Rittenhouse Women’s Wellness Center

Spring is Here. Get Ready to Exercise!

May 01, 2013

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Internal Medicine Blog

By Dr. Monica Duvall

 

Now that the weather has (finally!) started to improve, many of us are focused on getting outside for some fresh air and fitness. But what's the best way to do this safely, with the maximum benefits to our health? Variety and moderation are the keys.

 

Exercise is any physical activity designed to improve/maintain some aspect of physical fitness. The benefits of exercise are numerous--risks for diabetes, high blood pressure, osteoporosis, cardiovascular disease, and stroke are all reduced in those who exercise regularly. Mood is improved, and life expectancy is increased. Although every individual's exercise program should be tailored to her own preferences, abilities, and lifestyle, the health goals are basically the same for all. There are 4 main types of physical activity that help to achieve these goals:

 

1. Aerobic exercise: increases the blood flow to your heart and conditions the heart muscle. This type of exercise includes running, walking, swimming, etc. You should aim to get 30 minutes of moderate aerobic activity 5 days a week (this may be broken up into 10-minute intervals throughout the day) for maximal benefit.

 

2. Weight training: strengthens muscles and supports bone strength. This is the type of exercise that prevents osteoporosis and bone fractures. At least one set of twelve repetitions for each major muscle group is recommended, two or three times weekly.

 

3. Stretching: improves flexibility and balance and reduces the risk of injury. You should stretch each joint and hold for at least 10 seconds. Yoga is a great example of a stretching program.

 

4. Avoidance of inactivity: refers to a multitude of choices made throughout the day to be active instead of sedentary. A number of studies have shown that reducing the amount of time spent sitting--watching TV, etc,--has active health benefits above and beyond traditional forms of exercise. So get up and do the dishes, even if you have a dishwasher. Take the stairs instead of the elevator. Fidget!

 

Most people can begin an exercise program slowly and safely and work up to a level that is well-tolerated and sustainable. However, anyone with diabetes or cardiovascular risk factors should discuss the need for stress testing prior to initiating a new exercise program. Other health concerns can be discussed with your doctor on a case-by-case basis, to make sure that your regimen does not aggravate existing conditions. Of course, it is always important to stay well-hydrated when exercising, and make sure you are appropriately attired for the type of exercise and the conditions in which you will be exercising. Finally, it is important to be aware of warning signs that could be a sign of a serious problem while exercising--such as chest pains, difficulty catching your breath, dizziness, extreme fatigue, or joint pains--stop exercising if you have these symptoms, and seek medical attention.   By being smart and sensible, and creating a well-rounded exercise program, you can improve your overall level of fitness and wellness.

 

Good luck!

Do You Need an Antibiotic for Your Cold, Cough, or Sinus Infection? Usually, the Answer is NO

December 27, 2012

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Internal Medicine Blog

By: Dr. Monica Duvall
 
Now that we are in the thick of winter, many of us have been getting sick with respiratory illnesses. A typical first reaction in this situation is "I'd better see my doctor right away for an antibiotic before this gets worse". But in the vast majority of cases these infections are caused by viruses, and antibiotics (which only treat illnesses caused by bacteria) are unhelpful.
 
Take the common cold. Symptoms of a cold are sneezing, runny nose, sore throat, and nasal congestion. Colds are ALWAYS caused by viruses, and therefore, antibiotics will NEVER cure a cold. The goal of treatment is to manage your symptoms with medications and other therapeutic measures until the symptoms resolve, usually anywhere from 3-14 days for complete symptom resolution. Options for management of cold symptoms include over-the-counter decongestants such as pseudoephedrine, antihistamines such as diphenhydramine for runny nose and sneezing, and acetaminophen or ibuprofen for sore throat. Drinking plenty of fluids and getting adequate rest will also help you to feel better while you are sick, although these things will not shorten your illness.
 
Another common infection people develop this time of year is acute sinusitis, or inflammation of the nasal passages and sinuses. Symptoms can include nasal congestion, pain in the teeth or face, thick yellow or green nasal discharge, ear pressure or fullness, and occasionally, fever. The vast majority of sinus infections--more than 98%!--are also caused by viruses, so again, antibiotics will not help or shorten the duration of your symptoms. It can take 7-10 days before a typical sinus infection starts to resolve. Symptoms that suggest a bacterial sinus infection are fever over 102 degrees, sudden worsening of symptoms in the middle of your illness, or an illness that lasts 7-10 days without any improvement--in these cases, it is prudent to schedule an office appointment for an evaluation without delay. You may also schedule an appointment if over-the-counter medications are not controlling your symptoms adequately. Typically, however, the mainstay of management of acute sinusitis is to treat symptoms with nasal decongestants/sprays, nasal saline irrigation, and acetaminophen or ibuprofen for pain (limit the use of nasal sprays such as Afrin to 3 days, as longer use can actually worsen congestion).
 
The last type of infection we commonly see this time of year is Bronchitis, or inflammation of the large airways in the lungs. Bronchitis presents as coughing and congestion in the chest (commonly described as a "chest cold"), along with mucus which can be yellow or green in color. Again, most of these illnesses are caused by viruses, frequently in conjunction with common cold symptoms, and it can take up to 2-3 weeks before the cough completely resolves (although you should be improving over this time period). Over-the-counter cough medications may offer modest relief of cough symptoms; using a humidifier may also soothe cough and sore throat. Some studies suggest that a teaspoon of honey may be beneficial in soothing cough, as well. Symptoms that may signal a more serious lung infection--such as the flu or pneumonia, or the bacterial infection Bordetella pertussis ("whooping cough")--include high fevers, fatigue and body aches, coughing up blood, shortness of breath, chest pains, or a barking cough. If you have any of these symptoms, antibiotics or other prescription medications may be indicated, and you should call the office right away to schedule an appointment.
 
The take-home point is that most of the respiratory infections you may develop this time of year are caused by viruses, and can be safely and effectively treated at home with over-the-counter medications, rest, and TIME. If you do develop a respiratory illness and you are not sure how serious your symptoms are, if any of the "flag" symptoms noted above are present, or if you have a chronic respiratory or other condition that may complicate your illness or treatment, you should always contact us to discuss how you're feeling or schedule an appointment for an evaluation in the office.

Should I Be Vaccinated Against Pertussis?

November 29, 2012

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Internal Medicine Blog

By: Dr. Leslie Saltzman 

Pertussis, also known as “whooping cough,” is a highly contagious, acute respiratory illness caused by Bordetella pertussis bacteria. The name comes from the Latin term meaning “intense cough.”

Over the last few years there has been an increase in the number of cases reported, with outbreaks reported in Pennsylvania.

The classic symptoms of pertussis include cough, an inspiratory whooping sound and vomiting after spells of coughing. However in adults, the symptoms are often much milder. It is thought that pertussis is responsible for 13-20% of cough illnesses lasting for more than one week in adolescents and adults. Most adults have much longer illnesses lasting from 3-6 weeks. Infants and young children typically contract the illness from adults. Each year pertussis causes approximately 300,000 deaths.

Individuals with pertussis are considered infectious until they have completed five days of appropriate antibiotic treatment.

An important misconception is that childhood pertussis vaccination confers lifelong immunity. Protective immunity wanes after 5 to 10 years and rarely lasts more than 12 years. Therefore, booster vaccination is recommended for adolescents and adults. In 2006 Tdap (Adacel) vaccine was introduced specifically for adults. It is recommended that all adults receive this vaccine one time.

The vaccine is generally well tolerated. It can cause injection site pain, headache, fatigue, GI upset and in rare cases flu like symptoms.

 

 

The Facts About Neti Pots

October 29, 2012

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Internal Medicine Blog

By: Jillan Rowbotham, D.O.

As we transition from fall allergy season to the winter cold and flu season many people are looking to alternative solutions for relief from mucus and nasal congestion. Nasal saline irrigation, often administered with a neti pot, has become a popular adjunct therapy. Reports of deaths from amebic brain infections linked to neti pot use were widely publicized in the media and raised some concern about this therapy. Before you take the plunge it is worth asking - are neti pots effective and are they safe?

A neti pot is a container with a spout that is designed to irrigate the nasal passages, usually with a salt water solution. The spout of the neti pot is placed in one nostril as the head is tilted and the solution flows into one nostril and out the other, flushing out mucus and particulate matter with it. They are used for head colds, sinus problems, allergies, and some people irrigate their nasal passages daily as part of their general health routine.

Though there are many enthusiastic neti pot users out there, the evidence for the true benefit of nasal saline irrigation is sparse and inconsistent. In one study of chronic rhinosinusitis (inflammation of the nasal and sinus passages persisting over 12 weeks) daily use of nasal saline irrigation showed a 64% reduction in overall symptom severity. However, there is some concern that ongoing daily use of nasal saline irrigation may make a person more susceptible to infection by washing away the protective layer of “good” mucus that acts as a first line of respiratory defense. For use with allergies, acute upper respiratory infections (colds), and nasal inflammation of pregnancy there is even less data on efficacy but, overall, safety and tolerability across the board looks good.

Fewer than 10% of people using nasal saline irrigation report adverse effects. The most common include a sensation of ear fullness, stinging of the nasal passages, and in rare occasions nosebleeds. The most serious concerns related to neti pot use have to do with the solution that is used in the neti pot, not the technique itself. You can make your own solution at home with purchased salt packets or by adding ¼ tsp salt per cup of water. The water you use to prepare the solution is very important and the CDC recommends it be bottled water that has been distilled or sterilized. Tap water can be used but only if it has been boiled for 5-7 minutes then allowed to cool.

There are organisms in bottled and tap water that are okay for drinking but can be harmful if introduced deeply into the nasal or sinus passages. In the deadly cases of amebic brain infections linked to neti pot use evidence of the causative ameba was found in the home plumbing. Other organisms cultured from hot water heaters have also been implicated in cases of chronic sinus infections in regular neti pot users who did not prepare their water correctly. You should make up fresh solution each time you use your neti pot. Care must also be taken to clean and completely dry the neti pot after each use.

Since it is generally well tolerated and safe when the proper solution is used, nasal saline irrigation, including the use of neti pots, can generally be recommended. Though hard evidence is lacking it is unlikely to hurt you and it just might help so go ahead and give it a try.

 

The Importance of Cervical Cancer Screenings

September 24, 2012

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Internal Medicine Blog

By: Monica Duvall, M.D.

Cervical cancer, while one of the most prevalent diseases affecting women around the world, has seen markedly reduced incidence in the US over the past few decades due to a number of developments in prevention and screening. Risk factors for cervical cancer include early age at first intercourse, multiple sexual partners, multiple births, smoking, and immunodeficiency. It has further been established that the vast majority of cervical cancers are caused by "high risk" strains of the HPV, or Human Papilloma Virus, which affects cervical cells. Efforts at preventing cervical cancer in this country have focused on modifying certain lifestyle choices that put one at increased risk, as well as the development of vaccines against the HPV virus, and of course, screening with the pap smear test.

The many HPV virus subtypes are transmissable through sexual activity, including oral-genital and skin-skin contact. HPV infection is extremely common in sexually active women. In women under 30, the infection often clears in a couple of years, but in older women it can linger. Condoms do have some efficacy in preventing the spread of HPV, so it is important to use them consistently. In addition, the Gardasil vaccine, which is available here at RIM, was FDA-approved in 2006 for girls/women ages 9-26 (and more recently, for boys/men in the same age group, as well). This three-shot vaccination series protects against 2 types of high-risk HPV which are responsible for about 70% of all the cervical cancer cases in the US, as well as two types of HPV which cause genital warts. At this point, it is unknown how long the protection afforded by the vaccine lasts, and it does not yet change the pap smear screening interals for vaccinated individuals, but it does offer another level of protection against cervical cancer.

Chocolate: The New Health Food?

September 20, 2012

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Internal Medicine Blog

By: Monica Duvall, M.D.

 

Just in time for Easter, a new study has found that healthy people who eat chocolate regularly are slimmer than those who eat chocolate less often--good news for those of us with a sweet tooth! The study assessed data from more than 1000 people aged 20-85. The subjects reported eating chocolate an average of 2 times a week, while exercising an average of 3.6 times a week and following a healthy diet. Those who ate chocolate more frequently (5 times a week) had a body mass index which was one point lower than those who did not eat it as regularly. Body Mass Index, which measures body fat from a person's height and weight, is optimally between 18 and 25. For the average American woman, who is 5'4", a 1-point difference in BMI translates to a difference of about 6 pounds--pretty significant!

 

This study comes on the heels of other research over the past couple of years which has suggested a variety of additional health benefits related to chocolate. Last summer, a British study which analyzed data from over 100,000 people concluded that those who ate the most chocolate on a regular basis had a 37% lower risk of heart disease, a 31% lower risk of developing diabetes, and a 29% lower risk of stroke than the others. Earlier studies by researchers at Harvard showed associations between chocolate or cocoa consumption and decreased blood pressure, deceased LDL (bad) cholesterol, increased HDL (good) cholesterol, and decreased insulin resistance (a hallmark of Diabetes).

 

These positive health benefits can be traced to powerful antioxidants called Flavonoids which are found in the cocoa bean. Flavonoids help fight inflammation, improve blood vessel flow, and may have effects on metabolism. Chocolate with higher cocoa content has more flavonoids, and presumably, confers more of the benefits everyone is talking about.

 

A caveat of the above studies is that they did not identify the optimal amount of chocolate necessary to confer benefit, nor did they specify what type of chocolate the study subjects were eating.   And of course, much processed chocolate is loaded with sugar, fat and calories. So what is the takeaway here--how to make use of this exciting news? The answer is somewhat elusive for now, but for those who are looking for a DAILY chocolate fix, an ounce of either dark or unsweetened chocolate, with respective cocoa contents of 70% and 100%, seems to be a smart choice. An alternative is pure cocoa powder, which can be added to coffee or other foods once a day. The key is to choose chocolate with a high cocoa content--and enjoy it in moderation.

Essential "to do's" for the Upcoming Months

August 28, 2012

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Internal Medicine Blog

By: Leslie Saltzman, D.O.

I love September, it reminds me of the excitement I felt as a kid at the start of every school year. As September begins, it’s a great time to plan for the weeks and months ahead. For me that means planning the workouts and scheduling the doctor’s appointments now. What is essential?

• Vigorous aerobic exercise at least 75 minutes weekly plus weight strengthening twice weekly
• Annual physical
• Flu shot
• Tetanus Booster (every 10 years)
• Gyn exam/ pap smear (at least every 3 years), annually if you’ve had an abnormal pap or gyn cancer
• Dental exams/ cleanings at least twice a year
• Eye exam (frequency depends on age)

Over 40:

All of the above plus:

• Mammogram (every 2 years between 40-50)

50+:

All of the above plus:

• Annual Mammogram
• Colonoscopy

60+:

All of the above plus:

• Shingelles (Zostax) vaccine
• Dexa scan
• Pneumovax (age 65) you may need this earlier

Have a great fall.

Dr. Saltzman

Tick Bites: Prevention and Removal

July 30, 2012

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Internal Medicine Blog

By: Jillan Rowbotham, D.O.

As you head outdoors to get the most out of these last few weeks of summer mosquitoes aren’t the only biting insects you have to worry about; ticks are also looking to make a meal out of you. Ticks can get on you if you walk through areas where they live such as tall grass, leaf litter or shrubs. Ticks are more than just a creepy nuisance, they can also transmit disease. Though most tick bites will not make you sick, you do want to remove any tick as soon as possible. Ticks can be as small as a poppy seed so when you come in from the outdoors be sure to examine you scalp and skin carefully. Don’t forget to check your ears and belly button. If you find a tick the following steps can help you remove it quickly and safely.

Gently clean the area with an antiseptic solution or soap and water. Take care not to scrub the tick too hard, just clean the skin around it.

Use fine-tipped tweezers to grasp the tick as close to the skin's surface as possible. Do not grab the tick around its belly, you could push infected fluid from the tick into your body if you squeeze it.

Gently pull the tick straight upward with steady, even pressure. Do not twist; this can cause the mouth parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers. If you are unable to remove the mouth easily with tweezers, leave it alone as they will normally be expelled spontaneously.

After the tick has been removed, wash the area of the tick bite and your hands with soap and water.

You can put the tick in a dry jar or ziplock bag and save it in the freezer for later identification.

Do not try to smother a tick that is stuck to your skin with petroleum jelly, nail polish, or rubbing alcohol. Do not burn the tick while it is stuck to your skin. These methods don't get the tick off your skin and can cause the insect to burrow deeper and release more saliva which increases the chances of disease transmission.

You can reduce the likelihood of getting bit by avoiding tick-infested areas, walking in the center of trails while hiking, using an insect repellent with DEET, and wearing long sleeves and tucking your pant legs into your socks if you are going to be in high brush or hiking. Ticks can ride into the home on clothing and pets then attach to a person later so carefully examine pets, clothing, and bags. Put your clothes in the dryer on high heat for an hour to kill any hidden ticks.

If you find a tick that you think has been attached for more than 36 hours please contact the office, antibiotic prophylaxis to prevent Lyme disease may be appropriate. Though most ticks do not transmit disease be sure to come into the office if you develop symptoms such as a rash, fever, headache, fatigue, muscle aches, joint pain, or flu-like symptoms after a tick bite.

What You Need to Know About Acid Reflux

June 28, 2012

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Internal Medicine Blog

By:  Monica Duvall, M.D.

Most of us have experienced heartburn at one time or another--or know someone who has.  A tight or burning sensation develops in the center of the chest, usually in response to overindulgence of certain trigger foods, and is resolved with antacids--nothing to worry about, right?  Not necessarily. 

Acid reflux occurs when stomach contents, including stomach acid, wash back into the esophagus.  This is caused by weakness of the lower esophageal sphincter, which separates the stomach from the esophagus.  When this happens, people experience symptoms such as heartburn, regurgitation, or trouble swallowing.  Less well-known symptoms of acid reflux can include airway spasm, cough, laryngitis, nausea, and "globus", which is a constant foreign body sensation in one's throat. 

Many people will experience some "physiologic" reflux which is brief and without adverse consequences.  But for a number of others, reflux can be more persistent, and cause other complications over time if left untreated.  These may include ulcer, esophagitis (inflammation of the esophageal tissue), stricture (narrowing of the esophagus), and Barrett's esophagus, which increases the risk of cancer of the esophagus.  Asthma and sinus infections have also been linked to uncontrolled reflux symptoms.  Reflux which produces mild symptoms 2 or more times a week, or moderate to severe symptoms at least once a week, needs treatment.  In this situation lifestyle modification, as well as a trial of an antacid medication, is indicated for a period of time. The two types of medications commonly used are H2 blockers and proton pump inhibitors--both are available over-the-counter, but should be taken under a doctor's supervision so that therapy can be adequately monitored and adjusted as needed.  If reflux symptoms cannot be controlled with a trial of lifestyle changes and medication, then the American Gastroenterological Association recommends endoscopy with biopsy to rule out other conditions and to look for worrisome changes in the esophagus that may result from chronic acid exposure.  

Individuals can minimize their symptoms of esophageal reflux by avoiding trigger foods, such as chocolate, fatty or spicy foods, and alcohol.  Acidic beverages such as red wine or orange juice may also exacerbate reflux symptoms.  Remaining upright after eating and elevating the head of the bed has been shown to be helpful, as well as weight loss and smoking cessation (to promote more salivation, which neutralizes the stomach acid).  But the most important thing is recognizing the symptoms of reflux and seeking treatment early to prevent complications from this common condition.

Endocrine Disruptors and How to Lower Your Risk

May 31, 2012

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Internal Medicine Blog

By: Leslie Saltzman, D.O., Medical Director

An endocrine disrupter is a chemical that can disrupt or interfere with the proper functioning of the endocrine system. The endocrine system consists primarily of glands that produce hormones that help to guide the development, growth, reproduction, and behavior of human beings and animals. Hormones work by attaching to specialized receptors on cell surfaces. A problem can occur if a chemical (instead of a natural hormone) binds to the receptor and blocks the action of the hormone. Consequently, normal biological function can be blocked by the presence of endocrine disrupting chemicals.

These days there is growing evidence linking this class of chemicals to problems in humans. These include breast cancer, infertility, low sperm counts, genital deformities, early menstruation and even diabetes and obesity.

Endocrine disruptors are everywhere. They’re in thermal receipts that come out of gas pumps and A.T.M.’s. They’re in canned foods, cosmetics, plastics and food packaging. Test your blood or urine, and you’ll surely find them there, as well as in human breast milk and in cord blood of newborn babies.

 

• Food and drink storage: Avoid plastic:
  • Use refillable stainless steel or glass water bottles when on the go;
  • Store and heat food in glass, ceramic, or paper; not plastic
• Food packaging: Avoid BPA Opt for:
  • Fresh or frozen fruit and veggies;
  • Dry beans;
  • Food and drink packaged in glass, not cans;
• Fish: Avoid mercury, dioxin, and PCBs in fresh water fish and ocean fish:
  • Trim fat from all fish to minimize dioxin and PCBs;
  • Choose small non-predatory fish (salmon, perch, trout, tilapia, whitefish, pollock, etc) to minimize mercury;
• Pesticides: Teething toys: Give babies teethers made of natural materials: cotton, wood, etc.;
  • Opt for organic food (especially meat and dairy when possible) or food consistently low in pesticides (Get the list);
  • Use non-toxic strategies to fend off pests inside the home, on the yard, and on your pets;
  • Encourage non-toxic alternative to pesticides in your child’s school;
• Personal Care Products: Check cosmeticdatabase.org for a safety rating of over 69,000 personal care products. There’s a special section for “babies and moms” that lists baby wipes and diaper creams to avoid;