The Pregnant Athlete Series: Birth and Pain Management

Posted by elizabeth January 17, 2020 8:25 pm Leave your thoughts

It is finally time to get your baby out. By the end of the third trimester you are going to be more than ready to have your baby in your arms and not in your belly anymore. I want you to use one mantra above everything else. “As long as my baby and myself are healthy”. This mantra is going to serve you well in the chaos that happens when birthing a baby.

Some women have made birth plans and visualized exactly how they want their birth to go. That is amazing and a wonderful exercise I encourage everyone to do. Just be ok and know that your birth plan is most likely going to be thrown out the window. I did not have a set birth plan, I had events and goals in mind for my birthing process. None of them happened and I ended up in labour for 36 hours and in a 2.5 hour C-section with IV Ab and hemorrhaging. I did have an elective C-section and I know that was hard to come to terms with. I went through months of prep and visualizations. I did all the midwife appointments, pelvic physiotherapist appointments, meditations and epi-no exercises. The result was the last case scenario I wanted. At the end of the day I have a happy thriving little boy, and it didn’t matter how he came into the world. This mentality happened a few months after the traumatic delivery. I will be talking about the 4^th trimester in my next blog post, and will give advice about healing on a physical, mental/emotional and spiritual level.

Athletes tend to have a wonderful mentality during labour. The “no pain no gain” mentality really helps to focus and persevere through hours of pushing. Knowing you are going to get through this, and focusing on those deep belly breaths are going to be the key to dilating and pushing through the pain.

We should talk about pain here. There are numerous different pain management types: Getting in the a warm water bath, Pressure on the pelvis, Movement, Deep breathing, Tens Machine, Laughing Gas and an epidural.

Let’s start with getting into a warm bath. This is an option if you water hasn’t broken. The warm water is soothing and helps to relax the intense contractions as you dilate. This is a great place to start your pain management during labour. Walking around will also help you dilate and get out your nervous energy. Dancing has become and internet sensation and has lots of research on it for pain during labour and stimulating labour. Bouncing on a yoga ball is another form of movement that helps you relax and uses gravity to bring the baby downwards. I loved being on the yoga ball and having my husband push with very firm pressure on my pelvis during an active contraction. It seemed to be the best form of pain management in my case.

Deep breathing is always going to be encouraged through an active contraction. It will help you open and stop tensing your body. When you tense your body you are fighting against dilation, and this will prolong your labour. Put on some meditative music and focus on your breath. Just keep telling yourself to open like a flower and visualize it. It does really help.

Tens machine can he attached to your back or belly (wherever you are experiencing labour pains). This will significantly decrease pain. Make sure to bring one with you, or ask your midwife/Obgyn to have one available for you during your birth. I highly recommend this method of pain management. The laughing gas is good. You have to pace yourself and take deep breaths. It will minimize the pain for a little bit, and it will not harm the baby. It is a great additive to your pain management regime. You can use all of these techniques together and progress. You can do multiple at the same time. Just make sure you talk to the people who are helping to deliver your baby and get the comfort that you need.

Some people who can’t relax will be suggested to have an epidural. This is typically a safe option. Keep in mind that an epidural too early can prolong labour by slowing down your dilation. If you want an epidural try and last to about 5-6 cm before you get one. If your body can’t relax and isn’t dilating an epidural maybe a good option. It does allow you to rest and take away the pain before having to push. Don’t rule an epidural out if you feel you need one. You will know if you want one when you go into labour. Remember your birth plan is going to have to be flexible.

Most women will be pushing for an average of 3 hours. So remember you have to save energy to push. No matter what your birth plan is, or your pain management plan, remember healthy baby and healthy mama. Everything in between will become a blur, I promise!

The Pregnant Athlete Series: The Third Trimester

Posted by elizabeth January 10, 2020 6:32 pm Leave your thoughts

The Third trimester is a big one… pun intended. By now 95% of women are starting to show. There are a few exception if you are tall or suffering from hyperemesis gravidarum (chronically throwing up). This is when you are going to want to start preparing the nurseries and having your baby showers. I want you to add in meal prep for months after you give birth. Start freezing meals because you are not going to have the time or energy to make a nutritious nourishing meal that you will need to properly recover. Every time you make meal double the batch and freeze half. You will be thanking yourself later.

We are going to talk about the pelvic floor again. This is the final stages to get your pelvic floor moving again. Focusing on belly breathing and mediation. Gentle stretches in frog pose and downward dog are also going to open and stretch the pelvic floor. I said this before you will need the pelvic floor to have full range of motion to have an effective contraction. The more effective the contraction the less time you will be pushing.

I also suggest investigating the Epi-NO is it a device that will help the tissues in the vagina to open. This device significantly reduces the risk of tearing during delivery. You use the inflator to gradually open the vaginal canal. This device can also be used to strength the pelvic floor and vaginal canal muscles after delivery. You will start incorporating perianal massages to help decrease tearing, and you will start evening primrose oil to soften the cervix. This is a glorious month of preparation for the big delivery day.

Exercise is going to be very modified by this stage. You are going to find that running distances is not feasible. Sprinting can be ok up until the point your abdomen pulls too much on the front of you. You should continue to do different cardio machines. Try the elliptical or the arc trainer. These are a great way to get your heart rate up and stay healthy. Speaking of heart rate to elevate your heart rate during pregnancy can be stressful on the baby. Your body is going to tell you what you can and can’t do. If you start to feel sensations in your chest, shortness of breath and anxiety you have gone too far. These are signs of a heart attack which does not mean you are going into cardiac arrest, it just means to rest and not be as intense. Try and keep your heart rate during cardio exercise in the 160 bpm. Most athletes are used to going above the recommended heart rate during exercise, your body can handle it. A lot less cardio exercise is going to get your heart rate in that range than you are used to.

Weight gain is another topic that is going to come up during this trimester. This is where most of the weight gain I going to occur as the baby rapidly grows in your uterus. A lot of doctors and midwives are going to use your BMI to predict the safe amount of weight you should gain during pregnancy. BMI is not made for athletes and most people are going to gain more than 15 lbs in their pregnancy. I use common sense when interpreting this chart.

Most athletes fall into the normal weight category, and should gain between 25-35 lbs. This being said your body is going to do what it needs to do. I gained 57 pounds during my pregnancy. I took on a lot of water weight. My ankles were swollen and the rest of my body was puffy, especially in the third trimester. Try and not obsess about weight gain. As long as your baby and vitals are fine, you shouldn’t stress.

At the end of this trimester you are going to have your little bundle of joy. Next week I am going to talk about delivery. We will cover C sections, natural births, epidurals, laughing gas, tens machine, mantras, you name it and we will cover it.

The Pregnant Athlete Series- Second Trimester

Posted by elizabeth December 21, 2019 9:58 pm Leave your thoughts

The second trimester of pregnancy is the easiest trimester in my opinion. Most of the time all the pregnancy symptoms disappear, the baby bump grows, and the risk of spontaneous abortion has dropped significantly. Your energy starts to return and you will get some of your sanity back. For athletes specifically this is where you are going to have modify your exercise routine, and really start to incorporate other stress management techniques that do not revolve around exercise. This is the trimester where you are going to have to start working on our pelvic floor.

Let’s start with the pelvic floor exercises. I think a pelvic floor physiotherapist is an absolute asset during pregnancy. This is going to save you a lot of trouble for years to come. They will do a personal assessment and work with you individually to optimize your pelvic floor. Key points for athletes and their pelvic floor:

Your pelvic floor is most likely going to be too tight. This is going to cause issues with delivery. You need to make sure your pelvic floor is moving properly. You need to have a full contraction, which means your pelvic floor has to completely relax as well as tighten.
Pelvic floor is really effected by breathing exercises and meditation. Make sure to start incorporate belly breathing and relaxation into your routine.

Exercise routine changes are going to drastically change towards the end of this trimester. Exercise is going to work with your shape. If you are like me and didn’t have a true baby bump until 6.5 months, you are going to have to adjust more later on. When the baby bump comes through we want to avoid crunches and focusing on the abdominal muscles. Your abs are supposed to stretch around the baby. You will have to let go of the notion of a flat stomach. My pelvic floor physiotherapist told me that I needed to stop working on my abs so I would start to show. “if you don’t allow them to stretch they are going to rip”. She was completely right. Focus on a flat abdomen after you give birth and have recovered. So the main point here is relax on core exercises.

In terms of lifting weights …. Do as much as you can without causing strain during the exercise. This means your body is going to tell you if that is too much. It will fatigue faster, and I swear the dumbbells will feel heavier than they were. It is unrealistic to think that you are going to be lifting the same amount of weight for the same reps and sets as you did before pregnancy. This is frustrating but your body is going through some drastic changes. Be patient with yourself. Still go to the gym as many days you were going before, and know that the workouts will not be as intense, but they will still be challenging with being pregnant. Do what you can. You are going to thank yourself for putting in the effort to exercise. Some midwives will say 50 lbs max, and will not apply to an athlete working out for an hour. Fifty lbs refers to how much weight you can carry safely during your pregnancy all day if you work in a warehouse.

Stress Management is going to have to start happening in any way that is not exercising. Your body is changing, your hormones are fluctuating and you are not yourself. You are starting to transition into another phase of your life. You are going to be stressed about the unknown, being a good mom, what to do with this new child, and how do I keep my relationships up. It is a lot to handle. Starting to journal, or meditate. Get outside and be in nature, no matter the time of year. Colour in an adult colouring book, or start painting. Find something that you can channel your stress into and help you release it. Keep trying out different stress management techniques until you find something that resonates with you.

Next week we are going to over the third trimester! The baby is coming and we are going to go over what to have done before baby gets here, further changes to your exercise routine, and weight gain expectations. Stay tuned!

The Pregnant Athlete Series- The First Trimester

Posted by elizabeth December 13, 2019 9:57 pm Leave your thoughts

The first trimester is always a stressful one. You are unaware you are pregnant for the first month or so and you experience the most symptoms. We worry about spontaneous abortion rates and extreme fatigue. The first trimester has been described by numerous women, as the trimester from Hell. Personally I was one of the lucky women who had minimal side effects. I had never felt this level of fatigue, but I wasn’t nauseous, craving any foods, and I only experienced 2 bouts of morning sickness. Every female and every pregnancy is going to be different. The focus on the first trimester is to listen to your body. Every craving, every ache or pain, and every sensitivity.

Now this does not mean over eat and think that you are eating for two and you can stop exercising. Diet and portion control is still very important while you are pregnant. Nutrition for pregnant athletes is going to change from your previous diet. You need to incorporate more complex carbs and decrease the amount of protein you are eating. You will need the energy with whole grains throughout your entire pregnancy and you will need to back off the protein for your kidney health. Your poor kidneys are going to be working extra hard for the next 40 weeks, let’s not bog them down more with too much protein.

Athletes are prone to the regular pregnancy symptoms, and you will need to have some symptom relief. I will not being going over the regular pregnancy symptoms. I am going to focus on the aspects of pregnancy that the athlete is going to experience differently. That being said, an app that I really loved and appreciated is “What to Expect”. It is a life saver, and will give you advice and information on each week of gestation. You will feel very informed and prepared. I think it is important to note that miscarriage rates will decrease after 12 weeks, and pushing yourself too hard is going to stress your body and fetus. Athletes are going to have to learn balance in their routine.

Exercise is going to be hit or miss during this trimester. Fatigue, morning sickness, or nausea are going to dictate how often you hit the gym or go for a run. You are going to need to honour your body. Don’t push too hard. The general rule for exercise is keep the same level of activity and this is going to be challenging. Don’t worry too much about avoiding certain exercises or limiting your cardio in the first trimester. Do what you were doing before as long as you can. Every female is going to be different about when they need to drop their cardio. This means if you were doing a 5 KM run in 25 mins, expect to do a 5 KM run slower. You will gradually see your 5 KM time increase. This is normal, cherish the fact you are still able to run.

The second and third trimester is where exercise is going to be altered more. Your belly and the way your body changed shape will dictate which exercises you can do. The key is to keep working out as much as possible. You will thank yourself after you have given birth. Trust me the first trimester is going to pass. Listening to your body. Focus on the connection with the little one in your belly. It goes faster than you think.

Pregnant Athlete Series: Fertility

Posted by elizabeth December 6, 2019 12:15 pm Leave your thoughts

I am going to take the next 2 months to go over what I learned as a pregnant Athlete. This is near and dear to my heart because my baby boy Theo is turning 1 at the end of the year. I was pretty big last December and I am going to share my insights with everyone.

This series is going to go through the different stages of pregnancy and getting pregnant. I will go over what to look for, how to change your workout routine for each stage of pregnancy and some of the myths that surround pregnancy.

This week I am going to start with fertility in Female athletes. Fertility in female athletes can be a sensitive topic. Athletes are fit, we eat and exercise right. We are perfect speicimens….. Just not always for getting pregnant. Each athlete is different and will have different challenges in their health, I am going to address the main challenge that I see in female athletes who are trying to conceive.

BODY FAT PERCENTAGE!!!!!

Now depending on your body fat percentage you are going to find it easier than other athletes to conceive. The optimal body fat percentage for a woman is 22-25%[1]. Most athletes just shuttered there. The minimum body fat percentage that Toni Weschler, the author of Taking Charge of your Fertility, recommends is 18%¹. Fat in the body helps to produce Estrogen. Women need the estrogen and progesterone in proper concentrations to maintain a pregnancy and even conceive.

If you are wondering if your body fat is too low go see your local Naturopath or Medical Doctor to find out. Generally if you are having regular periods you most likely don’t have to worry about your body fat percentage to conceive.

I need to address BMI and athletes. BMI is not the same body fat percentage and BMI is not going to apply to athletes. They are going to tell you that you are obese with a BMI of around 30. If the doctor uses BMI they are going to try and get you to lose weight which is going to be counter intuitive to getting pregnant. BMI is also going to be important when your midwife or OBGYN try to tell you how much weight to gain. I will come back to this topic. You will not be following the BMI Standards of weight gain during pregnancy.

Supplementation:

In general take your pre-natal, fish oils, probiotics, eliminate alcohol and smoking any substances. If you are over 30 and have been trying to get pregnant for a year, get your medical doctor to give you a referral to a specialist. There is absolutely no harm in getting the specialized testing done to find out what is going on in your specific case. Once that is done try getting some acupuncture and focus on positives of life. Adding stress to this situation is not going to make a baby. It is just going to stress you out.

Next week I will be going through the first trimester for the Female athlete. Stay tuned.

[1] Body Fat Percentage. You need Body fat for conception. Fertility Authority. Retrieved Oct 9, 2019. Updated 2019. https://www.fertilityauthority.com/blogger/cindy-bailey/2010/12/21/you-need-body-fat-conception

The Keto Diet is a No Go for Psoriasis Sufferers

Posted by elizabeth November 29, 2019 1:47 pm Leave your thoughts

There is a new study that has come out about the Ketogenic Diet. The ketogenic diet focuses on limited carbs and focusing on high fat and protein. This shifts your body into ketosis. Your body now will use fat as its main energy source compared to glucose. Your body uses glucose as its main energy source when your body isn’t pushed into ketosis.

This study was done on mice, and found there was a right way to do the keto diet and a wrong way. This study focused on the types of fats you eat while being keto. We all know that not all fats are the same. This study was expecting to a keto diet high in MCT (medium chain triglycerides) and Omega-3s is going to help with psoriasis. These fats help when your body is not in ketosis. It has the opposite effect. The fats that we found were anti-inflammatory are making the psoriatic plaque formation worse. LCTs (Long chain trigycerides) did not have any effects on the skin.

“Ketogenic diets supplemented with MCTs not only induce the expression of pro-inflammatory cytokines, but also lead to an accumulation of neutrophils in the skin resulting in a worse clinical appearance of the skin of the mice. Neutrophils are of particular interest since they are known to express a receptor for MCTs and therefore a ketogenic diet containing MCTs may have an impact on other neutrophil-mediated diseases not limited to the skin.”- Co-lead investigator Roland Lang, PhD

What Dr. Lang, PhD is saying, is that the fats we consider anti-inflammatory are pro-inflammatory when your body is in ketosis. The effects so the inflammation the MCT fats are causing are not only going to be seen in the skin. Other inflammatory diseases would be effected as well. This is something that is going to need to have more research.

This study had a very high fat percentage in the diet. This is something that people would not have. So this study should be taken with a grain of salt. If you have psoriasis I would avoid the keto diet until more research can be done.

Felix Locker, Julia Leitner, Sepideh Aminzadeh-Gohari, Daniela D. Weber, Philippe Sanio, Andreas Koller, René Günther Feichtinger, Richard Weiss, Barbara Kofler, Roland Lang. The Influence of Ketogenic Diets on Psoriasiform-Like Skin Inflammation. Journal of Investigative Dermatology, 2019; DOI: 10.1016/j.jid.2019.07.718

Using “Food as thy Medicine”- Hippocrates.

Posted by elizabeth November 22, 2019 10:52 am Leave your thoughts

Hippocrates was a smart man. He was an ancient Greek Physician who is referred to as the “Father of Medicine”[1]. He was considered the ideal physician for centuraries¹. The Hippocratic Oath, the oath Doctors say and must abide, by was named after him¹. He started looking into anatomy, pharmacology, and Epidemiology¹. After all the research and ailments that he treated he always held true to Food as Thy Medicine. He would of course offer complementary prescription of herbs and salves but maintained the body will not function properly if the proper food was not consumed¹. In ancient Greece, that would have been a different diet than it is today, but his philosophy still holds true.

Today, we have neglected the basic foundation of health. North Americans eat a mix of fried food, grotesque portions, lots of trans fats, and “synthetic” food. We have completely neglected diet, and portion control. We want to eats lots of sugar and bad fats because it tastes good, and we are most likely addicted to it. We have genetically modified our food to the point our bodies are no longer recognizing it as food. Food Sensitivities did not pop out of nowhere, we have transformed our food into something our immune system recognizes as a foreign invader. Diet is one of the hardest prescriptions to follow, and it has the best impact on your overall well-being, with long lasting results. It takes discipline and dedication to treat medical conditions through diet.

Prescription pills and Herbal Supplements are a lot easier to take, and they take effect within hours to days. Diet is not as quick. It can take anywhere between 3 to 6 weeks of following the diet to notice a really big change. There are small changes along the way, but nothing most people will notice. Pills and Herbal Supplements can have side effects, diet doesn’t have any. We are in an age of instant gratification and diet isn’t something that will provide that. We are also in an age where obesity and disease are running rampant. More and more autoimmune conditions are popping up. Why do you think this is? I am not saying I have the answer. I am also not saying that proper nutrition is easy. I am saying, Diet is the place to start, and Medical Meals is here to help you navigate the whole foods world. I have gone through some medical conditions and told you which foods you need to avoid and consume to get better. There is a diet dairy that is going to help you every step of the way. You will be notified if there are hidden ingredients and you will make the connections immediately. Medical Meals was designed to provide expert advice on the most fundament building block of health. Remember Food as Thy Medicine.

[1] Hippocrates Greek Physician. Smith, W.D. Encyclopedia Britannica. Retrieved May 1, 2019. Updated March 11, 2019. https://www.britannica.com/biography/Hippocrates.

What to Expect When using Diet for Symptom Relief

Posted by elizabeth November 15, 2019 9:23 pm Leave your thoughts

Diet is a wonderful option to get rid of your symptoms and provide lasting effects. There are a few key points I think you should keep in mind:

It does not work over night: Diet takes 3 to 6 weeks minimum to see results. And this number is true if you are following the diet properly
Diet can cure disease: Diet is the basic building block your body needs to function optimally. The food is providing your body with the micro and macronutrience it creates to heal. Your body is doing the work.
There is a Dietary Invention for every Medical condition: Good nutrition is important to heal any disease, but researched dietary interventions are available for most conditions. Sometimes Diet can be used for symptom management, pain relief, and overall vitality. In all medical conditions it is going to be an important keystone.
One Diet fixes all: Everyone is different. There nutritional needs are different based on nutrient deficiencies, activity level, Food allergies or sensitivities and what medical conditions they have Your own Naturopathic Doctor, or Dietician will be able to give you an individual diet to follow if you have numerous medical conditions.
Diet alone is enough: Diet is one aspect of healthy living. You need to exercise, take care of your mental health, get fresh air and sometimes use other methods to heal. Remember diet isn’t where you stop. You will end up using food to maintain your health, but other modalities are going to optimize it. There are times where hydrotherapy, herbs, medications, and surgery are going to be indicated.

I’ve said this before, changing your diet is one of the hardest things you will ever have to do, but it will be the most rewarding. Keeping those 5 points in mind, I wish you well on your journey and please don’t give up. As long as you keep trying to change your diet there is always hope.

How do I know that I am not eating enough?

Posted by elizabeth November 7, 2019 4:33 pm Leave your thoughts

In North America we have one of the highest prevalence of eating disorders in the world[1] . We focus on obesity and restricting calorie intake. We rarely talk about anorexia, bulimia or orthorexia, and the effects that a restrictive diet has on your body. Anorexia, Bullemia, Binge Eating, orthorexia, and any other eating disorder has a psychological component and co-morbidities¹. This blog post is going to focus on the effects of a restrictive diet only. A restrictive calorie intake does not mean you have gone to the point where a medical professional would diagnose you with an eating disorder. It is more that you are on a permanent diet. There are a 2 prominent problems with prolonged restrictive calorie intake: permanent metabolism derangement, and weight gain.

Permanent metabolism derangement happens when your body is going to be live in stress mode. Your metabolism slows down and does not respond to dietary changes. Your body has taken over and is going to start storing the little food it has and conserve it for even harder times ahead. There is nothing you can do to snap your body out of this state. This is going to cause weight gain, and your body will have a very hard time parting with the excess fat. It is almost impossible to change this weight gain. The best option is to watch your portions and focus on the low calorie healthy foods like vegetables.

A male should be eating around 2500-3000 calories/day and a female should be 1700- 2200 calories/day. A diet for a female is 1200 cals/day and male is 1700 cals/day. Anything under the diet intake is extreme caloric restrictions. People should not be staying at the diet caloric intake let alone beneath it. Food is good for you. I always tell any weight management patient that your relationship with food is more mental/psychological/emotional than anything else. We need to have a healthy relationship with food. We cannot exist without it.

[1] General Statistics. Eating Disorder Statistics. Get informed. National Association of Anorexia Nervosa and Associated Disorders. Retrieved May 8, 2019. Updated 2019. https://anad.org/education-and-awareness/about-eating-disorders/eating-disorders-statistics/

Is Organic food really worth the extra money?

Posted by elizabeth November 1, 2019 4:55 pm Leave your thoughts

In a country where genetically modified and processed foods are considered to be staples in our diet we think that food labelled organic is the healthy option. It has to be worth the extra money since it is grown without pesticides, caught in the wild, or allowed to run free on the farm. Unfortunately this isn’t the case. Organic Products used to mean anything that is made up of Hydrogen and Carbon atoms. In the past there was no regulatory body ensuring the claims of organic, free range, or wild. As of January 15, 2019 The Canadian Food Inspection Agency (CFIA) created Safe Food for Canadians Regulations[1]. Any food, seed, or animal feed that is labelled organic will be inspected by the CFIA¹. The Canada Organic Logo now has regulations¹. The catch is there is a timeline for these regulations to be enforced¹. Regulations are going to be phased in over 12 to 30 months¹.

In 2018, the CFIA revamped the original regulations for the Canadian Organic Logo[2] . This is very promising. There are stricter regulations on what substances can be used in order to grow or raise organic foods². If the CFIA can properly enforce the new regulations they have created organic foods will be worth the extra money. In 2.5 years we can hopefully believe the certified organic label. Until then I suggest to pick and choose where you spend the extra money to buy organic. You should try and buy locally from your city’s farmer markets and see which fruits and veggies are on the dirty dozen list. The Environmental Working Group (EWG) tests foods that have the highest pesticides and creates the dirty dozen for that year. These pesticides that can build up in your body. For 2019 the dirty dozen are; Strawberries, Spinach, Kale, Nectarines, Apples, Grapes, Peaches, Cherries, Pears, Tomatoes, Celery, and Potatoes[3].

Once the new regulations take effect I will have to revisit this topic and give you an update. There will be new studies and updates on how well the government is enforcing these new regulations.

[1] Organic Products. Canadian Food Inspection Agency. Government of Canada. Retrieved April 28, 2019. Updated April 17, 2019. http://www.inspection.gc.ca/food/requirements/organic-products/eng/1526652186199/1526652186496

[2] Organic Production Systems: general principles and management standards. Canadian Food Inspection Agency. Retrieved April 28, 2019. Updated April 3, 2013. http://www.publications.gc.ca/site/eng/9.854643/publication.html.

[3] “Dirty Dozen Foods” has surprising new Offender, EWG confirms report. Prevnetion.com. Retrieved April 28, 2019. Updated 2019. https://www.prevention.com/food-nutrition/healthy-eating/a26873528/dirty-dozen-foods-2019/.

FREE 15 MINUTE CONSULTATION