Internal Medicine Blog
- 25 June 2015
- Internal Medicine Blog
Many of our patients use the summer months to catch up on routine health screenings--gyn exams, dental cleanings, physicals--which is great. Despite this motivation to get healthy, however, I have noticed that when it comes to vaccinations, many patients are unaware, or uninterested, in taking care of this very important--and effective--step in preventing disease. The development of vaccines has been one of the most important and cost-effective public health initiatives of the past century, saving untold numbers of lives worldwide from now-preventable disease. Ironically, this success has caused some vaccine apathy in our population, as many once-deadly diseases are simply off our radar and do not seem to pose an immediate threat.
The American Committee on Immunization Practices (ACIP) releases new vaccine updates annually, and occasionally more frequently. CDC researchers recently analyzed data from the 2013 National Health Interview Survey and found that for at least six vaccines recommended for adults by the ACIP, the rates of coverage were far below the goals of the Healthy People 2020 targets (this is a national collaborative effort to reduce disease and promote health in America).
So, what vaccines should you be getting? Here is a general list of vaccines recommended for a healthy adult:
1. First of all, all adults should get a tetanus shot every 10 years, and a Tdap (Tetanus and Pertussis, or whooping cough) shot at least once. In addition, pregnant women should be getting the Tdap shot in the third trimester of EVERY pregnancy, regardless of previous immunization status--this will protect you and your newborn from whooping cough, which can be deadly (it is usually recommended that any close contacts of your newborn also be up to date on this immunization).
2. Flu shots are now universally recommended for everyone, healthy or not (this not only protects you, but contributes to "herd immunity", reducing the likelihood of spreading disease through a community).
3. Shingles vaccination is recommended for all adults over age 60, even if you have had the shingles, even if you think you have never had the chicken pox.
4. Two pneumonia vaccines are recommended for all adults over age 65. One or two pneumonia shots are also recommended for younger people who are smokers or have chronic lung diseases (including asthma) or certain other chronic diseases (including Diabetes, liver disease, congestive heart failure).
5. MMR/Varicella (Chickenpox)--vaccination is recommended is you were born after 1957 and have not been previously vaccinated. Some OBs recommend getting screened for titers for these diseases prior to conception, so women planning to conceive can get vaccinated safely ahead of time, reducing the risk of contracting these diseases while pregnant.
6. Gardasil (HPV) vaccination with the 2-, 4-, or new 9-valent vaccine is recommended for all girls/women from age 9-26 to prevent cervical cancer (those who were previously vaccinated with the 2- or 4-valent vaccines do not have to repeat the series with the 9-valent version, because all of the vaccines protect against the highest-risk HPV strains, 16 and 18). Cervical cancer is still a significant cause of death worldwide; the development of this vaccine is a remarkable modern vaccine success story.
7. Hepatitis B may be considered for those who are sexually active, and is recommended for healthcare workers, as this liver disease can be spread through exposure to contaminated blood and body fluids.
This is by no means a comprehensive list; certain other vaccines like Hepatitis A, Typhoid, and Polio are recommended for travel to certain countries, or under other circumstances. And there are some people with health conditions or allergies that are contraindications to some/all of the above vaccines, so it is best to have a conversation with your provider about what YOU need. The takeaway point is that vaccines have changed the face of disease in our world, and they continue to be a valuable component of your efforts to maintain good health. Be sure to round up your immunization records ahead of your next physical, so you and your physician can make sure you are up to date.
- 28 May 2015
- Internal Medicine Blog
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.
- 01 May 2015
- Internal Medicine Blog
By: Lauren O'Brien, M.D.
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.
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.
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.
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!
- 27 April 2015
- Internal Medicine Blog
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!
- 31 March 2015
- Internal Medicine Blog
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!
- 24 March 2015
- 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.
- 02 March 2015
- Internal Medicine Blog
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!
- 02 January 2015
- Internal Medicine Blog
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!
- 25 November 2014
- Internal Medicine Blog
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.
- 27 October 2014
- 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.
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.
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