Internal Medicine Blog

Let's All Catch Up on Vitamin D

By: Maria Mazzotti, D.O.

CatchuponvitaminD 1

Even though vitamin D is a hot topic in Women’s Health, the current recommendations start with newborns.  The new recommendations for Vitamin D intake start within a few days of birth-400 International units in exclusively breast-fed infants. Starting at age one, the recommendation jumps to 600 I.U. (previously the recommendations was 200 I.U.) in part because it was found that the risk of rickets decreases substantially at the increased recommendations. Vitamin D supplementation recommendations actually start even earlier.  Currently, pregnant females should be getting at least 600 I.U daily since vitamin d crossed the placental barrier and builds fetal stores.  In darker skinned individual and individuals whose cultural and religious practices include complete skin cover, the recommendations are set at 1,000 I.U.


Having said that, sun exposure during most months, mid-day, for 10-15 minutes without sunscreen is sufficient for vitamin D synthesis in light skinned individuals. Dark skinned pigmentation, winter season, or northern latitudes can markedly reduce skin synthesis and increase dietary intake. 

Besides living in northern latitudes and being darker skinned, other common causes of decreased vitamin D deficiency include decreased synthesis, decreased nutritional intake, maternal vitamin D deficiency, prematurity, exclusive breast feeding and obesity due to the increased sequestration of vitamin D in fat , malabsorption and medication interference with absorption.  Most countries have milk and orange juice fortified supplementation to help with this. Other common foods that contain vitamin D are fatty fish, canned tuna fish, egg yolks, fortified cereals, beef liver, cod liver oil and calcium rich foods because your body needs calcium to absorb vitamin D.

In turn, vitamin D helps your muscles absorb calcium. Decreased calcium causes your muscles to cramp, hurt or feel weak.  Included in your body muscles is the most important muscle of all, your heart muscle. Foods high in calcium include milk, yogurt, cheese, leafy greens, seafood, legumes and fruit. Also important to note is that there is no evidence to support calcium intake and increased risk of developing kidney stones.

With the increased daylight, now is the time to try and increase your vitamin D production and intake if you have not already done so.  And when stopping in for your annual checkup, you can see how well you are doing with your vitamin D status.

May: Skin Cancer Awareness Month

By: Lauren O'Brien, M.D.

SKIN CANCER AWARENESS

Spring has sprung. and soon those long, hot days of summer will be upon us. We are all ready to enjoy the warmer, days the sun has in store for us, so this is the perfect time to reflect on the potential hazards that can come with all of that UV exposure.

May is Skin Cancer Awareness Month, so let's review some important skin cancer stats.


THE FACTS
:

As a group, skin cancers are the most common cancers of humans. Melanoma is the most deadly form of skin cancer. The overall lifetime risk of melanoma is 1:50, but it represents the most common cancer in women aged 25-29 and the second most common cancer in women 30-34.

 

WHO IS AT RISK?

Melanoma can affect ANYONE, but there are certain people who are at greater risk.


1) Caucasians have a higher risk than other races

2) If you have >50 moles, or large/atypical moles, you are at higher risk.

3) Caucasians with light skin, freckles, red or blond hair, and those with blue or green eyes are at higher risk.

4) Your risk is increased if you have had a previous melanoma, other skin cancers (basal cell, squamous cell) or other cancers such as breast or thyroid cancer.

5) You have an increased risk if you have a family history of melanoma.

6) Your risk is increased if you have a history of a sunburn, or if you visited a tanning bed prior age 30.

 

PREVENTION:

Now that we know more about skin cancer and melanoma, the best strategy is to prevent the skin damagebefore it occurs. Here are some ways we can prevent skin cancer:


1) Seek shade and avoid sunburns. It is most important to look for shade between l0am and 2pm when the suns rays are the strongest.

2) Avoid sun lamps and tanning beds- as we said before, this is linked to an increased risk of melanoma especially if used before age 30.

3) Wear hats with a 2-3 inch brim to protect your face, ears, and neck. Plain baseball caps leave your neck and ears exposed and straw hats offer less protection than those made with a tightly woven fabric. If possible, wear long sleeves and pants for added protection.

4) Don't forget the sunglasses with UVA and UVB protection to keep your eyes safe.

5) Use a broad-spectrum sunscreen with an SPF of 30 or higher. Use at least a palmful to cover arms, legs, face, and neck. Use a lip balm with sunscreen as well. Be sure to apply 30 minutes prior to going out in the sun and reapply every 2 hours. Remember, sunscreen acts as a filter and does not give 100% protection. If you stay out in the sun for many hours in a day you can still get burned.

6) Use extra caution near water, snow and sand as they reflect the damaging rays of the sun and can increase your chances of sunburn.


EARLY DETECTION:

Many skin cancers can be cured if found early, so surveillance and early detection are key. If you are in one of the high-risk groups, seeing a dermatologist yearly for a full body skin check is a good idea. You can do your own surveillance at home in between visits by following these tips:


1) Look for any new growths or sores that do not heal.

2) Follow the "ABCDE 's of skin cancer when evaluating moles:

 

  • Asymmetry-  ½ of a mole does not match the other half
  • Border- the edges of the mole are ragged, notched or blurred
  • Color- the color of the mole is mottled or uneven
  • Diameter- the size of the mole is unusually large, greater than the size of the tip of a pencil eraser (6mm)
  • Evolving- a mole is changing in size, shape or color, or if a mole is new to you.

If you note any of these changes, make an appointment to see your doctor or dermatologist for further evaluation. With a little diligence, you can still enjoy the energizing summer sun and keep your skin safe at the same time!

Spring has sprung. and soon those long, hot days of summer will be upon us. We are all ready to enjoy the warmer, days the sun has in store for us, so this is the perfect time to reflect on the potential hazards that can come with all of that UV exposure.

 

May is Skin Cancer Awareness Month, so let's review some important skin cancer stats.

 

THE FACTS:

 

As a group, skin cancers are the most common cancers of humans. Melanoma is the most deadly form of skin cancer. The overall lifetime risk of melanoma is 1:50, but it represents the most common cancer in women aged 25-29 and the second most common cancer in women 30-34.

 

WHO IS AT RISK?

Melanoma can affect ANYON but there are certain people who are at greater risk.

 

1) Caucasians have a higher risk than other races

2) If you have >50 moles, or large/atypical moles, you are at higher risk.

3) Caucasians with light skin, freckles, red or blond hair, and those with blue or green eyes are at higher risk.

4) Your risk is increased if you have had a previous melanoma, other skin cancers (basal cell, squamous cell) or other cancers such as breast or thyroid cancer.

5) You have an increased risk if you have a family history of melanoma.

6) Your risk is increased if you have a history of a sunburn, or if you visited a tanning bed prior age 30.

 

PREVENTION:

Now that we know more about skin cancer and melanoma, the best strategy is to prevent the skin damage before it occurs. Here are some ways we can prevent skin cancer:

1) Seek shade and avoid sunburns. It is most important to look for shade between l0am and 2pm when the suns rays are the strongest.

2) Avoid sun lamps and tanning beds- as we said before, this is linked to an increased risk of melanoma especially if used before age 30.

3) Wear hats with a 2-3 inch brim to protect your face, ears and neck. Plain baseball caps leave your neck and ears exposed and straw hats offer less protection than those made with a tightly woven fabric. If possible, wear long

sleeves and pants for added protection.

4) Don't forget the sun glasses with UVA and UVB protection to keep your eyes safe.

5) Use a broad spectrum sunscreen with an SPF of 30 or higher. Use at least a palmful to cover arms, legs, face and neck. Use a lip balm with sunscreen as well. Be sure to apply 30 minutes prior to going out in the sun and reapply every 2 hours. Remember, sunscreen acts as a filter and does not give 100% protection. If you stay out in the sun for many hours in a day you can still get burned.

6) Use extra caution near water, snow and sand as they reflect the damaging rays of the sun and can increase your chances of sunburn.

 

 

EARLY DETECTION:

Many skin cancers can be cure if found early, so surveillance and early detection are key. If you are in one of the high risk groups, seeing a dermatologist yearly for a full body skin check is a good idea. You can do your own surveillance at home in between visits by following these tips:

 

1) Look for any new growths or sores that do not heal.

2) Follow the "ABCDE 's of skin cancer when evaluating moles:

 

Asymmetry-  ½ of a mole does not match the other half

Border- the edges of the mole are ragged, notched or blurred

Color- the color of the mole is mottled or uneven

Diameter- the size of the mole is unusually large, greater than the size of the tip of a pencil eraser (6mm)

Evolving- a mole is changing in size, shape or color, or if a mole is new to you.

 

If you note any of these changes, make an appointment to see your doctor or dermatologist for further evaluation. With a little diligence you can still enjoy the energizing summer sun and keep your skin safe at the same time!

What You Need To Know About Melanoma

sunscreenladywithmoles copy

Although there are different types of skin cancer, melanoma is by far the most dangerous type. Melanoma is the most common form of cancer for adults ages 25-29 and, despite being highly curable if caught early, an estimated 1 American dies every 61 minutes because of this cancer.

What is Melanoma?

Melanoma is a type of cancer that originates from the cells in your skin that hold pigment – melanocytes. The majority of melanomas are black or brown, but they can also be pink, purple, red, white and blue! The primary cause of this type of cancer is intense exposure to ultraviolet light (typically resulting in sunburn)

ABCDEs of Melanoma

The biggest prevention tool for melanoma is knowing your skin and noticing any changes that occur. To help understand changes, you can use ‘the ABCDEs of Melanoma’:

Asymmetry – regular moles are more likely to be symmetrical

Borders – regular moles typically have smooth borders, whereas Melanoma can have rough, even scalloped borders

Color – regular moles tend to be uniform in color

Diameter – benign moles tend to be small – under ¼ inch

Evolution – regular moles do not change over time; any change in size, color, shape or unusual activity -such as bleeding, crusting or itching – is usually a sign of danger.

What can I do?

Other than monitoring your skin and having annual skin checks with a dermatologist, there are steps you can take to avoid the kind of exposure that causes melanoma:

·         Stay in the shade, especially between the hours of 10am and 4 pm ‘peak sun hours’

·         Avoid tanning, especially in UV tanning beds

·         Use a broad spectrum sunscreen that covers both UVA and UVB with an SPF of 30-50. Sunscreens with an SPF of over 50 have been shown to have a limited benefit and can be more costly. Also – do not forget to reapply our sunscreen every 2 hours or after excessive sweating and/or swimming.

·         Last but not least – make sure to keep your newborns shaded and out of the sun and make sure to use sunscreen once your baby has reached 6 months!

If you have any moles that you are concerned about, our physicians, Dr. Lauren O’Brien and Dr. Stephanie McKnight will be happy to see you and even remove the lesion if necessary! We can also refer you to a dermatologist if you do not see one regularly. So take care of your skin and have a safe and wonderful summer!

What You Need to Know About Alcohol Abuse

alcoholAn estimated 1 in every 12 adults are living with alcohol abuse or dependence. 

Alcohol Abuse is an often and seemingly socially acceptable behavior that affects millions of people in the United States. In fact, according to the CDC, 88000 deaths per year are linked to excessive alcohol use.



WHAT is alcohol abuse?

Alcohol Abuse or alcoholism is a chronic disease recognized by the following 4 symptoms:

• Cravings (the urge to drink)

Loss of Control (Not being able to stop once drinking has begun)

• Tolerance (The need to drink greater amounts of alcohol for the desired psychological effect.)

• Physical Dependence (Withdrawal symptoms after stopping drinking: nausea, sweating, shakiness, anxiety).

But everyone drinks alcohol! Why should I be worried?

Other than the emotional and financial impact alcohol abuse can have on your life, it also ravages your body; excessive alcohol use affects ALL of you organ systems!

The most commonly known outcomes of alcohol abuse are:

• Liver diseases - hepatitis, cirrhosis

• Gastrointestinal complaints – gastritis, pancreatitis

• Neurological impairment – dementia, neuropathy

• Cardiovascular problems – hypertension, heart attacks

• Unintentional Injuries – motor vehicle accidents, drowning, falls

• Alcohol abuse can even lead to the development of diabetes!

What can I do?

Although there is treatment for alcohol abuse, there currently is no ultimate cure. Preventing the development of this condition is the best course of action for anyone. In order to play it safe, the U.S. Department of Health recommends that women do not imbibe more than one drink per day.

If you feel that you may have a problem with alcohol or are uncertain, discussion is the first step. Schedule an appointment to talk to your doctor as soon as you are able. Your physician can help determine whether your habits need correction and, if necessary can help you find an optimal treatment program which can include counseling and/or medications.

If you are not ready to talk to a doctor, please explore the following resources:

www.ncadd.org - National Council on Alcoholism and Drug Dependence

www.niaaa.nih.gov - National Institute on Alcohol Abuse and Alcoholism

www.recovery.org - Connecting people and their families with the information and resources to help them recover from substance abuse and behavioral disorders.

Don’t allow your life and health to be washed away – talk to your Primary Care Provider today!

How to Manage Springtime Allergies

Springtime allergies

Spring is on its way! Along with budding trees and flowers comes pollen — a common trigger for allergies. Limiting the frequency and duration of your exposure to pollen can prevent or decrease symptoms and reduce your need for medications. For those who suffer from spring allergies here are a few tips to make the season more enjoyable.

  • Limit outdoor activities when pollen counts are the highest, between 5am and 10am.
  • Pay attention to pollen reports, available with the daily weather report and online, and stay indoors when counts are high. Dry, windy days are more likely to have large amounts of pollen in the air than damp, rainy days when most pollen is washed to the ground.
  • Keep windows and doors closed to keep pollen from drifting into your house. Likewise, keep your car windows rolled up and sunroof closed when you drive and adjust your ventilation system to re-circulate inter-compartment air instead of drawing air from outside.
  • Pollen can accumulate on your clothes and hair while you are outdoors. Remove your shoes at the door and change out of clothes you’ve worn outside. Shower to rinse pollen from your skin and hair. Your pet’s fur presents a similar problem. Though it is certainly not practical to bathe your dog every night, try to keep pets off of the furniture and out of your bed so that you will limit your exposure.
  • Wash bedding often and always machine dry. Pollen may collect on laundry if it is hung outside.
  • Rinse out your nasal passages once you are inside for the day or before you go to bed. If you can’t get the hang of a neti pot, pick up a reusable nasal irrigation kit available at most pharmacies.

Ensure Safe Travels

By: Maria Mazzotti, D.O.

As spring comes along, some of us are starting to think about our summer vacation plans.  If you are one of those people who is considering traveling to an area that requires updating your vaccines or getting vaccines that are not required growing up in the United States, it is never too early to get started with your Travel Visit. 

There are a few things to keep in mind before traveling:

·          Schedule your travel appointment as soon as possible. We recommend 4-6 weeks in advance.

·          Have a  list of your medical problems, medications, allergies and your doctors name and phone numbers.

·          If you have artificial devices in your body.

·          Insurance companies may or may not pay for the travel visit, vaccines and medications.

·          Some vaccines require more than one shot.

·          We do not carry the Yellow Fever Vaccine.  You are able to do a travel visit with one of our doctors and then they will give you a Rx to get the vaccine injected at a local pharmacy. 

·          Check with your insurance company if you require more medication for extended vacations.

How to prepare for your travel visit:

·          Have your travel itinerary with you at the time of your visit.

·          Have a copy of your previous vaccines.

Scheduling a travel visit will help to ensure that you make the best out of your trip!


2015 Wellness Goals

By: Jillan Rowbotham, D.O.

2015 has made an arrival and now is the time to consider making some resolutions. These goals will help you focus on a healthier you in the new year.

1.     Be informed about what you are consuming

If you are not in the habit of reading food labels I highly recommend it. Many people underestimate calorie, fat, and sodium content and overestimate portion size. Even with reading individual labels it can be hard to keep track of your total consumption throughout the day. Keeping a food diary can make this easier and there are many websites and apps that make it less time consuming and more informative. Livestrong.com and Sparkpeople.com are two popular sites that also have phone apps.

2.     Start moving

You don’t have to join a gym or start running marathons to be healthy. Take a class, do an exercise video at home, or walk on your lunch break. As a general goal you should aim for at least 30 minutes of physical activity every day but this can be broken up into three 10-minute sessions if you don’t have 30 minutes in a row available. Weight training is an important part fitness and weight loss plans. Meeting with a personal trainer can help you learn what weights and exercises will best help you meet your goals.

3.     Eliminate tobacco

If you don’t smoke, don’t start. “Social smoking” still counts as smoking; consider making this the last year you light up when having a drink. Even those occasional cigarettes add up over time. If you are not ready to quit right now at least pause to consider it – is there a goal time, even if it is far in the future, you would like to be quit by (ie your wedding or a child’s graduation)? What would change in your life if you were no longer smoking? Just thinking about quitting can bring you closer to being ready. If you are ready to quit and would like some help please come in and see us. Even if you aren’t able to stay quit you are still better off than if you didn’t try.

4.     Increase your water intake

Most of us don’t drink enough water. The Institute of Medicine determined that adequate daily intake for a woman is 2.2 liters, which is just a little more than the classic “eight 8-ounce glasses” or 64 ounces. You need more when you are exercising, sick, pregnant or breastfeeding, or in a warmer climate. Staying well hydrated helps your skin and other important organs and can fight off fatigue and hunger. Count up the amount of non-caffeinated fluid you are drinking in a day – how close to 64 ounces are you?

5.     Get enough sleep

Most adults need seven to eight hours of sleep, six is generally not enough. Getting a good night’s rest can help you function better in every aspect of your waking life. Cutting out some screen time or having the kids help more around the house can help get you into bed earlier. Make this the year you seek help if you suffer from chronic insomnia or anxiety that prevents you from getting sleep.

6.     Moderate caffeine intake

A moderate amount of caffeine is 200 to 300 milligrams (mg) or about two to four 8-ounce cups of brewed coffee a day. Don’t forget to count caffeine in tea (black, green, or iced tea), soda, and hot chocolate. Because caffeine can interfere with your sleep cycle even if you do not have problems falling asleep, I recommend finishing your last caffeinated beverage at least eight hours before you go to bed.

7.     Moderate alcohol intake

If you drink alcohol, do so in moderation. Moderate intake for a woman is one drink a day. One drink is considered 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of liquor.

8.     Manage stress

Stress symptoms can affect your body, thoughts, feelings, and behavior. Stress can cause many physical symptoms including headaches, digestive issues, chest pain, memory problems, and eczema, to name a few. Stress that is left unchecked can contribute to health problems such as high blood pressure, heart disease, obesity, and diabetes. Managing your stress is an important part of any healthy lifestyle. Regular exercise, particularly yoga and tai chi, getting enough sleep, practicing relaxation techniques, and maintaining a good social support system can help reduce stress. Many people benefit from professional counseling to find stress management strategies that work for them.

9.     Stay up to date with routine screening tests

Depending on your age and other risk factors this may include PAP smears, mammograms, colonoscopies, cholesterol screening, etc. Not sure if you are due for anything? An annual physical provides a good opportunity to review current screening recommendations and get up to date.

10.   Be an active participant in your health

Learn what you can about any health conditions you have and stay informed about what conditions run in your family. Know what prescriptions, over-the-counter medicines, and supplements you are taking and what they are for. Keep track of the dates of your most recent screening tests and any abnormal results. We are always happy to provide a copy of your labs to you and to go over anything you may have questions on – just ask!

Holiday Allergens

By: Maria Mazzotti, D.O., Board Certified Physician

I often tell patients to wait for the first cold week of the fall/winter season to stop their allergy medications.  And while that works for a lot of people, I am forgetting that the holidays can also be a source of allergy flares.  This is due to exposure to mold, dust mites, seasonal greenery/decorations live and artificial and foods .

During the holiday season the weather gets colder so we tend to keep the door sand windows shut more than in the other seasons, so the usual indoor allergens (pet dander, mold and dust mites may be higher).  Another reason is that during this time of the year pets tend be indoors more increasing our exposure.  Also we are bringing in live plants/trees  that may have mold spores and mildew which thrive in the damp evergreens.  The sap on the aromatic evergreen trees can also be source of skin irritation. When opting for the artificial decorations, keep in mind that these are also often stored in dusty/moldy basements which can be a problem for those reasons.  The sometimes potent Potpourri aromas can also be a problem for asthma patients.   Also keep in mind that those beautiful Poinsettia’s are in the rubber family and can cause problems for us who have latex allergies.   When warming up by the wood burning fireplaces don’t forget that they can be sources of a lot of ash and smoke which may cause problems for you and your guests.  And we often overlook the effects of stress which can also trigger asthma symptoms for some of us.

One other big group that causes problems this time of the year is food allergies.  Often times, we do not want to disappoint friends and relatives by not trying the home made foods, but before doing so, do not forget to ask if the ingredients include something you are intolerant or allergic to.  These can include milk, eggs, peanuts, tree nuts, fish, shell fish, soy and wheat.  These 8 groups account for 90% of food allergies.

There are things we can do to reduce our exposure so we can still enjoy the holiday season without a trip to the doctor or ER.  When handling any live trees you may want to throw on Latex free gloves so you do not come in contact with the sap from the evergreen trees.  You may also want to water the trees down with your garden hose or blast them with the leaf blower before bringing them in.  When handling the artificial decorations, make sure you dust them off and maybe wear a mask when doing so. 

If all else fails, thankfully there are medications that can help.  Antihistamines like,Benadryl, Zyrtec, Claritin and Allegra often are enough.   Hydrocortisone creams can help with skin irritations also.  Patients who have asthma should make sure their Albuterol inhalers are still good.  Also, if you have food allergies make sure your Epipen is not expired.  Sometimes, though, if you have tried a thing or two you may still need help from your doctor or need to see an allergist, so do not feel like you need to treat on your own.

Over the Counter Cold Treatments

By: Jillan Rowbotham, D.O. 

It is never a good time to get sick but unfortunately the cold and flu season is once again squarely upon us. The common cold lasts an average of seven to ten days and usually starts with a sore throat and possibly low grade fever, then progresses to nasal and sinus congestion. Finally, a cough, sometimes productive of mucus, is usually the last symptom to develop and the last to resolve. There is not yet a cure for the common cold and antibiotics not only won’t help but increase the risk of allergic reactions, side effects, and development of resistant bacteria. Plenty of rest and fluids is a mainstay of treatment but there are also many medicines available over-the-counter that can help make things a little more manageable - the key is picking the right medicines for the symptoms you are having.

Over-the-counter cold preparations are confusing with endless combinations of medicines and claims to alleviate certain symptoms. The best approach to selecting the most helpful one is to understand what active ingredients are in each pill and what they are expected to treat. This can help you tailor what you are taking to your current symptoms and limit side effects.

Dextromethorphan, also termed as “DM”, is a cough suppressant that acts directly on the cough center in the brain. It comes as a liquid cough medicine or as a pill. In some studies two teaspoons of honey were shown to be just as effective for reducing nighttime coughing.

Guaifenesin works by thinning mucus or phlegm. This can be helpful if you are having a lot of post-nasal drip (mucus down the back of your throat, clearing your throat a lot), or are coughing up mucus. It should be taken with plenty of water.

Oxymetolazone is a nasal spray also sold under the brand name Afrin. It can give you quick relief from nasal congestion but it cannot be used for more than 72 hours or 3 days in a row. If used longer than that it can actually cause worsening congestion. I like to use Afrin for those nights when you simply cannot breathe out of your nose and the misery of that keeps you from sleeping. It also can be helpful if you are congested before plane trips to help your ears equilibrate to pressure changes.

Pseudoephedrine is a very effective decongestant that is sold behind the pharmacist’s counter though you do not need a prescription for it. You will need to show identification to purchase it and are limited to the quantity you can buy at one time. It is the “D” component in Mucinex –D, Allegra – D, etc. Decongestants relieve nasal stuffiness by narrowing blood vessels and reducing swelling in the nose. This narrowing can affect other blood vessels as well, which can increase blood pressure. This medicine is not a good choice for people with heart disease or poorly controlled high blood pressure. Some people cannot take pseudoephedrine because it makes them feel jittery, spacey, or gives them palpitations. It comes in a 4-6 hour preparation or a 12-hour preparation. Until you know how it affects you I recommend the shorter lasting form.

Pharmacies tend to be sold out of it often during the height of cold season so I like to make sure I always keep some on hand.

Phenylephrine is the decongestant that is sold in the pharmacy shelves and can be a good choice for people who do not like the way pseudoephedrine makes them feel. Some feel it is a less effective decongestant.

Drowsy antihistamines include Benadryl (diphenhydramine) and doxylamine which is found in NyQuil, Alka-Seltzer Night, and other night time preparations.

Many combination pills will also include acetaminophen as a pain reliever and fever reducer. Be mindful of how much you are taking. It is best not to take additional acetaminophen, or Tylenol, with these as too much can be toxic to your liver.

 If you have any questions or concerns about the use of over-the-counter medications please do not hesitate to contact us. If your symptoms are lasting longer than usual, you have a persistent high fever, shortness of breath, or just don’t feel right it may be more than the common cold. Please come in and see us in the office.

Focus on Breast Cancer

By: Monica Duvall, M.D., Board Certified Physician

As we embark on Breast Cancer Awareness month, it is worthwhile to review the statistics, risk factors, and preventive strategies of this globally devastating disease.  Breast cancer is the most frequently diagnosed malignancy worldwide.  It is the most common female cancer in the U.S., and it is the second leading cause of cancer death in women in the U.S., with over 40,000 deaths annually.

Non-modifiable factors that are associated with an increased risk of breast cancer are female gender, white race, increasing age, postmenopausal status, and prolonged exposure to estrogen, such as early onset of periods or late menopause.  Family history of breast or certain other cancers may also increase your risk--this should be discussed with your doctor.   Other factors that may increase the risk of breast cancer include obesity in postmenopausal (but not premenopausal) women, and hormone replacement therapy.  Lifestyle factors have also been implicated in the diagnosis of breast cancer.  For example, there is a significant dose-dependent relationship between alcohol intake and breast cancer, even with as little as three drinks a week.  Smoking also appears to increase the risk of breast cancer.

There are also some protective factors that appear to decrease breast cancer risk.  Breastfeeding is one example.  Physical activity appears to be another protective factor--yet another good reason to get out and exercise!  Finally, there is some evidence that soy products, and other phytoestrogens like legumes, flaxseeds, and sesame seeds may be protective.

So aside from awareness of negative/positive risk factors, how can we reduce our risk of developing breast cancer?  Cancers are most easily treated if they are detected early; therefore, the first line of attack against breast cancer begins at home, by developing "breast self-awareness".  Each woman should be familiar with her breast/axillary (armpit) exam--including skin and texture changes, as well as lumps.  Any change from your baseline should be brought to the attention of your doctor immediately.  Clinical breast exams, performed by your doctor during your annual gynecological appointment, are another important factor in screening for breast cancer.  And mammograms are advised by most professional organizations starting at age 40; the specific interval for these can again be discussed with your doctor, depending on your age.  Finally, women with family history may be advised to consider testing for one of the known breast cancer genes.   Breast cancer takes a terrible toll on the women and families whom it has affected; awareness of risks and preventive tools is the best defense we have in containing, and hopefully one day, curing, this disease.

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