the body’s homeostatic balance, one is at risk for developing hyperthermia (elevated body temperature), a dangerous condition which can impair brain, heart, or other organ function. Untreated hyperthermia can cause heat cramps (painful muscle tightening), heat edema (ankle and foot swelling), heat exhaustion (characterized by dizziness, thirst, nausea, and weakness), and in worst case scenarios, heat stroke (body temperature elevation to 104 degrees or higher, potentially fatal).

Scary, no?  But preventable? YES!  Please make sure to keep your cool in the following ways:

  • Take breaks from the sun, especially in air conditioned rooms

  • Hydrate, hydrate, hydrate…especially with water.  Remember that alcohol and coffee DEhydrate, so please drink 2 cups of water for every 1 cup of coffee or alcohol.

  • Wear light colored and loose fitting clothes

  • Shower or bathe in cool water

  • Pull the curtains or blinds CLOSED during the hottest, sunniest parts of the day

A little common sense goes a long way…good luck beating the heat in the safest way possible!

Women’s Health in a sn-APP!

By Riva Preil

The Office of Research on Women’s Health (ORWH) at the National Institutes of Health (NIH) proudly presents “A Primer for Women’s Health: Learn about Your Body in 52 Weeks.”  This wonderful tool will present a different health tip every week for one year in regards to women’s health. For example, week one provides information regarding how to maximize one’s visit to the doctor and how to effectively communicate and relay health related matters to one’s physician.  This primer also empowers women by providing information to reduce the risk of illness, for we all know that an ounce of prevention is worth more than a pound of cure. And not only is the information accessible online, the NIH has created an app for you to access the information directly from your smart phone!  Fortunately, we live in day and age when technology enables us to access useful information with the click of a button or the swipe of a finger.  Let’s take advantage of this fantastic tool courtesy of the NIH, and may we all benefit from the information for the next 52 weeks and beyond!


It is NOT Okay to Pee During Workouts!

By Riva Preil

A disturbing and somewhat shocking You Tube video was recently produced by Cross Fit entitled “Do You Pee During Workouts?”

As of this writing, over 220,000 viewers have watched this video which features a misinformed gynecologist expressing her view that it is okay to pee while exercising. The video proceeds to feature multiple women who at initially bashfully confess but ultimately proudly declare “I pee during workouts!”  One interviewee even has the guts to state, “It’s a correlate of intensity…and you know, maybe Heather and I are just going harder than everyone else,” as if a urine leak is a badge of honor of a true athlete.  Nothing can be farther from the truth!

The Australian Physiotherapy Association (APA) responded to the video by stating that leaking urine while exercising is not normal, and it is actually avoidable. Beyond Basics Physical Therapy strongly supports the response of the APA in vehement opposition to Cross Fit’s tolerance to incontinence.  It is NOT normal to leak urine while exercising, lifting your child, coughing, sneezing, or laughing (stress urinary incontinence).  It is also not normal to leak urine on one’s way to the bathroom or to have to make a mad dash to the bathroom, otherwise they would leak on the way (urge incontinence).  If you or someone you know is all too familiar with any of the aforementioned symptoms, please speak to your primary care physician and request a prescription for pelvic floor physical therapy.  Specially trained physical therapists (like the P.T.s at Beyond Basics) teach patients how to strengthen their pelvic floor muscles with tactile, visual (ex. biofeedback), and verbal cuing.  So maintain the intensity of your workout while maintaining your continence- it IS within your reach!

Craniosacral Therapy and BBPT

By Riva Preil

The craniosacral (CS) system refers to the brain, spinal cord, and surrounding membrane (referred to as the Dura Mater).  The CS system also contains cerebrospinal fluid (CSF) which is constantly being produced and reabsorbed.  It is a semi-closed hydraulic system that undergoes pressure changes continuously due to the fluid pressure changes with the cerebrospinal fluid.  The system was first explored by Dr. A.T. Still, an osteopath who studied the body as a unit, in the early 1900s.  His student, Dr. William Sutherland, continued his work in the 1920s.  Dr. Sutherland realized that the sutures of the brain, the joints where the cranial bones meet, are designed for movement and mobility.  (This opposed the previously held belief by most in the medical community that the sutures are fixed and immobile structures.)  He explained how impaired movement of these bones and joints can interfere with the craniosacral system and must be mobilized in order to restore full health and function.  He also described the primary respiratory mechanism, the phenomenon of constant rhythmic motions, especially the temporal bone, due to the cerebrospinal fluid pressure changes.

Dr. Sutherland opened the Cranial Academy in 1947, where his student, Dr. John Upledger, known in the field as the father of craniosacral therapy, furthered his studies.  He confirmed that the cranial bones are not fused, that the sutures are vascularized, innervated, and fibrous structures, and the presence of energetic fields.  He also put forth the Pressurestat Model, the concept of the craniosacral rhythm being palpable throughout the body (not just within the brain and spinal cord) due to the aforementioned fluid filled hydraulic system.  This model takes into account the effect of both the osseous (bone related) and membranous factors in contributing to the craniosacral system function.  He also worked with children who have autism and discovered that cranial work helped improve their learning abilities, concentration, and social skills.  Dr. Upledger created the Upledger Institute International which trains medical care providers in the practice of craniosacral therapy.

Several therapists at Beyond Basics Physical Therapy are trained in these techniques which help mobilize and restore function to the craniosacral system.  To experience the benefits of this subtle yet powerful method, please contact us and we will be happy to answer any questions you may have regarding this powerful work.

Pilates: Leg Swings

By Denise Vidal

In our last blog, we explored different aspects of our hip joint by moving our legs upward and downward in the coronal plane. In this blog, we will continue with the theme of massaging different aspects of our hip joint by adding movement in a different plane.

We will begin in the same position as we last finished, lying on your side with your bottom leg bent.  You can put a pillow under your head to allow for better alignment of your spine.  If you need a reminder, please refer to the last blog in our archived exercises.

As always, we will start with the breath.  Inhale deeply through your nose, and exhale completely out of your mouth.  As you exhale, feel your abdominals narrow across your waist.  To increase this sensation, make your exhale audible.  That is, as you exhale make a sound as if you are blowing out your birthday candles.  To ensure that you are exhaling completely, imagine that you are blowing out the candles at you 100th birthday party.

Remember, our goal is to create tone in the abdomen to maintain stability in our pelvis.  Our abdominals create the best support when they are engaged completely.  Because our abdominals engage in response to respiration, it is important to breathe fully to create the maximum amount of stability.

On your next exhale, begin to lift your top leg.  With your leg lifted, observe if you are lifting only your thigh, or if you are hiking your hip.  Again, we want to stabilize our pelvis, while moving the leg in the hip joint.  If you are able to maintain a stable pelvis, move your leg forward and backward as if you are walking.  See if you can continue to keep the pelvis stable as you add focus to your breath, exhaling as you take the leg forward and inhaling as you take the leg back.

Do eight swings of your leg, forward and back.  If you feel comfortable, add five little circles of the leg in each direction, inhaling as you circle forward and exhaling as you circle backward.  You should feel your gluteal muscles working, as well as your abs. When you are ready, repeat the exercise on your other side.

If you feel any discomfort or pain, discontinue the exercise.  Contact your doctor or physical therapist before continuing any exercise routine.

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Stop Flip-Flops?

By Riva Preil

Sure, they may be cute, comfortable, and convenient in an attempt to beat the summer heat…but from a biomechanical perspective, flip-flops may be a poor choice for your summer footwear.  Consider the force that is sent through the lower extremities to the pelvis and spine with each step…multiply that by 10,000 (the recommended amount of steps individuals should take daily)= an immense amount of force is transmitted through the feet and up the kinematic chain each day.  During the normal gait pattern, individuals enter the stance phase (upon completion of the swing phase) with heel strike, followed by foot flat (when the entire foot contacts the ground) and completed with push off through the large toe.  However, flip-flop-wearers take shorter steps, clench their toes excessively (to prevent the flip flop from falling off), and perform heel strike with a decreased amount of vertical force compared to sneaker-wearers.  The poor support offered by flip flops is unfortunately associated with developing plantar fasciitis (tightness of the connective tissue on the bottom of the foot), knee, hip, and even low back pain.

 You may be saying to yourself, “Fine, Riva, I get it…but I’d like to see you try getting a pedicure in sneakers!”  Point well taken, it is not practical or fun to completely eliminate flip-flops from one’s wardrobe.  However, try to replace flip-flops every 3-4 months considering how quickly they lose support. Furthermore, try not to wear them for prolonged periods of time.  Leather flip-flops provide more support than plastic ones, and avoid wearing socks with flip flops.  Finally, make sure that they fit properly- there should be full support from heel to toe.  By following these simple suggestions, you can enjoy your flip flops in tip top health this summer.  Have a happy and healthy summer from all of us at Beyond Basics Physical Therapy!

Scleroderma Scholarship II

By Riva Preil

Scleroderma is more prevalent in women than men, and in fact they are four times more likely to develop the disease.  In the United States, 1 in 1,000 individuals develop scleroderma, and onset is usually between 30 to 50.  The older a person is at the age of diagnosis, the more dangerous the disease is.  It is commonly found amongst African American females and the native American Choctaw tribe.  In children, the systemic version is much more frequently diagnosed than the diffuse version.

Unfortunately, there is no direct cure for scleroderma, however there are options for symptom management.  Immunosuppressive agents (such as cyclophosphamide, methotrexate, and azathioprine) are used to counteract the hypersensitive autoimmune response.  Skin fibrosis has been treated somewhat successfully with D-penicillamine, cyclosporine, colchicine, and EPA (an omega-3 oil derivative).  Vasodilator medications are used to improve blood flow to the extremities for individuals who suffer from Raynaud’s phenomenon.