How to sit

How Should I Sit?

Most Americans sit in an office chair all day. In fact, about 86% sit an average 13 hours per day! A good number of people realize that sitting all day is not ideal, but it is unavoidable in order to pay the bills and get from point A to point B. Since we spend most of our day sitting, it is imperative that we sit correctly to avoid back and neck pain as well as other issues. We need to consider how we sit at a desk, behind the wheel of a car, and on the couch in order to make the best of the situation.

For starters, the type of chair that you select is very important. It should support the curvature of your spine and be at about a 100-110 reclined angle so that your upper and lower back are both supported. When sitting, your hips should go as far back in the chair as possible and your feet should rest on the floor or a footrest so that your thighs are parallel to the floor. Ideally, your knees should be equal to or lower than your hips and your shoulders should always be relaxed.

Your keyboard and mouse should be easy to reach and at the same level.  The monitor should be directly in front of you, with the top of the screen around eye level or 2-3 inches above eye level to keep your neck relaxed.  Those who wear bifocals should lower the screen. Additionally, the screen should be centered above the monitor. Your hands should be at the level of your elbows or slightly, your wrists should be straight and your arms should be close to your body. After adjusting your chair to make sure your wrists and arms are correct, put your feet flat on the floor. If your feet do not reach the floor, use a footrest or anything nearby to keep your feet flat. Make sure there is room for your legs under the desk and try to keep this area free from clutter.

Many people use the computer and type at the same time while craning their neck to use the phone. If you talk on the phone, use a headset or put the phone on speaker to avoid neck issues. Also, be careful of the glare coming from windows or actual light. It is important to take frequent breaks to get up and stretch about every 20-30 minutes. Try to rest and refocus your eyes to avoid fatigue by looking away from the computer monitor into the distance or covering them for 5-10 seconds.

It is important to consider how you sit in every situation, not just behind a desk. Slouching on a couch, crossing your legs, or sitting incorrectly in a car can all have a negative impact.  When driving, the steering wheel should be as low as possible and you should hold it at 9 am and 3 pm instead of 10 am and 2 pm to help relax your shoulder. Also, try to keep your wrists straight while driving. Your knees should be in line with your hips, the seat should be reclined 100-110 degrees, and you should be able to reach the pedals without straining. Your neck should rest on the neck rest and you should try not to slouch. On a couch, if your couch is deep and you are slouching, put a small pillow behind your lower back.

Since we can’t help sitting too much throughout the day, let’s make the best of a bad situation. Correct your posture and pay attention. This will help you feel better and be more productive.

Living with IBS

 

Irritable Bowel Syndrome, or IBS, is one of the most common health concerns facing Americans today yet it’s one of the least discussed. Many people who have this condition suffer in silence due to it being somewhat of a “taboo” subject or just for not knowing that there is an actual problem. April is IBS awareness month and with it we aim to shed light on a condition which plagues thousands of people every single day.

The walls of the intestines are lined with layers of muscle that contract and relax in a coordinated rhythm as they move food from your stomach through your intestinal tract to your rectum. If you have Irritable Bowel Syndrome, the contractions may be stronger and last longer than normal which will cause gas, bloating, and/or diarrhea. The opposite can also occur with weak intestinal contractions, slowing food passage and leading to hard, dry stools. Abnormalities in your gastrointestinal nervous system also may play a role, causing you to experience greater than normal discomfort when your abdomen stretches from gas or stool. Poorly coordinated signals between the brain and the intestines can make your body overreact to the changes that normally occur in the digestive process. This overreaction can cause pain, diarrhea or constipation.

As many as 1 in 5 American adults experience signs and/or symptoms of IBS. There are two common forms of IBS – IBS-C, with constipation, and IBS-D, with diarrhea. It is unknown what causes IBS but there are many factors, including family history, which are considered to be a trigger for those suffering with this illness.

One of the biggest triggers for IBS is a person’s diet. Many people have more severe symptoms when they eat certain things. Some doctors will recommend doing an elimination diet to pinpoint what the exact trigger food(s) could be. Some other recommendations include: eliminating high-gas foods such as carbonated beverages, vegetables (especially cabbage, broccoli, Brussel sprouts, and cauliflower) and raw fruits, eliminating gluten (wheat, barley, and rye) or avoiding refined (not whole) grains, eliminating FODMAPs, avoiding high protein diets, limiting or eliminating caffeine (such as coffee), and experimenting with fiber intake. A person suffering with IBS should eat smaller meals and drink plenty of liquids, especially water! It’s also important to note that a person with this illness should be careful with their dairy intake, regardless if they are lactose intolerant or not.

Another common trigger for IBS sufferers is stress. Many people find that their symptoms are worsened or brought on during periods of increased stress. While stress certainly will aggravate your symptoms, there has not been any research found to cause them.

Women, especially under the age of 45, are twice as likely to develop IBS. Researchers believe that this is due to hormonal changes. Many women find that their symptoms are more prevalent during or around their menstrual cycle. IBS worsens as hormone levels fall. As hormone levels fall to the lowest point during menstruation, symptoms such as stomach pain, discomfort, and constipation or diarrhea become more common and intense. What’s worse, those who suffer from painful periods, are twice as likely to have an increase in symptoms.

Even though the signs and symptoms are uncomfortable IBS, unlike ulcerative colitis and Crohn’s disease (which are forms of inflammatory bowel disease), doesn’t cause changes in bowel tissue or increase your risk for colorectal cancer. Some symptoms that may indicate a more serious condition include rectal bleeding, abdominal pain that progresses or occurs at night, and/or weight loss.

While there is no cure for IBS, there are certain things that have been proven to alleviate some of the symptoms. One easy remedy is to exercise regularly. Incorporating regular exercise into your routine will not only help you to look & feel better about yourself, it will also help to stimulate normal contractions in your intestines. If you’ve been inactive, start slowly and gradually increase the amount of time you exercise. If you have other medical problems, check with your doctor before starting an exercise program. Another form of therapy, while non-traditional, is the use of herbs such as peppermint. Peppermint is a natural antispasmodic that relaxes smooth muscles in the intestines. It’s important to note that while it may ease your IBS symptoms, peppermint may increase heartburn. Before taking any herbs, check with your doctor to be sure they won’t interact or interfere with other medications. Probiotics are “good” bacteria that normally live in your intestines and are found in certain foods, such as yogurt and in dietary supplements. It’s been suggested that if you have Irritable Bowel Syndrome, you may not have enough good bacteria so by adding probiotics to your diet, you may ease your symptoms.

IBS can be a long-lasting problem that can impact how you live your life. Many people with IBS miss work or school more often and they may feel less comfortable taking part in daily activities. If you feel that you may have IBS, contact your doctor for further testing.

By Gina Stallone

 

References:

http://www.webmd.com/ibs/guide/default.htm

http://www.newsweek.com/2016/11/18/fodmap-diet-ibs-digestive-disorders-healthy-eating-517684.html

http://www.ibsdiets.org/fodmap-diet/fodmap-food-list/

http://www.aboutibs.org/ibs-awareness-month.html

http://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/basics/definition/con-20024578

Slim fit girl doing planking core muscles exercise indoors at ho

Keep Your Core Strong

In the world of exercise, the core is a common focus. Often times, we hear about how important it is to strengthen our core and to improve core stability, but what exactly does this mean? The core is made up of much more than the abdominal muscles. In fact, we derive most of the power in the body from the core.  It is imperative to have core strength and stability to prevent injury and to increase performance. Therefore, it is extremely important to understand what the core is and how we can strengthen it effectively.

The core connects the upper body to the lower body and it affects how we move these body parts. It is involved in activities of daily living, such as bending and lifting, sitting properly at a desk, housework, gardening, sports, balance and stability, good posture, and preventing back pain. Weak core muscles can negatively affect your daily functions. With our sedentary lifestyles, most of us have weak cores. We need to continually work at strengthening these muscles.

The core is made up of muscles from the neck and shoulders down to the pelvis. These include the multifidus, interspinales, intertransversarii, rotatores, internal and external obliques, transversus abdonminis, erector spinae, quadratus lumborum, latissimus dorsi, thoracolumbar fascia, and abdominal fascia. Therefore, core training is not as simple as doing sit-ups.  It is important to train all of the core muscles, not just the “abs,” for effective movement. The core transfers force and acts as a stabilizer, which is why it is important to train the core dynamically in all planes of motion rather than in isolation. Therefore, deadlifts, squats, pushups, pikes to pushups, and planks would be much more effective at training the core than sit-ups. These exercises will create more efficient movement and increased strength. Further, the core should be engaged while weight training other body parts in order to develop core strength. It is important to note that many traditional core exercises do not adequately recruit the abs and have been shown to damage the lower back.

Core stability creates efficient movement and proper positioning to prevent injury. For example, if a cyclist reaches too far forward while biking, it changes the position of the hips and pelvis, which affects posture and power. Similarly, while running, tight hips and lack of hip extension can cause the lower back to hurt and affect performance. It is helpful to use a foam roller to decrease inflammation and tension and to prevent restrictive movement before exercising.  Additionally, meeting with a personal trainer to learn the proper form will ensure you are exercising effectively in order to reach all of your fitness goals.

Don’t neglect your core, since it is the foundation for your health and fitness. The stronger the core, the stronger you are and the better you will feel.  A stronger core equals a more solid you!

Please click on this link for some effective core exercises: http://thearenafitness.com/exercise-library/exercise-gallery/images/pdf/exercise_pdfs/3_core.pdf

Body Types

No Body Is Perfect

by Gina Stallone

This week is National Eating Disorders Awareness Week. This year, the theme is It’s Time to Talk About It because it’s time we explore the various eating disorders, shed light on what is normally considered a taboo subject, and discuss the many life-saving resources that exist.

Eating disorders often involve extreme emotions, attitudes, & behaviors surrounding food and weight. They are real, complex conditions, which can have serious consequences for the person’s health and for the various relationships in his/her life. An eating disorder is not a fad or a phase…or even a lifestyle choice. Rather, these disorders are serious and potentially life threatening conditions that affect a person’s emotional and physical health. The sooner a person seeks treatment, the more likely he/she is to recover physically…and emotionally.

Let’s break down a few common eating disorders so you can recognize a problem when and if you see one:

  • Anorexia: A person suffering from this disorder does not eat, or does not eat an adequate amount of calories/nutrients to sustain daily living. By denying the body its essential nutrients, the body is forced to slow down in order to conserve energy. This results in the following: abnormally slow heart rate and low blood pressure, reduction of bone density (osteoporosis), muscle loss and weakness, severe dehydration, dry hair and skin (hair loss is common), fainting, fatigue, & overall weakness. Additionally, Anorexia has the highest mortality rate of any psychiatric disorder.

Atypical Anorexia – A person suffering from this disorder will have many of the same symptoms as those with Anorexia. The difference is the person will exhibit those symptoms without weight loss. They are often within or above normal weight range, making their presentation “atypical.” A person struggling with Atypical Anorexia may exhibit an extreme fear of being fat or of any weight changes and resort to abnormal eating behaviors, such as calorie counting, cutting out certain foods/food groups, avoiding social events and functions that involve food, and more. Many individuals who have Atypical Anorexia may not even realize that they are struggling with a severe and deadly eating disorder, simply due to the weight stigma that surrounds this disease. A person may think, “I am not sick enough to have an eating disorder,” because he/she may be within or above a normal weight range.

  • Bulimia: This is when a person will consume large quantities of food, but often follow eating with self-induced vomiting. The recurrent binge-and-purge cycles of bulimia can affect the entire digestive system. It can lead also to electrolyte & chemical imbalances in the body that affect the heart and other major organ functions. Other health consequences include: potential for gastric rupture, inflammation & possible rupture of the esophagus, tooth decay & staining, chronic irregular bowel movements & constipation, peptic ulcers & pancreatitis.
  • Binge Eating Disorder: Also known as Compulsive Eating Disorder, this involves frequent episodes of consuming very large amounts of food but without behaviors to prevent weight gain, such as self-induced vomiting. There is often a feeling of shame or guilt which accompanies the binge episodes. Binge Eating Disorder often results in many of the same health risks associated with clinical obesity, including high blood pressure, high cholesterol, heart disease, Type II diabetes, & gallbladder disease.

Many people struggle with body dissatisfaction and sub-clinical disordered eating. Research shows that as early as the age of 6, girls start to express concern about their own weight and that an estimated 40-60% of girls ages 6-12 are concerned with becoming too fat. 35-57% of adolescent girls engage in crash dieting, fasting, self-induced vomiting, diet pills, or laxatives. In fact, approximately a half million teenagers struggle with eating disorders or some sort of disordered eating. In the United States, 20 million women and 10 million men suffer from a clinically significant eating disorder at some time in their life.

There are various ways in which we can help to prevent eating disorders. Take steps to educate one another, challenge the “ideal” way to look, and spread the word about eating disorders as a whole. Genuine awareness will help avoid judgmental attitudes about weight and about food.

First, educate yourself about the body and food. This will help set a positive example for a healthy and balanced relationship with food. It is important to be healthy and not to talk about or to behave as if you are constantly dieting. Avoid categorizing foods as good versus bad, and just learn optimal ways to eat. Food should be used as fuel to power your body and to provide the essential nutrients needed for daily living. Strive to achieve a healthy balance within your diet…and within yourself.

Remember that there is no ideal or perfect body. Challenge the false belief that “thin is in.” Every person’s body is different. Weight and/or body type does not determine anything about a person’s character or personality, so there should not be any preconceived notions indicating otherwise. We need to love ourselves and our bodies and appreciate all of our good attributes instead of comparing ourselves to an impossible ideal.

Along these lines, we need to educate children in order to help them accept and enjoy their bodies. We should encourage healthy, balanced eating while encouraging physical activity. Convey the message that weight and appearance are not the most critical aspects of their identity and self-worth.  Be sure to always promote and celebrate body positivity while encouraging an open & safe place for dialogue. Many warning signs for eating disorders can appear before puberty. Watch out for things such as refusing typical family meals (or skipping meals entirely), or commenting negatively about themselves or others, such as “I’m too fat; she’s too fat.” Also, pay attention if clothes shopping that becomes stressful, if they withdraw from friends, or they show signs of irritability, depression, and any signs of extreme dieting, bingeing or purging.

Remember, a person can suffer with eating disorder tendencies regardless of their size, shape, or weight. If you have found yourself struggling with abnormal eating patterns or unusual thoughts when it comes to your body and food, be sure to talk with someone you trust. If you think someone you know is struggling with any type of disordered eating, express your concern in a caring manner. Be firm but compassionate and definitely encourage the person to seek professional help. After all, life is too short to spend another day at war with yourself.

 

 

References:

National Eating Disorders Association. N.p., n.d. Web. 15 Feb. 2017. <http://www.nationaleatingdisorders.org/>.

 

The War on Women’s Bodies | National Eating Disorders Association. N.p., n.d. Web. 20 Feb. 2017. <https://www.nationaleatingdisorders.org/war-womens-bodies>.

Sweaty Person

Don’t Sweat It!

People exercise for many reasons. Whether it is heart health, weight loss, balance, or stress relief, there is a common misconception that you have to sweat in order to have a productive workout and to see results.  In fact, many people feel that it is a waste of time to exercise if they don’t break a sweat! However, you can still get a great workout and see changes in your body without drenching your clothing.

The human body sweats to regulate body temperature and to cool the body down. During exercise our heart rate and blood pressure increase, which can also cause the body to sweat. In general, men sweat more than women. Some research shows that the more fit you are, the more you sweat. Additionally stress, hormones, genetics, and environmental temperature are factors that affect the rate of perspiration.

Sweating is not directly correlated to the amount of calories burned, and it does not determine whether or not you achieved your workout goals. A good workout should be defined by the duration, intensity, and load of the workout – for both aerobic and resistance exercise.  You can improve muscle tone and strength, improve balance and posture, fix motor problems, increase core strength, and improve endurance without breaking a sweat! For example, pilates, yoga, and strength training with weights are all great for improving muscle tone and endurance. However, most of the time, sweating is kept to a minimum during these activities.

Breaking a sweat occurs more often during a cardio-intensive workout, such as running or spinning.  Aerobic workouts are great for your heart health and they do burn calories as well as help with fitness and weight loss. However, these workouts do not build a substantial amount of muscle and therefore do not increase metabolic rate. A combination of aerobic and resistance training is the best way to reach optimal fitness and weight loss goals.

It is important to understand that you do not have to kill yourself for hours each day sweating profusely to look and feel great. It is great to work up a sweat during a workout, but you do not have to sweat profusely every single session! It is much more important to make sure you are activating the proper muscle groups and using correct form in order to prevent injury and to move efficiently. This will enable your muscle groups to work properly and therefore will help you strengthen them appropriately. This, in turn, will give you the body you want and help you to reach all of your fitness goals.

Arena Heart Healthy Tips (1)

Heart Healthy Habits

February is American Heart Month, which focuses on the prevention of cardiovascular (or heart) disease. Cardiovascular is a term which relates to the heart, as well as the arteries and veins that supply our organs with blood. According to the American Heart Association, heart disease is the leading cause of death for men and women, accounting for 1 in 4 deaths in the United States.  Many Americans have at least one risk factor for heart disease such as high blood pressure, obesity, physical inactivity, or an unhealthy diet. Your risk also increases with age; however, regardless of age, it is NEVER too early to start practicing heart-healthy habits. Here are a few steps you can begin implementing at any age:

  • Check your family history. Ask family members if they have had heart disease or any risk factors for it. If the answer is yes, you have an increased chance for developing the disease will go up so it’s definitely important to learn the information sooner rather than later.
  • Smoking will double your risk for heart disease and stroke. Avoid all smoke, including second hand. Plus smoking combined with certain oral contraceptives can cause an increase in your blood pressure, so women should be sure to choose their birth control carefully.
  • Know your numbers, such as your cholesterol and blood pressure, which will impact your heart health. Visit your doctor regularly to monitor both of these. As we age, it becomes increasingly more critical to monitor changes in our body so make sure to get those regular checkups and screenings.
  • Excess weight increases the heart’s work. It also raises blood pressure, blood cholesterol, and triglyceride levels while lowering HDL (good) cholesterol levels. It can also make diabetes more likely to develop. By losing as little as 10 pounds, you can lower your risk for heart disease.
  • Follow a healthy, balanced diet & exercise regularly. As we age, our dietary needs, as well as physical limits, may change. However, regardless of your age, making smart food choices and keeping yourself active will insure a longer lifespan. A good rule of thumb is to follow these guidelines:
    • Eat more fruits & vegetables, whole grains, low-fat dairy, poultry/fish, and nuts.
    • Avoid red meat, as well as sugary and processed foods, and foods high in sodium.
    • For overall cardiovascular health, the AHA suggests 30 minutes of aerobic activity, 5 days per week along with muscle-strengthening activity at least 2 days per week.
  • Regular physical activity can relieve tension, anxiety, depression & anger. Exercise increases the flow of oxygen, which directly affects the brain. Long term stress will cause an increase in heart rate and blood pressure, which can lead to damage of the artery walls. Find ways to reduce and/or manage your stress at home and at work. Practice stress management and relaxation techniques. A stressful situation will almost always cause your quality of sleep to decline, which can also impact your heart health.
  • Part of living a heart-healthy lifestyle is also dependent on getting enough sleep. People who don’t sleep enough are at a higher risk for cardiovascular disease—regardless of age, weight, smoking and exercise habits.Studies show that adults who sleep fewer than six hours per night are about twice as likely to have a stroke or heart attack as people who slept six to eight hours per night. Good-quality sleep decreases the work of your heart, as blood pressure and heart rate go down at night. Lack of sleep can also increase insulin resistance, a risk factor for the development of type 2 diabetes and heart disease.

Making small adjustments to your daily routine will dramatically improve your overall quality of life. Remember – it’s never too early!! Take action today so you can look forward to a healthier tomorrow!

by Gina Stallone

Bachelor-Looking-final

Late Night Binge: Habit or Hunger?

Late night snacking is one of the number one problems with America’s eating habits today. Cookies and milk after dinner, bowl of popcorn while watching your Wednesday night sitcoms, a handful of M&M’s from the dining room candy bowl. It all adds up, and increases blood sugar before bedtime, which in turn will cause you to store body fat as your sleep.

Now are you eating due to hunger or habit? Majority of poor eating requires behavior modification, not just a “diet plan”. So let’s talk about a few things that can be done in order to prevent that late night binge.

Step outside for some air

When you head to the kitchen for that late night snack, step outside for some air, take the dog for a walk around the block one or two times before you choose something to eat. A combination of the fresh air, time to think, and endorphin production might change your mind about that sleeve of Oreos.

Change the type of snack

It’s not necessarily the time that you are eating the food, but how the food is broken down in the body and how your body reacts. Carbohydrates break down as sugar in the body. Insulin kicks in to bring the blood sugar down. Insulin will remain high as you sleep due to your sugary treat, and insulin tells the body to store body fat. If you spike your insulin before bed, you will essentially be storing fat while you sleep. So choose a snack that is low in sugar, contains a sufficient amount of protein (>10g), and has a good source of fats. The fat and protein sources will satiate you without increasing insulin production. Walnuts are a great choice!

Eliminate mindless eating

Walnuts would be a great evening snack to munch on to cure that late night craving, but did you know a serving size is only a quarter of a cup? A person could easily eat over a full cup of walnuts if they are paying attention to the television rather than how big their handfuls are, and a cup of walnuts has over 800 calories in it. This could be half the necessary calories in someone’s daily diet! Don’t keep snack containers and bags next to the couch in order to prevent overeating mindlessly. Make sure to measure out a serving size of your snack in the kitchen and only make one trip.

Make sure not to skip meals during the day

Whether you feel hunger or not throughout the work day, your body requires fuel in order to function properly. If the body is not supplied with enough energy to work efficiently, you will in turn crave high caloric foods later in the evening, your body’s feedback mechanism to make up for what it lost. Set alarms on your phone to remind yourself to eat so you can prevent the late night binge. Don’t let the day get away from you!

Avoid sugary foods

Did you know sugar is highly addictive? The same sensors in the brain are signaled when eating your chocolate ice cream that would be affected if you were to inject illicit drugs into your system. Once the brain is signaled, the body will crave more, and even withdraw from the sugar when you look to eliminate it. Remind yourself of this before choosing a sugary treat!

Healthy weight loss or maintenance is not putting yourself on a diet. It’s behavior modification and making healthy lifestyle habits for a long and healthy future!

By:

 From Maze Men’s Health

Kristie brings her expertise as an Exercise Physiologist to Maze, focusing on helping patients improve health behaviors in order to assist in the therapy of male sexual dysfunction and improvement of endothelial function. She takes both a lifestyle and behavioral approach to creating wellness goals for patients in order to benefit their treatment outcome.

Winterize your body

Winterize Your Body

Rick Weinstein, MD, MBA

Cold weather and icy conditions are not only a risk factor for your car in the winter but also for your body. Just as you need to warm up your car before you drive in the winter you need to do the same for yourself if you will be pursuing outdoor activities in the colder months. Before you exercise you need to increase circulation to your muscles and get your heart pumping. I advise my patients to do a light jog or jump on an exercise bike for 5 minutes indoors before going outside to exercise. Once you are warmed up, a good stretch will help prevent injuries. For skiers and snowboarders it is very important to stretch calf muscles, hamstrings and quads.

To stretch calf muscles, do the runner’s stretch. Bring one leg 2 feet behind the other and keeping your back knee straight, lean against a wall. To stretch your hamstrings, sit on the floor in a V and reach for your toes one leg at a time. And finally stretch your quads, lie on your stomach and bring your foot your butt pulling using the arm on the same side. Do each stretch for each leg for 20 seconds and repeat 3 times. If something else feels tight when warming up, stretch that out as well.

In the winter, you may put snow tires on your car for optimal driving. This is also a good idea for yourself. You should wear the appropriate clothing for the winter. Typically you will start out your winter work out feeling very cold, but over time you will start to sweat and even fell warm. Being able to loosen clothing such as unzipping a jacket or opening vents will help you from getting too hot. Layers are important and being able to loosen or remove these layers is key. You lose a lot of body heat through your head (especially children), so I recommend starting with a hat but overtime you may want to remove this. Of course if you ski, always wear your helmet.

Even though you are feeling cool during the winter work outs, hydration can still be an issue. Try to drink enough water before you work out and keep drinking while you are exercising. If you will be exercising for less than an hour, you only need to drink water. If you are going for more than an hour, you will need to replace the electrolytes you are sweating out. Drinks such as Gatorade can replace the lost electrolytes as well as lost water.

If something is hurting, don’t make the mistake of pushing through it. If it continues to hurt or you have a real injury, call your local orthopedic sports medicine specialist’s office number. Keep that doctor’s number on your cell and don’t hesitate to call and get checked. My office is very busy Monday mornings from the weekend injuries, but I always get my patients in to see me the same day for urgent injuries. Try and prevent injuries before they happen, but if you need to be seen see a local specialist ASAP.