Internal Medicine Blog

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
  • HIV/AIDS
  • 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:
http://naworks.org/find-a-meeting/ AA meetings: http://www.aasepia.org/meetings/). Friends and family of substance abusers who need help coping with related trauma can also attend meetings designed for family members: http://www.nar-anon.org/find-a-meeting/.

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 www.cancer.org 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.

What You Should Know About Hepatitis

July 28th is World Hepatitis Day, created to raise understanding and awareness of what viral hepatitis is and what can be done about it.

Viral hepatitis is a term referring to any of several infections that attack your liver and cause damage to its’ cellular structure. The viruses we usually refer to when discussing viral hepatitis are: Hepatitis A, B, C, Delta and E. There are, however, other viruses that cause liver inflammation and, reversely, these five viruses can also cause damage and symptoms outside of the liver.

Viral hepatitis typically presents as an acute infection – there are some cases that are ‘subclinical’ meaning patients do not even have obvious symptoms and may go through an infection without ever knowing they had it! More commonly, however, patients present with symptoms including: fatigue, loss of appetite, nausea, vomiting, and jaundice (yellowing of the skin due to buildup of bilirubin – a pigment that your liver removes from the bloodstream when it is functioning properly). Very rarely, severe cases can even progress to liver failure, brain disease and may be fatal.

Many cases of acute hepatitis resolve within days, weeks or months. However, sometimes acute hepatitis can progress into chronic infection (this only happens with types B, C and Delta). Most often (85% of adult cases) this happens with Hepatitis C. In fact, infection with Hepatitis C can very often present only subclinically with patients experiencing only some fatigue and indigestion. Of course, the concern with these asymptomatic patients is that they may be spreading the infection without being aware of it.

The Delta virus is actually a co-infection that is only present along with Hepatitis B virus. Its presence is usually an indicator of more severe or chronic hepatitis B infection. It spreads through contact with infected blood (through injection or sexual contact)

Hepatitis A is spread primarily through infected food, water or close physical contact with another infected person. It is most common in areas with poor sanitation, such as developing countries or amongst injection drug users. This infection only presents as an acute illness and does not progress to chronic infection.

Hepatitis E is similar to A in that it does not progress to chronic infection and is typically spread through contaminated water, although you can also get this infection by eating contaminated animal products or transfusion of infected blood. This infection is most common in Asia. This infection is most dangerous for pregnant women – the virus can cross the placenta and infect the fetus. Due to immune system changes during pregnancy, pregnant women are more at risk to have severe consequences such as liver failure. Infection in the 3rd trimester can be fatal.

Hepatitis B is transmitted through infected blood or bodily fluid contact – this means both sexual and percutaneous transmission is possible. In some developing countries, dentists with inadequate sterilization equipment can be a source of infection. In general, since hepatitis B can live outside of the body for up to 7 days, any kind of intervention can potentially introduce the virus. This form of viral hepatitis can also develop into a chronic infection; an estimated 240 million people worldwide have chronic hepatitis B. Children under 6 years of age are most likely to develop chronic hepatitis B if they are infected.

Hepatitis C is a blood borne infection – you can only get it through unscreened blood transfusion, unsafe injection practices or unsterilized medical equipment. It can also travel through the placenta of an infected mother and cause infection in her baby. This form of hepatitis can be considered the most dangerous since it can often go undetected for decades as a chronic, asymptomatic infection.

Can hepatitis be cured?

We now have the medications available to clear most patients of their viral hepatitis. Most of the viral infections require only supportive therapy – making sure patients are hydrated and other symptoms – such as nausea and vomiting are reduced. Anti-viral therapies have been shown to be helpful for severe or chronic cases of Hepatitis B. We also now have treatment targeted at Hepatitis C that has made this infection curable as well.

Of course, with severe forms of hepatitis, patients have to be well enough to respond to available medications and fully recover. Some patients will also have irreversible damage from the infection, such as liver failure. Therefore, the best thing is to never become infected in the first place!

What can I do?

First and foremost you should know your status. Get tested for hepatitis B and C to ensure that you are not an asymptomatic carrier of this infection – knowing your status is the best way to protect your partners and future children.

If you are travelling out of the country, schedule a travel visit to find out if your travels will be through an area where Hepatitis A and E are common – this will alert you to be mindful of sanitation shortcomings, make sure you do not eat undercooked food or water that has not been sterilized.

If you are an injection drug user, please use safe practices by not sharing needles. You should also be mindful in any place that uses needles – if you are getting tattoos or piercing, make sure your provider uses proper sanitation techniques.

Healthcare workers are a special risk category for hepatitis infection since they are in contact with patients all the time. For this reason, make sure you are always using proper protection equipment (masks, gloves, eye shields) when working with patients.

Lastly, and most importantly – get vaccinated. Hepatitis A vaccines are available for patients travelling to endemic areas to make your trip worry-free. Hepatitis B vaccinations are available starting from birth! You can get your newborn vaccinated before they ever leave the hospital. Remember – Hepatitis B can live for up to 7 days outside of the body, so your baby can be at risk anytime they are in need of medical intervention – by vaccinating your baby, you can remove this risk-factor entirely. Healthcare workers who have not been vaccinated, should also get the vaccine series so that you can be safe and secure in your work. There is also a vaccine for Hepatitis E in China that will hopefully soon be available worldwide.

Viral hepatitis can be a mild inconvenience for some patients and a life-changing consequence for others, however, now that we have new treatments available, it is no longer a death sentence. Protect yourself by knowing your status and your options – schedule an appointment with one of our providers today!

What You Should Know About Hives

By: Monica Duvall, M.D.

Hives
 are raised, red, itchy patches of skin (also called Urticaria, welts, or wheals) that can be frustrating to experience.  Hives are commonly caused by a number of triggers, and figuring out the cause is sometimes challenging.  Hives can be the result of allergies to medicines like penicillin, or to foods like nut, soy, or shellfish.  They can be caused by viral, bacterial, or parasitic infections (especially in children), by physical contact with substances like plants (such as poison ivy or poison oak) or latex, and by insect bites or stings.  Some people can even develop hives in response to less obvious triggers, such as exposure to temperature changes, or pressure on the skin.  Regardless of the cause, treatment ofhives is usually initiated with medications called antihistamines (Loratadine, Cetirizine, Benadryl); in more resistant or diffuse cases, a short course of oral steroids may be used to reduce the swelling, itching and inflammation.  

Occasionally, hives are accompanied by a more serious type of allergic reaction called Angioedema.  Angioedema causes swelling of the face, eye area, hands feet or genitals.  This can be treated with the same medications as hives, but angioedema should always be evaluated by a health care professional to make sure it does not progress to a more serious type of allergic reaction.  Other complications of hives that require emergent attention include hives that are accompanied by throat closing or breathing difficulty; nausea, vomiting or abdominal pain; or passing out--these symptoms will not respond to regular antihistamines alone.

Although typically hives will be a self-limited affliction, with lesions coming and going in minutes to hours, and episodes lasting for a few days, in some cases, they can last for  weeks.  If hives last for six weeks or more, they are called chronic hives.  This type of hives is more difficult to manage, and often, a cause if not found.  Symptoms will usually resolve over several months, however.  Generally, hives can be successfully managed by avoidance of triggers and prompt treatment of outbreaks.  For more information about this and other skin issues, ask you health care provider.

IV Nutrient Therapy

By: Phil Kim, M.D.

Nutrient Intravenous Infusion is a concept pioneered in the 1970s by John Myers, MD, a physician from Baltimore, Maryland. These infusions are a great means to provide essential nutrients and vitamins to patients who cannot absorb them naturally or to obtain higher concentrations than could be achieved by oral means alone. A good example of this is Vitamin C which may have antiviral and antibacterial properties at concentrations higher than would be expected with regular meals. Over the past 50 years nutrient intravenous infusions have been developed to treat a variety of clinical conditions. Millions of these infusions have been used to treat patients worldwide.

Myers’ original solution has now been modified to treat symptoms related to asthma, migraines, fatigue, fibromyalgia, acute muscle spasm, upper respiratory tract infections, sinusitis, seasonal allergic rhinitis and fluid dehydration. For chronic problems, patients may receive a number of  treatments until their condition improves. It is important to note that although intravenous nutrient therapy is not meant to ‘cure’ any illnesses, it can give patients an extra boost to help fight infections, relieve pain or give you the feeling of a little additional energy to continue to recover. We all know how important it is to ‘feel’ better when we are ill, even if this does not mean we are recovered. The way we feel helps give us the strength to continue!

Under the direction of physicians, intravenous infusions are currently offered in a safe manner in an outpatient setting. Each infusion can be individualized for a specific patient’s needs. Following insertion of a small IV, the infusion takes only 30-45 minutes. We will be offering a wide range of formulations for our patients to take advantage of including hangover recovery, jet lag, fatigue and stress relief, dehydration treatment, migraine relief, cold and flu remedy, vitamin boost and hydration, a beauty enhancement formula, and a treatment to maximize athletic performance. If you’re feeling under the weather or need an extra boost, IV Nutrient Therapy may be just the thing for you! Call our office to schedule today! Services are available on Sundays from 8am till 2pm.

NCQARittenhouse Internal Medicine™ has received the highest recognition from the National Center for Quality Assurance (NCQA). What this means for our patients

Begin Your Journey to Total Wellness

Sign up to learn more about Rittenhouse Women’s Wellness Center™
Location*
Please select a location
Name*
Please enter your name
Email*
Please enter a valid email address
Phone*
Invalid Input