Dr. Sarah Knuettel

May is mental Health Awareness month so I wanted to share a few of the things that I incorporate into my day to ensure a positive outlook on life.
I rambled on into new hobbies to help protect from dementia, because I ramble off topic regularly. Dementia is not a mental health condition, but actually a neurological condition, but the same things that protect against dementia also help against depression, anxiety, and other mental health conditions. There have been several studies that have linked engaging in at least an hour a day of a cognitively challenging leisure activity to a lesser incidence of certain types of dementia. Crafts and puzzles seemed to have the best results, but also bridge, or games that require socialization. Reading (but not just the newspaper) has shown some benefit. Regular physical activity also has a high protective property against depression, anxiety, and dementia. I also highly recommend volunteer activities. Trust me, you benefit more from this than anyone you are helping.
Let me know about what new hobbies you guys pick up and how it has helped you!

Well I’m back from vacation and I have passed my OMT boards so I thought I would cover a common disease, Migraines. I didn’t cover the medication options since choosing the best option is based on specific patient qualities.
For lifestyle modifications you can make changes to avoid triggers such at processed meats, alcohol, aged cheeses. Increase fatty acids like those in fish. Increase water intake to avoid dehydration. Avoiding triggers and learning to cope with triggers to increase tolerance. There are also electrical stimulation devices that can be considered and couple OMT techniques. Enjoy, and come talk with us if you need help with your migraine management. Appointments available at Newport and Greeneville office. For new and established patients.

***Disclaimer*** Attempt at your own risks, if it hurts stop doing it! Come see me and we can work out some home tricks for you.

So I didn’t post this one when I filmed it for obvious reasons once you watch it. But I promised a patient I would. These are some of my home tricks that I have made up. For me they are safe, I know when something is too much vs just the right force. If you have significant problems and you want to learn some of these it may be best for you to bring your foam roller to an OMT appointment and we can determine what would be safe for you. In general the first stretches and the pelvic reset will be safe for everyone to attempt, but be careful with the last tricks where you are lying on the foam roller. Maybe attempt on a soft surface first and if it hurts, stop.

Stress incontinence is very common especially in females. The bladder will shift down in the pelvis past the muscular sphincter whose function is to stop the flow of urine. Short and simple there is pelvic floor physical therapy that is ideal first line treatment. There are also pessary devices that can help shift the bladder back into proper placement that can help with incontinence in the setting of prolapse. If severe this may require a surgery.
Incontinence often leads to frequent UTIs, but can also lead to yeast infections or even just vaginal irritation from use of panty liners.
If you’re having any of these symptoms you should consider being evaluated to see if we can treat the underlying problem.
Accepting New patients in our Neeport office as well as our Greeneville office.

Another Iceland video! For those that didn’t see my initial video I played a little game where I talked about the first thing that came to mind when I saw something. For the ocean and Black Sand Beach I chose edema. There are so many causes so I quickly covered the basics. But I left out liver failure as well! This is why it is a good thing to have regular blood work by your primary care so we can catch abnormalities before they lead to failure of essential systems, and intervene early. Once edema begins in liver failure it’s fairly advanced. It is recommended to screen all adults at least once for Hep C because of its prevalence so we can treat before it damages the liver and leads to hepatocellular carcinoma.
For Edema it’s not as simple as just adding in a diuretic or “pee pill” because these are excreted by the kidneys which causes damage. Compression stockings and wrapping can be of great benefit. But you need to be trained to wrap legs- can’t be too tight or you can worsen your condition. Compression stockings starting at a lower compression first is the easiest first step. If you are experiencing edema or swelling come see us and let us screen for causes so we can treat before too much damage is done.

Hey guys I’m bringing back the rest of my Iceland videos I never finished sharing with you. In this video I talk about anxiety and one of my favorite grounding techniques to teach. Anxiety and depression can effect anyone. It can come and go or be persistent. Some have very mild symptoms and chose to control them with therapy and healthy coping mechanism. I’m always going on and on about grounding because I am a wanderer at heart and generally that means out in nature for me. Focusing on on your 5 senses can bring you back to your current environment when you are spiraling out of control with anxiety or panic. I also like teaching square breathing: breathe in for 4 seconds, hold for 4 seconds, breathe out 4seconds, hold 4 seconds and repeat.
If you need help managing your anxiety or depression, reach out for help. There are so many treatment options and we can discuss what is best for you after discussing your specific symptoms. I have offices in Newport and Greeneville and I am accepting New Patients if you are not already one of mine:)

I’m a bit rambly this morning I apologize. My poor little dog has been sick the past few days so I’m tired from broken sleep for night time walk abouts and constant cleaning.
Last nights video didn’t post apparently, but yesterday I had salmon and broccoli for lunch and low carb taco soup for dinner.
Today I have had a splash of protein shake in my coffee and an avacado smoothie. For dinner I will likely have more taco soup - because it’s amazing.

Part 3.

Oka so I made this video in 3 parts because I was having fun cooking. sadly Facebook won’t let me post all 3 videos in one post:(
Enjoy the series.
Total carbs:
1c spaghetti squash 5.5 Alfredo sauce for one serving 1 carb, other veggies maybe 1 carb, none for the sausage.
I also had a small little dark chocolate bar prob about 5 carbs. And had a cheese snack for dinner.
Definitely made it below my 30 carb/day limit and do not feel hungry.

Part 2

Avacado smoothie recipe: (makes 2 smoothies) 1 frozen chopped avacado, good amount of spinach, half a lemon peeled, 3/4 cup almond milk, 1/4 c heavy cream, 1/2 cup blueberries, splash of vanilla, heavy sprinkle of monk fruit. Net carbs would be 5.6 carbs plus 9 net carbs for added blueberries. I had half so 7.3 net carbs for my dinner. And maybe a couple for lunch, 3 net carbs for my morning protein shake.

Could also add protein powder or plain greek yogurt to smoothie for extra protein, and chia seeds for added energy.

Disclaimer* Ellie Mae does what she wants. I promise I have tried.

Week one down and I have lost 4 lbs. I want to add some goals to this week now that my body has adjusted to the new diet.
1. Continue low carb
2. Increase daily hydration
3. Add exercise
If you’re a patient of mine with any kind of heart disease you’ve likely heard my lecture on 150 min a week of moderate intensity exercise. If you want to burn more fat though, you have to work more at a level of high intensity exercise. Reasons why: at moderate intensity your body burns through the glucose in your plasma and muscles. This can be incredibly beneficial in regulating blood sugars and reducing insulin levels to prevent storage of fat. Moderate intensity is, at minimum, a brisk walk where you are breathing heavy. For glucose control I recommend this within 30 min of your largest meal to blunt the insulin spike.

High intensity exercise will start to use the energy stored in your adipose or fat cells. So if you want to burn fat, you’ll have to pick up the pace a bit. Don’t push yourself too hard at first because I want these changes to last for you. Start small and build up, don’t run yourself into rhabdo. I’ve used the couch to 5k app numerous times and I find it very easy to build up to longer distances this way.

Prep work for my Avacado ice cream! Happy Saturday.

Super boring tonight sorry. But I hope to bring more to the Facebook table when I try making Avacado ice cream this weekend.
For lunch I had a chicken teriyaki protein bowl from subway with no tomatoes - cuz gross. There are 33 carbs in that bowl, but without the tomato maybe I stayed barely above 30 carbs today. Some days you don’t have time to check the carbs so you make a guess and go with it.

So for dinner about 4 carbs for the strawberries, 4 for the mandarin orange slices, .5 for the almond slices and 7 for the honey and vinegrette = 15.5 carbs
Lunch chicken fajita with onions ( 3) green pepper (3) and lettuce = 6ish I estimated but I like my math.

One thing I always stress when discussing diets is the protein intake. I failed at that yesterday so I tried a little harder today. You want a healthy weight loss. Since I’m cutting carbs I’m trying harder to reach my protein goals. The small amount of mahi mahi on my salad today provided about 30g of protein and dinner probably provided about 10g with the tofu.
Recipe for tonight:
Firm tofu
2/3 c chopped mushrooms
Half a yellow onion
Sauté the above chopping up the tofu to a ground consistency and add the sauce packet. cook for a few min.
Then add 3 chopped water chestnuts.
Put it in a lettuce wrap and enjoy.
Takes maybe 20 min to make with chopping included.
Can also use ground chicken for higher protein intake and lower carb intake.

Our office New Year’s resolution is to work on understanding what our patients struggles are and help teach you how to obtain your goals. those who choose to participate are going to be working on a low carb diet and sharing our meals and mishaps with our patients on Facebook. Should be a fun experiment. I hope to share with you all some good recipes and if you’re looking for an accountability partner to help you with your diet feel free to join in.
Also had to look up cheese carb amount and it is about 0.4g per 1 ounce. so it’s a pretty carb friendly salad addition, way better than honey mustard dressing.
Total carb count for me today is about 20. Goal is to keep below 30g a day.

Wanted to get the word out. There is a free Narcan distribution and training at the Greeneville Walmart tomorrow 10/29 from 10am to 2pm.
If you miss this distribution also know that you can purchase Narcan at any pharmacy without a prescription. The cheapest I found was using a GoodRx coupon at the food city pharmacy and cost is $30. A life is definitely worth $30.