- 01 April 2014
- Internal Medicine Blog
By: Maria Mazzotti, D.O.
As the weather starts to give us a break, I would like to give you a few reminders to help you stay healthy and enjoy the rest of your year.
1. If you have not started your allergy medications, I would high recommend doing that immediately. Getting started early may make a big difference in controlling you allergies. That goes for Singular as well, since it take about for this particular medication to start working effectively. Also keep in mind that Ventolin, commonly used for asthma, has a short half life. So once you open the foil package, you need to discard it after 6 months, even if you have not finished all of the inhalations. If you have severe allergies, you want to make sure your Epipen has not expired. This is also a good time of the year to have your carpets cleaned of all of the debris that accumulated over the winter and you can keep the windows open to make sure the carpets dry well.
2. Make sure you are up to date with your Tdap vaccine. You may know this vaccine as the Tetanus shot, Pertussis vaccine or whooping cough vaccine. This vaccine protects against 3 different infections. This time of the year, when we start gardening and hiking, this vaccine is important because it protects you against “Lockjaw” if you get a bad cut, burn or step on something rusty. Also Whooping Cough season is from June to September. It takes a few weeks to kick in, so you still have time.
3. This is also a good time of the year to clean out your medicine closet. Do not keep any medications that you are actively using. It is better to write down any medications that you are allergic to or have side effects from, then to keep the medication bottle hand for reference.
4. Now is also a good time to schedule those tests that you were forced to cancel due to the bad weather (mammogram, colonoscopy, blood work, PAP, physical, DEXA Scan, etc) before the steamy weather hits.
5. Make sure your sunscreen is not expired. Remember to apply it at least 30 min before stepping out for it to be more effective.
6. If you have not already, make sure you sign up for Obamacare. This is the first time in our nation’s history that everyone can have healthcare. Having insurance saves us all money, and more importantly keeps us healthy.
7. Also you should change your heating filters when you start using your AC. It may also be a good time to get you system cleaned/inspected if you did not do so in the fall.
8. As you get ready to be more active outside, make sure your sneakers are not worn out.
9. This is also a good time to start juicing, since a lot of your favorite fruits are coming in season.
10. Most importantly, this is a good time to focus on getting heart healthy. Whether you need to loose weight or not, you should be doing at least 30 min of a cardiovascular workout five times per week. Keep it fun, have friends join in, but do not work through pain. Exercise is also an effective way to help with anxiety/stress/depression and difficulty sleeping. And if you loose weight along the way, it is a plus.
- 31 March 2014
- Nutrition Blog
The arrival of spring is certainly a reminder that you have one more season to clean up your diet before summertime arrives! Maybe you let your healthy diet habits hibernate over the long drawn out winter we just had but this month it’s time to spring clean your diet and life style to get back on track! Instead of trying a new fad diet, detox or meal replacement regimen, try these 10 tips to make sure you are bikini ready and feeling healthy by summer.
1.Drink at least 48 ounces of water a day:It is important to stay hydrated throughout the day for various reasons. Staying hydrated not only helps with your alertness, controlling appetite, and improving physical activity, but it also keeps everyday symptoms like fatigue, headaches and dry skin at bay.
2.Incorporate a color into every meal: Eating a diet with plenty of fruits and vegetables has been linked to improved health, and for good reason. Veggies and fruits (both fresh and frozen) are loaded with vitamins, minerals, fiber (a satiating nutrient) and antioxidants. In addition to bursting with healthy nutrients, fruits and vegetables are low in calories, which make both a great choice for the waistline.
3.Avoid processed carbohydrates: Consuming processed carbohydrates such as white flours in breads, pastas, cookies, cakes etc can contribute to weight gain due to the effects that they have on blood sugar levels. Try to only consume whole wheat/ whole grain products when eating carbohydrate sources other than fruits. Examples of whole wheat/whole grains sources include breads made with 100% whole wheat flour, brown rice, whole wheat pasta, popcorn (unsalted and non-buttered), oatmeal, quinoa, millet, barely, couscous, whole wheat pitas and tortillas. When choosing whole grain wraps, crackers or breads, aim to find bread that lists the first ingredient as 100% whole wheat flour and contains at least 3 grams of fiber.
4.Eat vegetarian once a week for all three meals:Cutting down on your animal consumption helps to slash saturated fat and cholesterol intake in the diet which can help reduce risk of cardiovascular disease, diabetes and obesity while trimming your waistline of fat and calories. Some delicious vegetarian protein options include tofu, seitan, brown rice with beans and tempeh. My personal favorite vegetarian protein dish is Whole Foods “General Tso Chicken”, which is made with seitan. I promise you will not regret trying it!
5.Add a source of protein to your snacks:To truly satisfy your hunger in between meals, add some protein options into the mix. Opt for a non fat plain Greek yogurt, string cheese, almonds, cottage cheese , hummus or nut butter along side of a piece of fruit or serving of raw vegetables.
6.Incorporate yogurt into your routine:Yogurt is a wonderful source of protein, calcium and gut friendly bacteria that helps keep your GI system healthy by alleviating constipation and diarrhea. Try non fat plain regular or greek yogurt and add your own fruit for a sweet touch
7.Aim for 3 servings of whole grains per day:Eating whole instead of refined grains substantially lowers total cholesterol, low-density lipoprotein (LDL, or bad) cholesterol, triglycerides, and insulin levels. Not only are whole grains beneficial to the heart but they will keep your hunger at bay between meals. Try having oatmeal for breakfast, add quinoa to your salad at lunch and incorporate couscous into your evening meal to reap all the benefits that whole grains offer to your diet.
8. MOVE MORE:Even though this is not a diet tip, it’s a statement to live by when trying to lose weight. By moving more you will burn more calories and build muscle. Aim to incorporate at least 10,000 (about 5 miles) steps per day which is equivalent to moderate exercise. If you are really trying to lose weight, I recommend that you engage in atleast 250 minutes of exercise per week.
- 31 March 2014
- Fitness Blog
1. Be Realistic : First and foremost, you should always set a schedule of how many days a week you want to workout. You may want to hit the gym 7 days a week from the start, but with work, school and a family, this presents road blocks. Get comfortable taking baby-steps, and accommodate goals to your lifestyle and current fitness status to prevent injury. A realistic schedule would be 3 days a week for 30 minutes each.
2. Team up with a friend: Surround yourself with friends who are looking to spring clean their fitness routine and healthy lifestyles as well. Working out with a friend can help you encourage each other, keep you on track, and can be the fuel to a fun fitness routine.
3. Revamp your playlist: Listening to the same tunes day in and day out can get monotonous and boring, especially during an intense workout. Check out pinterest for some new and uplifting songs that can rejuvenate your workout, and help get your body and mind moving.
4. Avoid the couch: After a long day at work, a comfy recliner may call your name. To avoid derailment from your new routine, pack a gym bag with you each day so that you have one less excuse not to get your workout in right after work hours.
5. Record your progress: Keeping a fitness and food journal is a nice way to track your progress as well as the way you feel after each workout. A journal will also be sure to keep you conscious of your daily activities and habits (good and bad) including food selections.
- 29 January 2014
- Nutrition Blog
By: Christina Ushler, Registered Dietitian
Here are a few tips on creating a vibrant winter!
Sleep: Most authorities are recommending 7-9 hours of sleep every night. It is important to listen to your body and do what feels best. Try to get to bed and wake up at the same time every day to avoid confusing your body. When the body is lacking in sleep, stress goes up and immunity goes down. You may also eat differently than if you were properly rested. Many clients notice they might crave more carbohydrates or coffee if they are sleep deprived. They also notice dips in energy and mood swings throughout the day. Your body needs sleep to recover and refuel for the next day.
Fruits and Vegetables: Aim for consuming at least 3 fruit per day and at least 3 vegetables per day. Fruits and vegetables provide vitamins, minerals, nutrients and antioxidants. They are nutrient dense and lower in calories compared to other foods. Antioxidants help fight disease and improve immunity. Greens are great for detoxifying the body and increasing energy. Soups and stews are an easy way to get more veggies in. Blending and juicing are also great options.
Hydration: You may not be as thirsty in the winter but it still is essential to drink appropriate amounts of fluid for preventative measures. Instead of drinking cold water, try drinking water at room temperature or boiled. It is recommended to drink half of your body weight (pounds) in ounces of water per day. Therefore, a 140 pound person needs to consume 70 ounces of water or 8.75 cups fluid per day (8 ounces = 1 cup). Plain water is best. Coffees, teas and juices can dehydrate you further and should not be included in total intake.
Sugar: Watch the sugar intake! Many are overdoing it in the sugar department, especially in the cold winter months. Holiday parties and alcohol can cause our intake to increase dramatically. Sugar can suppress the immune system, accelerate aging, and even feed cancer. It is important to check the ingredients because sugar can be hidden in many foods. Try using natural sweeteners in recipes like honey, agave nectar, or 100% maple syrup. To knock out a sweet craving, try incorporating more sweet vegetables into your diet like yams, squash, carrots, and beets. Increasing naturally sweet foods in the diet will reduce your cravings for sugary foods and beverages.
Physical Activity: Stay active. Schedule in physical activity you enjoy. Otherwise, it may feel like a chore. There are plenty of opportunities to stay active in the winter. For example, you can join a gym, aerobics class, or take up skiing. There also are plenty of opportunities to do exercise from the comfort of your own home. YouTube is a great resource to find exercises and workouts for free. You can also purchase exercise videos from your favorite trainers or watch them for free on your TV. Exercise helps to detox the body and releases feel good hormones that keep us feeling good. It is recommended to schedule in at least 30 minutes per day.
Manage Stress: Chronic stress can lead to increased susceptibility to illness. When was the last time you scheduled time for your self? Schedule a massage, take on meditation, hire a coach, practice daily yoga, reduce your hours at work, or schedule in one night per week to devote 100% to your own needs. Some other suggestions might be to reduce your intake of drugs and alcohol, or even seek out therapy from a professional for new ideas and insights.
Remain Social: The cold weather might tempt you to avoid leaving the house and stay warm and cozy by the fire. However, this might cause you to feel isolated from the rest of the world. Statistics show that social activities help to bring happiness and connectivity to the world. Perhaps consider doing something different this winter, like skiing or ice skating. You might consider planning a vacation to somewhere warm during the colder months. There are also countless opportunities from joining a club, such as networking groups, painting classes, or a volleyball team.
For more tips on what you can do to stay healthy this winter, schedule an appointment with one of our Registered Dietitians today.
- 28 January 2014
- Fitness Blog
Running isn’t for everyone. But it could be for you, and it can be done just about anywhere, just about any time. Running is beneficial for both your mind and body. It can help to boost your mood, reduce stress, and improve your sleeping habits. Running improves cardiovascular health, aids in weight loss, and strengthens your bones, among numerous other benefits. However, running can be a hard activity to take up. If your new year’s resolution was to become more fit, running is an amazing place to start. It may seem daunting or scary, but here are a few tips to help you become the runner you always dreamed of being.
First, run at your own pace. Many experts will tell you there is a certain intensity that is most effective physiologically, and while this is true, it is not the case for beginners. These targets can be uncomfortable or impossible for beginning runners. This can be extremely discouraging. Instead pick a pace that is challenging, but relatively pleasant. As you get more comfortable, increase your pace.
Next, prepare yourself, a little soreness is normal and expected. It’s not just the exertion experienced during running that discourages many beginners from continuing. It’s also the soreness experienced afterward so-called delayed-onset muscle soreness or DOMS. DOMS is caused by muscle damage associated with unaccustomed levels of exertion. The more you run, the less you will experience DOMS. Unfortunately you have to experience it to become resistant to it.
While DOMS is unavoidable for the beginning runner, you can minimize it. In your first workout you want to apply just enough stress to trigger this effect and no more, because doing any more will only result in more soreness without resulting in any more resistance to future muscle damage.
Make your first run short—only about 10 minutes. And instead of running for 10 minutes continuously, break it up. Start with interval training. Run faster than you normally would for 15 to 30 seconds, and then slow to a walk. When you’re ready, run for another 15 to 30 seconds, then walk again. Continue in this manner until you’ve put in 10 minutes and stop, even if you feel you could do more. You may feel good now, but you will feel sore tomorrow. As you run more often, this will subside.
Lastly, give it some time. It takes about a month to start feeling more comfortable when you run if you run consistently and build slowly. Set your expectations accordingly, but don’t give up. Take a “no excuses” mentality into your first month of running. Don’t miss a planned run, no matter how much you dread the next one. If you do this, you will progress at the maximum rate possible and find yourself enjoying your runs after four weeks and no longer needing to psych yourself into doing the next run.
Good luck, and if you need help setting or reaching your fitness goals, or would like a running plan designed specifically for you, contact RWWC today and schedule an appointment with a fitness specialist.
- 28 January 2014
- Internal Medicine Blog
By: Catherine Liebman, D.O.
Since joining the Rittenhouse Women’s Wellness Center in July, Dr. Catherine Liebman is often asked to explain “What is Osteopathic Manipulation?” and who may benefit from it. Osteopathic Manipulative Medicine (OMM) is a medical specialty that is specific to Doctors of Osteopathy (DOs). While all DOs get some training in OMM in medical school, others choose it as their specialty. For an OMM specialist the main focus is the musculoskeletal system. OMM is the application of manipulation to the body to address problems in the joints, muscles, nerves, connective tissues, and organs. Dr. Liebman incorporates OMM into conventional musculoskeletal medicine including orthopedic examinations, interpretation of x-rays and MRIs, managing physical therapy, injections, medications, and medical acupuncture, to create a unique and integrated approach to patient care.
OMM is based on the principle that the structure and function of the body depend on one another. During a visit Dr. Liebman assesses the patient for joints that are out of alignment, muscles imbalances, and connective tissues that are restricted. The dysfunctions that are identified are corrected with Osteopathic techniques. Many Osteopathic techniques are well known in other areas of musculoskeletal medicine, including myofascial release, soft tissue techniques, strain-counterstrain, muscle energy, and craniosacral therapy. The goal is to treat a patient with the most current clinical medical practices and to identify and correct the cause of pain, not just mask the symptoms.
As an example, a patient with low back pain may be evaluated for any organ or neurologic cause, receive a prescription for a medication and/or x-ray, and receive an OMM treatment to improve the symptoms immediately – all in one visit. It is truly integrated and holistic healthcare. Initial visits typically take one hour for evaluation and treatment and follow-up visits take 30 minutes. Depending on the situation, patients may need to return for more treatment. The treatment and management of the patient is tailored to her unique situation, and may include other modalities as well. However, the goal is to give patients the tools to feel and perform their best on their own and prevent further injuries.
Conditions commonly treated with OMM include:
- Chronic pain
- Acute pain
- Sports injuries
- Neck pain
- Low back pain
- Joint injuries
- 06 January 2014
- Internal Medicine Blog
Ask the Doctor: January 6th, 2014
Answered by: Dr. Linda Bullock
Question: How important is it, if you have a family history of heart disease, but are not exhibiting symptoms yourself, to have blood tests for C-reactive protein and lipoprotein A? I believe these might be better assess your risk of arterial plaque.
Answer: The U.S. Preventive Services Task Force deems these tests lacking enough evidence to use them for clinical decision making. Traditional tests (total cholesterol, HDL, triglycerides) still guide treatment.
C-reactive protein is produced by the liver and is a general marker for increased inflammation in the body. It may be associated with an increased risk for heart disease but it is not specific. Lipoprotein(a) is a circulating lipoprotein and it has been associated with an increased risk of coronary artery disease, but the added value of this test beyond measuring a lipid panel is not known at this time.
Measuring these and other tests such as the homocysteine level and the ankle brachial index may be used to guide treatment decisions in the future. Reducing risk factors is imperative, especially if you have a family history. If you smoke, please stop. If you have diabetes or hypertension, these should be treated. If you are overweight, try to reach your optimal weight. Diet and exercise are the cornerstones for risk reduction and if your cholesterol is elevated after you have maximized your healthy behaviors, you may need a cholesterol medication.
Questin: December 1, 2013
Answered By: Dr. Linda Bullock
Question: "I've been told to get my calcium from food only, and the allergist wants me to limit my dairy. There are many "calcium fortified" food items like cereals and almond milk, but is seems to me getting calcium from these products are no different then taking a pill. Should these be avoided as well?"
Answer: Taking calcium pills may be counterproductive so current recommendations suggest food sources of calcium. while dairy products are very high in calcium, there are other foods high in calcium. dark green leafy vegetables such as broccoli, kale and collard greens, oysters, salmon, sardines, molasses, tofu, parsley, dried figs and almonds, to name a few. When it comes to fortified foods, there are several stipulations to consider (according to fitday.com). 1) calcium absorption is better at higher acidity levels in the stomach 2) products with calcium carbonate are absorbed equally as well as dairy. 3) precipitation can cause the nutrients to settle on the bottom of the container, shaking the container can improve this. 4) plant estrogen is soy can increase calcium absorption. Hope this helps.
Calcium Levels in Milk vs. Almond, Rice and Soy Milk / Nutrition / Healthy Eating
Question About Menopause: Answered by: Dr. Linda Bullock
- 06 January 2014
- Nutrition Blog
Welcome to the New Year! Let this year be a year for a renewed commitment to living healthy. If you have thought about taking action towards better health or are currently taking action and making changes to your life, add these wellness resolutions provided by our dietitian, Theresa Shank, into your routine to keep you motivated, energized, fit and feeling healthy and beautiful inside and out this year.
Typically New Year resolutions are unrealistic and poorly executed. The first step to making a change that will last is changing a single behavior one at a time. Unhealthy behaviors develop over the course of time. Thus, replacing unhealthy behaviors with healthy ones will require time. Stay underwhelmed instead of overwhelmed and not think that you have to reassess and change everything in your life. Instead, work towards changing one thing at a time this year such as the changes listed below.
Mindful eating is very important while keeping your brain sharp and your waistline down. If your resolution was to eat healthier try practicing mindful eating techniques during before and during each meal. Ask yourself questions such as; does my body need this? Am I craving this just because I am sad, bored or stressed out? Engaging in mindful eating does not require lots of practice or training. Try focusing on what you are eating, notice aromas, texture and tastes and your responses both physical and emotional. Take at least 20 minutes to eat your entire meal; that’s how long it takes your brain to notice if it is full. The principle to mindful eating is learning to hear what your body is telling you about hunger and satisfaction.
Add meatless Mondays into your weekly schedule. Challenge yourself to not include meet into your eating routine on Mondays. This will help you to decrease your overall intake of fat and saturated fat that is shown to increase LDL cholesterol levels. Try making stir-fry with tofu instead of chicken or combining a mixture of beans and vegetables to make a nutrient rich and fiber filled meal that will help keep your hunger at bay.
Pile on the veggies. It’s no secret that almost all vegetables are naturally low in fat and calorie, good sources of dietary fiber, potassium, folate, and vitamins A and C. In order to meet the recommended daily intake of 4 servings of vegetables a day, try setting a goal to incorporate a color into every meal to insure consuming enough vegetables throughout the day.
Slash added sugar intake to cut calories and ease weight loss. Women should not consume more than 6 teaspoons of added sugar a day, which equates out to 24 grams of sugar. Sugar is hidden EVERYWHERE so please look at labels and monitor your intake throughout the day. Added sugars include soft drinks, sweetened teas and juice drinks, and sport drinks such as Gatorade. Additional sources of added sugars include sweet treats such as cookies, cakes, ice cream, coffee creamers, candy, salad dressings, syrups, crackers, bread etc. Look at your labels and try choosing foods that contain less than 8 grams of added sugar per serving to keep your intake in check.
Lastly, try to avoid refined carbohydrates. By reducing your intake of refined carbohydrates you will better be able to control your blood sugar levels, sustain your hunger and help promote healthy bowel movement regimens. Reﬁned carbohydrates include reﬁned ﬂours found in sources such as white bread and pasta, white rice, fruit juices, and all sweeteners, such as white sugar, corn syrup, fructose, and cane juice. One or more of these are found in most processed, boxed, canned, frozen, commercially-prepared, and fast foods. Instead of refined carbohydrates, try to only consume whole grains when eating carbohydrates. Examples of whole grains include breads made with 100% whole-wheat flour, brown rice, whole-wheat pasta, popcorn (unsalted and non-buttered), oatmeal, quinoa, millet, barely, couscous, whole-wheat pitas and tortillas. When choosing whole grain wraps, bread, crackers etc aim to find bread with 0 grams of sugar and at least 3 grams of fiber.
All of these tips are manageable and applicable to the average woman’s daily lifestyle. This year make a change and stick with it because you are worth it. By following these tips, Theresa guarantee’s that weight loss will happen. After accomplishing these goals, we encourage you to schedule a visit with Theresa to learn how to maintain these goals and create news ones so that you can continue to live a happy and healthy 2014.
- 02 January 2014
- Fitness Blog
Holiday stress affects many women through out the holidays. Your in-laws are around more often, you have to cook dinner for 20 guests, make it to Grandmas house by six and traffic is crawling. These stressful situations can increase your levels of stress hormones: cortisol and adrenaline. These hormones can affect your memory and ability to process new information as well as raise your risk of depression and anxiety. But it turns out there is an easy fix.
Studies show that just 20 minutes of physical activity can help tremendously. As your heart rate rises during cardio exercise, levels of the feel-good neurochemicals serotonin, dopamine and norepinephrine rise in the body. So does brain-derived neurotrophic factor (BDNF), a substance that may protect your brain from emotional disorders and repair damage that stress and depression cause. At the same time, opiate-like endorphins and endocannabinoids (similar to the other kind of cannabis) flood the system, leading to a sense of well-being.
In short, a mere 20 minute work out session can produce mood benefits that last as long as 12 hours to help alleviate the stress you may have been faced with this holiday season.
- 02 January 2014
- Internal Medicine Blog
What is cervical cancer?
“Cervical cancer” is a disease which causes the cells of the cervix to grow in an out of control way. The abnormal cells develop the ability to spread and invade other organs. When this occurs, cervical cancer can spread and ultimately lead to death. This can even occur in young, healthy woman.
What are the risk factors?
Most cervical cancer is caused by a sexually transmitted virus. This virus is called HPV. The virus is spread by skin to skin contact, which means that condoms may not protect you. Some strains of the virus cause genital warts, however most strains cause no symptoms at all. Most of the time, your immune system clears the virus. However, some woman remain infected, this constant infection with HPV can lead to cervical cancer. Having the virus does not mean you will develop cancer, although it does mean that you should be vigilant!
Other factors which can increase your risk of cervical cancer are:
*long-term oral contraception
*multiple sexual partners
What can I do?
Make sure to schedule your annual gynecological exam! The American College of Obstetricians and Gynecologists recommends annual pap smears for all women starting from 21 years of age.
The best way to detect cervical cancer is by having your pap smear. There are different recommendations for when to have your pap smear (from every 6 months-every 3 years), which depend on your previous results. However, even if you do not get your pap smear once a year you should schedule an annual exam to regularly reassess your risk factors, as well as to get an internal and breast exam and std testing when necessary. If you are under the age of 26, your doctor may also recommend the HPV vaccine series. The HPV vaccine is used to prevent infection with HPV types 6, 11, 16 and 18 and is covered by most insurances (please contact your carrier for additional coverage information)
Lastly, please make sure to follow through with any additional appointments that your physician recommends. Scheduling a colposcopy with a gynecologist may not sound like fun, but timely follow-up can make the difference between a small treatment procedure and extensive cancer therapy. In summary – don’t delay! If you have not had your pap smear for several years or if you have any further questions about cervical cancer, schedule an appointment with one of our physicians right away and take control of your health!