During the first 6 months, the American Academy of Pediatrics recommends healthy babies only eat breast milk or iron-fortified formula. These liquid foods provide all the nutrients your baby needs for healthy growth and development. Generally, water, juice and solid foods aren’t needed until 4-6 months.

Your baby’s doctor will likely recommend solid foods when your baby shows he is ready. Signs your baby is ready for solid food includes:

• Drinking more than 36-48 ounces of formula per day
• Seems hungry after milk feedings
• Getting hungry more often
• Waking up during the night for feedings
• Having doubled his birth weight
• Showing interesting in the food you’re eating
• Can sit with your help and hold head steady

What should baby’s first foods be?

First foods should be limited to low-allergy foods, vegetables, and fruits. Offering solid foods too early can lead to allergies. Also, keep in mind that solids foods should not be used to help your baby sleep through the night.

First foods and feeding:

• iron-fortified single-grain rice cereal
• thin cereal with breast milk or formula
• warm the milk before to room temperature before adding to the cereal
• don’t heat bottles or baby food with the microwave—it heats foods unevenly
• hold your baby more upright than you would for a bottle or breast feeding
• feeding your baby after he has already has some milk so she will be more like to try the new food
• if your baby is too hungry, they may get too frustrated with the new experience

Your baby may reject the new food at first, but be patient. Soon they will be an expert and act like a hungry little bird when they see that spoon!

Buy our e-book - Growing A Healthy Baby: a guide to your baby’s nutrition and get these important questions answered:

• Is your baby getting enough to eat
• What foods often cause allergies
• Is it OK to make your own baby food
• Which foods are safe foods
• Which foods are choking foods
• What to do if your baby swallows poison

You’ll also get lots of helpful feeding tips for ages 6-12 months.

This booklet was used in by one of the nations largest HMOs for their “First Bites” program.

Pregnancy weight chart. Use this chart to record your weekly weight throughout your pregnancy.

Daily Food Guide.  This guide will help you get your nutrition from all food groups and give you an idea of how much to eat of each food.

2-Day Food Record. By completing this 2-day food record, you can learn which foods you are getting too much of and which foods you are not getting enough of.

Keep in mind that these tools are for mothers with a normal pregnancy. They are only suggestions for ways to help you gain weight at a healthy rate. Always follow your doctors advice and if these tools fit into what your doctor has told you to do, then feel free to print them out and use them.

Steps you can take to control your diabetes:

• Attend self-management education classes offered by your health care provider or a local hospital.
• Know your hemoglobin A1c level. A1c level should be below 7.0.
• See your diabetes educator and registered dietitian as recommended by your doctor.
• Eat a healthy diet. Eat high carbohydrate foods such as starches, fruit and milk evenly over the entire day.
• Eat regularly, watch your portion sizes, lower your fat intake and increase your fiber intake.
• Check your blood sugar as recommended by your doctor.
• Reach or maintain a healthy body weight.
• Keep your blood pressure below 130/80.
• Talk about the use of medicines called statins and ACE inhibitors with your doctor. These medicines have reduced the risk of heart attack and stroke in people who have diabetes.
• Get a yearly dilated and complete eye exam. Diabetes is the leading cause of blindness.
• Get a pneumonia shot if you have not already had one.
• Get a flu shot every fall.
• Learn as much as you can about how to keep your diabetes under control.

If you need a reminder, attached is a flier you can print out and put on your refrigerator.

Disclaimer: Nothing mentioned here is intended to replace common sense, legal, medical or other professional advice, and is meant to inform and entertain the reader.

The CDC recommends that kids ages 6 months to 18 years of age get the flu vaccine because they are so vulnerable to the flu because of the way the virus spreads. Kids aren’t as likely to practice hygiene to prevent getting or spreading the flu like hand washing and covering their mouth when they cough or sneeze. Kids probably won’t recognize flu symptoms in another child and avoid contact with them.

The flu usually spreads from person to person when an infected person coughs or sneezes germs into the air. Germs enter the blood stream when the contaminated air is breathed in. Germs can get on hands by touching surfaces that are contaminated with the flu virus, such as wet areas in a restroom or kitchen. The germs then get into your body when you touch your face, eyes, nose or mouth. If a child has the flu, he can spread germs to others by touching surfaces that other kids touch—toys and door knobs, not covering their nose when they sneeze or mouth when they cough.

Most healthy adults can infect others beginning 1 day before symptoms develop and up to 5 days after becoming sick. That means you might be able to pass on the flu to someone else before you know you are sick, as well as while you are sick. Teach your child to wash their hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.Cleaning their hands often with soap and water or an alcohol-based product and also covering their cough with a tissue or their sleeve will help prevent the spread of the flu.

Symptoms of seasonal flu can include:

• Fever
• Headache
• Extreme tiredness
• Dry cough
• Sore throat
• Runny or stuffy nose
• Muscle aches
• Nausea, vomiting, and diarrhea (more common in children than adults)

If you or your child get the H1N1 flu, the treatment is the same—plenty of fluids, rest and dose-appropriate acetaminophen for a fever. After all, it is still the flu we’re talking about. After 24 fever-free hours without the aid of medicine, your child can go back to school.

These children should be seen by their doctor—call before taking your child in. Call your child’s doctor if:

• A baby younger than 12 weeks has a fever greater than 100.4 degrees Fahrenheit
• A child, older than 12 weeks has a fever for three days
• A child’s fever returns after a 12-24 hour time period
• A child is not passing urine or making tears for more than six hours
• A child does not smile or show interest in playing for several hours

Call 911 if:

• A child cannot speak while trying to breathe
• The child aas a blue or dark purple color to the nail beds, lips or gums
• The child Is not responding to you because he is too tired or weak

Disclaimer: Nothing mentioned here is intended to replace common sense, legal, medical or other professional advice, and is meant to inform and entertain the reader.

Fetal kick counts help tell how active your baby is. Besides counting kicks, you will be counting every time your baby moves, rolls, or twists. Your baby has times when he is more active than others. Active times are usually after you have been up and walking around for awhile, after a meal, or after you have had something cold to eat or drink, such as ice water.

Your doctor may have you do kick counts two or three times a day for several days; your doctor will tell you how often to do them and when to call him or her. If so, try to do them at the same time every day or after the same activity. For example, do them before you get up, an hour after eating lunch, and when you go to bed at night. If you are self-monitoring contractions, you can do kick counts at the same time.

The American College of Obstetricians and Gynecologists recommends that you time how long it takes you to feel 10 kicks, flutters, swishes or rolls. Ideally, you want to feel at least 10 movements within 2 hours. Most likely you will feel 10 movements in much less time. This free Kick Counts Worksheet is an easy way to record kick counts. Print it out an d write down the date and time of the first movement. Every time you feel your baby move or kick, check off one of the 10 boxes. After you check all ten boxes, write down the time of the tenth movement. If you cannot feel your baby move, drink a glass of cold water or walk around for a few minutes and try again. Some doctors recommend that you call if your baby moves less than 10 times in an hour.

Introduction

Achilles tendonitis is when the Achilles tendon becomes inflamed or irritated. This inflammation is often the result of a lot of stress on your calf muscles and Achilles tendon from either a sudden increase in intensity or frequency of exercise. Chronic overuse can contribute to micro-tears in the Achilles tendon, leading to wear and tear over time that weakens the tendon and thickening of the tendon from scar tissue.

When treated promptly, Achilles tendonitis is often short-lived. Left untreated, Achilles tendonitis can cause persistent pain or cause your tendon to rupture. The healing process causes scar tissue to form. Because scar tissue is not as elastic as the tendon, the scar tissue doesn’t allow the tendon to stretch normally, which can lead to a rupture of the tendon.

Fortunately, rest and over-the-counter medications to reduce your pain and inflammation may be all the treatment you need for Achilles tendonitis. In some cases, physical therapy may be needed. If you ignore symptoms, the result can be a rupture or tear of the tendon and surgery may be needed.

Where is the Achilles tendon and what does it do?

Tendons are strong, fibrous tissues that attach muscles to bones. When muscles contract, they pull on the tendon that moves the bone. The Achilles tendon attaches the two calf muscles (the outer gastrocnemius and the underlying soleus) that share the Achilles tendon to the heel bone (calcaneus). When contracted, the calf muscles pull on the Achilles tendon causing the foot to point downward helping you to rise up onto the ball of your foot. As the calf muscles relax, they allow you to lower your heel to the ground. This powerful muscle group in your calf helps you sprint, jump, or climb and provides the push-off phase in walking and running.

What causes Achilles tendonitis?

Achilles tendonitis is an overuse injury—doing too much too soon. Problems with the Achilles tendon affect athletes most often; especially runners, basketball players, and sports that require jumping—like volleyball and tennis. Problems are also common in middle-aged adults. Some injuries to the Achilles tendon are minor and some rather severe.

Achilles tendonitis can be either acute which occurs over a period of a few days following and increase in training, or chronic which occurs over a longer period of time. In athletes, problems are often acute following a sudden increase in training—either distance, speed or hills. Risk factors for non-athletes include diabetes, age, obesity, steroids, certain antibiotics or a “weekend warrior” injury.

What do Achilles tendon problems feel like?

Acute:

• Gradual onset of pain over a period of days
• Pain when exercise begins that gets better as the exercise progresses
• Pain gets better with rest
• Tenderness to pressure in the area

Chronic Achilles tendonitis can follow acute tendonitis if untreated. Chronic tendonitis is more difficult to treat.

• Gradual onset of pain over a period of weeks or months
• Pain with exercise that is constant throughout exercise
• Pain when walking up hill or up stairs
• Pain and stiffness in the tendon after rest and especially early in the morning
• Nodules or lumps in the tendon
• Tenderness with pressure
• Swelling or thickening of the tendon
• May have skin redness over the area
• May feel creaking when moving the ankle or pressing the tendon with your fingers

You can have pain either where the Achilles tendon attaches to the calf muscle—tendonitis—or where it attaches to the heel bone (calcaneus)—bursitis. There is a fluid filled sac between the tendon and the bone, called a bursa that limits friction when the tendon glides up and down at the back of the heel bone. Bursitis usually starts as pain and irritation at the back of the heel. You may see redness or swelling there. Shoes can aggravate the condition making it hard to wear shoes.

Tendonitis occurs just above the heel. Tendonitis is caused by a violent strain to the calf muscles or the tendon during a strong contraction of the muscle as when running or sprinting. This strain can occur where the muscles join the Achilles tendon. You will have pain when pressing on the Achilles tendon and with walking, especially when pushing off your toes or putting weight on your toes as when going down stairs or stepping off a curb.

How are Achilles tendon problems identified?

Diagnosis is done by your doctor taking a history—“what were you doing when the pain started?”—and a physical exam to see where your calf and/or foot hurt. You will likely have xrays to rule out fracture and identify bone spurs or other problems.

What are my treatment options?

Your treatment will depend on the severity of our injury and how long it has been since your injury. You will likely be started on rest, ice and anti-inflammatory medicines such as aspirin or NSAIDs.

Rest:

Resting the painful Achilles tendon allows the inflammation to subside and allow for healing. A period of rest—stopping the activity that is causing the pain—after the onset of symptoms is important in controlling Achilles tendonitis.

Immobilization:

In patients who have more significant symptoms, a period of immobilization can help. Either a removable walking boot, or sometimes even a cast, can allow the inflamed tissue to cool down quickly. Wearing a walking boot keeps the calf muscle from pulling on the Achilles tendon. The boot prevents you from pushing off with the ball of your foot or pointing your toes downward. The walking boot should be worn when walking. However, there is some benefit to wearing the boot even when you’re at rest as the boot keeps a slight stretch on the tendon and prevents further shortening.

Night Splint:

A night splint keeps the foot in a similar position as the walking boot, with a gentle stretch on the Achilles tendon. However, a night splint is not sturdy enough to allow walking. Daily use of a night splint while sedentary, from minutes to several hours, can assist physical therapy and continues the rehabilitation while at home. After recovery, a night splint can help prevent recurrent strains and maintains lower extremity flexibility, especially in athletes.

Physical Therapy

For some injuries, physical therapy is recommended to help remove or stretch scar tissue and to control pain and swelling. Patients with mild symptoms of bursitis or tendonitis often do well with two to four weeks of physical therapy. The physical therapist’s goal is to keep your pain and swelling under control, improve your range of motion and strength, and ensure you regain a normal walking pattern. Treatments such as ultrasound, moist heat, and massage are used to control pain and inflammation. As pain eases, treatment progresses to include stretching and strengthening exercise. Physical therapy can also include shockwaves, ultrasound, and ice. The key to proper ice and heat therapy is knowing when to ice and heat an injury. Your physical therapist knows when and how to apply treatment to reduce swelling and pain while still allowing the healing inflammatory process. Your therapist will teach you a home-care program to go along with the office therapy to help speed healing.

One purpose of the treatment is to break up scar tissue that has formed and to stretch out the scar tissue allowing the tendon to stretch normally without pain or tearing. The order of treatment is important. You don’t want to stretch a “cold” tendon. Injured tendons shorten and need to be stretched. Also, be careful not to overdo stretching. Only gentle stretches for the calf muscles and Achilles tendon are used at first. As the tendon heals and pain eases, more aggressive stretches are done. Ask your therapist, “On a scale of 1-10, how much should I be stretching the tendon.” To prevent further scar tissue from forming, ice is applied after stretching, massage, or treatments. Don’t overdo therapy as this can slow down the healing process by adding further injury to the tendon.

Ultrasound

Ultrasound—high or low frequency sound waves—can help increase the blood flow to the area to reduce swelling and speed healing. The vibrating sound waves can travel deep into the tissue (muscles) creating gentle heat. The heat increases the blood flow to the area to deliver oxygen and nutrients and remove cell wastes. The deep heat also helps relieve pain, inflammation and muscle spasms. Ultrasound is painless. You may feel tingling; often, you won’t feel anything at all.

Electrical Stimulation

Low-energy shock wave therapy has been used successfully for chronic tendonitis. This therapy does not require anesthesia and can take several treatment sessions. The vibrations produced by the energy waves are applied to the painful areas. Shock wave therapy stimulates soft-tissue healing by increasing blood supply to the treated area. Small electrode pads are placed on the painful area. Then you control the degree of “shock” to the area. The therapy can last as long as 20 minutes. During the treatment, you can increase the intensity as you adjust to each level. During treatment you should feel a tingling sensation, but not pain.

Electrical stimulation can also be used in iontophoresis. This treatment involves the application of a topical anti-inflammatory to the area. The stimulation forces the medication into the tissues reducing inflammation.

Steroid Injections

Steroid injections are rarely used because it is believed they can weaken the tendon increasing the risk of total rupture.

What to expect after treatment.

If you have mild symptoms, you should do well with 2-4 weeks of physical therapy; more severe injuries can take as long as 2-3 months. As your condition improves, you can begin doing exercises to strengthen your calf muscles. Strengthening starts gradually using exercises that work the calf muscles but protect the healing area. Eventually, you can do specialized strengthening exercises that work the calf muscle while it lengthens. For example, standing on your tiptoes and then carefully lowering your heels back to the ground.

When your healing is well under way, regular visits to the therapist’s office will end. Your therapist will continue to be a resource, but you will be in charge of doing your exercises as part of an ongoing home program. You should be able to get back to normal activities. If you are an athlete, you will be guided through rehab specific to your sport.

It is important to properly rehab the tendon after you recover from the injury or the injury will return.

Since we have not been sufficiently vaccinated to prevent the H1N1 flu, it’s important to inform employees about what they can do to prevent the spread of cold and flu viruses, particularly H1N1 (Swine flu). Keeping your workforce healthy and at work is a goal of many employers—our sample letter to employees will tell employees what they can do to protect themselves and their family from getting the H1N1 flu. Having a healthy workplace not only helps your business continue to run as it should, but it also keeps employees from taking illnesses home to their families.

You can download this sample letter to employees that will help you keep your workforce informed about preventing the spread of the H1N1 virus. Feel free to make changes to suit the culture of your office.

Content of the Sample Letter to Employees for H1N1 Virus

These are important tips for preventing the spread of the H1N1 (Swine flu) virus to your family, home, school and workplace. The information below comes from the Centers for Disease Control and other reliable health information sources.  As always, your personal doctor is the recommended source for all of your health questions.

How Germs Spread
The flu, is caused by viruses that infect the nose, throat, and lungs. The flu usually spreads from person to person when an infected person coughs or sneezes germs into the air. Germs enter the blood stream when the contaminated air is breathed in. Germs can get on your hands by touching surfaces that are contaminated with the flu virus, such as wet areas in a restroom or kitchen. The germs then get into your body when you touch your face, eyes, nose or mouth. If you have the flu, you can spread germs to others by touching surfaces that others touch such as door knobs, not covering your nose when you sneeze or mouth when you cough.

How to Help Stop the Spread of Germs

Clean your hands: Wash your hands often — with soap and warm water — rub your hands together vigorously, scrubbing all surfaces including backs of hands, between fingers, under fingernails and wrists. Wash for 30 seconds. The soap lather combined with the scrubbing helps dislodge and remove germs. The germs stick to the soap and get washed down the drain. Rinse your hands well while keeping them lower than your elbows so the dirty water runs down the drain and not your arms. Always wash your hands after coughing or sneezing into your hands,  blowing your nose, after touching someone who is sick, or when using public restrooms.

Dry your hands well:
Use paper towels to dry your hands and to turn off the faucet. If you are in a public restroom, use the paper towel to open the restroom door.

If soap and water aren’t available, use alcohol-based disposable hand wipes or gel sanitizers.
You can find them in most supermarkets and drugstores. Be sure to buy sanitizers that contain at least 60% alcohol. When using a gel, rub the gel over all hand surfaces until your hands are dry. The gel doesn’t need water to work; the alcohol in the gel kills germs that cause colds and the flu. If your hands look dirty, use soap & water.

Cover your mouth and nose when you sneeze or cough:
Cough or sneeze into a tissue and then throw it away. If you do not have a tissue, cough or sneeze into your elbow or sleeve. Clean your hands every time you cough or sneeze. Make sure all trashcans for tissues have liners; throw the liners out with the trash.

Avoid touching your eyes, nose, or mouth:
Germs are often spread when a person touches a contaminated surface and then touches their eyes, nose, or mouth. Germs can live for 2 hours or more on dry surfaces like doorknobs, desks, and tables and even longer on areas that are wet like sinks and faucets.

Stay home when you’re sick and check with your doctor when needed.

Practice other good health habits:
Get plenty of sleep, be physically active, manage stress, drink plenty of fluids, and eat nutritious food so you can fend off viruses.  Avoid people that have the flu or flu symptoms. Teach your kids how to wash their hands and how to sneeze or cough into their elbow or sleeve.

Sis and grandson Bo - Christmas '08

Clickety, clickety back to the top. Her MRI shows no signs of tumor pressure on any nerves, or any bone loss that would lead to a collapse. But no real explanation as to the cause of the back pain. The next week, she starts having nausea; a little at first and then worsening as the week goes along. Down we go again as we wait for an ultrasound of her gallbladder ordered by the gastroenterologist looking for possible spread of the cancer. Up we go when we find her gallbladder is full of gallstones and not cancer. We teeter at the top again, wondering, worrying. Will they be able to do the bellybutton surgery since she has the mesh in her abdomen as a result of the trans flap surgery? If they can’t do the bellybutton surgery, will her heart take the stress of abdominal surgery? If they do the abdominal surgery will she be out of the hospital in time for her monthly bone scan, liver studies, and chemo. If she misses a dose of the chemo she’s out of the trial.

I sit and listen as she schedules pre-op hospital visit, pre-op visit with the cardiologist, bone scans, liver studies and chemo—timing it all so the puzzle pieces of surgery, scan and chemo fit perfectly. Just as she sits back after the last phone call the phone rings—the surgeon has to change the surgery date. I lose it.  I’m screaming at the pure thoughtlessness of these clowns and why doesn’t she go see people that have more decency than to call up and change dates after they know what you have to go through juggling all the dates and tests and chemo. She just shrugs and says, “People get their appointments shifted around for me all the time.” And she starts her calling and scheduling all over again.

On her surgery date, we ride to the hospital, hoping for the bellybutton surgery. Her daughters and best friend show up, along with about every nurse in the hospital. Pretty soon pre-op is rolling with laughter as they all tell stories about my sister. She’s been a nurse for many years and knows everyone. Then come the hugs as they take her away.  While we wait we wander aimlessly around the hospital snack shop and gift shop. In the gift shop are constant reminders of breast cancer. Pink ribbons, pink pens, pink hats and scarves. I’ve developed a love-hate relationship with pink. I buy another pink ribbon. As we walk into the waiting area, we see her surgeon coming toward us. Please, please, please…

To be continued…

Ansley with sis Dec. 08

Our first high came when it was determined that the cancer was only in her bones. If they could keep it in her bones, she could live another 5-10 years. As we teeter at the top, her oncologist goes through her options. They are few. She can’t take the chemo she had previously because it caused her to have heart failure. Her chemo choices are now limited to a pill along with radiation and a monthly treatment with an osteoporosis medication to help build up her bone density. They also offer her a clinical trial.  The clinical trial consists of the pills she would get without the trial along with a new chemo injection. She chooses the clinical trial. But she has to have the radiation before she starts the trial. So weeks pass while she is tattooed and radiated and gets ready for the trial.

The trial is not blind and there are two branches. One branch gets monthly pills. The other branch gets the new shot each month and the pills. There has been quite a bit of success with the shot and the pills—but, her draw is just the pills. We plummet to the bottom . Then clickety, clickety we ride to the top as she gets her monthly chemo and bone scans and find the cancer has not progressed. ANY progression means she’s out of the trial because the new trial med isn’t working. Out of the clinical trial means her options are reduced to a different, possibly less successful medication.

Despite the bone scans and monthly visits to her oncologist she continues to see patients. Her patients love her and are willing to be shuffled around and rescheduled at the last minute when something unexpected comes up for her. I laugh when she tells stories about how her patients are whining to her about runny noses and bruises and she wants to say, “You think that’s bad, I’ve got cancer—now buck up!”

Six months go by, not much to report. She has little twinges of pain now and then, but all of her tests are “normal” for someone with metastatic breast cancer. Then about 8 weeks ago, out of the blue, her back hurts her so badly she can’t take the pain. Being a nurse practitioner she knows too much and she panics as she wonders if her vertebrae are collapsing around her spine and will she soon be paralyzed. Pancake collapses of the spine can happen to patients with cancer in their vertebra. White knuckled, we fall from our high as she schedules an MRI of her spine to look for signs of spine collapse or nerve damage.

To be continued…

My sister has metastatic breast cancer. You’d think our family would have gotten used to the emotional ups and downs of waiting on tests, bone scans, PET scans and biopsies.  But we haven’t. It’s the hope of one more day, week, or whatever we can have with this fabulous, caring person that keeps us going. That keeps us texting,  posting, and calling each other with any little tidbit of information. Between her daughters, siblings, inlaws, outlaws and our parents sometimes passing on information is like the game of gossip. What starts out as reliable, medical explanations become messages of joy and hope or sometimes tears and despair.

She was first diagnosed in Sept. 2000 with a very aggressive cancer. Almost overnight the lump was there. She’s a nurse practitioner,  so she had a mammogram done in her office after work one night. When she looked at the films she stared at her cancer in disbelief—a spot the size of a quarter in the left upper quadrant. Trust me when I tell you, nurses always know the best doctors. So she immediately called out to her colleagues to find a breast surgeon for the biopsy and surgery. After the biopsy confirmed the worst, her surgeon decided the lump was too big for surgery, so she found the “best” oncologist and started her chemo. Trading her hair for a smaller, operable lump was a no-brainer. Trading her normal breast for a chance at no recurrence was a decision few women could have made.

After the chemo, she had bilateral mastectomies using the trans flap method, followed by breast reconstruction. Every year she had scans, blood work and xrays to check for recurrence. We celebrated 5 years of cancer free. Every year, even last year, she was fine. A month after her annual bone scan, in Sept 08, she was having a pain in her sternum that wouldn’t go away. In October she called her oncologist who ordered a bone scan—it lit up like a string of pearls down her spine to a golf-ball sized tumor on her iliac crest. A PET scan confirmed the worst. And thus we were strapped into our seats on the worst ride of our lives.

To be continued…