Rittenhouse Women’s Wellness Center

The Importance of the Whooping Cough Vaccination

January 31, 2012

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Internal Medicine Blog

By: Jillan Rowbotham, D.O.

Whooping cough is on the rise in the U.S., including the Philadelphia area. Staying up to date with your vaccinations can help protect you and your loved ones.

Whooping cough, also known as pertussis, comes as a vaccine in a combination with tetanus and diphtheria vaccines. The combo vaccination is known as tdap. Most people complete the initial series of vaccinations when they are young and the CDC now recommends a tdap booster every ten years for adults. Whooping cough can infect people at any age but those who are unvaccinated or are too young to be fully vaccinated are at most risk for serious complications, including death. It is important to make sure you are up to date with your tdap booster if you are spending much time around little ones as they most often contract the disease from a caretaker or family member. Expectant moms can get the tdap booster after the 20^th week of pregnancy or may be offered it immediately after delivery.

Whooping cough is spread from person to person by respiratory droplets, such as through coughing and sneezing. Droplets usually don’t travel more than three feet so reasonably close contact is required. Initial symptoms are similar to that of the common cold: runny nose, sneezing, and a mild cough. The cough then worsens to bouts of spasmodic coughing sometimes followed by a deep forced inhalation which can sounds like a ‘whoop.’ This phase of coughing can last one to six weeks, though sometimes up to ten weeks. Being vaccinated reduces the risk of contracting whooping cough and can decrease the severity of symptoms. If you have close contact with some with a confirmed diagnosis of whooping cough please contact the office, prophylactic antibiotics may be administered regardless of vaccination status.

For more information visit http://www.cdc.gov/features/Pertussis/

Top Ten Goals for Total Wellness

December 28, 2011

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Internal Medicine Blog

By: Jillan Rowbotham, D.O.

Consider making some of these goals the focus of your resolution for a healthier you in the new year.

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.

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?

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.

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.

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.

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.

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.

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.

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.

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!

Skin Cancer Signs, Symptoms, Causes, Treatments and Prevention

December 01, 2011

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Internal Medicine Blog

By: Marina Bachurina, MD

Dr. Bachurina is a board certified internist at RWWC . Prior to her internal medicine residency at Drexel's Easton Hospital, she was a Dermatologist in St. Petersburg, Russia.

Skin Cancer is the most frequently diagnosed type of cancer. It is usually caused by cumulative sun exposure. In its simplest form, the disease is the uncontrolled growth of abnormal skin cells.

Melanoma is the most dangerous type of skin cancer and the leading cause of death from skin diseases; it is not as common as other types of skin cancer, though the rate is increasing, especially in young people. People who are most at risk typically have fair skin, light eyes, light hair and a history of relatives diagnosed with Melanoma. Some common causes are living in sunny climates, spending a lot of time in strong sunlight, or having had one or more blistering sunburns during childhood. Another common cause is tanning. A weakened immune system, certain types of moles, or multiple birthmarks, can also be risk factors.

As a physician, I suggest checking your skin frequently, looking at the size, shape, color and texture of any suspicious areas. It is important to bring any changes or concerns to the attention of your physician. If a skin cancer diagnosis is suspected, a skin biopsy will be performed, and sent to the lab for further examination. Once melanoma has been diagnosed, CT scans or other types of x-ray tests may be done to see if the cancer has spread.
               

If you have had melanoma and recovered, it is very important to examine your body regularly for any unusual changes. Your risk for melanoma is increased once you have had this cancer. Melanoma may return years later.

For preventative measures, you should perform a self exam once a month, using a mirror to check hard-to-see places: call your physician at Rittenhouse Internal Medicine if you notice any changes. The American Cancer Society recommends professional skin examinations every year for people older than 40, and every 3 years for people 20 to 40. If you have a family history of melanoma, you will also need frequent skin exams. Most importantly, the best way to prevent skin cancer is to reduce your exposure to sunlight. When exposed, protect your skin with high-quality sunscreens, apply at least 30 min before exposure (even when going outdoors for a short period of time), use protective clothing and hats, and follow these guidelines in the winter too!

Which Over the Counter Medication Best Suits Your Needs?

October 28, 2011

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Internal Medicine Blog

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.

The Importance of Vitamin D

September 06, 2011

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Internal Medicine Blog

Vitamin D has been in the news a lot lately. It plays a major role in calcium absorption but recent research suggests it may do much more. Scientists have discovered vitamin D receptors on almost all tissues of the body meaning it may have a much larger effect on our health and development of disease than previously thought. This discovery has prompted increased interest in vitamin D and lots of buzz in the media about the potential benefits. First, it is important to understand where vitamin D comes from and if you may be at risk for deficiency. 

Vitamin D is the only vitamin that is also a hormone. It is sometimes called the “sunshine” vitamin because it is synthesized in the skin from direct exposure to ultraviolet B rays. This process requires direct sun exposure; indirect rays or light through a window does not contribute. Ten to 15 minutes of sunshine three times a week can be sufficient to prevent deficiencies. Your body’s vitamin D production can be hindered by being further from the equator, air pollution, cloud cover, and sunscreen use.

If you have been told your vitamin D levels are a little low don’t worry – you are in good company. A lot of women in our area have insufficient or deficient levels of vitamin D. This could be due to our latitude, responsible use of sunscreen to protect our skin, tall city buildings blocking direct sun rays, and working long hours inside. Other risk factors for low levels of vitamin D include advanced age, obesity, and having darker skin.

Vitamin D also occurs naturally in a few foods such as fish, oysters, and eggs. Because of this limited representation in the typical American diet, many foods are fortified with vitamin D. Vitamin D is often added to milk and other dairy products, soy milk, and breakfast cereals. Sometimes this is not enough and you may need to add a vitamin D supplement. Recommended daily value for adults under 70 is 600 IU a day; those over 70 require around 800 IU a day. You may be directed by us to take a higher dose for a period of time if your levels are low. Safety research supports an upper limit of a dose of vitamin D to be 10,000 IU daily. This does not mean that you should take 10,000 IU a day but that doses above that may be harmful. A dose of 1,000 to 2,000 IU a day is much more reasonable. If you are purchasing a vitamin D supplement look for vitamin D3, or cholecalciferol, over vitamin D2, ergocalciferol.

We have known for some time about vitamin D's role in helping the body absorb calcium, in maintaining bone density, and in preventing osteoporosis. New research suggests it may also help protect against chronic diseases such as certain types of cancers, cardiovascular disease, high blood pressure, autoimmune diseases, and mood disorders. It is important to remember that further research is needed in these areas to confirm these associations and determine what the role of supplementation might be. There is a lot more work to be done in this area and taking mega-doses of vitamin D is not recommended and may be harmful.

Protecting Your Skin in the Sun

July 31, 2011

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Internal Medicine Blog

No matter how diligent I try to be about applying sunscreen I always seem to end up with a burnt patch. I miss a spot, wash it off (the back of my hands and forearms are common causalities), or get caught up in the activities of the day and forget to reapply. Though new labeling guidelines starting next year will help us form a better understanding of what our sunscreen is and isn’t doing for us, sometimes the best option to protect our skin is to keep it covered up. But not all clothing is created equal.

The degree of protection clothing offers you is designated by a UPF rating, or Ultraviolet Protection Factor, a measurement of the amount of UV radiation the fabric prevents from reaching your skin. A UPF of 30-49 is considered very good protection, 50 and above is considered excellent by the Skin Cancer Foundation. Tightly-woven dark-colored fabric offers the most protection from the sun. Light colors, tight fitting items where the fibers are stretched, and wet clothes offer less protection. A white T shirt has an average UPF of 7, this goes down to only 3 when it is wet. If you can see through a fabric when you can hold it up to the light, then UV rays can get though to your skin. A good choice for a beach cover up would be a long-sleeved, dark denim shirt which has an average UPF of 1,700. You can also buy clothing specially treated with a chemical sun block to provide more protection, look for UPF labeling on these garments.

If dark denim is not the beach look you are going for this year, a wide-brimmed hat can offer protection roughly equivalent to an SPF of 5 for your face, ears, and neck and looks very chic paired with dark over-sized sunglasses. Look for a brim 3 inches or wider.

Clothing and accessories should be used to augment, not replace, the protection provided by sunscreen. You should still regularly use a sunscreen with SPF of 15 or higher and try to remember to reapply often.

For more information on new sunscreen labeling guidelines that will take affect summer 2012 visit www.fda.gov/sunscreen.

Managing Your Medical Records

June 02, 2011

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Internal Medicine Blog

Whether you have been relatively healthy your whole life or have been juggling a few chronic medical conditions, everyone can benefit from keeping a home record of their medical history. Though our office Electronic Medical Record system is able to keep an up to date account of your medical history, you want to be prepared for when medical emergencies happen on vacation or if you find yourself moving out of town or out of state. After all, you are your first and best healthcare advocate. Whether you want to store your information in a computer file or Google document or prefer to write things down in a dedicated notebook, every home medical record should contain the following:

- Current and previous medical conditions and any past surgeries, including when and why they were done.

- A current account of your family medical history including your siblings, parents, and grandparents.

- Allergies you have to any medications or foods.

- A list of current medications, don’t forget to include any vitamins or supplements.  You should also keep a separate list of medications you have taken and did not like or did not find helpful so that these can be avoided in the future.

- Dates of any adult vaccinations – you need a tetanus booster every ten years so this is one that people often lose track of.

- Dates and results of screening tests like PAP smears, mammograms, and colonoscopies. This will help ensure you do not fall behind on important cancer screening tests. Also, some insurance plans will not cover these tests if they are done too soon so knowing the dates can keep you from having to foot the bill.

- Any blood work and imaging tests (X-rays, CT scans, MRIs, etc) and when, where, and why they were done (i.e. what symptoms you were having that prompted the testing).

- Names of previous doctors you have seen and the practice address and phone number in case records need to be obtained at a later time

It can be useful to obtain and keep a copy of blood work or imaging studies for your own records but keep in mind lab and radiology reports are written by health care professionals for health care professionals. Many times the significance of results needs to be interpreted in the context why the tests were ordered. Variation from the range of normal does not necessarily indicate a serious problem and there are many things that may be incidentally discovered on CT scans and MRIs that don’t mean anything negative to your health. Please be judicious with what and how you Google and if you ever have questions about previous blood work or imaging results please let us know! We would be happy to answer any questions you have.

Are You Drinking Too Much Alcohol?

March 31, 2011

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Internal Medicine Blog

I am often concerned that patients are drinking too much, yet find the conversation about alcohol difficult. Many women are unaware that the maximum per day that a women should drink is one drink a day (one beer, glass of wine or one shot) The safe amount for men is two drinks per day. The reasons for this gender differences include women’s lower body size, percentage of body weight composed of water, and differences in metabolism.
 
I often get the impression that when women think of alcohol abuse or alcoholism they think of the homeless person on the street who is drinking at 10 am. They don’t think of women who drink a half bottle of wine each night or a few martinis as having a problem.
 
Women suffer from the health consequences of excess alcohol at much lower levels of alcohol consumption. We all know that excess alcohol affects the liver and can lead to permanent liver damage. Alcohol is also associated with a linear increase in breast cancer incidence, so the more you drink the higher your risk.Alcohol is also associated with cardiomyopathy (a degenerative disease of the heart muscle), brain shrinkage, pancreatits, colon cancer and other gastrointestinal cancers.
 
If you think you may be drinking to much, start with this survey http://www.alcoholscreening.org/Home.aspx. If you want to cut back on your drinking, the first thing is to remove alcohol from your home. If you are having problems cutting back, they are many programs and private counselors that we can recommend.

Managing Springtime Allergies

February 28, 2011

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Internal Medicine Blog

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.

For more information on Dr. Rowbotham’s practice, click here.

Early to Bed, Early to Rise

January 31, 2011

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Internal Medicine Blog

An important part of keeping your immune system strong during this winter’s cold and flu season is making sure you get enough sleep. Adults need around seven to eight hours of sleep a night, but many fall short of that. If you are having trouble sleeping there are a few adjustments you can make at home that just might help you get the sleep you need.

Create a routine to help prepare your mind and body for sleep

• Establish a relaxing bedtime routine such as taking a warm bath and reading for 10 minutes before going to bed. By doing the same thing every night before going to sleep eventually these activities will help you feel sleepy.
• If you find that your mind races when you try to go to sleep, putting your thoughts down on paper can help get them out of your head. Try writing in a journal an hour or so before you go to bed. You want to avoid doing any activities that may be mentally or emotionally stimulating right before you try to go to sleep.
• Resist the temptation to ‘sleep in’ on weekends or days you don’t have to work. It is better to have a regular bedtime and waking time.

Create a calming sleep environment

• Your bedroom should be dark, quiet, cool, and tidy. Visible clutter can keep your mind active and add to stress. If noise is a problem, a humidifier this time of year can provide soothing white noise as well as some much-needed moisture into the air.
• Use your bed only for sleeping or for having sex. Avoid watching TV, talking on the phone, or eating in bed.
• Keep all bedroom clocks out of sight. Clock watching can add to stress and makes it harder to fall asleep.

Pay attention to the timing of activities

• Try not to consume caffeine after lunch; it can take from 6-8 hours to eliminate just half of the caffeine you ingest. Even if you are able to fall asleep shortly after consuming caffeine, its stimulant effects still prevent your body from reaching the deeper, more restorative levels of sleep.
• Limit or stop using nicotine and alcohol close to bedtime. Though alcohol may initially make you feel sleepy, it often causes you to wake up in the middle of the night.
• Exercise daily in the morning or afternoon. Exercising at night can make you too alert to fall asleep.
• Don’t eat a large meal close to your bedtime.
• Avoid daytime naps, they can be disruptive to your efforts to have a set bedtime and may lead to fewer hours of sleep in a 24 hour period.

Consistent use of these techniques and reestablishing routines takes time and effort, but a good night’s sleep is well worth it!

For more information on Dr. Rowbotham’s practice, click here.