- 02 January 2017
- Nutrition Blog
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.
- 02 January 2017
- Internal Medicine Blog
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
○ Dark chocolate
○ Miso soup
○ 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.
- 02 January 2017
- Internal Medicine Blog
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:
- Sexually Transmitted Diseases
- Domestic Violence
- Child Abuse
- Motor Vehicle Crashes
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.
- 28 November 2016
- Emotional Well-Being Blog
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
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.
- 28 November 2016
- Nutrition Blog
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!
- 24 October 2016
- Skin Care Blog
If you didn't know, - November is Healthy Skin Awareness month. Maintaining healthy skin starts from the inside out. A well balanced diet that includes plenty of fruits and vegetables and hydration are critical. Diet combined with proper skin care,which includes in office treatments and at home regimes, will keep you looking your best.
A well balanced diet that includes fruits and vegetables provides your body with the vitamins and minerals necessary to combat free radicals which can lead to premature aging. Vitamins A, C and E are antioxidants that prevent damage to the molecules that support your skin cells. It is important to ingest these vitamins as well as apply them topically to provide the ultimate protection against these damaging free radicals.
Along with fruits and vegetables, it is very important to drink plenty of water throughout the day. Staying hydrated will not only leave the skin glowing but also rids the skin and body of harmful toxins. Staying hydrated with water can also minimize fine lines on the face by keeping the skin looking plump and firm. It is recommended to drink 8 full glasses of water as a daily minimum.
Lastly, a consistent skin care regime that includes in house medical spa treatments and at home products, are the finishing touches in keeping your skin looking its best. A basic regimen consisting ofat least a cleanser, moisturizer and spf is recommended. There are many other products you can incorporate into your regimen to keep the skin healthy and address specific problems such as rosacea, hyperpigmentation, acne, fine lines and wrinkles. Two treatments that we offer here at the Dermacenter that will keep the skin healthy and glowing are chemical peels and microdermabrasions. It is important to exfoliate the skin with these treatments because it rids the skin of old dead skin cells so new healthy ones are able to generate. When the skin is not exfoliated old skin cells pile up on the surface leaving the skin looking dull and dry which can also lead to acne or more visible fine lines and wrinkles. At the Dermacenter Medical Spa, we carry cosmetics by Environ which has a product line geared to every skin type. Check out the link below to find out more information on Environ or come in for a consult to meet your Dermacenter aesthetician and discuss which products are best for you to get your skin back to being healthy!
- 24 October 2016
- Internal Medicine Blog
If you are one of the 42 million Americans who still smoke cigarettes, or if you have family and friends that still do, we wanted to share a national initiative that is going on this month to help smokers quit. It is called “The Great American Smokeout” and takes place on November 17th this year. This special day was established by the American Cancer Society to help smokers pick a quit date and stick to it. It can be very difficult to quit smoking, but knowing that you are not alone in the struggle can be helpful, and hopefully motivating.
To help those who want to join in on “The Great American Smokeout” and choose November 17th as their quit date, we have gathered additional information and resources to help prepare you (or your family and friends) leading up to the big day.
The first thing to note is the innumerable benefits to quitting smoking. Diseases caused by smoking claim an estimated 443,000 American lives each year, including those that are not affected directly, for instance babies and children. According to the US Surgeon General, the choice to quit smoking is the “single most important step that smokers can take to enhance the length and quality of [their] life.” So, the choice to quit smoking- even for one day- is so important to your overall health that it can significantly reduce your risk of cancer and other diseases.
Now that you’ve made the decision to quit smoking, the next step is to pick a quit date, which we recommend to be within the month, so you don’t have the opportunity to change your mind. The quit date is important because it allows you time to prepare and plan. We encourage you to consider making an appointment with one of our providers to discuss options that are available to you, including Nicotine replacement therapy and prescription drugs. For many people, it may take the combination of medicine, changing personal habits, and emotional support in order to quit.
Which brings us to the next important step: building up your support system. Tell your family, friends, and co-workers that you are planning to quit, so that they can help motivate and encourage you. Also, consider stop-smoking programs, Nicotine Anonymous meetings, self-help materials, and telephone quit lines which all can be a great help as you lead up to your quit date.
Before you know it, it will be November 17th and you will be amongst thousands of other smokers who have decided to choose their health over their habit, and starting on a path to successfully quitting for good!! So, schedule an appointment to see one of our providers and check out the American Cancer Society’s webpage to learn more about resources that are available to you at www.cancer.org or calling 1-800-227-2345.
- 24 October 2016
- Internal Medicine Blog
It's unlikely that diabetes is on the forefront of your mind as we approach the end of the year and a busy holiday season, but November is Diabetes Awareness Month and now is really a better time than ever to think about your own personal risk factors for the development of this complex and chronic condition. Diabetes Mellitus is the name given to a group of metabolic diseases that are caused by the body's decreased ability to utilize sugar appropriately. These diseases are ultimately caused by defects in the way that the body uses and/or makes insulin. Insulin is a very important hormone secreted by the pancreas that allows our tissues to absorb sugar in the bloodstream from the food that we eat, in addition to performing a number of other important functions. When the pancreas cannot make insulin or the tissues in our body become resistant to its effects, this results in high levels of sugar in the blood, otherwise known as hyperglycemia. Persistent hyperglycemia can cause many bothersome symptoms and both short and long-term complications, ranging anywhere from persistent nausea and fatigue to heart attack, strokes, chronic kidney disease, blindness, poor circulation, and nerve damage. Diabetes has the potential to affect literally every organ in our bodies. Somewhat surprisingly, perhaps, diabetes can can also be entirely asymptomatic. Regardless of the severity of symptoms, persistent hyperglycemia is an extremely serious condition that still puts one at risk for the complications noted above. Therefore, screening those at risk is a crucial first step in managing this condition.
It is estimated that about 30 million Americans live with a form of diabetes, most of whom have type 2 diabetes. Unlike type 1 diabetes, which is an autoimmune disease of the pancreas that is typically diagnosed in childhood and adolescence, type 2 diabetes typically develops during adulthood and has a slow and insidious onset. There are several factors that increase your likelihood of developing diabetes. If any of the following conditions or situations apply to you, you should talk to your healthcare provider about screening for diabetes:
- Sedentary lifestyle
- Overweight or obese
- First-degree relative with diabetes (such as your mother, father, or sibling)
- African American, Latino, Native American, Asian American, or Pacific Islander race/ethnicity
- Dyslipidemia (specifically, low HDL levels and high triglyceride levels)
- History of cardiovascular disease
- History of gestational diabetes or delivering a baby > 9 lbs.
There are several types of tests available to screen for diabetes. The easiest tests that can be ordered during a routine office visit include a fasting glucose level or a hemoglobin A1c. A fasting glucose level of over 126 mg/dl or a hemoglobin A1c level over 6.5% is considered to be diagnostic for diabetes, though these tests should be repeated to confirm their accuracy. Any test that is borderline high is consistent with pre-diabetes, which is essentially a warning sign that you are likely to develop diabetes without an intervention. While several of the risk factors listed above are beyond one's control, like family history or ethnicity, many of them are, of course, modifiable. The best way to prevent diabetes for those who are predisposed is to engage in a regular exercise routine, work on portion control, and reducing or eliminating consumption of foods that are high in sugar – such as sweets and sodas. These sorts of changes can be extremely challenging, so don't ever hesitate to let your healthcare provider know if you need additional help or support. There is also a prescription medication called metformin that can be taken to help your body use sugar more appropriately, which can in turn help to prevent the progression from pre-diabetes to diabetes. This medication is most effective when it is used in combination with lifestyle changes.
While the holiday season may not seem like the best time to think about your health, it can provide a great opportunity to learn more about your risk factors for diabetes as you connect with family members and reflect on your own health histories and habits. This is really the first step in determining whether you are at risk for diabetes, and the next is to speak to your healthcare provider to learn more about screening and risk reduction. Our priority as healthcare providers is to offer you non-judgmental guidance and support as we work with you to optimize your health and minimize your risk factors for chronic diseases such as diabetes, and, most importantly, to remind you that big changes start in small ways.
- 24 October 2016
- Nutrition Blog
By: Marissa Martino, Registered Dietitian
Anyone can be affected by the negative habit of stress eating, whether it’s more prevalent during the holidays, or even all year around. There are many reasons why we binge eat because of stress, but luckily there are also many ways to confront this destructive behavior. First, is to understand exactly why we stress eat. Biologically, our bodies are regulated by hormones, many of which control and greatly affect our weight. Cortisol, the “stress hormone” can actually create cravings and make it physically harder for our bodies to drop fat. This hormone is important to be aware of since it can create nervous energy and make us “orally fidgety”, causing nail biting, teeth clenching and also eating without being aware. To grasp stress eating, we need to first understand that for many people, emotions become tied to eating habits, which makes weight and anything related to, such as food, a very emotional subject. It’s important to recognize what emotion is driving us to eat, and realizing that the end result is always the same- guilt, along with the same emotions from before eating lurking close by. This is why the first step to combating stress eating is to figure out what your triggers are.
What emotion prompts you to crave foods, and what caused that emotion? The next step is to become comfortable with confronting that emotion and learn how to openly communicate with whomever or whatever the trigger is for that emotion. Another trick is to keep a food journal. As a dietitian, I recommend this for everyone- whether you’re dealing with stress eating, want to lose weight, or even just become a healthier version of yourself.
Documenting everything that you consume will make you much more aware of your selections. You can also assess your hunger levels each time before you eat or drink- are you physically hungry (grumbling), or are you just bored? After you eat or drink, then document your satiety level. If you were actually hungry, the result of eating should be satisfying. If you ate or drank due to stress or boredom, your satisfaction level will be much lower.
Another important key is replacing a stress eating with a healthy habit. Once you understand what your trigger is, tame that stress by engaging in something that interests you, whether it’s yoga, going to the gym, meditation in a quiet place. Fight boredom with whatever hobbies interest you and don’t forget to do a hunger check before eating or drinking. If you are concerned with weight loss, keep temptations out of the house to avoid any mishaps. Battling stress eating is a journey to understanding ourselves better and becoming healthier physically and also mentally. Also remember that we are all human, and if we fall off track, don’t wait until the next day to get back on track. Learn from your setback and move past your obstacles as quick as possible. Believe in yourself and be a part of your own support system!
- 26 September 2016
- Internal Medicine Blog
Often, conditions of the skin can have a psychological aspect that also needs to be addressed. Research has shown that mental illness, stress and other psychological factors can activate or worsen skin conditions.
Did you know that the skin is the body’s largest organ? It is a protective barrier that helps the body fight against injury and inflammation. The skin is involved in many complex biological processes, including the brain and nervous system. The brain and nervous system influence the skin’s immune cells through various receptors. When you are facing chronic negative stressors, research suggests it disrupts the function of the skin’s protective barrier, potentially leading to or exacerbating a skin condition.
Only in the past several decades have we seen the resurgence of the mind-body awareness in medicine; and only in the past decade have we seen an emphasis on understanding the interaction between the mind and the skin. Psychodermatology is a holistic view within the medical world looking into the cause and effect relationship of the mind and skin. Psychodermatologic disorders often fall into three different categories:
Psychological skin conditions are usually chronic conditions and can often be exacerbated by stress and other emotional factors.
- Alopecia Areata
Secondary Psychiatric skin conditions, due to their visibility, can erode one’s self esteem, leading to social phobia’s and depression.
- Severe Acne
Primary Psychiatric skin conditions are symptoms of a psychiatric disorder and recognizing them is important in the treatment of a mental illness.
- Trichotillomania (chronic hair pulling)
- Delusional Parasitosis
- Body Dysmorphic Disorder
- Dermatitis Artefacta (self-inflicted picking, cutting)
When treating all skin conditions, it is important to know that not everyone responds emotionally through the skin, nor do all people react the same way to having a skin condition. But, evidence has suggested in patients with psychological issues that intersect with a skin condition, treating both the mind and skin offers the best chance for improvement. Like I tell all my patients, take ten minutes to relax and meditate, stick to a healthy diet, go for a walk in the park; your mind and skin will thank you for it.