Fitness For Degenerative Conditions

December 27th 2020

Host Kimberly King joins Anne-Margaret Tovar to discuss fitness for degenerative conditions. Learn what options are available and what's best for you! Anne-Margaret Tovar is a Wellness Coordinator and works at the St. Jude Wellness Center. Tune in!

0:00:00.0 Speaker 1: The advice and informational content does not necessarily represent the views of Mother's Market and Kitchen. Mother's recommends consulting your health professional for your personal medical condition.

0:00:11.3 Kimberly King: Hello, I'm Kimberly King and welcome to the Mother's Market podcast, a show dedicated to the truth, beauty and goodness of the human condition. On today's episode, as we age, it's important to keep our bodies in motion, and to find the right kind of exercise for our ageing muscles. Listen closely to find out ways you can keep in shape even if you have some degenerative conditions. But first up, Anne-Margaret Tovar is a wellness coordinator at St. Jude Wellness Center. She has her master's degree in kinesiology with an emphasis in gerokinesiology and motor behaviour. She is a certified balance and mobility specialist and certified to teach Silver Sneakers at the Arthritis Foundation classes and has taught dance for about 18 years. Anne enjoys the opportunity to speak with an amazing population that allows her to share her knowledge of balance and mobility. When Anne is not teaching, she enjoys yoga, walking, resistance training and golf. And we welcome you to the Mother's Market podcast. How are you doing?

0:01:11.2 Anne-Margaret Tovar: I'm doing great, thank you for having me.

0:01:13.8 KK: Thanks for being here. Why don't you fill our audience in a little bit on your mission and your work before we get to today's show topic?

0:01:23.7 AT: Well, so the work that I do for the Wellness Center is, I work teaching predominantly older adults, or anybody who has a chronic condition. I offer group classes, as well as one-on-one instruction. And actually how I got to that is, I had started teaching... You'd mentioned that I had taught dance for 18 years, and one of the things that I really enjoyed doing when I was doing that was through the community centres, and I got involved working with the senior tap class, and that translated into working and volunteering for the senior centres. And when I went back to school to finish my degree, I knew that I wanted to work with older adults. I had originally started out thinking I was going to be a PE teacher, but ended up going in a little bit different direction. [chuckle]

0:02:10.9 KK: Doesn't that always happen, right?

0:02:14.9 AT: It really is. And one of the things that I really, really loved about working with kids was that it was all about developmental milestones, but also, I noticed that as my mother was aging, that she was starting to lose some of her coordination and some of her strength, and I really wanted to do things, and I really was really interested in helping her make sure that she was able to get the most out of her life, and also not, in turn, also help other older adults. And so she's really been a big inspiration for me to go in this direction because I realised that not only did I wanna just help my own mother, I wanted to help other people as well, so it's really been like that. [chuckle]

0:02:55.7 KK: You are speaking to my heart, I love that. My mother suffers from Alzheimer's and she has declined considerably. So when you can give back like that, and people really don't always necessarily think ahead. So bless you for what you do. I think that's amazing. Today, we are talking about fitness and wellness for degenerative or for those kinds of conditions in seniors, as you mentioned as well, but I wanted to find out, you're a personal trainer, but I also see from your job description that you do more than that, and you talked about it a little bit, but what kinds of personal training are offered at the St. Jude Wellness Center?

0:03:31.2 AT: Well, we offer a lot of different types of personal training. We offer... That can be specialised for... The first thing you wanna do is you wanna make sure that you know any limitations that somebody might come in with, or any movements that somebody may happen to avoid because of a past injury, or maybe, like you said, they have a degenerative condition or something that's progressing or they're trying to recover from injury. So we create... Those are... We consider this population special populations, and basically it means they need specific interventions chosen for them so that we can combat a specific thing. And we use a lot of evidence-based intervention in our stuff, in our training. So that's what we focus towards.

0:04:18.2 AT: So the chronic conditions we work with are, can be something like it's imbalanced impairment, or maybe somebody has arthritis or osteoporosis or MS. So there's a lot of different types of conditions that someone can have. And it can be something very mild, it could be that they're post-rehab, they've just completed physical therapy and are not quite ready to go back and work out on their own in the gym. Or it could be something where we have to provide an alternative form of exercise because maybe land-based exercise is not appropriate for them. So that's the type of personal training that we do offer at the Wellness Center.

0:05:02.1 KK: Can you talk a little bit about more into depth what kinds of clients you work with and train?

0:05:10.3 AT: Sure. So the types of clients that we work with, again, as I told you, there would be somebody who comes in with a chronic condition. Maybe a lot of times, they're referred by their doctor and they want them to be not just working out, but they think that maybe they need some sort of form of supervision or maybe some advanced techniques in regards to that. So not quite somebody who's trying to do physical therapy because we certainly do encounter people that might not be ready for us that we refer to physical therapy, but this is for the person that maybe they are sedentary and they haven't been back to exercise or maybe they've tried exercising, then they've injured themselves, and so we wanna make sure that they're getting more supervision and more instruction, somebody who might be returning to exercise or new to exercise. Again, it could be somebody who is experiencing changes in their life, where they're seeing decline in strength, or maybe a decline in endurance or even balance. And so I try to offer those things that really impact those types of things in a positive way. Could also be somebody who's experiencing... Maybe they've broken a bone and they found out they've got osteoporosis, and so they are looking for an intervention. So a lot of our stuff is intervention-based, so to try to create a positive change to keep them healthy.

0:06:21.6 KK: That's really interesting. Tell me a little bit about... You mentioned the special populations that you're excited about possibly working with in the future. What is new on your horizon there?

0:06:30.9 AT: So new on our horizon. Right now, we've been doing a lot of... In the past, we've done a lot of classes. We call them by different names. We've done our balance class, which is the balance for life class, and we have our Parkinson's class, which is, Let's be big. And those two things are what we actually started out with at the wellness Center. And we do a lot of intervention with that, which they can go into different levels and they can also do one-on-one. So with the balance for Life class, we basically work on things like Center of gravity training, which is basically having them more in tuned with how they're moving their bodies through space, and also working on proprioception, knowing where their limbs are, maybe even a walking pattern because maybe they've got a shuffle to their feet. So we work on... We combat different things, whether it has to do with how they're shifting their movement, or maybe it's even just something as simple as just being decondition with leg strength.

0:07:33.4 AT: We also challenge the environment to make sure that they're working all their systems of balance, because there's three systems of balance that work in conjunction to create an environment which you can stand up. And so we combat each one of those systems to make sure they're strengthening them. For let's be big, their situation's a little bit different, because this is a progressive condition. We try to combat some of those things that are more common with Parkinson's. So we really focus on trying to give them back the ability to move more freely and to move more safely. And so we use a lot of different interventions throughout to try to create a really well-rounded programme for them... One of the things that we did, actually, that was really new for us this year obviously because we do have the pandemic, and there is... With COVID, we got the opportunity to work in conjunction with our physical therapy department to create a COVID Recovery Programme, where the physical therapists are taking them post recovery or post-COVID and working on a wellness plan for them to gain strength and be able to... Really, it's more of a physical therapy type thing, where they're offering them breath work and endurance. Then once they're ready, we have our post-COVID recovery programme, which is online, and they can do virtually just to continue those gains that they make with the physical therapist one-on-one.

0:09:10.1 AT: We also have our Arthritis Foundation, and what's really great about the Arthritis Foundation classes is that we have two types. We have a full body class in which we work on all areas of the body, but then we also have a focused exercise class for people who have specifically knee osteoarthritis. And what we gain there is we try to increase mobility, reduce pain, build strength, and also maybe reduce the need for having that knee replacement or maybe even recovering from that knee replacement. For our osteoporosis group, we have the bone builders, which really focuses on using resistance training to help stimulate bone growth. So we have groups that come in and do that now. Right now, it's mostly one-on-one, or maybe up to two to three people maximum, but anybody who's coming in at this moment, anybody coming into our facility is receiving specific intervention. So it's not just a general fitness facility at all. It's really specialised on creating intervention.

0:10:20.0 AT: We also do have the people who come in for weight management that are looking to be at a healthy weight, and we also offer all... It can be very encompassing of a whole person wellness in which we also provide not just meditation, but also things like we also have... I'm sure you did your interview with Megan to get the cooking involved and the correct diet involved. Really, we have done a lot of things with the post-pain programme, we do a post-pain programme, which our pain programme refers people to us to continue doing exercise. We've been... It's really great because we've had some really wonderful success for stories that have really warmed my heart of people who started out barely able to move and they've moved on to other classes and now they're doing... They're able to do personal training and they've really, really taken a handle and taken back their lives. And that's really such a wonderful, wonderful situation.

0:11:22.5 AT: And we try to offer things for every level, we have our post-pool therapy programme, which we mentioned that sometimes land-based exercise is not appropriate for everyone. And even in the physical therapy department, that's true as well. And so those folks, they might take them into a pool because it makes them more buoyant and it's less impactful to their joints. And so there's less pain. And we're able to offer a post-pool programme in which they could take those exercises they've learnt from the physical therapist and continue to do them independently under the watchful eye of one of our specialised trainers. So that's a little bit about our... [chuckle] That's a little bit of why we call it special populations, because as you can see, all of those things are very, very specific.

0:12:12.8 KK: And Anne just listening to you discuss going into all these different categories, I think it's amazing, people kind of forget that, especially in this situation where there's... Alzheimer's are elderly. It is a muscle that you have to really remember how to use that. My mom for instance, is shuffling backward a little bit, because if you don't use it, you lose it. And you really have to keep a hold of them, but you don't really necessarily think about that on a daily basis. You do, but I think that's wonderful that you're there with these exercises.

0:12:45.5 AT: And it's really true about what you say about using it or losing it because it really doesn't take very long to lose those gains or to get into a situation. If you stop moving your body, your body becomes accustomed to that. I can share my own experience with my mother that she had did suffer an injury and she was laid up for four days. And that translated to her having to receive physical therapy for almost a month because of just four days of being sedentary. So really, people don't... Really being sedentary or not moving can really impact something, somebody. And this was a situation where she wasn't able to move at all for a period of time, and it really took its toll on her. Now... Maybe it's a little bit different. I know when I got sick a few years back, I was out of work for a week, but boy, when I went back, I'm telling you, it took me a good three weeks to get back into moving my body, was pretty happy to stay still and not do anything.

[laughter]

0:13:56.4 KK: That's because somebody is waiting on you, right? It's easy to really just relax and...

0:14:01.9 AT: And it really is, and the thing is as we age and now as we experiencing change in our bodies and maybe we start realising that, maybe we feel like we can't do as much, maybe we don't feel safe in doing some of the things that we used to do, and we stop doing them. And then when we stop doing them and we do less, we can do less. So the idea is not to change it all today, it's about moving more, a little more often.

0:14:24.0 KK: Yeah. I love that. What about if you're home? Like we all are right now, especially here in California, but are there any household items that we can incorporate with working out or keeping moving and all of that?

0:14:37.3 AT: There really are, there really are. And it doesn't matter what condition you have, there's always something. I'm sure we've all seen the items online, but for those of the people who haven't, you can do simple things, if you're a beginning exerciser, maybe in part of our senior population, you can do things like two soup cans, can be used as instead of a dumbbell, or even two water bottles, water bottles can be great because they have their nice soft compliant surface that you can grip. Or let's say you're looking for something that's a little bit heavier. You can always use a laundry detergent bottle as a kettlebell. Obviously, it's not super comfortable with the vertical handle, but you know what? If you take a pillow case and you slide it through and you're holding onto both sides, now you've got a kettlebell, a very comfortable kettlebell.

0:15:31.8 KK: Yeah. That's a really good tip right there. Yeah, sure things to do.

0:15:36.8 AT: It is. And most people don't think about that. I've seen people in my virtual classes that I see them using a kettlebell. I'm like, Okay, grab whatever you got, a pillowcase, a sock. I don't care. Throw something in there, make it more comfortable, you can also use... There's also a lot of things you can use to do leg exercises. In our classes, we do an exercise in which we squeeze a ball. Now, most of us think, oh, you have a ball, but what if you don't? What could you do? Well, if you took a couch pillow and you fold it in a corner, now you've got a perfectly cushy something that provides resistance for you to do some hip abduction. And all of these exercises that... All of these things that you can use, you can use them in a standing position or a sitting position, obviously not the pillow squeeze, but if you're going to use your hand weights, you can use them sitting down or standing up. There's a lot of things. I've seen other people say to use a couch cushion as opposed to... I don't know that I recommend that, especially guys, if you want your wife not to be mad at you, I probably wouldn't put my shoe on that. But there's other things you can do, or maybe you don't think about. I mean, you could use a bicep... Tricep strength exercise with a bicycle pump. There's a lot of things that you can do. And if you...

0:16:55.9 AT: Yes, if you need to stretch, let's say you need to stretch and you need to use a stretch strap and you don't have a yoga strap. Your towel, a bath towel works really great. Maybe you're used to having all of those really nice foam rollers from your Pilates class. You take two bath towels lengthwise and roll them, and now you've got at least some sort of support that you can lay on your spine if you're trying to do your spinal correcting Exercises. If you're trying to do, if you don't have a slider, you could take something like if you've got smooth floors, you could take a micro fibre towel and get into a plank and run your feet right back and forth in a push-up position. That'll get you tired. Or when you're not ready for that, and you just wanna do some gentle exercises, then grab a paper plate, put it under your shoe and slide it forward and back, if you've got knee arthritis, that'll help you for resurfacing exercises. So there's a lot we do. There's a lot I do. And I know this because we do a lot of online classes. [chuckle]

0:18:01.4 KK: Yeah, no, I think this is fantastic. Great, great information. We have to take a quick break right now. More in just a moment. With Anne-Margaret Tovar. Thank you so much. Stay with us and we'll be right back.

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0:18:39.0 KK: And now back to our interview with Anne-Margaret Tovar. We're talking about fitness and wellness for the degenerative conditions, pardon me. And so this has been really interesting, Anne-Margaret. And it's also great to know what lies ahead with our seniors, but beyond seniors, let's talk a little bit about the less big group exercises for Parkinson's disease and how they're different from any other fitness group. Let's get into that a little bit.

0:19:04.2 AT: Okay. So with Parkinson's, there are several things that we focus on... We focus on... They normally... People with Parkinson's can experience rigidity in any of their joints, they can... So rigidity is, they basically lose their ability to move big, everything seems to be very diminished and very closed in, or they don't move as... They won't move as freely as they should, also when they do move, their movements tend to slow down, so which we refer to as Bradykinesia. There's also because of the inability to move in any significant size in that slow movement, there also seems to be... There's also a lack of strength, so that impacts their strength and their overall muscle tone, so basically their gross motor skills, so that's a big thing that we do as well as their fine motor skills. Also along with losing their ability to move in a bigger manner, they also tend to have a diminished vocalization. So the exercises that we do are all about... I always tell my clients, take up as much real stake as you possibly can for every movement, so we talk about extending our fingers, extending our arms, so really extension type of movements is really important to do with Parkinson's clients as well as making sure that we also increase the strength, so once we've got our big movements working and our joints are moving and we are able to build some strength in the legs and the arms, then we can combine both of those things and try to increase speed and improve power.

0:21:02.9 AT: So power is a really big, important thing that we do, so with big ballistic movements in full extension, so we have a lot of exercises that we do in that, we call out the numbers, and so we'll give different numbers. We have this one exercise that we do that we touch from floor to ceiling, but during our exercise, we are spelling out power, so we're spelling out P-O-W-E-R, and that really encourages them, and they do it as a group, and it really encourages them, I think, to utilize their voice. Now, we do, also do things, we try to utilize... You take our, let's be big group, and we try to use the best practices out there, so we utilize things from Lee Silverman's Voice Training, which is otherwise known as BIG and LOUD. PWR, which is Parkinson's Wellness Recovery out of Ohio. We use interventions from best Parkinson's program, we use things from... Boxing seems to be a really big thing that they have, the rocket study. So we try to utilize things with boxing.

0:22:08.5 AT: So really, there's been bike interventions, we try to get them on the bikes when we can. Now, obviously, it's a little bit different at home, but we try to do as much as we can into as much variety as we can, because really there's no one perfect exercise to combat any of these things, so those are a little bit different because we're specifically working on combating those things. Now, although as we age, other people might experience rigidity, slow movement, it just seems to be specific to this group that they tend to come all at once, or sometimes only one time, so it's just... It's the culmination of different things. Now, I always tell the spouses of my clients, you should be doing these exercises too, because they really are good for the entire, for everybody, but they're definitely very important to the specific population, so you're not just gonna go ahead and throw cardio into there, you're going to... Although you do wanna have that. You're focusing specifically on things that tend to plug this particular population.

0:23:17.5 KK: Well, and it's funny when you were talking about the P-O-W-E-R, I kept thinking of the YMCA dance, right? Is that sort of what you guys do when you're spelling out power? [chuckle]

0:23:26.4 AT: Kind of... I mean, it's kind of. So one of the things is, like I told you, we do best practices, some of the names of that, I think they're all really great exercises, but some of them when you're trying to teach the clients... One of the things that can happen with Parkinson's is there tends to be... It can affect the cognitive function and that affect memory. So what we try to do is we try to create a very rich environment for them to be able to remember things, and so we rename, we rename a lot of exercise. So our power chair is for those people who might be familiar with LSVT is, the floor to ceiling, it's five movements and we basically spell out power. Where another movement called side to side, basically starts with your hand out and goes across the body with your palm up, and we call that bowl of cherries, because you're offering someone a bowl of cherries. So it gives a visual to what we're going to do, and they know all of the names. So we renamed some of the exercises instead of just something that was directional, but something more richer for them to remember. Yeah, so it's a lot of fun and sometimes I let them come up too.

[laughter]

0:24:53.9 KK: What are other conditions that should follow specific fitness guidelines rather than join a basic exercise class? And also, you talked a little bit about that pool program and personal training, but let's talk about other fitness guidelines.

0:25:09.6 AT: Okay, so I did talk about osteoporosis, and so we do a lot of resistance training, and the idea is as the muscle becomes stronger, it creates more strain on the bone, which stimulates the bone growth, but there are certainly what we call contraindications, which is like maybe movements that we should avoid. For like with osteoporosis, we need to make sure that we're very careful on what we have them lift towards the front of them, because anything, even something as minimal as three pounds could cause a spinal fracture. Another thing we wanna do is we try to avoid movements such as twisting motions, because again, that puts our spine at risk. So there's the exercises that may not be appropriate for a population, and then for somebody who has received a hip replacement, 'cause somebody might come in for one type of exercise, but come in with not just that condition, you can have multiple chronic conditions.

0:26:12.1 AT: I know, wouldn't it be nice to be like, "Okay, you've got arthritis. So you're not gonna have anything else." You might have... You might come in for something and have a hip replacement, so there's things we have to be careful about to make sure that you don't hurt yourself again, there are certain movements that PTs and orthopedic surgeons want, maybe you want something with the hip replacement, depending on how they perform the surgery, maybe want them to avoid, and those might be for now, this might be for six months, or this might be, you should really never do this again.

0:26:40.3 AT: And so that's one of the things that we have to think about when we are working with a population. One of the things that we have is we have a balanced program, so I can talk about how they are completely different, and then how you intersect them. So the balance class I told you, basically, we're talking about learning how to move through your center of gravity, really being able to tell when your weight is evenly distributed between right and left and front and back, and then maybe you also have a vestibular issue, which means that you have a hard time telling direction of up when your head's [0:27:14.8] ____ or maybe you lose your balance when you're turning your head. Or maybe you don't do very well because you've got neuropathy, and so if the lights go out, you can't tell, you're very unsteady on your feet, and that can happen, not just because it's late at night and you can't see it. It can happen coming out of a movie theater, when you're used to being in dark and it's nice and bright.

0:27:41.6 AT: So there's the balance program working on systems of balance. Well, we talked about Parkinson's, and we talked about how we do these big powerful movements, okay, but you know what, some of those folks come in with balance impairment as well. So it's really hard for us to say, "Hey, we want you to move big and powerful," that could be very unsafe for somebody who also has balance impairment, so we also incorporate those types of exercises into The Parkinson's program. So with the chronic conditions, you have to think about what other conditions they are, because people come in very rarely with just one.

0:28:18.7 KK: Yeah, and that seems to be what you specialize in. You're used to knowing how to navigate around that. Thank you. I think it's so interesting. Let's talk a little bit about what should someone look for in credentials and what questions should people be asking for who's looking for a specific trainer for some of these conditions that you've discussed?

0:28:39.3 AT: One of the things you wanna do is you want to make sure that you're going to some place that is going to hire people who are gonna ask the questions for you. Now, if you're looking to hire somebody independently on your own, you might wanna ask about what kind of experience they have and where they have that experience at, because you wanna make sure... I'm not saying that somebody newly out of school can't be a good trainer, because many times, as part of your education, you are put into those environments where you're being trained to work with specific populations.

0:29:14.8 AT: I know that the Cal State Fullerton group has the Center for Successful Aging, and I know that part of... Many of our instructors come from there, and I know that they have a lot of experience working with older adults there, because that's primarily what they're doing and it is part of their education, but that's not... Everybody doesn't have that experience. So it depends on if the person that you are wanting to work with has this experience that you need to be able to make sure that you are successful in your journey. Education too, you wanna make sure that somebody has the proper education because there are so many things that you can learn and say, "Okay, let's learn, order of exercise from A-Z," but if you don't know the principles behind it, you might implement them incorrectly and you can be a danger to somebody.

0:30:01.0 KK: Absolutely.

0:30:01.4 AT: There's a lot of foundational knowledge that happens in school, so you really wanna make sure that you know just not how to do the exercises, but why we're doing and why we're doing those, and what other tools do you need to know in order to make that program successful. And also having a good certification. If you wanna have somebody teaching pilates as an intervention, they probably should have a certification and not just somebody that says, "Oh, I workout. I workout and I have experience knowing." And that's very common. That's very common that you'll have somebody who's really strong and they workout and they think, "Hey, I can be a trainer," and maybe they can after the proper education and certifications they can.

0:30:47.5 AT: Yeah, and all certs are not the same, so you really wanna make sure that the certifications are reputable. When we're at the wellness center, you have to have a minimum of a Bachelor's degree in Exercise Science. All of our trainers right now, our personal trainers have Master's degrees in Exercise Science, so we're very confident in their ability, not just to have foundational knowledge, but that application of that, and we like it because, like I said, we do evidence-based intervention, so there's a very research-mindedness in implementation of that at our center, and it's really nice, and I think it creates an environment where we trust our trainers to be able to provide a really safe environment.

0:31:34.8 KK: And safe too. Absolutely. I love that you can absolutely feel your passion and hear your passion about wellness for your clients, and I guess... Can I ask you, what is your favorite part of your job?

0:31:47.1 AT: You know, this is really hard to answer because obviously administering that intervention, you can tell that I probably really enjoyed that.

0:31:56.3 KK: You do.

0:31:56.4 AT: And I do, but also providing an environment that's fun for our clients, even in person and online, because right now I think that's so important because people, if they do come, are able to come in to see us for one-on-one intervention, we might be the only person they see, and online you wanna provide that because it's really hard to be disconnected from the world. And you wanna at least give them that moment of being able to connect with somebody. But it's also important for me, one of the things I do is making sure that when I know that I found the correct activity for someone, maybe somebody wanted to train and going to gym, and we're like, "You know, maybe we should try this instead." And then they flourish. That's the important part, is thriving and flourishing, and knowing that I've created the best experience I can for my clients, I think that's probably has to be number one, is knowing that I'm doing my best to provide the best experience for our clients at the Wellness Center.

0:32:58.0 KK: Well, your passion drives you. Last question; what safety protocols are in place for you all at the St. Jude Wellness Center?

0:33:07.6 AT: So what we're doing is, we obviously are following the CDC guidelines, we have everything separated out. We have a very limited capacity, which is why we're... At this time, we're not having... We don't have any group classes. Everything is either a personal training, a duet, or a three-person intervention. And that's because we need to stay below 10% capacity. So it's really important as to not go over that. But in addition to that, we make sure that we space everybody out well over the 6 feet of separation, we have... We probably more are like 15 feet in-between people. There's a lot of... If you're training one person or two people, it doesn't matter, you normally will have gloves on and you're wiping things down as they're using it, or you're providing a small amount of equipment for each individual person to use. We're doing things like having our air filters that we have running, as well as our air conditioning system has an air filter in it. Prior to coming in, we are taking temperatures, hand sanitizer on our clients when they come in the door, and we're making sure that we tag them.

0:34:32.5 AT: We, as a center, we're walking around, everybody comes in through the same entrance in which we take our temperatures and make sure that we're tagged each day to make sure that we are safe, and making sure that we're basically scrubbing everything down, following protocols for wet time, so it's not just like a quick wipe, it's making sure that we're doing exactly everything to hospital standard to keep our clients safe. And of course, everybody has to have a mask on and it has to be worn properly over the nose and under the chin, so it's exactly what we're supposed to be doing in line with what our guidelines are from the CDC and the hospital.

0:35:09.1 KK: Good for you. Well, you are doing such great work. Thank you so much for you joining us today for your time, and some really great advice, we really appreciate your knowledge, and we look forward to having you on again in the future. In the meantime though, please check out the website for Anne-Margaret at stjudewellnesscenter.org and we look forward to your next visit. Thank you.

0:35:29.3 AT: Thank you.

0:35:34.9 S1: Thanks for listening to the Mother's Market podcast, and for shopping at Mother's Market. The advice and informational content does not necessarily represent the views of Mother's Market and Kitchen. Mother's recommends consulting your health professional for your personal medical condition.

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