• Maintain a healthy lifestyle through diet, exercise and keeping up with doctor appointments. Brim says this reduces your risk of a stroke, which can lead to a voice disorder. It can also prevent everyday illness and coughing.
  
  “If someone has had the flu or COVID and they’ve had a consistent cough, it can cause trauma to the vocal cords,” Brim explains. “The vocal cords are closing so rapidly with each cough.”
  
  Using a humidifier and taking lozenges without menthol can help with that pesky cough, Brim adds.
   
• Aim for 40 to 60 ounces of water per day.
  
  “That’s very helpful in maintaining a healthy environment for your vocal cords. It makes sure they’re not getting too strained,” Brim says.
   
• Watch your caffeine. High amounts can strain your vocal cords, Brim says.
  
  “Do you really need that second latte at noon?” she asks with a smirk.
   
• Don’t yell all the time. Obvious, right? But it’s tricky if you use your voice for a living.

“Maybe you have a job like an auctioneer or a teacher trying to yell over a group of students. You have to make your voice louder [for your job],” Brim says.

“Try to focus on more projection. And take vocal rests,” she adds. “Take 10 minutes to let your vocal cords reset. Drink water. Try to decrease the trauma to the vocal cords as much as possible.”

Learn more

Read about all the ways medical professionals help restore voices on the OSF HealthCare website.

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“Mom! I have to go!”

“Hold it!”

It's an exchange you probably had as a kid on long car rides. But Uwais Zaid, MD, says it’s not just a funny vacation story. A person of any age or profession can find themselves holding their urine for a long time.

“In the medical field, we see this all the time,” says Dr. Zaid, a urologist who sees patients at OSF HealthCare. “When you’re rushing from patient to patient, doctors, nurses and technicians might not go to the bathroom as much as they should. They hold their urine the whole day.”

Dr. Zaid is sharing his playbook: why this phenomenon happens, how to fix it and what can happen if you don’t.

Why do we hold our pee?

Dr. Zaid says some people hold their urine simply based on the situation. They’re on a long car ride, and stopping will make them late. Or they might be at a dinner party and don’t want to seem rude by leaving the table.

“Then there’s another subset of people who just don’t have the desire to urinate. There’s something medically wrong,” Dr. Zaid explains. “As we get older, we can get dementia and be forgetful. So sometimes people just forget they need to urinate. Sometimes, you can have lack of bladder sensation from neurological conditions like multiple sclerosis. Or they might have had their bladder stretched for so long due to things like an enlarged prostate or scar tissue in the urethra.”

The consequences

In the short term, holding your pee will make you feel uncomfortable and antsy. We all know the feeling. Dr. Zaid has even heard from patients, “The feeling doesn’t bother me that much. What’s the problem?”

A few problems, the doctor says.

“It does increase your risk of urinary tract infections [UTIs]. Your bladder is almost like a swamp instead of flowing like a river. You have stagnation of urine,” Dr. Zaid says. “It can increase the risk of bladder stones. Also, the bladder is connected to the kidneys. It’s one fluid column. So if your bladder gets really distended, it can back up and hurt your kidneys. You can get kidney swelling.

“And when the bladder is chronically distended, you can get pouches called bladder diverticuli. Those pockets can hold on to urine and be sources for infection,” Dr. Zaid adds. Over time, these pouches can also lead to worse urinary control and even the inability to pass urine.

If holding your urine and not getting treatment for it lead to, for example, the kidney issues Dr. Zaid outlined, serious health problems and, rarely, even death are possible. Dr. Zaid says that shouldn’t scare people into drastically altering their bathroom habits. But it is something to be aware of.

Prevention and treatment

So what should be the best practices when we start thinking about the toilet?

• Before you even head for the bathroom, Dr. Zaid urges you to take care of your bladder and kidneys by staying hydrated. The U.S. Centers for Disease Control and Prevention (CDC) says daily water intake recommendations vary by person. So it’s a conversation you should have with your primary care provider. But, the CDC has general tips about staying hydrated and the dangers of drinking sugary or caffeinated drinks often.
   
• Plan ahead. For example, if you have a long commute, leave early to make time for rest stop breaks, and avoid drinks like soda. If you have a busy day at work, make a promise to yourself that you’ll take breaks to use the restroom. You can set a reminder alarm on your phone to nudge you.
   
• Try the “double void.”
  
  “You get to the toilet. You get done peeing. Wait 30 seconds, and then try to get a little more out,” Dr. Zaid suggests. “But don’t bear down and push because that creates trauma for your pelvic floor.”
   
• For older adults who might simply forget to use the bathroom, make sure they have someone checking in on them. Make sure they are empowered to speak up about their health. Setting an alarm reminder and having a clear path to the toilet can also help.

If someone consistently avoids or forgets to urinate or experiences symptoms like frequent UTIs, discomfort or difficulty emptying the bladder, it’s time to see a doctor.

Dr. Zaid says the first thing a urologist would do is look for anything blocking the urine. For men, this could be an enlarged prostate, scar tissue in the urethra, a bladder stone or tumor or trauma to the bladder area. For women, it could be a prolapse, when the bladder falls through the vagina.

“We can look inside the bladder with a camera. We can do a urodynamic study, which tells us about bladder function,” Dr. Zaid says.

Doctors would then form a treatment plan depending on what’s found. For example, bladder stones could be a “wait and see” situation. Or, a doctor could perform a procedure to remove the stones or break them apart and allow them to pass. Dr. Zaid says this is sometimes done with a laser in a minimally invasive procedure.

Dr. Zaid says in some more serious cases, the bladder stops working entirely.

“It’s something we can’t often fix. It’s really frustrating,” Dr. Zaid says.

Those people, he says, would need a catheter. It could be a short-term one to help drain the bladder or a long-term one to help correct the problem for a while.

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• Dysarthria (pronounced diss-ARR-three-ah): Brim says this common voice disorder could be brought on by a neurological issue, such as the effects of a stroke, Parkinson’s disease or a traumatic brain injury. Muscle issues and medication side effects can also play a role. It all leads to the most common symptom: slurred speech. Brim says to picture trying to talk with a mouth full of marbles. The person’s speech could also be a different volume (too quiet or too loud) and speed (too slow or too fast).
  
  “There’s a restorative approach where we do different types of [vocal] exercises. Try to get that voice to where it sounds better and clearer,” Brim explains. “Then there’s a compensatory approach. For a person with Parkinson’s or amyotrophic lateral sclerosis [ALS] where their voice probably isn’t going to improve in the long run, we might look at an alternative communication device. Or, do we need environmental assistance to help them communicate?”
  
  A communication device could include a voice box to amplify speech or, if someone has lost their voice entirely, a speech generating tablet.
  
  “The [speech generating device] has a bunch of communication presets on it,” such as common phrases conveying hunger or pain, Brim says. “They can have it pre-programmed with their actual voice before they lose it.”

• Dysphonia (pronounced diss-PHONE-ee-ah): This is a general term to describe a voice abnormality, Brim says. Neurological issues and brain injuries are common causes.
  
  “The most common dysphonia people know is spasmodic dysphonia. We really don’t know a specific cause. We assume it’s neurological,” Brim says. “This brings voice tremors. The vocal cords are not abducting or adducting correctly.

“When they’re adducting, the vocal cords are coming together. If you have an adductor-type spasmodic dysphonia, the vocal cords aren’t wanting to go away from each other. They’re wanting to stay together. So there’s a really strained voice. It sounds very harsh, almost like people are trying to force the voice out,” Brim outlines.

“Or you have abductor dysphonia, where the vocal cords are pulling away. The person has a breathy voice because the vocal cords are open all the time. Speech comes out very quiet and whispery. They’re losing all their air in one go,” Brim adds.

Treatment could include voice exercises or Botox injections. Or, if the person has a nodule or polyp on the vocal cords, those can be removed surgically.

“We go over healthy voice habits, such as increasing water intake,” Brim says, describing how she might work with someone after surgery. “Have a humidifier in the house to help increase moisture in the air. Use more of a quiet voice. Try not to yell or project too loudly because that can strain the vocal cords. Try to make your voice sound different but not in a way that causes harm.”

Something else Brim will preach to patients that you might not connect with voice issues: reduce your caffeine intake. Caffeine can increase muscle tension in your vocal cords, she says.

• Vocal cord paralysis: Brim says this is commonly caused by trauma to the throat, such as a car accident or having a breathing tube.
  
  “It’s similar to a bruise or fracture or torn ligament. When there’s trauma to the vocal cord area, there’s damage. And that causes paralysis sometimes,” Brim says. “You can have, most commonly, unilateral vocal cord paralysis, where one doesn’t move. Or you can have bilateral [paralysis] where both aren’t moving.”
  
  Brim says this is often treated with Botox or surgery to get the vocal cords vibrating again. The person would follow up with speech therapy.

There is hope

Brim is up front with her patients: You might not get your voice back to where it was, but you can make improvements. So don’t give up.

“I’d love to wave a magic wand and make your voice great,” Brim suggests with a smile. “But there are other steps we can take so you don’t feel locked in. You don’t feel like no one can understand you and no one can communicate with you.”

Learn more

Read about all the ways medical professionals help restore voices on the OSF HealthCare website.

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Migraines are a part of life for many. From stress to dehydration to a woman’s menstrual cycle and even more serious issues such as a stroke, the headaches can pop up often. And they’re something you should know how to manage.

Amber Oberheim, APRN, a primary care provider at OSF HealthCare, says migraines can often be treated with ibuprofen (Advil is a common brand name) or naproxen (Aleve), plus lifestyle changes including better sleep. But, an online search will also yield plenty of non-medicinal, at-home remedies. Experts will remind you that these aren’t cure-alls. But it’s important to know what works and what doesn’t.

Myth vs. fact

• A cold or warm cloth on the head and neck: Stick to cold, Oberheim says.
  
  “One of the theories for why migraines happen is vasodilation, or increased blood flow to your brain,” Oberheim explains. “So we talk about using a cold compress over your eyes, on the back of your neck or at the top of your head. That cold sensation constricts blood vessels, thereby decreasing blood flow.”
  
  Oberheim adds that there are even migraine caps that stay in the freezer until use. Those are available over the counter at retail outlets.
   
• Rest and deep breathing: Oberheim says there’s no guarantee that your migraine will be gone when you wake up from a nap. But, she says rest and deep breathing can’t hurt. Take a break in a cool, dark room, and avoid screens and loud noises.
   
• Caffeine: It’s good general advice to ingest caffeine in moderation for heart and mental health. But, Oberheim says a soda might help with that headache.
  
  “We look at medications in Excedrin Migraine [pills]. Caffeine is one of them,” Oberheim says. “Caffeine has been proven to be effective sometimes in early management of migraine headaches.”
   
• Supplements: There’s a lot to choose from in this aisle of the pharmacy. And experts warn that you should choose with provider guidance since supplements aren’t regulated like others under the eye of the United States Food and Drug Administration. However, Oberheim says some research has shown that taking vitamin B2 (also called riboflavin) and magnesium daily can help with the number of migraines.
   
• Massaging your head: It’s a tactic some of us learned when we were kids. Massaging your temples (the area between your eyes and the top of your ears) could help with head pain.
  
  “I don’t think there’s any data that would support that. I think it’s more of a comfort,” Oberheim says. “When you’re experiencing pain and you can have a sensation that’s not pain somewhere on your body, it might help lessen the pain.”
  
  For example, Oberheim says when her patients are getting a blood draw through an IV in their elbow, a provider might scratch their upper arm (between the point of pain and the brain) to “confuse” the pain signal and lessen the discomfort. The same logic applies to rubbing your head during a migraine.
   
• Taking a shower: It depends, Oberheim says.
  
  “I could see if stress or muscle tension is creating a headache. Taking a warm shower or bath to relax might help,” Oberheim says. “However, if we’re thinking about a classic migraine with the theory of increased blood flow to the brain, taking a hot bath or shower might actually make it worse.
  
  “It never hurts to try, but I think it’s going to be patient-specific,” she adds.

When in doubt

Oberheim says some people have a history of migraines and know how to manage them. But if the headaches suddenly increase in frequency or intensity, you should see a health care provider. Also, talk to a provider if you have questions about starting or changing at-home treatment. The provider can determine what works for you. You don’t want new medications to negatively interact with drugs you’re already on, for example.

“Often, a migraine can last for longer than a typical headache. It can be accompanied by symptoms like nausea, light sensitivity and noise sensitivity,” Oberheim says, warning of the dangers if migraines are not treated quickly. “There are certain types of migraines that can also affect your vision.”

Temporary decreased function of your limbs is another rare, but possible side effect, Oberheim says.

Learn more

Read more about how to spot and treat a migraine on the OSF HealthCare website.

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Author's note: This is part two of a four part story on infant nutrition misconceptions. Read part one here, part three here and part four here.



Bringing a new baby home raises the focus on their and mom’s well-being. Toward the top of the list: what and how the child is being fed.

Whether you choose to breastfeed or use formula, misconceptions about infant nutrition are everywhere. Xandra Anderson, a certified lactation consultant at OSF HealthCare, cuts through the noise.

• Do I need to change what I put in my body while breastfeeding?
  
  This covers a lot of ground, from a mom’s diet to whether she should abstain from alcohol, caffeine, tobacco and medication.

o    Diet: Healthy eating is always good. But Anderson says new moms generally don’t have to change their diet for breastfeeding. If your diet is heavy on certain things (like garlic or dairy) and you notice your baby is extra fussy, you can try changing your meals. A provider may also want to test your baby for allergies.

o    Alcohol and caffeine: Drink these in moderation and with precise timing, Anderson says.

“Babies are very sensitive to caffeine. If you have a cup of coffee and nurse right away, the baby is going to be awake for a lot longer than normal,” Anderson says.

“That doesn’t mean you have to not drink coffee. Just maybe not add three shots of espresso to your morning coffee,” she adds with a smirk.

For alcohol, Anderson says the drink will filter out of your breastmilk like it filters out of your blood. So after having a couple of alcoholic drinks, wait two to three hours before breastfeeding or pumping.

“The breastmilk isn’t ruined. You just need to give it time,” Anderson says.

But here’s a lifehack if mom feels full of breast milk and wants to pump right after having a drink: Go ahead and pump, and use the milk on your baby’s acne or in their bathwater. Just keep it away from their mouth.

“It’s antimicrobial. It’s antibacterial. It’s moisturizing,” Anderson says, singing the praises of breast milk. “Our babies are in the most perfect environment in the womb. Once they’re born, their world is cold, dark and dry. They can get dry skin, acne or cradle cap [greasy or flaky spots on the scalp]. Breast milk is a great way to prevent or heal those things.”

o    Medication and other health care issues: Anderson says most medication is safe to use while breastfeeding. In fact, it’s important to stay the course – for example, with mental health medication – so you can be the best mom possible. Talk with your health care provider if you have questions.

If you have a medical procedure, also get advice from a professional. For example, Anderson says if you get a hepatobiliary iminodiacetic acid (HIDA) scan for a gallbladder concern, you’ll be radioactive for around 24 hours. Don’t breastfeed during that time. Or if your breasts feel full and you have to pump, dump the milk down the drain.

o    Tobacco: Anderson admits it’s tough to kick the habit. But she reminds moms: infants are very sensitive to nicotine. It can disrupt the child’s sleep and feeding and even interfere with organ development. Secondhand smoke can increase the risk of a respiratory infection and sudden infant death syndrome (SIDS).

If you’re smoking with a new baby at home, do so after breastfeeding, then wait two to three hours before nursing again. Wear one jacket while smoking so you don’t get an odor or residue on a lot of your clothes or the baby.

Learn more

Read more about how to have a successful pregnancy and following years on the OSF HealthCare website.

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If you’re pregnant and looking for a New Year’s resolution, maybe take a look at the amount of caffeine you’re consuming these days.

Children who were exposed to small amounts of caffeine before birth were shorter on average than those who were not, according to a recent study published in the Journal of the American Medical Association (JAMA).

The gaps in height, while not significant, were detected at age 4 through age 8, researchers said. The findings were reported even in the children of pregnant women who consumed less than 50 mg of caffeine per day on average, which is well below the current guidelines.

According to the American Academy of Obstetricians and Gynecologists, pregnant women should consume no more than 200 mg of caffeine a day.

A mug of filtered coffee has about 140 mg. Caffeine is also found in tea, soft drinks, energy drinks, cocoa, chocolate and some medications.

“That is about 12 ounces of coffee a day. So that would be larger amounts of tea, and tea doesn't have as much caffeine," says Dr. Jamie Plett, an OB/GYN with OSF HealthCare. "There is some caffeine in chocolate but that's a negligible amount, typically. But that's way less than what’s found in energy drinks and things.”

When it comes to growth in children there are, of course, other factors at play including gender, health conditions, nutrition and environmental conditions.

“Obviously genetics is going to be the biggest one as to the height of the child," says Dr. Plett. "But also, there have been studies before that show that nutrition during pregnancy is going to change the height of the child as well.”

According to the researchers of the most recent study, there is no way to know if the difference in height would continue into adulthood. If it did, the biggest concern would be the possibility of heart disease, obesity and diabetes, which are often associated with smaller stature.

Dr. Plett makes a point of talking with her pregnant patients about caffeine intake during an initial visit and the importance of staying around the 200 mg mark daily.

“It seems like just people are more aware of what they're putting into their bodies when they're pregnant. So they think a little bit more about ‘oh, do I really need this extra cup of coffee today?’ So I don't know that there's necessarily a decrease in a craving because I think if people are used to drinking that caffeine, they like it. Also, it's harder to sleep when you're pregnant. So people sometimes want that extra caffeine because it makes a little bit easier to get through their normal day. But I think people do think about it a little bit more before they ingest anything whether that’s food or drink or whatever during pregnancy.”

Dr. Plett cautions parents not to overthink any one study, and to talk with your provider if you have questions or concerns.

“I think some of it is taking this a little with a grain of salt," says Dr. Plett. "Knowing that there is still data pending, but knowing that this is a possibility, and all findings in science have to start somewhere. So this may be something just to keep an eye on in the future. Maybe think about that cup of coffee every morning, maybe have one every other day or a couple times a week instead. But I also have found that almost naturally people decrease their caffeine intake in pregnancy. The most common cause I’ve found in headaches early in pregnancy is caffeine withdrawal; they’re so used to having that first cup of coffee and if they don’t have it anymore, it’s pretty common to have those headaches.”

As with any major lifestyle or dietary change, remember to talk with your health care provider first, as changes can affect your mood or medical conditions.

 

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It can be an embarrassing ailment, but experts say it’s time to talk about it.

Urinary incontinence is when a person leaks urine by accident.

Uwais Zaid, MD, a urologist at OSF HealthCare in Alton, Illinois, says urinary incontinence can wreak havoc on a person’s social life and intimacy with partners. In other words, you can’t go out and have a good time with friends if you don’t know when you’re going to suddenly “go.”

“It can be associated with medications. It can be associated with aging,” Dr. Zaid says. “It can be associated with certain surgeries. A lot of our cancer survivors, whether they're from prostate cancer, cervical cancer, uterine cancer…they can have effects to their urinary control.

“Things as normal as having children,” Dr. Zaid adds as a cause.  “Over time [childbirths] can wreak havoc on the pelvic floor and on the urinary sphincter, and you can have urinary accidents as a result.”

While incontinence is often associated with older people, Dr. Zaid says all those precursors apply to any age.

Dr. Zaid says urinary incontinence breaks down into four groups.

• Stress: This is when the bladder sphincter does not work as well. Simple things like coughing, sneezing, laughing or bending over could provoke a release of urine.
• Urge: “When the bladder has a mind of its own,” Dr. Zaid remarks. This is when you have to go and you just can’t make it to the bathroom in time. Dr. Zaid adds that hearing or seeing certain triggers like running water or jingling of keys as you rush to enter your home might provoke urge incontinence.
• Overflow: This occurs when your bladder is full. This is the opposite of urge incontinence, Dr. Zaid says, and is associated with infections and kidney issues.
•  Functional: This applies to someone who may have normal bladder control but can’t get to the toilet in time due to physical limitations like arthritis.

A health care provider will ask you about your symptoms and health history to see which type of urinary incontinence is ailing you. Testing would typically follow. Each type of incontinence, generally, has its own treatment plan.

• Stress: A provider may recommend pelvic floor physical therapy as treatment. For women, a small device can be inserted to stop leaks. Surgery is also an option.
• Urge: You may be told to cut back on caffeinated food and drink, spicy food and alcohol. Medicine and surgery are also options.
• Overflow: “That's where we need to make sure we're not missing anything like a blockage - for women, a prolapse and for men, an enlarged prostate.” Dr. Zaid says.  “A stone in the bladder. A tumor in the bladder. And we also need to make sure the kidneys are functioning okay.”
• Functional: Since people with this type of incontinence may have a normal bladder, external solutions are necessary. For example, keeping your route to the bathroom clear of obstacles like chairs and doors. For older adults with physical limitations, have a walker handy for when the need to go arises.

Other tactics include urgency suppression, when you distract yourself from thinking about urinating. You could take long, relaxing breaths or sit completely still.

Timed voiding is when you schedule times to urinate. Dr. Zaid says this can work in both directions. If you are urinating too frequently, set a timer on your phone to go every hour. Then when you get comfortable, you can increase the time. If you are holding on to your urine too long, set a plan, get comfortable then decrease the time.

The bottom line: if something seems off about your bathroom visits or if friends or family remark “You’re sure in there a lot,” see a doctor.

“If you’re chronically wet down below, it increases your risk of fungal infections and skin breakdowns,” among other serious health issues, Dr. Zaid says.

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