Category: Diane Mueller ND RN FNP-BC

The leaves are falling, there is a brisk feel to the air, and the clocks are falling back to daylight savings time. These are sure signs of fall and the winter months to follow. Most people dread the short cold winter days and long nights. However, this is the time of year that it is imperative that you stay healthy. Unlike the bears who hibernate during winter, humans need to step up thoughts of good nutrition and exercise. The most common geographic areas that SAD is prevalent are the upper north where there are limited hours of sunshine.

Seasonal Affective Disorder  (SAD) affects up to 9% of the US population. This is a disorder that is commonly triggered by falling temperatures and lack of sunshine during the winter months. Most persons who are affected by SAD have no symptoms during the spring or summer months when there is more daylight and outdoor activities are abundant.

Some of the symptoms of SAD include depression, excessive sleeping, lack of energy, weight gain, fatigue and difficulty concentrating. The symptoms can come and go, but are more noticeable during times when the daylight is shortest (typically December and January).  Some persons who suffer from SAD may require counseling or hospitalization if the symptoms become severe.

There are several treatments for SAD- but if the symptoms become severe, or thoughts of suicide arise, the person should seek medical attention immediately.

Some suggestions for preventing and helping persons experiencing SAD:

  • Outdoor activity — get outside and participate in physical activity. Go for a walk at lunchtime when the sun is typically the brightest. Participate in outdoor winter sports, such as snowshoeing, skiing, ice skating or sledding. Raking leaves in the sunshine is a great activity, and will also help to keep the weight off. Any physical activity that is in the sunshine will help.
  • If you cannot get out in the sunshine, some people benefit from full spectrum light therapy. This is a special light that can be found in many stores and set up in the home or office. Although full spectrum light does not take the place of sunshine, it is much more effective that a typical light bulb.
  • Good nutrition- Weight gain is very common during the winter months. This is a time that focus on healthy nutrition is essential. Try to avoid processed foods (chips, snacks) and foods containing gluten (breads, cookies, cake, etc).  Focus on lean meats (chicken, fish, pork, beef, etc), vegetables, fruits, and nuts (unless allergic). Fill the plate with steamed vegetables and lean protein.  Avoid high fat, high calorie deserts (such as pie, cake and cookies) and treat yourself to fresh fruit instead. A small serving of high quality dark chocolate has antioxidants that can actually help mood.
  • If the symptoms of SAD become out of control, the advice of a health care professional is necessary. Don’t be afraid to talk with your health care provider about your symptoms- we are here to help!

With Thanksgiving fast approaching, many people are looking forward to a big turkey dinner with all of the ‘fixins’. But, how healthy is that dinner? And what are some healthier alternatives?

  • TURKEY- is a great source of high protein (along with fish and eggs) that is low in calories. Roast turkey is also low in cholesterol thereby making it a great choice for heart-healthy diet. Turkey is low in carbohydrate, thus improving the stability of insulin production after a meal. Roasting the turkey is much healthier that frying—which increases the cholesterol content significantly. Choosing white meat (such as the turkey breast) is healthier than red portions (such as thigh or wing).  Some people are concerned about the amount of tryptophan found in turkey. Tryptophan is an amino acid that is similar to Melatonin, and often helps people sleep.  Research has shown that the amount of tryptophan in turkey is actually no greater than that found in foods such as chicken, tuna or other meats. People who blame sleepiness after a large turkey dinner should consider that other foods that accompany turkey might be the culprit.
  • Dressing or stuffing—this is probably one of the highest calorie and fat options on the table. One single serving (one cup) of regular bread dressing has over 350 calories, 17 grams of fat and almost no protein—and that is just 1 cup!! In addition, stuffing is loaded with gluten, which has been shown to cause inflammation in the system. As an alternative, try fruit and nut “stuffing” – its both delicious and looks beautiful. Another option would be cauliflower rice or mashed cauliflower- the recipe can be found at
  • Bread or biscuits—another high calorie, gluten rich side dish that can be avoided. Instead of bread or biscuits, how about substituting a rice cake? If you just have to have bread, reach for the gluten-free type.  Or you can just eliminate this side altogether and add another vegetable.
  • Cranberries—oh yes, that yummy side dish that may not be as bad as you thought! If you serve cranberries from a can, keep in mind that it is loaded with sugar and calories. Think about substituting fresh or dried instead of canned. Fresh cranberries are a wonderful addition to almost any table, and are one of the highest berries in antioxidants. Research has shown that fresh cranberries help reduce the incidence of urinary tract infections, help people with gum disease and help to reduce stomach ulcer formation. Fresh cranberries also contain Flavinoids which can help prevent heart disease. With zero fat and only 51 calories per cup, cranberries are a great choice!
  • Vegetables—almost any vegetable is suitable with turkey. Try steamed carrots, green beans or peas instead of canned. 2/3 of the dinner plate should be filled with vegetables. Also try fresh veggies as a side- such as celery hearts filled with hummus.
  • Desert—ok, everyone loves desert after a great meal… but think about some healthy choices. A small slice of pumpkin pie has over 300 calories and over 15 grams of fat—and that does not include the whipped topping!!  Instead, choose fresh sliced apples, sliced kiwi or a fruit salad. For a real treat, try high quality dark chocolate- which has antioxidants galore!
  • And after that big meal… go outside for a walk! Play ball with the kids or walk the dog. About 30 minutes of exercise will help digestion and ward off the feeling of bloating and tiredness.

 Start a few new traditions

  • Instead of cooking a big meal, volunteer you and your family to serve at the local soup kitchen
  • Take a meal to a shut-in or elderly person who lives alone
  • Offer to drive your elderly neighbor to church or a family gathering
  • Volunteer at your local nursing home to visit with the residents
  • Join a group of carolers at the local children’s hospital or nursing home
  • Volunteer at the local food bank
  • Take the money you would spend on a big meal and purchase a few coats/hats/gloves for the needy
  • Adopt a family – there are many families who do not have any food to eat

 “For each new morning with its light,
For rest and shelter of the night,
For health and food,
For love and friends,
For everything Thy goodness sends”

Ralph Waldo Emerson (1803-1882).


After a thorough evaluation, and diagnostic tests as indicated, treatments should begin with the least invasive (conservative) and progress to more invasive, depending on the individual.

  • The first line of treatment may be an exercise program focused on muscle strengthening and range of motion. This is generally directed by a physical therapist.  Some people may benefit from cervical traction (device that uses a small halter attached to a weight) under the guidance of a physical therapist.
  • Work and activity modifications may be helpful, especially for those who have jobs that involve heavy labor.  Bedrest is not generally recommended, and may make the pain worse. Adjusting chair/desk height, computer station adjustments, or other ergonomic considerations may also help with the pain for those who work primarily at desk type jobs.
  • Alternating ice and heat to the neck can be helpful if the pain is triggered by certain activities. Caution should be used when using an electric heating pad or microwave heat wraps, as these can result in significant skin burns. A good rule of thumb is to set a timer to 15 minutes, and alternate ice, then heat.
  • Medications such as NSAIDs (ibuprofen, Aleve, naproxen), and muscle relaxers can be very beneficial. Chronic use of narcotics is generally not indicated, as this can lead to dependency. Some people can benefit from other types of medications prescribed by a provider.
  • Injections of steroids (Epidural steroid injection) or local anesthetic blocks can often help with nerve type pain that originates from pressure on the nerves in the neck. Although the injection does not cure the disc degeneration, or slow the arthritis process, injections can help by providing temporary pain relief. In some cases the effects of the injection can last for many months.
  • Occipital nerve blocks: If the pain is from pressure on the occipital nerve, a specific block in the nerve can result in considerable relief. Sometimes, a nerve block is used as both a therapeutic (help the pain), as well as a diagnostic test (if the pain is helped by the block, there may be a better understanding that this is the source of the pain). If the patient has very good relief of the pain from a block, a nerve root ablation (“burning” the nerve) may be a more permanent solution.
  • Surgery- when other less invasive treatments have failed, some people may need cervical surgery. The type of surgery is based on the neurologic examination and the findings on the imaging studies.

If you think you have CERVICOGENIC HEADACHE, one of the providers at the

Neurosurgery Center of Colorado may be able to help- call today for an appointment.

There are many risk factors for developing Cervicogenic Headache. Many are factors that you can control, such as smoking, poor posture, exercise and rest.

Some tips for healthy neck habits:

  • Smoking and the use of tobacco products can significantly accelerate the rate of drying out of the discs. If you smoke, either quit or begin a smoking cessation program as soon as possible.
  • Get plenty of rest at night, as a good night’s sleep can help with muscle tension in the neck. Place a pillow under the head when lying flat.
  • Some people benefit from a special pillow (cervical pillow) that is curved on the edges to give the neck additional support
  • If you notice that you have neck pain when looking down (at the computer/paperwork/books) for long periods, explore a different height of the computer or chair that you use. Raise the height of your work such that you are looking straight ahead.
  • Maintain good posture while sitting or walking
  • Do not “pop” your neck or allow anyone else to
  • Move frequently- if you have a job that requires long periods of time in one position, stand up and do stretches, or relax the shoulders and gently rotate your head back and forth.
  • Exercise daily- walking is a good way to stretch the muscles,  maintain healthy weight and reduce stress
  • If you note pain that progressively gets worse, or if there is pain/numbness/tingling that radiates down the arm, or if you notice weakness in the hands or arms, consult your primary care provider.

Check back next week for common treatment options for Cervicogenic Headache!

The causes of cervicogenic headache are varied and typically depend on the problem in the structure of the neck. Various causes are described below:

  • Degenerative changes: The most common cause of cervicogenic headache is degenerative change (arthritis) in the neck (cervical spine). These are natural aging changes that cause bony spur formation, pressure on the nerves, and laxity/hardening of the ligaments.
  • Kyhposis (reversal of cervical curvature): The neck normally has a gentle C-shaped curve (lordosis) that allows the neck to curve slightly backwards. This normal position keeps the head in balance and reduces neck strain. As our discs dry out, they lose some of their height , resulting in straightening of the neck neck.  In some cases, the neck angles forward instead of backward. This causes greater strain on the muscles at the back of the neck, and results in occipital headache.
  • Whiplash: This is an injury that occurs from the head being “whipped” back/forth quickly. The mechanism of injury is from the head moving in a flexion/extension motion. The most common type of Whiplash injury is due to motor vehicle crash or contact sports injury (such as football or soccer). Headaches following whiplash are very common and have been reported in 80% of persons at 2 months following whiplash injury. Even 2 years after a whiplash injury, 20-25% of persons will still have headaches
  • Nerve compression: A common cause of nerve compression is degenerative disc disease, or arthritis in the neck. As the spine ages, and the discs lose their height, the small joints on the sides become more narrow. The nerves then have less room to travel through the joint, resulting in pressure on specific nerves. Another cause can be from a herniated disc in the neck that causes pressure on a specific nerve. Less commonly, nerve compression may be due to other causes such as tumors or abnormal fluid cavities in the spinal cord.

Tune in next week  to read about the risk factors for causing CERVICOGENIC HEADACHE.

Cervicogenic headache is a common type of head pain that occurs in approximately 2.5% of the U.S. population. Occipital (back of the head) headaches generally occur from problems in the neck, especially the upper part of the neck. The pain originates in the neck, but it can radiate up to the head and cause head pain- called cervicogenic headache.

The headache usually radiates from the neck to the occipital area (back of the head), to the temples, or around the eyes. It can be on one side of the head (unilateral) or both sides (bilateral). The pain is often described as dull, aching, and is aggravated with head/neck movement. Poor posture, looking up, or looking down for long periods of time can trigger or worsen the head pain. Some people who have desk jobs or look up or down for long periods of time can have cervicogenic headache. Generalized muscle tension can also result in headaches that radiate from the neck up to the head.

The pain of cervicogenic headache can be due to problems in the neck, such as cervical discs disease, facet joint degeneration (arthritis), ligaments that become less stretchy, or from muscle spasm. The pain can come from any area of the neck, but commonly originates from the upper (C2-3, C3-4) joints or discs.  Pain can also occur from unstable areas in the upper two joints (atlanto-occipital and atlanto-axial joints), and is called “atlanto-axial instability”.

For causes of cervicogenic headache, please check back next week for part II.

Watermelon is a fruit that originated in South Africa. Originally, watermelon was a wild type of fruit plant, but the species has been cultivated and spread throughout the world. There are about 1200 species of watermelon grown today. The largest producer of watermelon is China. Watermelon contains about 92% water (hence the name) and very low fat. There is a large sugar component (about 6.2 grams per slice), so people who are diabetic or glucose intolerant need to be careful eating large quantities. Watermelon is a good source of Vitamin C and Lycopene. For those people trying to lose weight, watermelon should be on the menu as it contains fiber and a natural diuretic. Try substituting a cold slice of watermelon for desert or a snack.

Heat Stroke

HEAT STROKE– is generally defined as the inability of the body to cool down after physical activity. Persons most at risk for heat stroke include the very young child, elderly, persons who work outdoors in the heat, and persons who exercise in the heat of the day. Obesity can increase the risk of heat stroke. Persons who take certain medications, such as diuretics, blood pressure pills and diet pills are also at higher risk.        

The symptoms of heat stroke include: chills, weakness, dizziness, extreme muscle fatigue, nausea, shortness of breath, rapid heart rate, confusion and absence of sweating. If you feel these symptoms, stop activity immediately, drink water, rest in a cool place, and seek medical attention immediately if the symptoms persist. If left untreated, heat stroke can lead to damage to the kidneys, and other organs. True heat stroke is a medical emergency and treatment (call 911) should be sought immediately.        

 Take these precautions to help prevent heat stroke:

  • Drink at least 8-12 ounces of water- both before and after exercise. Take a full water bottle with you when you exercise, so it is readily available.
  • Drink electrolyte solution before and after extreme/strenuous exercise
  • Avoid drinking caffeine or alcohol
  • Wear light colored, loose clothing. Wear clothing appropriate to the temperature
  • Wear clothing with SPF >20
  • Stay out of direct sunlight if possible. If you feel yourself becoming too hot, rest in the shade and drink water
  • If possible, exercise early in the morning or late in the evening- avoid the heat of the afternoon.
  • Humidity decreases the ability of the body to cool down- exercise indoors during high humid times.
  • Do not participate in sports or exercise if you have a fever or upper respiratory infection
  • Remove helmet/padding and any excess clothing immediately if symptoms of heat exhaustion are noted
  • NEVER leave a child or pet in a hot car for any length of time– this can be life-threatening





The temperature in Denver broke several records in June this year.  This is a sure sign that summer has arrived. If you are among the millions of persons who spend time outdoors during the summer, you need to be aware of the dangers of excessive heat exposure. Persons who work out in the sun every day (such as roofers, construction workers, road repair and lawn maintenance) are at higher risk for heat related health problems.

Heat Exhaustion is an illness that is directly related to exposure to high temperatures for an extended period of time. Persons at higher risk for heat exhaustion are those who exercise in the sun or during the highest temperatures of the day, and those who work outdoors in the heat daily. The main reason people experience heat exhaustion is due to dehydration (not enough fluid).

The common symptoms of heat exhaustion include muscle cramps, dizziness, headache, light-headedness, nausea, sweating and fast heart beat.

Ways to avoid heat exhaustion include:

  • Drink plenty of water- try to drink at least 8 ounces every 30 minutes
  • Avoid alcohol or caffeinated beverages
  • Wear sunscreen with a minimum SPF 30- reapply frequently
  • Wear a wide brim hat
  • Rest under shade or in a cool place every few hours
  • Wear clothing with SPF rating >20
  • Wear light color, loose fitting clothing
  • Avoid strenuous outdoor activities during the peak heat hours of the day

If you feel you have the symptoms of heat exhaustion, you need to take the following measures immediately

  • Move out of the heat to a cool area- in a shady spot or indoors with a fan or air conditioner
  • Drink plenty of water- do not drink beverages with caffeine or alcohol
  • Remove clothing that is damp
  • Take a cool shower
  • Wrap a cool towel around your neck

If the symptoms do not improve within 30 minutes of taking the above cooling measures, seek medical attention. Heat Exhaustion that is untreated can lead to Heat Stroke— check for future blogs on heat stroke

Gluten is a protein compound that is found in most grains, including wheat, barley, and rye. Some form of gluten is also found in other foods such as white rice, oats and corn. Gluten is the substance that can be mixed with flour that helps give the texture and consistency of breads, crackers and some pasta. There can be small amounts of gluten in many other processed foods such as cereal, sauces, salad dressings, candy, processed meats, and condiments. Beer and many other alcoholic beverages also contain gluten. The best way of knowing if the food you eat contains gluten is to read the label carefully.

How do you know if you are gluten sensitive? One way of helping to determine if you are sensitive to gluten is to try a strict gluten-free diet for at least 3 months. As more people are becoming aware of gluten sensitivity, there are a wider variety of gluten-free products available. However, read all of the labels carefully, as some products may say “gluten free”, but can still contain a small amount. Be aware that many sauces, canned products and condiments contain small amounts of gluten. One easy way of avoiding gluten completely is to limit any processed food and stick with lean meat, fish, fruits, vegetables, nuts and berries (read more about the Paleo diet). While you avoid gluten, keep a food diary that includes your symptoms (or lack of symptoms). After 3 months, review the diary with your health care provider and discuss if your symptoms have improved.

SYMPTOMS of gluten intolerance include (but are not limited to):

  • Abdominal bloating/cramps/ pain
  • Diarrhea and/or constipation, nausea and vomiting
  • Fatigue
  • Weight  gain
  • Hair loss
  • Skin rash- called Dermatitis Herpetiformis- itching, blisters, redness
  • Depression and mood problems
  • Headaches
  • Joint pain/generalized muscle pain

What foods contain gluten?—most processed foods contain gluten unless stated otherwise on the label

  • Breads/cereals/pasta/tortillas
  • Candy
  • Ice cream
  • White rice
  • Pretzels, chips, pizza
  • many sauces, gravy, soy sauce and salad dressings
  • Beer and several alcoholic beverages
  • Cakes/cookies/pancakes
  • Processed meats (sausage, hot dogs, lunch meat, etc) and some cheese
  • Flavored milks (such as chocolate milk), and some soda such as root beer
  • Some additives in vitamins and supplements


The easiest way to avoid gluten is to avoid processed foods and stick to

lean meat, chicken, fish, fruits, vegetables, nuts and berries!