Internal Medicine Blog

April: Sexually Transmitted Infection Month

By: Maria Mazzotti, DO

April is Sexually Transmitted Infection month. Typically the nicer weather that comes with Spring causes an upsurge in STI’s. People are getting out more and meeting more people which may lead to more sexual encounters. 

Chlamydia is the most common sexually transmitted infection, especially in males and females between the ages of 20-25. Often times patients may not even have symptoms, but if left untreated in females it can lead to infertility. Once diagnosed, it is easily treated with antibiotics.

Gonorrhea is another common STI. In addition to it being found in the mucus membranes of the cervix, uterus and fallopian tubes, it can commonly infect the mucus membranes of the mouth, throat, eyes and rectum. .  Prolonged or undiagnosed gonorrhea infections can also lead to infertility, however this infection can also be treated fully with antibiotics once diagnosed.

Chlamydia and Gonorrhea cause 30-50% of a very serious complication of infections called Pelvic Inflammatory Disease. Symptoms of PID include lower abdominal/pelvic pain, increased discharge, irregular menstrual bleeding, fevers, pain with intercourse, urinary frequency and pain, cervical motion tenderness and inflammation. In addition to being sexually transmitted, these infections can be transmitted through pregnancy/delivery to newborns.

Trichomoniasis is a lesser known STI, but this infection seems to be on the rise. It is also treated with antibiotics. Fortunately, this parasite is not transmitted to newborns through pregnancy/deliveries. All of the above infections are diagnosed with a vaginal swab or urine test in females.

Syphilis is a less common infection these days. In addition to being transmitted sexually, it can also be transmitted through contact with blood products and with pregnancy. Unlike the previous infections, symptoms may (but don’t have to)include a rash and sores in the genital, rectal and mouth areas. Once diagnosed it is treated with antibiotics, but if left untreated it can lead to serious neurological complications.

Another infection that may present with genital lesions is Genital Herpes. This is a viral infection, and unlike the previous infections mentioned above, it is not curable. Antivirals will resolve acute symptoms and future outbreaks. These medications also suppress transmission to future partners. This infection can also be transmitted to newborns with pregnancy/delivery. Currently, the only way to diagnose this infection is with a culture of the lesion (usually obtained by a swab, but this has to be taken during an outbreak).

Hepatitis C has also been considered a sexually transmitted disease in the past, however newer studies show us that sexual transmission of this virus is not very effective. That being said, hepatitis C is still more likely to be transmitted sexually in people with other illnesses (such as HIV or diseases requiring dialysis) and those who may have wound-healing issues. The most common mode of transmission for HCV is parenteral through sharing needles or other instruments. This infection can also go undiagnosed for decades due to the varying severity of viral symptoms. Newer treatments can cause the virus to be undetectable.

Human Immunodeficiency Virus (HIV) is another sexually transmitted infection. In addition to being sexually transmitted it can be passed along in blood products and with pregnancy/delivery. At this time there are multiple regimens that will keep the infection under control or make the virus undetectable.  

Syphilis, Hepatitis C and HIV can be diagnosed with a blood test. When anyone is diagnosed with any of the infections mentioned so far, physicians are required to report the infection to the local health department. The local health department is in charge of preventing the spread of these infections as well as tracking the number of people being infected.

Human Papilloma Viral infections are transmitted with vaginal, rectal and oral sex. There are numerous strains that can cause cervical, rectal and laryngeal cancer. Certain strains also cause warts in these areas. There is no treatment for the infection, but this virus is the only virus which has a vaccine that can be used to prevent the common strains that cause Cervical, Vaginal, Vulvar, Anal, Throat and Penile Cancer. HPV vaccines are recommended for males and females from ages 9-26. 

At this point this summary has probably caused a lot of anxiety about being sexually active. It is important to remember that condom use with every sexual encounter can prevent most transmissions of these infections. Obviously, coming in for regular screenings for cervical cancer or STI screenings, even though they can be scary or painful, is important to you and your partner’s health. The safest thing to do is to Know Your Status! If you have not had STI screenings in some time and have been sexually active without protection - please don’t hesitate and schedule an appointment with one of our providers today. Do not hesitate to take the time to ask any questions that you are uncertain about. Having knowledge about your STI status and what infections are out there can help you make educated decisions about your health!

Seizure First Aid

By: Monica Duvall, MD

A seizure is a type of abnormal or excessive electrical activity in the brain that results in changes in a person's awareness and/or behavior. Seizures can be triggered by different mechanisms--head trauma, stroke, infection, tumor, low blood sugar, and excessive alcohol are some causes--and they often come without warning.The person who has a seizure may be injured during the seizure, and s/he may be confused or embarrassed afterward. Awareness of what happens and what to do during a seizure can help to keep the person seizing safe and calm.  

There are many types of seizures. Tonic-clonic, or Grand Mal, seizures are what most people think of when they hear the word "seizure", and this is the most common seizure situation in which first aid is needed. In this situation, a person loses consciousness for anywhere from seconds to a few minutes. The person typically becomes stiff and will have severe jerking movements. Often they lose control of their urine or have a bowel movement. Frequently they have very shallow breathing or may appear to not be breathing at all. Afterwards, the person will have a period of confusion, with no memory of what has happened. The person will likely be scared and embarrassed.

When a person has a Tonic-clonic seizure, it is important to remain calm. Delegate someone to call 911.  The person should be eased to the ground and rolled to his/her side, with the mouth facing downward to allow saliva to drain so s/he can breathe easily. The area should be cleared of any sharp or hard objects that could injure the seizing individual. Eyeglasses should be removed, tight clothing (like a necktie) should be loosened, and a soft item, like a pillow or jacket, should be placed under the head to prevent injury.  You should NOT restrain the seizing person, nor should you place anything in the person's mouth while they are seizing, even if you think they are not breathing.  People who are seizing CANNOT swallow their tongue, but they can choke on or be injured by other things that are placed in the mouth. If someone does stop breathing during a seizure, it is appropriate to start performing CPR only AFTER the seizure is over. Try to keep track of how long the seizure lasts, if possible. Keep crowds away, so the person seizing will not be overwhelmed when s/he returns to consciousness. When the seizure is over and the patient becomes more alert, explain in simple terms what has happened. You should stay with the person until they have fully recovered and/or until medical help arrives.  

Having a seizure is a frightening and dangerous occurrence; as a bystander, remaining calm and knowing what to do in this situation can help to prevent further injury to the seizing individual, and bring much-needed comfort to him/her at a critical time.

Blood Pressure and Your Heart

By: Maria Mazzotti, D.O. 

February is American Heart Month. There has been a long debate in medicine about which organ is more important, the heart or the brain. I am not sure we have reached a conclusion, but your heart is a vital organ. Prolonged elevated blood pressure is one of the main factors contributing to heart disease (as well as kidney disease).

Your blood pressure reading is made up of two numbers. When either or both are elevated this is called hypertension. Your systolic blood pressure (the top number in your blood pressure) is a reflection of the pressure in your heart when the blood is returning to your heart. The Diastolic blood pressure (bottom number of your blood pressure reading) is a reflection of the pressure your heart is pushing against to get the blood out of your heart to the rest of your body.

     -Normal blood pressure: systolic <120 mmHg and diastolic <80 mmHg

     -Prehypertension: systolic 120 to 139 mmHg or diastolic 80 to 89 mmHg

     -Stage 1 hypertension: systolic 140 to 159 mmHg or diastolic 90 to 99 mmHg

     -Stage 2 hypertension: systolic ≥160 mmHg or diastolic ≥100 mmHg

     -Isolated systolic hypertension: blood pressure of ≥140/<90 mmHg

     -Isolated diastolic hypertension: blood pressure <140/≥90 mmHg

There are multiple factors that impact your blood pressure. Genetics, age, weight, stress and diet can all contribute to causing hypertension. Obviously, you cannot do anything about your genetics and aging. However, we know our blood pressure may go up with weight gain and it can go down with weight loss. Caffeine, alcohol, processed foods, spinach, canned soups, red meat and licorice can increase your blood pressure also. Alternatively foods like flax seed, dark chocolate, olive oil, beets, pistachio, broccoli, bananas, yogurt, white beans, red bell peppers, citrus, seafood, whole grains, and kiwi can lower your blood pressure. Many of the blood pressure lowering foods are high in Calcium, Magnesium and Potassium (Also known as the DASH diet).   

Aside from diet, there are additional ways to decrease your blood pressure:  

  • Exercise and meditation
  • Controlling stress and anxiety
  • Treating any other illnesses you have that may impact blood pressure - such as diabetes.
In turn, your blood pressure can impact other organs. Elevated blood pressure can enlarge your heart, damage your blood vessels (which can, in turn, increase your blood pressure even more), affect your eyes and kidneys. Significant damage to these organs can lead to strokes, kidney failure and heart attacks.  

So during American Heart Month, be kind to your heart.  Focus on watching your diet, exercising and keeping your stress level down and you know you will have done all that you can to control your blood pressure. And in turn you will have one less risk factor for heart disease.

Preventing Vaginal Infections

By: Dana Shanis, M.D.

Most women have experienced a vaginal infection at some point in their lives and know how it can not only be uncomfortable, but can interfere with daily activities. These infections occur when the natural bacteria that live in the vagina, primarily Lactobacillus types, are unable to thrive. When present in the vagina, these bacteria create a byproduct that keeps the environment acidic, prevents attachment of bad bacteria and yeast, and promotes the local immune system to fight infections. 

Anything that changes the pH of the vagina can reduce or wipe out the good bacteria in the vagina and put you at risk for an infection. This can include stress, medical illnesses, and vaginal irritation by soap, detergents, or lubricants. Changes in hormone levels, due to birth control pills, your period, or around menopause can also affect the vaginal pH and increase the chances of an infection. Taking antibiotics can directly kill the good bacteria and is a significant risk factor for yeast infections. 

Since most of the bacteria in the vagina originate in the intestines, the best way to ensure there is enough good bacteria is to have a diet rich in probiotics. Dairy products and fermented foods (such as those listed below) are especially high in the strains of bacteria helpful in maintaining the vaginal environment. While getting probiotics from food is preferred, if needed, oral supplements can be used as well. Supplements with multiple Lactobacillus species, including L. acidophilus, are the most effective in restoring good bacteria to the vagina. It is also important to have adequate fiber intake in your diet to avoid constipation. Straining can irritate the pelvic floor muscles and cause spasms and inflammation, which can affect the local pH in addition to causing pelvic pain. 

Tips for Maintaining and Restoring Good Bacteria

      Use dye-free and fragrance-free soaps, detergents, tampons, and pads

      Avoid excess moisture by drying area after showering, wear cotton underwear

      Consider sensitive lubricant and/or latex-free condoms

      Do NOT douche

      Have probiotic foods daily

     ○ Yogurt

     ○ Kefir

     ○ Sauerkraut        

     ○ Dark chocolate

     ○ Miso soup

     ○ Pickles

     ○ Tempeh

     ○ Kimchi

     ○ Kombucha tea 

     ○ Soft cheeses                   

      Ensure adequate fiber intake ideally with vegetables and whole grains

Call your provider if you notice changes in your discharge, a new odor, itching, burning, bumps or abdominal pain.

Drug Addiction Awareness

By: Allison Andrews, WHNP

More than 3,500 people died from drug overdoses in Pennsylvania in 2015, a thirty percent increase from the previous year. In most of these deaths, numerous drugs were present. But opioids such as heroin and prescription painkillers were present in nearly sixty percent of the overdoses.

Many people don’t understand why or how addiction and overdose happens. They think that those who use drugs lack moral principles or willpower and that they should be able to make the choice to stop using. Understanding addiction and being educated on the disease is key in prevention.

Addiction is a complex and chronic disease characterized by drug seeking and use that is compulsive and difficult to control, despite consequences. Drugs and alcohol change the brain in ways that challenge an addict’s self-control and interfere with their ability to resist urges. These brain changes can be persistent, which is why addiction is considered a “relapsing” disease.

Addiction not only has a major impact on the addict, but also their families and the community. The effects of drug and alcohol abuse are cumulative; significantly contributing to costly social, physical, mental and public health problems. These problems include: 

  • Pregnancy
  • Sexually Transmitted Diseases
  • Domestic Violence
  • Child Abuse
  • Motor Vehicle Crashes
  • Crime
  • Homicide/Suicide
  • Overdose
Research has shown that prevention programs involving families, schools, communities and the media are effective for preventing or reducing use and addiction. Although personal events and cultural factors affect drug use trends, when young people view drugs as harmful, they are more likely to not take them.

Therefore, education and outreach are key in helping people understand abuse and addiction. Teachers, parents, and health care providers have a crucial role in educating the younger population and preventing abuse and addiction.

National Drug and Alcohol Facts Week is a national health observance to counteract the myths about drugs and alcohol that teens may get from social media, TV, movies or even friends and family. The National Institute of Drug Abuse and Alcohol Abuse hold educational events in communities this week so that teens can learn what science has taught us about abuse and addiction. Help our community by promoting National Drug and Alcohol Facts Week January 23-29, 2017 and together we can “SHATTER THE MYTHS.”

If you are struggling with drug (prescription or illicit) and alcohol use, know that any information you provide to your healthcare provider is confidential. Your PCP can help you find the treatment you need to get on the road to recovery. Substance abuse can harm not only our physical health, but your mental and financial well-being as well as the health of your friends and family. If you need help but are not ready to talk to your physician you can call SAMHSA’s helpline at any time: 1-800-662-HELP (4357) or attend an alcoholics or narcotics anonymous meeting (NA meetings: AA meetings: Friends and family of substance abusers who need help coping with related trauma can also attend meetings designed for family members:

Don’t wait for recovery to come to you; starting your journey to recovery is just a phone call away.

Quit Smoking for Good

By: Catherine McGinty, MSN, FNP-BC

If you are one of the 42 million Americans who still smoke cigarettes, or if you have family and friends that still do, we wanted to share a national initiative that is going on this month to help smokers quit.  It is called “The Great American Smokeout” and takes place on November 17th this year.  This special day was established by the American Cancer Society to help smokers pick a quit date and stick to it.  It can be very difficult to quit smoking, but knowing that you are not alone in the struggle can be helpful, and hopefully motivating.

To help those who want to join in on “The Great American Smokeout” and choose November 17th as their quit date, we have gathered additional information and resources to help prepare you (or your family and friends) leading up to the big day.

The first thing to note is the innumerable benefits to quitting smoking. Diseases caused by smoking claim an estimated 443,000 American lives each year, including those that are not affected directly, for instance babies and children.  According to the US Surgeon General, the choice to quit smoking is the “single most important step that smokers can take to enhance the length and quality of [their] life.” So, the choice to quit smoking- even for one day- is so important to your overall health that it can significantly reduce your risk of cancer and other diseases.

Now that you’ve made the decision to quit smoking, the next step is to pick a quit date, which we recommend to be within the month, so you don’t have the opportunity to change your mind.  The quit date is important because it allows you time to prepare and plan.  We encourage you to consider making an appointment with one of our providers to discuss options that are available to you, including Nicotine replacement therapy and prescription drugs. For many people, it may take the combination of medicine, changing personal habits, and emotional support in order to quit.

Which brings us to the next important step:  building up your support system.  Tell your family, friends, and co-workers that you are planning to quit, so that they can help motivate and encourage you.  Also, consider stop-smoking programs, Nicotine Anonymous meetings, self-help materials, and telephone quit lines which all can be a great help as you lead up to your quit date.  

Before you know it, it will be November 17th and you will be amongst thousands of other smokers who have decided to choose their health over their habit, and starting on a path to successfully quitting for good!! So, schedule an appointment to see one of our providers and check out the American Cancer Society’s webpage to learn more about resources that are available to you at or calling 1-800-227-2345.  

Diabetes: Are You at Risk?

By: Elizabeth Galbrecht, MSN, AGNP-C, WHNP-BC

It's unlikely that diabetes is on the forefront of your mind as we approach the end of the year and a busy holiday season, but November is Diabetes Awareness Month and now is really a better time than ever to think about your own personal risk factors for the development of this complex and chronic condition. Diabetes Mellitus is the name given to a group of metabolic diseases that are caused by the body's decreased ability to utilize sugar appropriately. These diseases are ultimately caused by defects in the way that the body uses and/or makes insulin. Insulin is a very important hormone secreted by the pancreas that allows our tissues to absorb sugar in the bloodstream from the food that we eat, in addition to performing a number of other important functions. When the pancreas cannot make insulin or the tissues in our body become resistant to its effects, this results in high levels of sugar in the blood, otherwise known as hyperglycemia. Persistent hyperglycemia can cause many bothersome symptoms and both short and long-term complications, ranging anywhere from persistent nausea and fatigue to heart attack, strokes, chronic kidney disease, blindness, poor circulation, and nerve damage. Diabetes has the potential to affect literally every organ in our bodies. Somewhat surprisingly, perhaps, diabetes can can also be entirely asymptomatic. Regardless of the severity of symptoms, persistent hyperglycemia is an extremely serious condition that still puts one at risk for the complications noted above. Therefore, screening those at risk is a crucial first step in managing this condition.

It is estimated that about 30 million Americans live with a form of diabetes, most of whom have type 2 diabetes. Unlike type 1 diabetes, which is an autoimmune disease of the pancreas that is typically diagnosed in childhood and adolescence, type 2 diabetes typically develops during adulthood and has a slow and insidious onset.  There are several factors that increase your likelihood of developing diabetes. If any of the following conditions or situations apply to you, you should talk to your healthcare provider about screening for diabetes:

 -  Sedentary lifestyle
 -  Overweight or obese
 - First-degree relative with diabetes (such as your mother, father, or sibling)
 - African American, Latino, Native American, Asian American, or Pacific Islander race/ethnicity
 - Hypertension
 - Dyslipidemia (specifically, low HDL levels and high triglyceride levels)
 -  PCOS
 - History of cardiovascular disease
 - History of gestational diabetes or delivering a baby > 9 lbs.

There are several types of tests available to screen for diabetes. The easiest tests that can be ordered during a routine office visit include a fasting glucose level or a hemoglobin A1c. A fasting glucose level of over 126 mg/dl or a hemoglobin A1c level over 6.5% is considered to be diagnostic for diabetes, though these tests should be repeated to confirm their accuracy. Any test that is borderline high is consistent with pre-diabetes, which is essentially a warning sign that you are likely to develop diabetes without an intervention. While several of the risk factors listed above are beyond one's control, like family history or ethnicity, many of them are, of course, modifiable. The best way to prevent diabetes for those who are predisposed is to engage in a regular exercise routine, work on portion control, and reducing or eliminating consumption of foods that are high in sugar – such as sweets and sodas. These sorts of changes can be extremely challenging, so don't ever hesitate to let your healthcare provider know if you need additional help or support. There is also a prescription medication called metformin that can be taken to help your body use sugar more appropriately, which can in turn help to prevent the progression from pre-diabetes to diabetes. This medication is most effective when it is used in combination with lifestyle changes.

While the holiday season may not seem like the best time to think about your health, it can provide a great opportunity to learn more about your risk factors for diabetes as you connect with family members and reflect on your own health histories and habits. This is really the first step in determining whether you are at risk for diabetes, and the next is to speak to your healthcare provider to learn more about screening and risk reduction. Our priority as healthcare providers is to offer you non-judgmental guidance and support as we work with you to optimize your health and minimize your risk factors for chronic diseases such as diabetes, and, most importantly, to remind you that big changes start in small ways.

The Mind and Skin Connection

By: Allison Andrews, NP

Often, conditions of the skin can have a psychological aspect that also needs to be addressed. Research has shown that mental illness, stress and other psychological factors can activate or worsen skin conditions.      

Did you know that the skin is the body’s largest organ? It is a protective barrier that helps the body fight against injury and inflammation. The skin is involved in many complex biological processes, including the brain and nervous system. The brain and nervous system influence the skin’s immune cells through various receptors. When you are facing chronic negative stressors, research suggests it disrupts the function of the skin’s protective barrier, potentially leading to or exacerbating a skin condition.

Only in the past several decades have we seen the resurgence of the mind-body awareness in medicine; and only in the past decade have we seen an emphasis on understanding the interaction between the mind and the skin. Psychodermatology is a holistic view within the medical world looking into the cause and effect relationship of the mind and skin. Psychodermatologic disorders often fall into three different categories:

Psychological skin conditions are usually chronic conditions and can often be exacerbated by stress and other emotional factors.

-       Acne
-       Alopecia Areata
-       Eczema
-       Hyperhidrosis
-       Pruritis          

Secondary Psychiatric skin conditions, due to their visibility, can erode one’s self esteem, leading to social phobia’s and depression.

-       Severe Acne
-       Psoriasis
-       Vitiligo

Primary Psychiatric skin conditions are symptoms of a psychiatric disorder and recognizing them is important in the treatment of a mental illness.

-       Trichotillomania (chronic hair pulling)
-       Delusional Parasitosis
-       Body Dysmorphic Disorder
-       Dermatitis Artefacta (self-inflicted picking, cutting)

When treating all skin conditions, it is important to know that not everyone responds emotionally through the skin, nor do all people react the same way to having a skin condition. But, evidence has suggested in patients with psychological issues that intersect with a skin condition, treating both the mind and skin offers the best chance for improvement. Like I tell all my patients, take ten minutes to relax and meditate, stick to a healthy diet, go for a walk in the park; your mind and skin will thank you for it. 

Hispanic Heritage Month

With September being Hispanic Heritage Month, we would like to take this opportunity to review some facts about health trends among Hispanics by sharing  both reassuring statistics as well as risks. These statistics are the result of  factors including genetic, environmental, social, and economic, which encompass diet, risk for disease, and access to healthcare services and education. An individual’s personal characteristics and behaviors will also affect their risk.

Traditionally, Hispanic people are less likely to eat processed foods, oils, fats and sugars when compared to White Americans. This diet typically includes lots of grains, beans, fresh fruit and vegetables. They also take in a higher amount of fiber compared to White Americans. Hispanics are 14% less likely to be smokers and tend to have 35% less heart disease and 49% fewer occurrences of cancer.

However, it is also important to also focus on less healthy trends, in order to understand risk and work towards prevention. 24% of Hispanics-Americans, when compared to White Americans, have a harder time controlling their blood pressure and are more likely to be overweight. They are also 50% more likely to be diabetic. Tuberculosis is also prevalent in foreign-born Hispanics resulting in more chronic lung damage than caucasians. Evidence suggests that the poorer socio-economic positions of some ethnic groups is the main driver of ethnic health inequalities. One quarter of Hispanics in the U.S. live under the poverty line. This can result in families being unable to obtain foods used in their native diets, especially families living in regions known as ‘food deserts’ where fast and processed foods are more readily available than fruits, vegetables and lean meats.

Keeping in mind the already present favorable medical statistics, these socioeconomic disparities can be mitigated with a little more support and food education It should also be noted that the diverse cultures of Latin America also make it difficult to pinpoint specific problems and recommendations for Hispanic-Americans as a whole; not only is this due to cuisines specific to a particular country but also the genetic strengths associated with multiple generations of Latin-Americans eating the same locally available foods for hundreds of years. In fact, some studies have demonstrated that moving away from traditional cuisine towards ‘American food’ has negatively impacted the health of young Hispanic-Americans the most. The consumption of more high-sodium fast foods (big offenders are mozzarella sticks, and fried chicken and fish) and simple sugars (high fructose corn syrup, sodas, breakfast cereal) has been a major factor in worsening the health of hispanic-americans. For patients who already have diabetes, the cultural shift can tip a controlled diet into one that is uncontrolled and results in complications such is foot, eye and kidney disease. Likewise, a high-sodium diet in an already overweight patient can be the difference between normal and hypertension and the heart disease to go along with it.

Another cultural shift noticed in hispanic americans as opposed to their counterparts in Latin America is a shift to 3 meals a day - Mexicans in particular typically eat 4-5 meals a day so a shift to 3 meals a day may impact the total amount of calories being consumed leading to obesity. Another shift is breastfeeding which is less prevalent in the U.S. than most Latin American countries - immigrating families may move away from initiating breastfeeding which may have an impact on higher child obesity rates. The exclusion to this is Puerto Rico: the island actually has lower breastfeeding initiation rates than in the U.S.! Therefore families whose ancestors immigrated to the U.S. may start initiating breastfeeding more than their counterparts in Puerto Rico.

Overall, the health status of the Hispanic community shows good roots and a promising future. Hopefully with more focus on health education and weight-loss support, we should begin to see positive changes and a marked degree of improved health in the Hispanic-American population. To our Hispanic patients - please take this month as an opportunity to review your health - schedule a physical with one of our primary care providers. If your diet is not what you would like it to be, remember we have two lovely registered dietitians available to evaluate your food choices and make recommendations that can work for you. As mentioned previously, local Latin-American cultures have evolved to be healthy in their environment, so harness the knowledge of your ancestry to help you make healthy food choices in the future!

8 Steps to A Healthy Pregnancy

By: Lauren O'Brien MD

It is never too early to start thinking about optimizing your health for a future pregnancy.  Whether you are currently trying to conceive or still years away from babies, knowing this important information will help guide your path to pregnancy.

  1. Talk With Your Doctor About Preconception CareDuring an office visit, we can discuss the topics presented here, but also tailor a preconception-plan especially for you.  It is important that existing medical conditions (such as depression, anxiety, high blood pressure, diabetes and asthma) be well controlled before pregnancy.  All prescription and over the counter medications should be discussed with your doctor as some could be unsafe during pregnancy. At this visit, we could also screen for sexually transmitted diseases and be sure you are up to date with vaccinations, especially rubella and varicella.  Finally, a review of any genetic illnesses or abnormalities present in a family should be done and referral to a genetic counselor made, if necessary.
  2. Healthy Diet
    When planning for pregnancy you are “eating for two”, but in quality, not quantity.  It is important that you maintain a diet high in fruits, vegetables, lean proteins and whole grain carbohydrates.  Avoid simple sugars and high fat foods.  Though fish can be an important source of healthy Omega 3s, when planning for pregnancy we must be careful of the type and quantity of fish consumed.  Steer clear of tilefish, king mackerel, shark, and swordfish as they are known to contain high levels of mercury.  Limit tuna to 6 oz per week and salmon to 12 ounces per week.  Do not consume raw seafood or meats and be sure all hot dogs and lunch meats are heated to steaming before eating.  Having calcium and Vitamin D in your diet is important, but be sure all dairy products are pasteurized.  Finally, keep caffeine to 300mg per day or less, which comes to about 2 cups per day.

  3. Avoid Toxins
    When planning pregnancy it is important to avoid tobacco, nicotine, recreational/illegal drugs and alcohol.  It is also best to avoid certain chemicals including those in paint thinners, paints, and insect and weed killers.  Individuals with pets in the home should refrain from changing cat litter or cleaning cages from rodents.
  4. Prenatal Vitamin
    All women contemplating pregnancy should start a prenatal vitamin containing 400-800mcg of folic acid once daily at least 3 months prior to trying to conceive.
  5. Achieve a Healthy Weight
    Make exercise a priority BEFORE getting pregnant. Plan to work up to 30min of exercise 5 times a week for optimal results.  Exercise is encouraged once you are pregnant as well. It helps to keep weight gains during pregnancy in an acceptable range.  Talk with your doctor to see if the types of exercise you are doing are appropriate for pregnancy.
  6. Learn to Relax
    Knowing how to handle the everyday stresses of life is important at all times of life, but never more so than when pregnant.  Trying to conceive, pregnancy and early motherhood are all very stressful times in a woman’s life and we need the tools to keep that stress under control.  Having family support, a trusted friend or a therapist can be helpful.  In addition, yoga, mindfulness meditation and progressive relaxation can help those stressful times feel more manageable.  
  7. Detoxify Your Enviornment
    This is the perfect time to think about changing out highly chemical and toxic products in your home for more natural ones.  
  8. Get Your Partner Involved As Well
    Male partners contribute half of the baby’s genetic material.  A man’s sperm can be damaged by alcohol, drugs, tobacco, caffeine and toxins.  Making sure his health is optimized is extremely important.  Female partners need to be a strong support for a pregnant mom and set the tone for a healthy family, so making sure everyone is in the best health possible is a priority.  Partners should visit their own doctors for a check-up as well.

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