Tips to Help Manage Holiday Stress

The holiday season is a time filled with excitement and special traditions. But it also brings a chaotic cluster of demands which can leave many feeling overwhelmed, out of sync, or even lonely. Baking, shopping, cleaning, decorating, wrapping, traveling…it can all add up to quite the list of things to do! It’s important to take a little time to regain control and balance. Here are some key things you can do to stay mentally and physically healthy throughout this busy holiday season.

Make a realistic plan. Set aside specific days for shopping, baking, visiting with family and friends, and other activities. Plan your menu and make a shopping list before you go to the store. This will help prevent last-minute scrambling for forgotten items. And if you need help with food or party prep, delegate and line up your helpers in advance.
It’s also important to remember that the holidays do not have to be perfect, or exactly the same as last year. As families grow and change, traditions and rituals can change too. Focus on a few favorite customs to enjoy if others are no longer possible.

Set a budget and stick to it by learning to say no. Before you even go shopping, decide how much money you can afford to spend. Gifts can be the main expense for many during the holiday season, but don’t forget to account for the cost of holiday meals, any wrapping or decor supplies, and any travel costs. If you are nervous about your budget, there are easy ways to save. Try homemade gifts instead or start a family gift exchange.

When your established plan or budget is in jeopardy, it’s important to say no. Overcommitting or overspending will only leave you resentful or overwhelmed later. Your family and friends will understand if you can’t be there for everything.

Acknowledge your feelings and set aside differences. Gathering with loved ones might be the most common holiday tradition. This positive practice can inadvertently be a negative reminder for some by pointing out those that couldn’t be with you this year. If a loved one has recently died or can’t be with you this year, it’s okay to feel sadness and grief. In fact, it’s absolutely normal. Take time to express your feelings. Next, reach out if you feel lonely or need support. Surrounding yourself with family and friends through social or religious gatherings is a great defense. Volunteering with others is also a great way to meet new people and spread cheer. If these feelings of hopelessness, anxiety, or sadness persist and you can’t sleep or motivate yourself to do routine chores, talk to your doctor or a mental health professional.

And if you are surrounded by family and old friends and your personality doesn’t really mesh with a few people, try to set aside any differences you may have. Do your best to accept family members and friends as they are. Set aside grievances for a more appropriate time.

Think positive and take time for you. When stressed, it’s that much harder to stop and regroup even though it’s what your body really needs. If holiday plans are getting too overwhelming, simply take a break. Even if you can only achieve 15 minutes of quiet, alone time – do it. Go for a walk, listen to soft music, work out, get a massage, or read a book. Recharge and then move forward with a better attitude. And when all else fails, just do less and enjoy more. The memories with loved ones are the whole point, not ribbons or fancy meals.

Don’t abandon your healthy habits. Amidst the carols, treats, and shopping, don’t forget the simple things – like eating breakfast and getting enough sleep each night. Keep time for exercise in your daily plan and enjoy special holiday treats in moderation. Have a healthy snack before holiday parties so that you don’t over indulge or bring a healthy food option to contribute. By sticking to your health routine as much as possible during the holidays, you won’t feel like you have to start over come January.

The holidays can be peaceful and enjoyable with a little planning and positive thinking. Learn to recognize your holiday triggers and delegate tasks so all the prep doesn’t become a burden. You can survive the frenzy! Just remember the reason for the season and hold loved ones close. Happy holidays from Medical Associates!



Sleep Apnea and Heart Disease, Stroke

Elderly man lost in thought

Plain old snoring can get a little annoying, especially for someone listening to it. But when a snorer repeatedly stops breathing for brief moments, it can lead to cardiovascular problems and potentially be life-threatening.

It’s a condition known as sleep apnea, in which the person may experience pauses in breathing five to 30 times per hour or more during sleep. These episodes wake the sleeper as he or she gasps for air. It prevents restful sleep and is associated with high blood pressure, arrhythmia, stroke and heart failure.

Heart disease is the leading cause of death in the United States, and stroke is also a leading cause of death and disability. High blood pressure is a major risk factor for both.

“The evidence is very strong for the relationship between sleep apnea and hypertension and cardiovascular disease generally, so people really need to know that,” said Donna Arnett, Ph.D., chair and professor of epidemiology at the School of Public Health at the University of Alabama at Birmingham and the incoming president of the American Heart Association.

A Common Problem
According to Dr. Arnett, one in five adults suffers from at least mild sleep apnea, and it afflicts more men than women. The most common type is obstructive sleep apnea (OSA), when weight on the upper chest and neck contributes to blocking the flow of air. OSA is associated with obesity, which is also a major risk factor for heart disease and stroke. Besides obesity contributing to sleep apnea, sleep deprivation caused by sleep apnea can, in an ongoing unhealthy cycle, lead to further obesity. In OSA the upper airway closes off because the muscles that hold it open lose tone. The more weight, the more loss of tone and the more severe the sleep apnea. Each time the airway closes, there is a pause in breathing.

A less prevalent type of sleep apnea is called central sleep apnea (CSA). In CSA the brain doesn’t send regular signals to the diaphragm to contract and expand. There is limited snoring and it has been associated with brain stem stroke because the brain stem is where the impulse to breathe comes from.

Listen to Those Snoring Complaints
A roommate or sleeping partner of someone with sleep apnea often notices it. “It’s really hard to detect if you live alone, unless you go through a sleep study,” Dr. Arnett said. People with sleep apnea may be more tired during the day and therefore prone to accidents or falling asleep.

Getting Proper Treatment
Through treatment known as continuous positive airway pressure, or CPAP, blood pressure is stabilized. The CPAP device involves wearing a mask while sleeping. It keeps air pressure in the breathing passages so they don’t close down.

In a sleep study, doctors count pauses in breathing to determine whether the patient has mild sleep apnea, characterized by five to 15 episodes per hour; moderate sleep apnea, defined by 15 to 30 per hour; or severe sleep apnea, meaning more than 30 each hour.

It’s certainly possible to have simple, loud snoring without sleep apnea. But with regular snoring, the person continues to inhale and exhale. With sleep apnea, the sleeping person tends to have periods when he or she stops breathing and nothing can be heard. The good news is treatment that keeps the breathing passages open and oxygen flowing can yield fast results, Dr. Arnett said. “Blood pressure comes down really quite quickly.”

Getting Good Rest
If you’re struggling to get a good night’s sleep follow some of these suggestions:

  • Get regular physical activity, but don’t do it right before bed because that gets your adrenaline pumping and can keep you awake.
  • Limit alcohol consumption to one drink per day for women and two drinks for men; too much alcohol interferes with sleep.
  • Avoid caffeine before bed.
  • Develop a pre-bedtime routine such as taking a warm bath, dimming the lights or having some herbal tea.

If you are experiencing symptoms of sleep apnea, be sure to discuss this with your primary care provider. A referral to a pulmonologist may be necessary. At Medical Associates, Dr. Mark K. Janes is Board Certified in sleep medicine and provides diagnosis and treatment of sleep disorders including sleep apnea. Examination of abnormalities of sleep is available with overnight trend oximetry and polysomnography.




Prediabetes:  What you Need to Know

Prediabetes is a serious health condition in which an individual’s blood sugar levels are higher than normal, but not high enough yet to be diagnosed with type 2 diabetes. Approximately 84 million American adults – more than 1 out of 3 – have prediabetes. Of those with prediabetes, 90% don’t know they have it. Prediabetes puts you at increased risk of developing type 2 diabetes, heart disease, and stroke.

You can have prediabetes for years with no clear symptoms, so it often goes undetected until serious health problems such as type 2 diabetes show up. It’s important to talk to your doctor about getting your blood sugar tested if you have any of the risk factors for prediabetes, which include:

  • Being overweight
  • Being 45 years or older
  • Having a parent, brother, or sister with type 2 diabetes
  • Being physically active less than 3 days a week
  • Having gestational diabetes (diabetes during pregnancy) or giving birth to a baby who weighed more than 9 pounds
  • Having polycystic ovary syndrome
  • Race and ethnicity are also a factor: African Americans, Hispanic/Latino Americans, American Indians, Pacific Islanders, and some Asian Americans are at higher risk.

Physical Activity
If you have prediabetes and are overweight, losing a small amount of weight and getting regular physical activity may help lower your risk for developing type 2 diabetes. A small amount of weight loss means around 5% to 7% of your body weight, just 10 to 14 pounds for a 200-pound person. Regular physical activity means spending at least 150 minutes a week of brisk walking or a similar activity. That’s just 30 minutes a day, five days a week.

What should I eat?
Nutrition is key to a healthy lifestyle when you have prediabetes. Along with other benefits, following a healthy meal plan and being active can help you keep your blood sugar (or blood glucose level) in your target range. What you choose to eat, how much you eat, and when you eat are all factors that can affect your blood sugar. A registered dietitian (RD) or certified diabetes educator (CDE) can help you create a meal plan that’s full of healthy-tasty options.The key is to eat a variety of healthy foods from all food groups, in the amounts your meal plan outlines. Some great food groups to include are:

  • Vegetables: Nonstarchy includes broccoli, carrots, greens, peppers, and tomatoes. Starchy includes potatoes, squash, corn, and green peas.
  • Fruits: Includes oranges, melon, berries, apples, bananas, and grapes.
  • Grains: At least half of your grains for the day should be whole grains. Includes wheat, rice, oats, cornmeal, barley, and quinoa, bread, pasta, cereal, and tortillas.
  • Protein: Includes lean meat (chicken or turkey without the skin), fish, eggs, nuts and peanuts, dried beans and certain peas (such as chickpeas and split peas), and meat substitutes, such as tofu.
  • Dairy: nonfat or low fat milk or lactose-free milk (if you have lactose intolerance) yogurt, and cheese.

Use oils when cooking food instead of butter, cream, shortening, lard, or stick margarine. Oils with heart-healthy fats, mainly come from the following foods:

  • Oils that are liquid at room temperature, such as canola and olive
  • Nuts and seeds
  • Heart-healthy fish such as salmon, tuna, and mackerel
  • Avocado

There are also some foods that those with prediabetes should limit. Try to stay away from fried foods and other foods high in saturated fat and trans fat. Foods high in salt or sodium are also good to avoid. Cut back on sweets, such as baked goods, candy, and ice cream. It’s also wise to limit beverages with added sugars, such as juice, regular soda, and regular sports or energy drinks. Drink water instead of these and consider using a sugar substitute in your coffee or tea.

Your primary care provider will keep a close watch on your blood glucose levels, monitoring them to make sure that your prediabetes doesn’t become type 2 diabetes. You should discuss diet and exercise recommendations with your doctor. Be honest about your habits and work together with your doctor to better control your blood glucose levels.



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A Guide to Mammograms

As part of Breast Cancer Awareness Month, October 19th is National Mammography Day. A mammogram is a low-dose X-ray that allows specialists to look for changes in the tissue of the breast. We hear this term and official recommendations regarding it often, but are you still confused about when you should start having a mammogram? And how often? You are not alone.

Over the past few years, some researchers have questioned the best timing and frequency for mammograms. However, the importance of a mammogram in the prevention and detection of cancer has not been contested. These images are the best test doctors have to find breast cancer early, sometimes up to a few years before it can be physically felt in the breast. At Medical Associates, we believe in the value of this early detection. Early detection leads to better outcomes and lowers the need for more aggressive treatments. For this reason we adhere to the recommendation of the American Cancer Society and recommend that all women age 40 and older have a yearly mammogram.

We realize a mammogram is an uncomfortable procedure for most women. The first one can be especially nerve-racking if you are not sure what to expect. Our team of professional, trained specialists want to assure you that there is nothing to fear. At your mammogram, you will stand in front of a special X-ray machine. The technologist will place your breast on a plastic imaging plate. Another clear plate will firmly press your breast from above. The plates will flatten the breast, holding it still while the X-ray is taken. You will feel some pressure during this time, but the compression of the breast only lasts a few seconds. This process is repeated to capture a side view of the breast, and then the whole process is repeated on the opposite breast. The entire procedure lasts about 20 minutes. Most X-ray techs aiding in your mammogram are women, and you and the technologist are the only ones in the room during the exam. A radiologist, a doctor trained to read mammograms and radiology exams, will later read your mammogram images.

A fairly recent development in mammography technology is something called a 3D mammogram. This type of image is done in tandem with the standard 2D exam. Compression of the breast may last a few seconds longer while the additional information is acquired. A recent study published in the Journal of the American Medical Association concluded that 3D mammography, when compared to 2D mammography, finds a 41 percent increase in the detection of invasive breast cancers and 29 percent increase in the detection of all breast cancers. 3D mammography also provides a 15 percent reduction in recall rates, decreasing the number of patients that need further imaging to make a determination. Medical Associates does offer this technology, but we ask you to check with your insurance company on your coverage. Because 3D mammography technology is fairly new, some insurance companies do not cover the additional charge.

Some women do experience discomfort during the mammogram process described above. Your breasts may be more tender or swollen close to or during your period. Try to avoid scheduling your mammogram during this time to help reduce any discomfort. Our technologists also advise that you not wear any deodorant, powder, or cream under your arms or chest on the day of your mammogram. Some of these items can show up on the images as white spots, prompting the need for new images. Mammograms are also best interpreted when compared with previous exams. This allows the radiologist to compare the images and look for changes in the breast tissue. If possible, try to get your mammogram from the same place each year, or provide the medical facility with a copy of any past mammograms.

You will usually get the results of your mammogram within a few weeks. If you are asked to come in for more imaging after a mammogram, do not be alarmed. This is fairly common and it does not mean that you have cancer. Additional imaging typically means more pictures, or even an ultrasound, may need to be done to look at a certain area more carefully. This is more common the first time you have a mammogram, as there are no previous images to compare your recent exam to. It is also fairly common in mammograms done in women before menopause.

It’s also important to note that an abnormal mammogram does not always mean you have cancer. You will need to have additional testing or procedures before the doctor can make that determination. You may also be referred to a specialist, but it does not necessarily mean you have cancer. It simply means an expertly trained physician will work with you providing follow up tests to either make a diagnosis or determine there is no cancer.

The mammography program at Medical Associates is accredited by the State of Iowa and the Food and Drug Administration. Our radiology technologists are educated, trained, and licensed professionals. If you would like to schedule your annual mammogram or have further questions regarding this test, please call your primary care provider.