- 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.
- 01 May 2015
- Internal Medicine Blog
By: Lauren O'Brien, M.D.
Spring has sprung. and soon those long, hot days of summer will be upon us. We are all ready to enjoy the warmer, days the sun has in store for us, so this is the perfect time to reflect on the potential hazards that can come with all of that UV exposure.
May is Skin Cancer Awareness Month, so let's review some important skin cancer stats.
As a group, skin cancers are the most common cancers of humans. Melanoma is the most deadly form of skin cancer. The overall lifetime risk of melanoma is 1:50, but it represents the most common cancer in women aged 25-29 and the second most common cancer in women 30-34.
WHO IS AT RISK?
Melanoma can affect ANYONE, but there are certain people who are at greater risk.
1) Caucasians have a higher risk than other races
2) If you have >50 moles, or large/atypical moles, you are at higher risk.
3) Caucasians with light skin, freckles, red or blond hair, and those with blue or green eyes are at higher risk.
4) Your risk is increased if you have had a previous melanoma, other skin cancers (basal cell, squamous cell) or other cancers such as breast or thyroid cancer.
5) You have an increased risk if you have a family history of melanoma.
6) Your risk is increased if you have a history of a sunburn, or if you visited a tanning bed prior age 30.
Now that we know more about skin cancer and melanoma, the best strategy is to prevent the skin damagebefore it occurs. Here are some ways we can prevent skin cancer:
1) Seek shade and avoid sunburns. It is most important to look for shade between l0am and 2pm when the suns rays are the strongest.
2) Avoid sun lamps and tanning beds- as we said before, this is linked to an increased risk of melanoma especially if used before age 30.
3) Wear hats with a 2-3 inch brim to protect your face, ears, and neck. Plain baseball caps leave your neck and ears exposed and straw hats offer less protection than those made with a tightly woven fabric. If possible, wear long sleeves and pants for added protection.
4) Don't forget the sunglasses with UVA and UVB protection to keep your eyes safe.
5) Use a broad-spectrum sunscreen with an SPF of 30 or higher. Use at least a palmful to cover arms, legs, face, and neck. Use a lip balm with sunscreen as well. Be sure to apply 30 minutes prior to going out in the sun and reapply every 2 hours. Remember, sunscreen acts as a filter and does not give 100% protection. If you stay out in the sun for many hours in a day you can still get burned.
6) Use extra caution near water, snow and sand as they reflect the damaging rays of the sun and can increase your chances of sunburn.
Many skin cancers can be cured if found early, so surveillance and early detection are key. If you are in one of the high-risk groups, seeing a dermatologist yearly for a full body skin check is a good idea. You can do your own surveillance at home in between visits by following these tips:
1) Look for any new growths or sores that do not heal.
2) Follow the "ABCDE 's of skin cancer when evaluating moles:
- Asymmetry- ½ of a mole does not match the other half
- Border- the edges of the mole are ragged, notched or blurred
- Color- the color of the mole is mottled or uneven
- Diameter- the size of the mole is unusually large, greater than the size of the tip of a pencil eraser (6mm)
- Evolving- a mole is changing in size, shape or color, or if a mole is new to you.
If you note any of these changes, make an appointment to see your doctor or dermatologist for further evaluation. With a little diligence, you can still enjoy the energizing summer sun and keep your skin safe at the same time!
- 27 April 2015
- Internal Medicine Blog
Although there are different types of skin cancer, melanoma is by far the most dangerous type. Melanoma is the most common form of cancer for adults ages 25-29 and, despite being highly curable if caught early, an estimated 1 American dies every 61 minutes because of this cancer.
What is Melanoma?
Melanoma is a type of cancer that originates from the cells in your skin that hold pigment – melanocytes. The majority of melanomas are black or brown, but they can also be pink, purple, red, white and blue! The primary cause of this type of cancer is intense exposure to ultraviolet light (typically resulting in sunburn)
ABCDEs of Melanoma
The biggest prevention tool for melanoma is knowing your skin and noticing any changes that occur. To help understand changes, you can use ‘the ABCDEs of Melanoma’:
Asymmetry – regular moles are more likely to be symmetrical
Borders – regular moles typically have smooth borders, whereas Melanoma can have rough, even scalloped borders
Color – regular moles tend to be uniform in color
Diameter – benign moles tend to be small – under ¼ inch
Evolution – regular moles do not change over time; any change in size, color, shape or unusual activity -such as bleeding, crusting or itching – is usually a sign of danger.
What can I do?
Other than monitoring your skin and having annual skin checks with a dermatologist, there are steps you can take to avoid the kind of exposure that causes melanoma:
· Stay in the shade, especially between the hours of 10am and 4 pm ‘peak sun hours’
· Avoid tanning, especially in UV tanning beds
· Use a broad spectrum sunscreen that covers both UVA and UVB with an SPF of 30-50. Sunscreens with an SPF of over 50 have been shown to have a limited benefit and can be more costly. Also – do not forget to reapply our sunscreen every 2 hours or after excessive sweating and/or swimming.
· Last but not least – make sure to keep your newborns shaded and out of the sun and make sure to use sunscreen once your baby has reached 6 months!
If you have any moles that you are concerned about, our physicians, Dr. Lauren O’Brien and Dr. Stephanie McKnight will be happy to see you and even remove the lesion if necessary! We can also refer you to a dermatologist if you do not see one regularly. So take care of your skin and have a safe and wonderful summer!
- 27 April 2015
- Nutrition Blog
Here are a few tips to help you purge your kitchen of the unhealthy items and replace them with whole, fresh, healthy foods.
Check the labels: As a rule, you should always check the nutrition label and ingredient list before buying any foods, condiments, drinks, etc. If the item is high in sugar, high in sodium, or has trans fat, get rid of it. Always check the serving size. Although a container may appear to be one serving, make sure you check to see just how many servings it contains. The following additives are a big red flag and a good indicator to purge that item from your pantry.
· High fructose corn syrup
· Artificial colors
· Artificial flavors
· Artificial sugars
· Anything with a number
· Enriched wheat
· Hydrogenated oil
· Monosodium glutamate (MSG)
· Preservatives (such as BHA, BHT, potassium sorbate)
Chuck the junk: Get rid of the foods, snacks, and drinks that are keeping you from sticking to a healthy eating routine. Here are some items to toss:
· Potato chips, pretzels, crackers, corn chips
· Ice cream, frozen yogurt, sorbet, popsicles
· Candy, cookies, brownies, cake
· Fried foods and snacks
· Soda, diet soda, juice, artificially flavored and sweetened drinks
· Artificial sweeteners
Check the expiration date: Make sure the food in your fridge and pantry has not expired. If it is expired, toss it out and replace it with a new, healthy version.
Donate your discards: After purging your kitchen of everything you no longer want or need, you may feel a little guilty about throwing it away. If you have a lot of unopened food, do some research to find a local food pantry, food bank, etc. and see if they will accept your unopened items.
Replenish your stock: Take inventory of what you got rid of and try to replenish your stock with the healthy alternative. For example, if you got rid of condiments containing artificial colors, flavors, and preservatives, find a natural alternative with minimal ingredients. A few great places to shop that don’t allow many, or any, of the unhealthy items on their shelves are Trader Joe’s, Whole Foods, and Mom’s Organic Market.
- 31 March 2015
- Internal Medicine Blog
Alcohol Abuse is an often and seemingly socially acceptable behavior that affects millions of people in the United States. In fact, according to the CDC, 88000 deaths per year are linked to excessive alcohol use.
WHAT is alcohol abuse?
Alcohol Abuse or alcoholism is a chronic disease recognized by the following 4 symptoms:
• Cravings (the urge to drink)
• Loss of Control (Not being able to stop once drinking has begun)
• Tolerance (The need to drink greater amounts of alcohol for the desired psychological effect.)
• Physical Dependence (Withdrawal symptoms after stopping drinking: nausea, sweating, shakiness, anxiety).
But everyone drinks alcohol! Why should I be worried?
Other than the emotional and financial impact alcohol abuse can have on your life, it also ravages your body; excessive alcohol use affects ALL of you organ systems!
The most commonly known outcomes of alcohol abuse are:
• Liver diseases - hepatitis, cirrhosis
• Gastrointestinal complaints – gastritis, pancreatitis
• Neurological impairment – dementia, neuropathy
• Cardiovascular problems – hypertension, heart attacks
• Unintentional Injuries – motor vehicle accidents, drowning, falls
• Alcohol abuse can even lead to the development of diabetes!
What can I do?
Although there is treatment for alcohol abuse, there currently is no ultimate cure. Preventing the development of this condition is the best course of action for anyone. In order to play it safe, the U.S. Department of Health recommends that women do not imbibe more than one drink per day.
If you feel that you may have a problem with alcohol or are uncertain, discussion is the first step. Schedule an appointment to talk to your doctor as soon as you are able. Your physician can help determine whether your habits need correction and, if necessary can help you find an optimal treatment program which can include counseling and/or medications.
If you are not ready to talk to a doctor, please explore the following resources:
www.ncadd.org - National Council on Alcoholism and Drug Dependence
www.niaaa.nih.gov - National Institute on Alcohol Abuse and Alcoholism
www.recovery.org - Connecting people and their families with the information and resources to help them recover from substance abuse and behavioral disorders.
Don’t allow your life and health to be washed away – talk to your Primary Care Provider today!
- 25 March 2015
- Fitness Blog
Spring has finally arrived and it is the perfect time to spring clean your workout routine. After the long winter months, this time of year is great to reevaluate and revitalize your workout! Here are some of the best and easiest ways to make sure you are getting the most out of your routine.
1. Footwear: First and foremost, make sure you are wearing the proper footwear for your workout. Depending on your goals, there are many sneakers to choose from nowadays. The best choices are lightweight and flexible. Make sure you are not wearing a shoe that is too heavy as it will tire you out and slow you down a lot sooner than a lightweight shoe selection. You should also purchase your workout sneakers at least ½ size larger than your regular shoe size as this will allow you to have more flexibility and decrease any strain on your toes.
2. Plan your workouts: One of the main reasons people give up on working out is due to lack of planning. Each week you should draw up what your workout for the entire week will look like. Be sure to plan at least 3-4 days of cardio lasting for 30-45 minutes during each session. Incorporating weights is key. Strength training helps to build lean muscle and boosts your resting metabolic rate so that you will burn calories for hours after your workout!
3. Incorporate Interval Training: If you don’t already, you should incorporate interval training into your routine. By alternating your speed every few minutes helps to build cardiovascular endurance, improves speed and burns tons of calories. Before trying interval training, be sure to speak to your physician about the benefits and risks of this workout regimen.
4. Stop Spot Training: Exercising a specific area of the body with the expectation to eliminate fat in that particular location is almost impossible. Every person is an individual and has different genetics. To attack problem areas, many factors need to be considered including hormonal imbalances as well as diet. In order to properly tackle those problem areas, you must use a total body approach. You need to assess your exercise routine as well as nutritional intake and genetics. The more you know about these 3 things, the more you will see a change in those problem areas.
5. Cool Down: After a long workout the last thing most people want to do is a cool down. Cooling down your body is very important. It helps to bring your heart rate down and relax your muscles. It also helps to alleviate feeling sick afterwards. Be sure to stretch! Stretching also relaxes muscles but also helps to speed circulation to your joints.
- 25 March 2015
- Nutrition Blog
With the Broad Street Run coming up, it’s important to properly fuel your body. Everything you eat and drink leading up to the run has a direct impact on performance. In order to help you better prepare, our dietitian, Theresa Shank, RD LDN has outlined the best advice to strengthen your body for this year’s race.
Hydration: Because of the high level of exercise your body is about to endure, hydration is key to regulating body temperature throughout the race. Not only is body temperature a concern, but also without proper hydration your body may experience muscle cramping, which can make for a very unpleasant Broad Street Run.
Pre-exercise: Drink at least 16 ounces of water or sports drink an hour or two before the race.
During: Drink 5-12 ounces of water or sports drink every 15-20 minutes during your run.
*Don’t drink TOO much. If you start to hear “sloshing” in your stomach or nauseous then wait at least 15 minutes before drinking more.
Post exercise: Drink 16-30 ounces of water or sports drink.
*Because you are running 10 miles, a sports drink with 5-8% of carbohydrate (Look at Daily Value Percentage) is appropriate for achieving proper hydration and replenishing of glycogen stores.
Pre-Exercise Nutritional Goals: It is important to prepare your body with adequate nutrition in the hours leading up to your 10 mile run. Two-three hours before the race, eat a full meal with at least 50 grams of carbohydrate.
Example: A bagel with a tablespoon of peanut butter
Pre-Exercise Fuel (30 minutes – one hour before): 30 grams of Carbohydrate
You want to eat a snack in at least an hour before the race that contains carbohydrates, protein, and a little bit of fat to power through your run.
· 6 ounces of Greek yogurt w/10 almonds and ½ cup fresh/frozen berries
· 2 slices of whole wheat bread with 1 Tbsp. of peanut butter and 2 tsp. of fruit preserves
· 1 hard-boiled egg, a slice of whole wheat toast and a small piece of fruit
· 1 English muffin with ½ banana and 1 Tbsp. of almond butter
· 8-ounce smoothie with 1-cup plain Greek yogurt, ½ banana, 1 Tbsp. peanut butter, ½ cup orange juice or low-fat milk, and ½ Cup ice. (blend together)
Post Exercise Fuel:
After the race, your body is continuing to burn calories. You must ensure proper nutrition after the event to replenish your body with the energy it lost. Focus on eating a small snack with a 4:1 carbs to protein ration within the first 15 minutes after your run. Choose a snack low in fat and fiber to insure proper digestion. Later, within two hours after your run eat a balanced meal.
Post Workout Snack Examples:
· 1 Cup of oatmeal with ½ cup frozen berries or ½ banana
· 8 ounces Greek yogurt with 1 piece of fruit
· 1 slice of whole wheat bread with 2 slices of turkey and 1 slice of low-fat cheese
· Sweet potato with lean protein
· 8 ounces low-fat/non-fat chocolate milk