- 18 August 2015
- Internal Medicine Blog
By: Lauren O’Brien, MD
With the heat of summer still upon us, I know that it is hard to believe that fall- and the dreaded flu season- will soon be here. Flu vaccines are set to arrive soon, so this is the perfect time to review some common misconceptions about this illness and vaccine.
Influenza is more than the “common cold”. It is a respiratory illness caused by the Influenza viruses, which can be very severe. Common symptoms include: fever, cough, sore throat, body aches, headaches and fatigue. Occasionally individuals will have vomiting and diarrhea, but this is more common in children. Most people who get the flu will recover in 5-14 days, but complications (such as pneumonia) can occur that can lead to serious illness or even death.
These complications and the control of the spread of the influenza virus are some of the main reasons why we recommend that all of our patients without contraindications get the flu vaccine. Here are a few common misconceptions to think about as you prepare to come in to the office for your yearly vaccine.
“I am healthy and I have never had the flu, so I don’t need to get the vaccine.”
It is great that an individual has escaped contracting the flu in the past and a healthy immune system is important, but it does not mean that you are naturally immune to the virus and will not come down with the flu in the future. The annual flu vaccine will help to protect you against getting the flu or at the very least give you a much milder case of symptoms. This leads to less missed days of work and less disruption in your daily life. In addition, the more healthy individuals we vaccinate the less likely the flu is to spread to those who are immunocompromised and those who cannot get the flu vaccine themselves.
“I got the flu from the vaccine in the past!”
This is a very common misconception. The flu vaccines that we give in the office are made from ‘inactivated” flu viruses and are therefore not infectious. The most common side effects include: local reactions at the sight of injection (redness, tenderness, or swelling). In some patients, a low grade fever, headache and body aches are possible, but these are not as severe as the flu and are of a much shorter duration.
In studies where some patients were given an injection of the flu vaccine versus an injection of a salt water solution, the only difference in side effects was a slight increase in arm soreness with the flu vaccine. There was no difference in fever, body aches or headaches.
“I got the flu vaccine last year, so I don’t need one this year”
The Influenza vaccine is an annual vaccine for good reason. The circulating strains of flu viruses can change from year to year. Because of this, scientists study the trends in circulation and make a very educated guess as to which strains will be present in the up coming flu season. Production of this year’s flu vaccine then ensues. Sometimes the scientists get it right on and the vaccine is highly effective. Sometimes they miss the mark (as with last season) and the effectiveness is low. Even in these cases, the vaccine can still provide enough protection so that an individual’s illness is much less severe. Therefore, since the viruses and vaccines change each year, an annual flu vaccine is essential.
“It’s too early to get the flu vaccine!”
We anticipate that the supply of this year’s flu vaccine will be arriving in September. This is a great time to get your vaccine. The flu season generally peaks in December thru February, but illness can be seen from October thru May. Getting your flu vaccine early allows you to mount the appropriate immune response early and gives you the best protection for the entire flu season. On the flip side, if you do not get in to the office in September or October, it’s not too late to get the flu vaccine. Vaccinating after December can still be effective for the remainder of the season.
“I am pregnant, so I can’t get the vaccine”
If you happen to be pregnant during the flu season it is even more important that you get the vaccine this year. Pregnancy increases an individual’s risk of complications from the flu so vaccination is highly recommended.
If you have further concerns about Influenza or the flu vaccine, please come in to see your doctor to discuss things further. If you are not coming in for your routine care this fall, please schedule a visit with one of our nurses to get your flu vaccine as soon as they become available.
- 18 August 2015
- Nutrition Blog
By: Angela Luciani, Registered Dietitian
Most of us have been there before – We want to eat healthy, so we go to the grocery store, purchase a ton of healthy foods/ingredients: vegetables, fruits, poultry or seafood and maybe even some snacks. We get home, we make lunch or dinner for a few nights but then reality sets in. By Wednesday, we either are sick of the food we have or we don’t have the right ingredients to make what we wanted. Plus, it’s the middle of the week/almost the weekend, so what do we do? Eat out of convenience because it seems faster and easier. So, when life gets busy, how can you stay on track? Whether you’re trying to get fit, lose weight, or just eat healthier in general, one of the keys to success is PLANNING.
1. Start small.
If planning out every single meal for the week sounds overwhelming, start with planning dinners so you know you have at least one balanced meal for the week.
2. Set time aside.
Find 15-30 minutes out of your busy schedule where you can sit down and plan your meals for the week. Maybe you can make use of that 30 minute train ride into the city or on your way home can or perhaps an afternoon over the weekend when your husband is watching football.
3. Choose recipes with a purpose.
There is an endless amount of blogs, magazines, cookbooks to choose recipes from for the week.
Try to select recipes that will overlap so that you can minimize how much you have to purchase. I like to compile my recipes -When I find a recipe I like, I print it out or write it down on a piece of paper and keep it in a folder. This way, I always have a fresh recipe dish to choose from so that my meals for the week don’t get repetitive or boring. Keep an eye on the nutrition facts and keep in mind serving sizes - choose recipes that are healthy and will help you meet your goals.
4. Make a Master Plan
Choosing a format to create your meal calendar is up to you. A simple notecard, a printable template, an excel spreadsheet or using an electronic version are all great ways to help you stay organized – whichever you choose, it is always a good idea to keep a paper copy for a visual. This helps hold yourself accountable for what you are supposed to eat for the week – and you can plan ahead for those nights you have business dinners or happy hours. Hang it on the fridge to remind yourself of your plan.
5. Plan your grocery list.
Save yourself some time and do this in conjunction with writing out your recipes/calendar meal plan. If you are unsure of what you have in your fridge, freezer or pantry, now is the time to check. Do an inventory before you leave and cross off the ingredients you do not need to purchase. Nothing is more frustrating than starting to make your meal and realizing you don’t have one of the ingredients.
6. Get the prep work over with
Don’t just unload the groceries from the car when you get home – Prep the ingredients for your week, dice up the vegetables, cut up the fruit and portion out your snacks. Prepping your meals and snacks ahead of time will make it more likely for you to grab these foods when you are hungry.
Using these tips can you set yourself up for success! Eating meals and snacks spaced out every three to four hours throughout the day will help maintain your blood sugar and will also prevent hunger before meals, which often times can lead to overeating.
- 18 August 2015
- Fitness Blog
As women, we are at a higher risk than men for developing the age-related bone density disorder, Osteoporosis. Osteoporosis causes our bones to become thinner and more porous. This makes us less able to support our own body weight. Osteoporosis can affect our quality of life as well as limit our ability to be independent. Bone density loss happens rapidly after menopause, and by the age of 50, about half of all women and men will break a bone because of Osteoporosis.
Don’t worry, there are a few things you can do to help reduce your risk of developing Osteoporosis. A diet full of calcium and vitamin D is helpful, as well as participating in physical activity. Studies show weight bearing exercises not only prevent bone density loss but also encourage bone growth. Shoulder, wrist, and hip joints as well as your spine are common sites where bone density loss occurs. These are great areas to strengthen through exercise.
If you have Osteoporosis, consult a physician before beginning an exercise program. If you are hoping to reduce your risk, be sure to start slow and work with someone who can show you the proper way to work out.
An ideal work out would include aerobic weight bearing exercises, resistance training, and flexibility exercises. It is important to note that these exercises should be done to improve muscle strength, therefore conserving bone mass, and should not generate joint pain. Exercises should be performed at low to moderate intensities.
If you have any questions or want to start reducing your risk of Osteoporosis, call and make an appointment with one of our fitness specialists today!
- 31 July 2015
- Internal Medicine Blog
At the end of last year the new version of Gardasil (Gardasil 9) was approved. This is very significant, because it has coverage for 5 additional HPV strains that account for 20% of cervical cancers diagnosed. So previously the vaccine was up to 75%, now it is up to 90% effective! The added news is it is just as safe.
The shot is approved for use in females ages 9 through 26. (In males ages 9 through 15.) Obviously the sooner you get the vaccine, the more effective it will be for you. HPV screening is not recommend before starting, therefore, even if you have tested positive for HPV, there are still strains it can protect you against. As long as you start your first dose by age 26 and follow through with the recommended immunization schedule, it will be covered by your insurance. It is administered on the initial dose, 2 months later and 6 months after the initial dose.
There are also a few more added benefits, but you do not hear about as frequently such as: protection against vulvar, vaginal and anal cancers. This is great news when I consider how frequently I see positive HPV results. Keep a look out for the arrival of the new Gardasil 9 to our office!
- 30 July 2015
- Internal Medicine Blog
By: Jillan Rowbotham, D.O.
With summer now in full swing sunburns are, unfortunately, an all too common occurrence. More than 30 percent of adults and 70 percent of children and adolescents report at least one sunburn during the course of a year. The best approach for sunburn is prevention through sun avoidance or diligent use and reapplication of a sunscreen. Sometimes, despite our best efforts, we end up lobster red after a sunny day.
Sunburn is a self-limiting condition that usually resolves in a few days. There is nothing you can do to reverse the skin damage or speed up the healing time but there are some things you can do, and things you shouldn’t do, to reduce pain and further damage.
Do get out of the sun as soon as possible if you think you are starting to get burned.
Don’t just apply sunscreen over burned areas in an attempt to stay outside longer.
Don’t think that a “base tan” is healthy and that it will protect you from getting sunburned. Tanned skin provides an SPF of less than four. Any change in skin color is a sign of damage and increases your risk of premature skin aging and skin cancer.
Don’t underestimate the relief you can get from an over the counter anti-inflammatory medication such as aspirin, ibuprofen (Advil, Motrin) or naproxen (Aleve). These medications are especially helpful if you take them as soon as you notice pain, don’t wait until the pain gets really bad.
Do be aware that NSAIDs such as ibuprofen or naproxen will make your skin more sensitive to the sun while you are taking them so take appropriate precautions to avoid getting burned again.
Do use cool water to soothe sunburned skin. A cool bath, shower, or compress (a towel soaked in cool water) can give you some relief. If your shower water pressure is high it is best to opt for a bath or cool compress to avoid pressure on your burn.
Do drink plenty of water. Sun exposure and heat can cause fluid loss through your skin.
Do feel free to use aloe on intact sunburned skin. Keep commercially-prepared aloe lotion or gel in the refrigerator to make it extra soothing. You can also apply aloe gel directly from the plant. I keep an aloe plant on hand for such occasions and have found that it makes a great houseplant and is surprisingly easy to keep alive.
Don’t use petroleum jelly, butter, egg whites, or other home remedies on your sunburn.
Don’t be tempted to pop a blister if one develops. Popping a blister will increase you risk of infection. If a blister does rupture on its own then apply a bit of antibacterial ointment and keep it clean and covered with a bandage. Don’t remove the top layer of skin, it helps protect the tender underlying skin and will eventually come off on its own. If left alone blisters will generally heal without scarring in 7-10 days.
Do treat peeling skin gently. Keep the peeling area moisturized and don’t try to speed up the peeling with harsh exfoliants or scrubbing with a loofah.
Do come into the office if your sunburn is severe, blistering, and covers a large part of your body; if you have developed a skin infection from scratching sunburned skin, or you have a severe sunburn that does not begin to improve within a few days.
If you have a severe sunburn and also have fever, headache, confusion, nausea, vomiting, blurry vision, or fainting you may also have heat exhaustion or heat stroke. If you have any of these problems, you should go to the emergency department immediately.
- 28 July 2015
- Nutrition Blog
How can you get the most out of your workout? Putting in time at the gym is just part of the equation to getting the results that you are looking for. While you may know the importance of pre-exercise nutrition, if you are not properly fueling your body afterwards, you are probably cutting yourself short. Whether you are a weekend warrior or a seasoned veteran - you may have different nutrient needs but eating the right foods at the right time to help recover from the wear and tear of exercise is essential. Feeding your body after a workout allows you to see the results you want in terms of increasing your energy levels, strength, endurance, building lean muscle and losing weight. Skipping your post-workout recovery can put you behind for your next workout and also increase your risk for illness and injury.
What should I eat after my work out?
A combination of both a carbohydrate and a protein is best. Also remember to rehydrate the body with fluid and electrolytes to replenish what’s lost when you sweat it out. Carbohydrates are stored in the muscles as glycogen and are the body’s main source of fuel during exercise. Protein is necessary to reduce muscle breakdown and stimulate growth. After a workout, it is necessary to replace the fuels that have been “used up.” Carbohydrates replace the fuel while protein rebuilds and repairs. Keep in mind - carbohydrates are known as “protein-sparing.” If our diet is too low in carbohydrates, our body will find other means for recovery and will start to break down muscle.
How soon should I eat?
Eating or drinking a carbohydrate within 30 minutes after you exercise has been shown by research to result in better glycogen repletion. This window of time is important because glycogen and protein re-building is at it’s highest; therefore, it is the most ideal time to re-energize and is ideal for a speedy recovery.
Keep in mind…
After a hard workout, it is easy to reward ourselves - but resist the urge to overindulge. Consuming more calories than you actually burned can be counter intuitive and can be just as bad as skipping your post-workout meal.
Developing a good post exercise nutrition plan is important for exercising and in order to feel your best!
Here are some examples of some great post-workout snacks/meals:
- 8 oz low fat chocolate milk
- Apple slices with peanut butter
- A handful of almonds and juice
- A glass of milk with an english muffin
- A hard-boiled egg and a piece of fruit
- Greek yogurt with ½ cup of yogurt and 1 cup of berries
- Burrito with beans (½ cup), cheese, brown rice (½ cup), guacamole (2tbsp) and salsa
- Turkey on a whole grain wrap with veggies
- 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.
- 25 June 2015
- Nutrition Blog
When you’re on the run all day, as most of us are during the busy summer months, remember to take a few healthy snacks along with you. Here are some tips to make snacking easy, and a list of some healthy go-to snacks.
· Try to incorporate protein into your snacks. This will help keep you fuller, longer.
· Bring a little cooler or lunch box in your car to transport snacks at the right temperature all day.
· Avoid processed “snack foods” and stick to real, whole foods such a fruits, veggies, protein, and fats.
· Keep your snacks around 150-200 calories
· Snacking throughout the day will help keep you from over eating when you get to mealtime.
· Plan your snacks ahead of time and portion them out each day to avoid overeating.
· Don’t use snacking as something to do when you are bored, instead use it as a means of fueling your body throughout the day.
10 Healthy Go-To Snacks
· 1 piece of fruit and a small handful of nuts
· Plain Greek yogurt with a small handful of nuts
· 1 Kind Bar with 5g of sugar or less
· String cheese and an apple
· 1 hardboiled egg
· Veggies and hummus
· 2 Wasa crackers with avocado and grilled chicken
· Apple with peanut butter
· Carrots and guacamole
· Edamame or veggies with edamame hummus
- 28 May 2015
- Nutrition Blog
It is always important to drink plenty of water. However, now that the weather is heating up and summer is right around the corner, it becomes even more crucial to get enough water each day. The gold standard for water intake is at least 64 oz. every day, which boils down to eight -8o.z glasses. So, think about your day, how many glasses do you drink? If the answer is not at least 8 glasses, try to increase the amount.
Here are some other ways to increase water intake:
- Eat foods with high water content
- Green, leafy veggies
- Cauliflower and broccoli
- Citrus fruits
- Add slices of lemon, lime, orange, or other citrus fruit
- Get an infusion water bottle that allows you to put fruit in the center cylinder to keep your water flavored all day.
- Add cucumber for some freshness
- Try adding mint or other fresh herbs to your water for an interesting flavor enhancer
Plan out your glasses of water throughout the day
Here’s an example
- 1 glass immediately when you wake up
- 1 with breakfast
- 1 in the morning before lunch
- 1 with lunch
- 1 in the afternoon
- 1 right before dinner
- 1 with dinner
- 1 at night
Get a big water bottle and drink it all day long, try to fill it up as you go throughout your day
- 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.