Blog

Nutrition and Kidney Health

By: Marissa Martino, Registered Dietitian

Most of us don’t even think about our kidney health until they are already in danger, whether that’s from uncontrolled blood sugar levels or other complications like high blood pressure or obesity. The status of our kidneys depends greatly on our diets, and is impacted by the different foods that we eat, as well as hydration levels. Before we discuss kidney health, let’s ask the question: What do your kidneys do? About 200 liters of blood are filtered daily through your kidneys, removing up to 2 liters of water and waste products via urine. If our kidneys are not working as efficiently as usual, the process of blood filtration is not as effective leaving dangerous amounts of waste in our body. The kidneys also release hormones that regulate blood pressure and produce red blood cells.

There are also kidney-friendly superfoods that we can incorporate into our diet on a daily basis. These include cruciferous veggies such as cabbage, cauliflower which are high in Vitamins C and K, but low in potassium. Berries are high in antioxidants and also have anti-inflammatory properties which are important for your kidneys as well as your entire body. Healthy fats such as fish and olive oil contain omega-3’s which also help prevent inflammation.

No one wants to deal with dialysis on a weekly basis, so being proactive with kidney health is important and smart. Even without a diagnosis of DM2 or kidney disease, we should take preventative measures. Patients who do have a diagnosis that can compromise kidney health in the future can still utilize these and other preventative measure to care for their kidneys as best as possible. Talk to your doctor about kidney-protective medications and talk to your local dietitian (that’s me) about changing your diet for optimal health. Once kidney damage is done, it’s irreversible, however, avoiding the damage is possible in many cases and can lead you to a much better quality of life.

There are preventative measures that can be taken to keep your kidneys healthy:

-       Limit alcohol intake
-       Watch out for salt by staying away from packaged, processed, canned foods
-       Read food labels -  make sure salt is under 20%
-       Get your bloodwork done! Kidney disease is a silent killer and symptoms don’t start to show until there is already significant damage in place..

Stay healthy and even if you have been diagnosed with a kidney damaging illness - do not lose hope. In many cases, these illnesses are not a death sentence, but they do require more effort to stay active and healthy. When in doubt, call our office and schedule an appointment with your physician or dietitian!

Seizure First Aid

By: Monica Duvall, MD

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


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

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

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

Winter Skincare

By: Maria Daly, Practice Manager

Skincare doesn’t end at the end of the summer! Your skin is a huge organ which protects you from the outside elements. Whether this is heat, cold, wind, water, a butter knife or a single bacterial cell - your skin has the capacity to protect you from all of these items and more.

In exchange, as with any item you value - your skin does need to be treated a certain way to ‘hone’ its protective properties and this treatment is a year-round process.


Depending on your climate, winter cold can be drying on the skin, so using a moisturizer on exposed areas such as your face, ears and hands can keep your skin from over drying and cracking in the cold - a process that exposes it to further damage.


Some people get cold rashes all over their body - this skin also needs to be moisturized to prevent the same consequences - overly dry skin can crack and bleed leading to further damage and possible infections.

Another skincare procedure many people opt out of in the winter is using sunscreen! The UV rays that can cause not only skin cancer but also simple ‘skin aging’ changes such as wrinkles affect our open skin whenever the sun is up, so using sunscreen is a vital part of keeping your skin healthy and protected.

At the DermaCenter we offer many types of Sunscreen, including Environ, Avene and La Roche Posay.  Our aestheticians can consult you to see which type of sunscreen is best for you. Please call the office to set up a free consultation to see what products are best for your skin!


The Link Between Your Heart and Your Skin

By: Jayme Hudson, Aesthetic Director

Did you know February is heart health awareness month? Many people are not aware that having a healthy heart and normal blood pressure can aide in the fight against premature aging and other adult skin issues. Elevated blood pressure can lead to fine lines, wrinkles, sagging skin and under eye bags. These problems may occur for a few different reasons. High blood pressure causes lack of oxygen to vital organs, such as the skin, and sleep disorders (lack of sleep). When the skin cells are lacking oxygen, the skin becomes dry leading to pronounced wrinkles and lines while lack of sleep does not allow the skin to naturally heal and repair itself.


Overall, maintaining a healthy heart and normal blood pressure is not only important for your overall health but also plays a big role in your appearance. Having a well balanced healthy diet, exercising daily, and reducing your sodium and alcohol intake are things you can do to improve your blood pressure which will leave you looking and feeling your best!

Blood Pressure and Your Heart

By: Maria Mazzotti, D.O. 

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


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

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

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

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

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

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

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

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

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

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

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

Nutrition Related Birth Defects: Healthy Eating During Pregnancy

By: Angela Luciani, Registered Dietitian

There’s no reason to wait for a positive pregnancy test to start making healthier choices and aim for an overall healthier lifestyle. Incorporating healthy habits is important and beneficial at any stage of pregnancy but also before conception. Implementing healthier habits before pregnancy can improve the health of the mother as well as the baby by preparing the body for the high demands of pregnancy. Women are susceptible to a number of complications during pregnancy.  Research suggests women who are obese (BMI over 30) have a higher incidence of pregnancy-induced hypertension, gestational diabetes, cesarean delivery, and macrosomia. Being either underweight or overweight can reduce the chance of conceiving. Ideally, both partners should aim for a healthy BMI (between 18.5-24.9). Excess body fat or insufficient amounts can interfere with fertility.  Starting pregnancy at a healthy weight can lower the risk of complications. Eating well can help keep blood pressure, blood sugar levels and weight at normal levels and can help reduce incidence of complications. 


While there are a various factors that influence a healthy pregnancy, good nutrition is, without question, a determining factor in both a healthy pregnancy and baby. Women who are overweight or obese before conception are more likely to have a baby with a structural defect, including neural tube defects. Neural tube defects may be preventable through a healthy lifestyle and adequate nutrition. Spina bifida is a condition in which the fetal spinal column is unable to close completely during the first month of pregnancy, causing damage to the developing spinal cord. Anencephaly is a more serious defect and prevents the development of the brain. Birth defects occur in the first weeks of pregnancy. Folic acid can help prevent neural tube defects; therefore, it is important to have these nutrients in your system during early stages of the baby’s development. Women of childbearing age should consume at least 400 micrograms (.4mg) of folic acid daily to prevent these two common and serious birth defects. Women carrying twins or more, and those with epilepsy or diabetes require extra folic acid. Another essential vitamin to prevent neural tube defects is choline. Ensuring adequate choline may not only lower the risk of brain or spinal cord birth defects but it may also enhance the development and function of the placenta and possibly lower an infant’s vulnerability to stress-related illnesses including mental health disturbances, hypertension and type 2 diabetes. The recommendation for choline is 425mg per day for women and increases to 450 mg per day when pregnant and 550 mg per day for lactating women.

Optimal fetal brain and eye development is dependent on omega-3 fatty acids, DHA and EPA which can be found in seafood and fish oil. Research has revealed long-term benefits of prenatal omega-3 fatty acid intake includes higher memory function later on. DHA may lower incidence of colds in infants and shorten duration of symptoms associated such as coughing and fever. Women should aim for 650mg of omega-3 fatty acids, of which 300 mg is DHA per day. Consuming 2-6-oz servings of low mercury fish per week such as wild caught Alaskan salmon, tilapia, shrimp or cod provides 100-250mg of omega-3, of which 50-100mg is from DHA.  Consider incorporating fish oil capsules, which are low in contaminants of mercury to assist in meeting the recommendations.  Vegetarians can obtain DHA from algae-derived DHA supplements.

Iron is necessary for both fetal and placental development and needs increase dramatically after becoming pregnant. Consumption of foods rich in iron is necessary to prevent a deficiency and/or anemia. Research suggests that iron stores at time of conception are a strong indicator for risk of developing iron deficiency anemia later in pregnancy and deficiency may increase risk for preterm delivery. Pregnant woman need at least 27 milligrams of iron each day..  Low levels of Vitamin B-12, which is essential in the production of red blood cells, can also lead to anemia.  The RDA for B-12 for pregnant females is 2.6 micrograms and 2.8 micrograms for breastfeeding females.

The best thing you can do for your baby is eat a healthy, well balanced diet.  It is important to understand the benefits of good nutrition prior to, as well throughout, pregnancy in order to minimize potential risks and complications. A well-balanced diet is achievable; however, may be difficult to obtain optimum levels of nutrients through diet alone; therefore, incorporating a prenatal vitamin prior to and throughout pregnancy may be necessary and can improve your chances of having a healthy baby. 

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.

HIV - Get Yourself Tested!

By: Dr. Courtney Liggera, Psy.D.

World AIDS Day is December 1st--it presents a worldwide opportunity for people to unite in the fight against HIV, to show their support for people living with HIV, and to commemorate those who have died.  


One of the best ways to join in this fight is to get tested for HIV. The CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health care. And if you have any risk factors, a general rule is to get tested annually.


Despite a lot of growth in terms of people's understanding and acceptance of the HIV virus, there still remains a great deal of stigma around getting tested for HIV. Many people still fear that others will think less of them if they are diagnosed with HIV. They are also worried that they could be discriminated against if others learned of their HIV-positive status. As a result, they don't get tested even if they fall into a high risk category.

Additionally, some people won’t get tested because they are scared of the results.  In the early days of the HIV epidemic, many people saw being diagnosed with HIV as a death sentence.  However, there has been tremendous growth and development in the treatment for HIV-positive individuals. While there remains no cure, regular testing increases the odds of early detection, which drastically improves outcomes. 
Some folks don’t get tested because they think they don’t have any of the risk factors for HIV.

However, a 2011 study showed that 69% of HIV-infected patients said they weren’t tested earlier because they didn’t think they were at risk!  (Source: Medwiser, a nonprofit dedicated to providing insightful and innovative solutions to the HIV/AIDS crisis.) It is important to know all possible risk factors. Specifically, HIV can be transmitted through a number of bodily fluids, including: blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast milk. If you have engaged in behaviors that put you in contact with these bodily fluids, you may be at risk for getting HIV. Examples are vaginal or anal sex without a condom or without being on medicines that prevent or treat HIV, or sharing injection drug equipment with someone who has HIV.


HIV testing is paramount in ensuring that infected people are diagnosed early and receive treatment which helps prevent new infections. According to Medwiser, here are some important facts about HIV testing:


  • 20% of individuals living with HIV don’t know they are infected
  • 49% of new HIV transmission are infected by people who don’t know they have the disease
  • Early diagnosis and treatment can decrease transmissibility by greater than 95%
  • HIV positive patients treated early will live an average of 11 years longer
Those who don’t get tested will be diagnosed late, when the virus may have already progressed to AIDS. This makes treatment less effective, increases the likelihood of transmitting HIV to others, and causes early death. .

A key part of taking care of yourself both physically and psychologically means finding a health care provider that you feel comfortable with and is someone with whom you feel you can be open and honest. The more you tell your provider about what’s really going on with you, the better they can help you. So talk with your healthcare provider about getting tested as soon as possible. Doing so will mean you are taking an integral part of HIV prevention and awareness.

Foods that Support Emotional Well-Being


By: Marissa Martino, Registered Dietitian

     Not many people associate emotional well-being with nutrition. Usually when we think about what we eat, we relate that to our physical health and how it affects our weight and appearance. However, that is only scratching the surface of the variety of roles that food and nutrition play. Food is made up of two categories:  macronutrients, or the caloric content of food- which includes carbohydrates, proteins and fats. The second category is called micronutrients, which consist of all of the vitamins and minerals. These macro and micronutrients are what affect our mood, energy levels, hormone balance and even the chemicals in our brain such as serotonin and dopamine.

 

Nutrient deficiencies can happen from not getting a good mix of unprocessed foods such as: whole grains, beans and legumes, lean proteins and a variety of colorful fruits and vegetables. Each color category of fruits and vegetables provides a different phytochemical make up. For example, dark purples and blues are primarily beneficial for their anthocyanin content, which is good for brain and cognitive health. Greens provide isothiocyanates, which supports liver function and cell health. Yellows and oranges serve as a good source of beta-carotene which supports your immune system and eyesight. When we don’t eat enough of nutrient dense whole foods, we are denying our bodies the correct balance of nutrients. Eating a diet high in carbs and processed foods can mess with our blood sugar levels and serotonin stability which can contribute to mood swings and depression. A lack of B vitamins (which come from legumes, whole grains and seeds) can cause irritability, fatigue and poor concentration.

 

Another important part of the equation is making sure we actually absorb the nutrients that we eat!  Many of us have poor “gut” health and chronic inflammation. Our “gut”, or intestines, are actually what absorb the nutrients from the food we eat and pass them into our bloodstream where they can be used. Your intestines are most likely inflamed if you experience any type of IBS, such as constipation, diarrhea, and cramping or bloating after eating. This means that you’re probably not absorbing the nutrients from your food correctly. Probiotics are the number one source for reestablishing a healthy flora in the gut.  However, contrary to popular belief, food sources like yogurt do not contain enough probiotics to balance out the healthy bacteria. Taking a probiotic supplement that is more concentrated with the right amount of live cultures is extremely important for mental, emotional and physical health.  To learn more about how nutrition and which probiotic brands are the most beneficial and affordable, make an appointment with one of our Registered Dietitians today!

Not many people associate emotional well-being with nutrition. Usually when we think about what we eat, we relate that to our physical health and how it affects our weight and appearance. However, that is only scratching the surface of the variety of roles that food and nutrition play. Food is made up of two categories:  macronutrients, or the caloric content of food- which includes carbohydrates, proteins and fats. The second category is called micronutrients, which consist of all of the vitamins and minerals. These macro and micronutrients are what affect our mood, energy levels, hormone balance and even the chemicals in our brain such as serotonin and dopamine.

 

Nutrient deficiencies can happen from not getting a good mix of unprocessed foods such as: whole grains, beans and legumes, lean proteins and a variety of colorful fruits and vegetables. Each color category of fruits and vegetables provides a different phytochemical make up. For example, dark purples and blues are primarily beneficial for their anthocyanin content, which is good for brain and cognitive health. Greens provide isothiocyanates, which supports liver function and cell health. Yellows and oranges serve as a good source of beta-carotene which supports your immune system and eyesight. When we don’t eat enough of nutrient dense whole foods, we are denying our bodies the correct balance of nutrients. Eating a diet high in carbs and processed foods can mess with our blood sugar levels and serotonin stability which can contribute to mood swings and depression. A lack of B vitamins (which come from legumes, whole grains and seeds) can cause irritability, fatigue and poor concentration.

 

Another important part of the equation is making sure we actually absorb the nutrients that we eat!  Many of us have poor “gut” health and chronic inflammation. Our “gut”, or intestines, are actually what absorb the nutrients from the food we eat and pass them into our bloodstream where they can be used. Your intestines are most likely inflamed if you experience any type of IBS, such as constipation, diarrhea, and cramping or bloating after eating. This means that you’re probably not absorbing the nutrients from your food correctly. Probiotics are the number one source for reestablishing a healthy flora in the gut.  However, contrary to popular belief, food sources like yogurt do not contain enough probiotics to balance out the healthy bacteria. Taking a probiotic supplement that is more concentrated with the right amount of live cultures is extremely important for mental, emotional and physical health.  To learn more about how nutrition and which probiotic brands are the most beneficial and affordable, make an appointment with one of our Registered Dietitians today!

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