Constipation. If your back passage (bowel release and anorectal action) isn't working well, nothing else in your pelvis (bladder, intimacy, pelvic organ support and core strength) will be working well.  So, brace yourself, let's talk constipation!
 
Do you enjoy a consistent, full, complete and satisfying bowel movement every morning?  BMs should be a minimum of every 2 - 3 days and a maximum of twice daily.  You should never need to rush, have skidmarks in your undies or lose stool without you knowing or before you're ready.  Ever.  The stool should be firm but not dry or very cracked, smooth but not sticky and medium sized to pass with comfort.  It should be brownish, of a consistent smell and without mucous or blood.  It shouldn't be painful to release your stool nor should you bear down.  Hemorrhoids can come with pregnancy or stress, but shouldn't be persistent.  You should be able to travel or change your routine without upsetting your BMs.  Your bowels are meant to digest your food and drink, transfer nutrition to your body, then get rid of the waste.  It's a beautiful system!
 
How does it actually work?  When you take that first warm drink in the morning, the sphincter between the esophagus (food tube) and the stomach sends a signal to the rectum that today's food is en route.  Yesterday's waste is nudged along the colon, down the digestive tract and into the rectum.  The sphincter at the end of the rectum opens up.  Counterintuitive?  Stool has just landed and it opens up to take a sample.  It checks if it's gas, liquid or solid. If it's gas, it nudges you. If it's liquid, it slams shut and gives you to signal that you need to move!  If it's solid, it shuts firmly and gives you the message, "Time to go to the toilet".  Don't delay.  It nudges, you calmly go.
 
Toileting habits are important. Sit comfortably and relax.  Your knees should be slightly higher than your hips, supported on a stool or block. Breathe into your belly and sense your pelvic floor softening, descending, and the sphincters opening up to let stool pass.  If you have the urge to push, don't!  Just breathe into your belly and do a bass hum, low growl or pursed lip outbreath to protect your pelvic floor.  Keep allowing your system to release and let go.  Don't stop the stool until your body says you're done.  Then belly breathe again, rock your pelvis and enjoy a few moments of quiet.  When you're sure you're done, do a few gentle pelvic floor squeezes to help clear the anus so that wiping is gentler and more complete.
 
You can support your digestive system.  Keep hydrated, drink mostly water, and enjoy a drink of warm water with tooth-brushing to help your stool stay hydrated overnight.  Be cautious with fibre, adding a little at a time.  Pay attention to the foods that your body finds a problem - what makes your stool too solid and/or what makes it too loose?   What gives you gas?  You're unique, so learn about you.  Support your system with a heated wheat bag and a massage.  Help your system release its waste products after all the work it's done for you.  Depending on your issues, there are specific techniques, stretches, breathing patterns and habit changes that will help you enjoy lovely BMs that support your health.
 
If you have specific problems with your bowel release, a pelvic physiotherapist provide you with with an internal and external assessment and treatment plan just for you.  Your digestion, bladder, pelvic organ support and intimate life will thank you!

 
Pelvic pain is complex and has many faces.  We've talked about Painful Periods, Endometriosis and now we're going to tackle Bladder Pain Syndrome.
 
Bladder Pain Syndrome may have begun like this:  You had a urinary tract infection that just didn't go away.  You felt urgency to void.  You felt pain just above your pubic bones (where your bladder lives), in your perineum and/or in the urethra (the tube from the bladder to the outer world). When urinary tract infections became chronic, the old thinking was that the interstitium (bladder lining) was inflamed, ergo the outdated name "Interstitial Cystitis". Bladder Pain Syndrome is far more complex, the name far more descriptive. 
 
In 2018, we know the onset of BPS is more like this:  Your bladder thinks that it's under threat…..a grizzly is at its door.  Your bladder may have suffered at some point in your life, perhaps when you were a child (Chronic infections? Withholding voiding? Difficulty with bedwetting?).  The part of your brain that worked with your bladder remembered this sense of distress.  Later on in life (with puberty, onset of intimate relations, stressful situations, baby having, an accident or menopause), your bladder had "flashbacks" and kicked into that difficult memory.  Your immune system pitched in, bringing on an immune response and inflammation.  Your bladder nerve endings and the nerve pathways to the brain were woken up.  Your tendons, muscles and fascia tightened up in order to protect the area. 
 
The outcome?  You may develop a hypersensitive, overactive, inflamed bladder.  As your bladder fills, it naturally stretches.  That tight and inflamed bladder isn't so keen on stretching, sending a threat message to the brain.  Your bladder naturally fills to 500-ish mls., but with BPS it can become painful at only 100 mls..  The bladder may also not welcome urine due to the inflamed lining, so you may feel a sense of urge to get rid of it…now!  If you experience these feelings for more than three months, your brain begins to focus on the bladder, becoming attentive to all bladder sensations from a little urine to moderately full to urgency to pain!  The natural voiding reflex and habits become distorted over time and your bladder forgets how to feel the "Oh, I'm getting full…..I'll have to go to the loo soonish, but no rush" sensation.  The rising tension in the pelvic floor creates more problems.  Toilet time naturally involves releasing the pelvic floor along with opening of your sphincters in a lovely dance.  With a tight pelvic floor, your urine stream may become slow, interrupted, painful and incomplete.  Intimacy may become painful.  You may have an accompanying challenge with bowel release (not constipation….it's the letting it go part that becomes slow and/or painful).  Your stress system and brain become alerted over time and this increases your perception of pain; it attaches it to your emotional state.  If you haven't slept, are having a bad day or have stress, you'll feel BPS more than you would have otherwise.  It's just all so connected.
 
What can you do about it?
 
Find a pelvic certified physio.  You'll be asked about how your bladder functions, how often you void, how it feels before, during and after voiding, how your bowel works (loading, comfort, movement, frequency), pelvic floor function, deep core function and how your life is working (your nutrition, sleep, understanding of pain, pelvic systems and stress management).  Your internal and external pelvis and deep core will be assessed.  Research has shown us that your pelvic floor needs to be calmed down in its hypertonicity (tension), pain and function or the dysfunction and pain in your bladder won't change. You will be taught pelvic floor releases with breathing patterns, general and specific stretches and perhaps the use of a wand (a pelvic trigger point tool for you to use). An elimination diet is helpful, but no two women with BPS have the same dietary triggers.  Eat food that agrees with you.  Get good sleep and downtime.  Find and manage your stressors.  Bladder Pain Syndrome can be managed well.  You can experience a cascade of wonderful changes when you take charge of your own health.

"That time of the month" may bring on cramps, bloating, food cravings, unpleasant moods, loss of energy for some women.  Consistently painful periods are NOT normal, so please ask for help if that is your experience and learn some ways to ease your discomfort!
 
Deep Breathing
 
Stress can increase period pain, make you skip or lose your periods altogether.  When you're stressed or in pain, your breathe at the top of your lungs, just under your collarbones.  Breathing deeply and fully into your low lungs creates rhythmic abdominal and pelvic movement.  It's a natural massage, moving your organs like seaweed dances in the ocean in response to waves.  Slow, relaxed deep breathing promotes relaxation, enhances your mood, improves your concentration and simply feels wonderful!  Use your breath to make a simple, accessible and lovely change. 
 
Here's how:  Ly on your bed with a pillow under your head and another under your knees.  Let you body release and relax.  Place one hand on your chest and the other on your low belly, making sure your elbows are supported on the bed.  No effort!  Now, breathe in slowly through your nose.  Let your belly lift, your low back arch, your pubic bones descend towards your feet and your hips release.  Your lower hand will have lifted and your upper hand will stay quiet on your upper chest.  Now just let the air seep out of your nose, exhaling without effort.  Let is be as slow as you're comfortable enjoying.  Count a slow 4 counts in and at least 4 or more (to 5 or 6?) out.  Repeat.  Enjoy.
 
Release Your Pelvic Floor
 
When our body experiences pain, it may respond by tightening up and holding back.  Periods, when completed with ease, are about letting go!  Our pelvic floor can get in the way of releasing our flow by becoming tight in response to pain.  Begin practicing release of your pelvic floor by sitting on a big ball or over an upholstered sofa/chair arm.  Breathe into your low belly, feel your pelvic floor open and release…….use this technique when you're in your painful cycle and you will find more ease with your flow.
 
Abdominal Massage
 
Start with a hot water bottle or heated wheat bag for 15 - 20 minutes in a restful position and quiet place.  Cover yourself with a blanket.  When you're all warmed up, remove the heat and, with the heel of your hand, massage your own belly, picturing a clock.  Find the "time" on the clock that needs special attention, keeping the massage gentle, slow and consistent.  You might need 10 - 15 minutes to massage, then 5 more minutes to repeat heat.  This stimulates blood flow, mobilizes your fascia and organs and distracts the pain nerves from being cranky.
 
Yoga
Yoga is a way of learning to breathe, release, strengthen, move and approach life with ease.  Some of the yoga poses that relieve period pain are Child's Pose, Knees to Chest, Forward Fold, Cat-Cow, Windshield Washer Spinal Twist and Savasana.
 
An experiment of one:  Try by adding 2 yoga "classes" (at home or in a class) per week for 3 months.  Employ low belly breaths, releasing your pelvic floor, heated tummy massage.  Keep track of your periods for 3 months.  Benefits may include:  reduced cramping intensity and length of time, less moodiness, more regular periods, lighter bleeding, less bloating, less tender breasts, better sleep, improved concentration and a more relaxed experience.  Find ease in your monthly cycles……they'll be a monthly experience for most of your life, so find what works for you!

POP, Not the Fizzy Kind!
 
POP, Pelvic Organ Prolapse, is experienced by almost 70% of women, yet fewer than 28% of us know what it is!  Let's define it, unravel its causes and Most Importantly, learn how to assess, stabilize, prevent and reverse POP. 
 
What is Pelvic Organ Prolapse?  The International Uro-gynecological Association defines POP as "the bulging/herniation of one or more of the pelvic organs (uterus, vagina, bowel and bladder) into or out of the vagina."  POP occurs when the muscles, ligaments and fascia (a network of supporting tissue) that hold these organs in their correct position become weakened.  POP is common because its causes are so common:  pregnancy, labour and childbirth, aging and menopause, genetics and family history, obesity, chronic cough, chronic constipation, heavy lifting (work or play), hypermobility (naturally stretchy people) and pelvic surgeries (especially hysterectomies).  Often the impact on supportive structures earlier in life (i.e. pregnancy) that create prolapse will not be functionally obvious until menopause.  That's why being assessed for POP at any time in a woman's life is so helpful…..it is usually preventable!
 
How would you guess that you have POP?  Women describe heaviness or a dragging sensation in the vagina or pelvic floor, a lump or bulge in the vagina, aching discomfort in the pelvic region, urinary or bowel problems, a dull backache or sexual problems.  These symptoms often worsen with activity or simply as the day goes on.  Bladder and bowel problems involve incomplete emptying, feeling the need to bear down or use manual help to finish the job on the toilet.  If the bladder prolapses on its own, it can create chronic bladder infections. This is due to kinking of the bladder neck before you've completely emptied leaving just enough urine behind to brew up another infection.  POP must be assessed functionally, graded, on repeated testing and with an understanding of the deep core system and breathing patterns.  Our bodies are supremely clever at recruiting "help", but often those patterns of recruitment cause further dysfunction. 
 
What can you do about POP?  Reversing POP is a new and exciting world in Pelvic Physiotherapy.  We used to think that surgery was the only option…….a challenging surgery and one that is oft repeated due to structural failure as life's activities challenge the repaired structures.  In a recent study in Vancouver, 79% of prolapse surgeries were cancelled after 8 weeks of pelvic physiotherapy, thereby avoiding the risks inherent in surgical intervention.
 
Creston has a bounty of options for you:

Pelvic physiotherapy will help you to make the changes necessary including:  integrated pelvic floor and deep core muscle training, establishing healthy bladder, bowel and lifestyle habits, and learning healthy ergonomics for coughing, toileting, lifting, sport/exercise and sitting/standing/resting your body through the day.  Pelvic Physiotherapy is available at Full Circle Health Centre with Joanne Gailius.  An assessment and a few follow-up sessions are usually all that you'll need.  Hypopressive training is available locally at Spitfire Fitness with Jenn.  Group and individual Pelvic Yoga Therapy is at The Yoga Room with Barb.  With your gynecologist, you may be fitted for a pessary, a ring that is inserted in the vagina to hold up the organs.  After trying all conservative options, you may need surgery.  You'll be ready and able to employ all the skills that you've learned already and you'll have greater benefit from the surgery!
 
Pelvic Organ Prolapse is common but not normal.  Learn about your pelvis, your deep core strength and a strong and healthy body through life's seasons.
 
 
 

Building and Supporting Your Bone Health!       
 
Bone health isn't an "old persons' thing".  In 2019, we enjoy living longer, yet we have declining bone health worldwide. 1 in 5 women who fall and fracture will die within a year of their fall; those who survive often experience a loss of independence and reduced quality of life.  Fall prevention with a focus on bone health is really important for a meaningful and fun life!
 
These Quick Facts will help you implement skills that will reduce your bone loss and support your bone building.  Brace Yourself!

• Get Active, Stay Active. Bone is reactive…..in order to create and rebuild strong bones, we must stress bone itself.  Your bone needs to impact the ground (walk, jog, play basketball, go up and down stairs, stomp the ground!).  Your muscles need to pull on your bones, creating stress on them (lift weights, pull theraband, join a dance or exercise class, come to yoga).  Often post-menopausal woman avoid these activities due to pelvic dysfunction, a common barrier to impactful exercise when there is a fear of leaking or aggravating pelvic organ prolapse (descent of your bladder, rectum or uterus).  Seek out a pelvic/women's health physio to help you with whatever challenge is stopping you from getting and staying active!

• Poking Chin with your head forward and a slouched upper back posture is rampant due to sitting too much and using tech….all day, every day.  We need to be aware of how we position our bodies when we are using cell phones, tablets and computers. The demands that we expose our bodies to will shape our bones and soft tissues.  If we're using tech or sitting for many of our waking hours, we owe it to ourselves to consider our posture, then change it to become bone building.

                  Quick checks: stand, sit, perch, move + lift your screen to eye level
                  + learn to type without looking down at your fingers.  Chin in!

• Loss of Estrogen happens due to menopause, estrogen suppressing medications (as part of cancer treatment) and/or hormonal medications given as contraception or for suppressing uterine fibroids/treatment of pelvic pain.  We may make these choices, but we need to learn to protect and support our bone in the meantime!
• Steroids are an amazing medication for "just the right condition/moment" and no other meds will do that job.  But again, "Steroid Induced Osteoporosis" is a real thing.  Learn to protect your bones while you benefit from steroid medications.
• Slim is awesome, skinny is not!  Being underweight and having low muscle mass as you age is highly correlated with bone loss.
• Wine and beer consumption increases your level of parathyroid hormones which leads to a leaching of Calcium from bone; alcohol is also implicated in our bone builders (Osteoblasts) getting lazy, so less new bone is laid down.  Reduce your consumption and you'll even sleep better!
• Reduce your salt.  When you eat excess salt and void (pee), excess calcium joins the excess salt that you're voiding, increasing your calcium loss.
• Phosphoric Acid has been linked to lower bone density in some epidemiological (big number) studies and is found in cola type drinks.  Drink water instead.
• Smoking blocks the hormone Calcitonin, an important bone building hormone. Nicotine and free radicals generated while smoking further destroy bone builders.  Stop smoking.
• Eat less sugar and/or control your diabetes for three reasons:  excess blood sugar slows down your bone builders, speeds up your bone eaters and slows healing of broken bones. 
• Vitamin D deficiency.  We have low sunlight in the winter and we use sunscreen/protective clothing in the summer!  Many people aren't getting enough Vitamin D to support bone health.  You can ask to have your levels checked by your doctor, then learn food options and/or supplementation to help bring you up to optimum Vitamin D levels.
• Chronic stress and lack of sleep lead to elevated Cortisol levels which dramatically decreases bone building so that more bone tissue is broken down than gets deposited.

 
Take control of your bone health by building new bone and losing less bone. Next:  fall prevention + balance building.
 
 
 
 

"Sitting is the new smoking" is a trendy phrase right now, yet many of us sit a lot!  We sit at work.  We sit because our muscles and joints are sore or simply because we're not active.  What to do?
Here are some very simple physioyoga rules to help you sit well, feel ease in sitting and help gravity pass vertically through you, not push you forward or backward.  Short term sitting is OK.  Long term sitting isn't!

• When you are in a chair, sit back so that you can tuck your bottom (sacrum/pelvis) against the lower chair back and your midspine (brastrap level and up) against the seatback of the chair.
• Make sure your hips are level or just slightly higher than your thighs, with your feet flat on the floor. 
• Place both feet flat on the ground in front of you.  Check that your heels and balls of your feet to your toes are all restful.  Check that your right and left foot are bearing weight evenly. Don't cross your ankles or thighs or jam your knees together or tuck a foot under you. 
• Find your “sit bones.” Place your hands on the rim of your pelvis just below your waist, and roll your pelvis back, so you are slumping. Then roll it forward, arching it, so you are sitting up very tall. Tip back and forth through these two extremes until you feel those lovely solid, thick sitting bones underneath you centrally. Make sure you are evenly weighted through the left and the right sit bone.  Repeat often. 
• Check in with your upper back, making sure that you're supported by the chair. If you're on a stool, find that middle, central place where your shoulders and upper back are quiet and there is no strain.
• Check in with your chin…..a restful neck and head-on-neck is found when you have a slight double chin with a gentle tuck inward.  If you are new to this posture, you'll notice a slight "thick feeling" in your throat when you do this because your throat structures are used to functioning on stretch.  Gently teach them to be long and tall again.  This helps your voice strengthen, your swallow improve, your breath deepen and your digestive system function with ease.  It's also good for your bone health as you have less downward + forward strain on your spine.
• Press your tongue to the roof of your mouth and imagine growing taller through that space, as if your spine is lengthening upward or there is a string attached from the top of your head to the ceiling.
• Place whatever you are looking at directly at eye level.  Be particularly aware of this if you are in progressive lens glasses.  In these glasses, we tend to jut out our chin to peer through the reading lens……adjust the screen/book/glasses, not your neck!
• If you need to stay sitting for long periods, find this restful, gravity neutral position with support under your feet or around your thighs or behind your lower spine/pelvis or behind your midback.  It's relearning, then strengthening then finding endurance, like training for anything in life and you may need support to begin relearning.  You may need to use support on long car trips.  Have compassion for yourself using a cushion or rolled towel.
• Change what you sit on: try a highstool to perch, up on your feet to stand, a standing/sitting desk (there are combos) and sit now and then. 
• Undulate your body in tiny movements (no one can see!) and then stand up tall every 30 minutes to "re-set" your tone/postural support system.
• Keep checking in, every 10 - 15 minutes to find the places where you hold tension.  Take a deep breath in and a longer breath out and release it….. release your tension with your breath.

Think of our grandmothers.  I was incredibly blessed to know my grandma well as she lived next door on our dairy farm and was the hub of our family wheel.  She had such variety in her daily activities and that's what kept her from sitting too long at once.  Let's be like Grandma!

Hello Full Circle Friends.  I've asked "local" women who work with women to share their offerings on my blog.  The first brave submitter is Shona Bohmer who lives and works in Cranbrook. 

Here's her story:

What is Restore Your Core™
Restore Your Core™ (RYC®) is an exercise program that uses a whole-body approach to train your core and pelvic floor muscles to be more functional, reflexive, and supportive. Diastasis recti and pelvic organ prolapse safe.
 
Name: Shona Bohmer
Location: Cranbrook, British Columbia Canada
Website: www.shonabohmer.com
Social Media handles:
Facebook: https://www.facebook.com/shonabohmermovement/
Instagram: https://www.instagram.com/shona.bohmer/
 
Restore Your Core™ Offerings: Group Classes, Workshops, One on One sessions in person or online via Zoom 
 
Describe your life in 3 sentences.
I’m a married mom of 3 amazing and nearly grown children. I enjoy gentle strengthening and mobility exercises, hiking, mountain biking, and lazing at the lake on a hot day. Restore Your Core™ has changed how I approach everything I do and I’ve turned into a total movement and body nerd! 
 
What inspired you to become an RYC® teacher?
While recovering from a car accident that left me in chronic pain, I discovered my passion for helping women in their own healing journeys. I found RYC® 6-months post-accident and it became clear to me why I was still having pain. My previous fitness choices and compensatory patterns left me unsupported, vulnerable to injury, and delayed my healing. I had been a regular exerciser for decades and had taken countless group classes (crossfit, dance, pilates, yoga, etc.). I had participated in workshops and retreats and, although I had put the time in, I knew very little about the body or movement. As I progressed through RYC® I found myself asking: “Why don’t I know this?” and “Why has no one ever told me this?” I learned so much in the process of healing my body, I felt compelled to share my knowledge.
 
What piece of advice would you give your pre-RYC® self?
Listen to my body and take time to rest. Pushing through pain or injury doesn’t work!
 
What makes you a standout RYC® teacher?
I love helping women understand how their alignment, compensations, and breathing patterns can influence their bodies. I support clients in developing the awareness required to improve their movement patterns, which ultimately reduces their pain and symptoms of core and pelvic floor dysfunction. Through this process women feel empowered and able to return to doing what they love. I develop meaningful relationships with my clients and continue to check-in on their progress, answer questions, and offer encouragement. In addition to being a certified RYC® teacher, I’m also trained in therapeutic yoga. I know from personal experience that healing is possible and it’s never too late to start.

Thanks Shona!
 
Stay tuned to hear from others.....wonder about Hypopressives?  Pelvic Yoga Therapy?  Core Strengthening classes at the Creston Rec Centre?  Let's all share!

What is More important than Diet and Exercise in Women’s Health?   SLEEP!
 
How does sleep deprivation during all seasons of a woman’s life affect your health?  “Catastrophic sleep loss epidemic” is how sleep researcher Dr. Matthew Walker (U of C Berkley) describes sleep challenges.  The factors contributing to sleep loss are:  the electrification of our homes, the electronic connectedness of our lives, the porous membrane between our home and work lives, loneliness/depression, the prevalence of alcohol and caffeine and hormonal changes. He has confirmed through research and clinical studies that lack of sleep contributes to cancer, Alzheimer’s disease, diabetes, poor mental health and obesity.  We also stigmatize sleep by associating a long, restorative sleep or nap with laziness or shame.
 
Eight hours is still our healthy goal.  But how do we get there?
 
Make it non-negotiable.  Plan your day around sleep.  Exercise must be before dinner, preferably before lunch.  Light stretching or restorative yoga are good options for your evening.  Reduce the size of your evening meal so that digestion is a breeze…make lunch your hearty meal! Eliminate sugar.  Completely.  Avoid alcohol at dinner but if you’re so inclined, enjoy it with food and strictly keep it to 5 oz. (that’s ½ c. + 1 T.)!  Daytime naps should be restricted to 20 minutes maximum and be completed before 1 pm.  Go to bed at the same time every night, setting your blanketed alarm for the same time every morning.  Be consistent to the point of being rigid!  Set a second alarm for 2 hours before your dedicated bedtime.  When it rings, turn off ALL blue light emitters in your home, from your smartphone to your ipad/ereader to your laptop/TV screens. 
 
 
Think of all the quieting activities that you provided for your babies in order to make sure that they (and you, the exhausted new parent) slept.  Downtraining.  Calming.  Enjoy a warm bath or shower (unless that’s your morning wake-up call!).  Savour a light protein snack (boiled egg, small piece of cheese, strip of chicken breast….no carbohydrate) to hold you through that pancreas/energy dip in the wee hours of the morning.  Your bladder shouldn’t awaken you at night unless you’re over 60, then only one trip to the loo is acceptable.  It is effective to reduce your fluid intake after dinner to give your bladder an opportunity to learn to behave.  If you enjoy a warm drink before bed, make it chamomile tea or warm milk…..nothing with alcohol.  Alcohol is pure sugar and guaranteed to keep you from falling asleep and/or to awaken you in a few hours. 
 
Do a “brain dump”….write down all your concerns, lists and plans and leave it in the kitchen.  Tomorrow will be soon enough to tackle it all and as Mom said, “It will all look better in the morning.”
 
Your bedroom should be a “sleep cove”….a dark and comfortable room with light restricting curtains, cool, comfortable temperature, your body kept warm (cozy quilts or blankets) and comfortable (clean, fresh sheets that invite you to sleep).  A light spray of lavender has been proven as a sleep promoter.  And your bedroom is not for reading, lounging, chatting, talking on the phone…..your bedroom is for sleep and intimacy.  Nothing else!  Your own sleep- promoting, dedicated space.
 
It takes time to retrain your sleep patterns.  Be patient, firm and compassionate with yourself.  Making sleep a priority now is an important part of your own self care and health promotion.  Look forward to bedtime, enjoy the restoration that sleep brings and awake with energy for today!

Fall is here in our chilly mornings, the leaves beginning to turn and our valley enjoying apple, plum and pear season.  But fall brings falls…..evidenced by the an icey film on our sidewalks on the shady side of the street.  Sleuthing out your bone health, understanding a Bone Mineral Density (DEXA) scan and then knowing how to help you enjoy brilliant bone health through every age and stage will help you avoid those pesky fall-induced fractures of your wrists, shoulders and hips.
Our bone health is based on our body's build, our weight management, our activity level and type/frequency of exercise, our diet, our general health and our age.  All of us have our own unique blend of variables; as women, our one commonality is the reduction of bone-protective estrogen as we wander through menopause.  Menopause is reached by a natural reduction and eventual cessation women's hormones in our bodies, through surgery (complete hysterectomy) or through taking estrogen suppressing medication (Tamoxifen or other aromatase inhibitors) or simply through the passage of time.
Women are typically referred every 3 - 5 years for a DEXA scan, available to us at the EK Regional Hospital in Cranbrook.  DEXA is an abbreviation of Dual Energy X-ray Absorptiometry, a targeted xray that measures the bone mineral content or density of your bones, is a reliable predictor of fracture risk.  A central DEXA measures the head of the hip and the mid lumbar (low back) spine (most commonly used and most reliable test).  A peripheral DEXA measures the forearm, the heel, wrist and hand bones.  The modern DEXAs are very low radiation scans, about 1% of a lateral spine xray.  Your height is usually measured so that any loss of height is documented in relation to the xray.  "Prospective Height Loss" tells us that if you lose more than 2 cm. of height over a period of three years, you may have a new compression fracture in your spine.  "Historical Height Loss" tells us that, if you're over 60 and have lost 6 cm. of height or are under 60 and have lost 4 cm. over more than three years, then again, a compression fracture must be considered.  An xray tech performs the test which is painless and takes about 15 minutes; from there, a radiologist interprets the results which are then sent off to your GP to discuss with you and to guide your treatment.
The DEXA test tells you 3 things about your bone mass:
1.    Your bone mass in grams per centimeter squared.
2.    A DEXA score comparing you to a healthy control group, often a 30 year old healthy woman, your "T score".
3.    A DEXA score comparing you to your peers, your "Z score".
Complications to your DEXA score can be caused by osteoarthritis in your spine (pitting or rough joint surfaces can look like bone loss), osteoarthritis in your hip (difficulty rotating your hip inward to the best testing position), compression fractures in your spine (can look like dense bone), obesity (if you're over 350 lbs., some DEXA units can't accurately guarantee that the score won't be skewed by photon passage through extra tissue), being too thin (scores are widely variable for thin women from one test to the next) and switching machines/locations (they are all calibrated very carefully).
In the end, you'll meet your doctor again to discuss the score.  We usually talk about the Tscore which will tell you a number, hovering just above or below 0.

• A T-score of +1 to -1: means you have normal bone mineral density.
• A T-score of -1 to -2.5: osteopenia or weakening bones
• A T-score of -2.5 or lower: osteoporosis or weakened bones
• Severe Osteoporosis is diagnosed when the T-score is -2.5 or lower, and the person has already suffered a fragility fracture.

These two words, osteopenia and osteoporosis carry concern, but they also bring you a job to do.  The next article will discuss ways in which you may address bone loss including posture, breathing patterns, exercise, activities of daily living recommendations, dietary suggestions and information on medications as well as evidenced based resources to look up online.  Cheers to strong bones!