- 27 April 2016
- Emotional Well-Being Blog
By: Robin Hornstein, PH.D.
It is likely that you or someone you know has a “weird” obsession with food or their body. These days, the culture of beauty and perfection is understood even when we are young girls watching the world around us. Three year olds more commonly ask their moms if they are fat. You probably can give a lecture yourself on the media ruining the lives of many girls with standards of beauty that most of us won’t meet in our lifetimes. Most women also have been on some diet by the time they are 25 and have their own diets in their heads (cheat days, no carbs if you eat cake at a party, Paleo, Weight Watchers points, healthy eating, juice cleanses, calorie counting). The list is long and the demand on our psyches is high.
I would argue that if more than 10% of your day is spent worrying about what you will or won’t eat and you are upset with yourself for losing the battle of these rules, you may have disordered eating or thinking about food. And if that time spent fretting is full of self-loathing, punishments, make-up time at the gym or other compensatory behaviors, you are headed for the emotional and physical suffering that can become an eating disorder. Further, if your worry interferes with socializing and intimacy with others on any level you are showing more signs of an eating disorder than you might want to live with day to day.
What crosses the line to an eating disorder? Well, first we need to know that the number one mental health disorder that leads to death is Anorexia. It beats out suicide, which is quite alarming and perhaps should be classified as a suicidal illness. I imagine that most of you reading this can define the major diagnoses in the Eating Disorder list: Anorexia, Bulimia, Binge Eating Disorder and Orthorexia may be familiar to you as you probably have read about these or have known someone who has struggled. Orthorexia is the least known and is actually best defined as a systematic elimination of foods one won’t eat as they are defined as unhealthy. The list is obsessive and ends up limiting many enjoyable life moments and affects mood and health. This disorder is not someone who says they don’t want to eat sugar – this is more a disorder where the body image and mood are affected by the choices that one will eat due to many factors. The underlying obsession leads to much anxiety, and Steven Bratmas, MD calls people with this disorder “health food junkies”.
In reality, if you see yourself in these descriptions and feel that you have any behaviors that you hide or get angry when you are confronted with them (bingeing, eating too few calories a day, exercising to excess, only eating certain foods, purging via vomiting or other methods etc.) you may require help to overcome these behaviors. And, it is not only our body that suffers. Living with an eating disorder is a disruption in your life. It is a mental health issue and not just a will-powered choice. Most women with an ED (Eating Disorder) also have other mental health issues that accompany the ED behaviors.
Depression, anxiety, obsessive-compulsive disorder and posttraumatic stress disorder are some of the illnesses that lead to or are caused by having an eating disorder. It affects all areas of one’s life. These disorders harm our bodies, careers, relationships, make us lonely, erode creativity and fun and hamper being a full and successful person in the world. What to do? Seek help. Tell someone and leave the secrets behind.
What I have learned as a therapist for the past 33 years is that secrets can lead to severe illness constricting our happiness and functioning. Tell your physician, a friend, anyone you trust and start to unwind how you got to this place. There are many types and levels of care and your people, as you trust them, can help guide you. One of my clients told me the other day that she goes to the gym and spends her time seeing who she is thinner or heavier than, who has greater endurance than her and how she will beat them next time. When I asked if this was an enjoyable use of her time or if she ever talked to anyone, she looked at me like I had three heads. Body image issues and eating disorders are issues of loneliness and a feeling of being less than everyone else. If this is part of your story, or someone you know, reach out for help. It is everywhere around you. A good team of a physician, nutritionist and therapist can help you untangle the web you are stuck in and find a full and rich life.
- 27 April 2016
- Nutrition Blog
By: Angela Luciani, RD
May is stroke prevention/awareness month. Each year, about 800,000 people suffer from a stroke (1). Anyone can have a stroke, including children. Having a stroke can be scary for many people because it is often an unpredictable event; however, up to 80% of strokes are preventable (2). There are some factors that increase your risk for a stroke that you cannot control such as age, gender, race as well as family/personal medical history but there are some steps you can take to modify your lifestyle in order to help reduce your risk.
- Incorporate a heart healthy diet – Diet plays an important role in reducing your risk for stroke as well as many other chronic diseases. Both poor cholesterol levels and high blood pressure are risk factors for having a stroke but can be improved with nutrition. Choosing a heart healthy diet includes the following:
- Incorporate a variety of fruits and vegetables
- Choose whole-grain, high-fiber foods
- Limit saturated fat and trans fat which can be found in items such as butter, cheese, fried and processed foods, red meat and other animal-based foods
- Choose lean meats and poultry such as chicken or turkey without the skin
- Incorporate fish at least two times a week for added benefits of omega 3’s
- Aim for a healthy weight – Obesity increases your risk of having a stroke. A normal BMI of 18.5-24.9 is recommended. Losing weight can have a significant impact on your stroke risk.
- Exercise daily – Exercise is one of the best ways to stay in shape as it can not only help you maintain or achieve a healthy weight but it also helps lower cholesterol levels and can keep blood pressure at a normal level. (It’s also a great way to de-stress!)
- Cut back on the alcohol! – Consuming too much alcohol can lead to high blood pressure and/or trigger an irregular heartbeat – both of which also increase your risk for a stroke. Alcohol can also tend to be high in calories, so regular consumption can make it difficult to maintain a healthy weight.
- 28 March 2016
- Internal Medicine Blog
April is Sexual Assault Awareness month, so we wanted to take the time to go over this tough issue that far too many women encounter. Many people think of sexual assault as “rape,” but what most people think of as rape is only just one form of sexual assault. Sexual assault comprises of sexual acts performed by one person on another without consent through intimidation or force. This can happen when someone is cognizant, or if the victim is passed out, drunk, or on drugs and not able to make decisions for herself. People can be sexually assaulted by strangers or people they know, such as family members.
Sexual assault is very common. In the United States, one in three women will be a victim of sexual assault during her lifetime and only 10 to 15 percent of sexual assaults are reported to the police. The number of cases that are reported decreases when the woman knows their assailant.
Sexual assault can be traumatizing and debilitating, but with the appropriate resources, it does not have to be overwhelming. The first thing you should do after a sexual assault is find a safe place away from the person who attacked you, then:
- Call a close friend or family member. Choose someone who will give you support no matter what.
- Call 911, go to the emergency room, or call a provider here. In the emergency room, a doctor or nurse can do an exam and make sure you are OK. They can take samples of cells or fluid from your body and clothes. These samples can show who your attacker was and what he or she did. You do not have to let the doctor or nurse do anything you do not want. We do not have the test kits available in our office to get DNA samples, so we would make sure to refer you to the appropriate center to have that done. Either way, either a provider here or at the emergency room will be able to offer you medicines that can reduce your chances of getting pregnant or an infection. Emergency contraception can work 5 days after being raped, but it works better the sooner you take it, so don’t wait. If you are older than 17, you can get some forms of emergency contraception without a prescription.
- Do NOT try to clean up before you see a doctor or nurse. If you clean up, you might wash away proof of what happened. This includes:
- do not change clothes
- do not take a shower or bathe
- do not brush your teeth
- do not wash the inside of your vagina or rectum (in other words, do not douche)
- If you can wait, try not to go to the bathroom or to eat anything until after you have seen a doctor or nurse
- Seek emotional support- someone you can talk to about what happened. We have therapists at our practice who are good resources to talk to after any traumatic event. Other options include your primary care provider, a crisis counselor, a social worker, or a sexual assault nurse examiner.
- Talk to your provider or counselor about filing a police report. If you do not want to report the assault, you do not have to, but people often change their mind later. Either way, it could be helpful to talk to one of the providers here or a counselor. Evidence is most useful when it is collected right after the assault.
- Return to our office 1 to 2 weeks. This will give us a chance to do any follow up lab work that is needed and to make sure you are doing Ok.
- Protect others if you might have an infection For at least 3 months after being raped, if you have sex with someone, use a condom every time. This will reduce the chance that you will spread any infections you might have caught. Also, wait at least 3 months before trying to get pregnant. That way, you can find out before you get pregnant if you have an infection that could hurt the baby.
- If it has been awhile since you have been attacked, please schedule an appointment with us anyway. It doesn’t matter if we cannot collect proof of the attack. We will be able to test and treat you for infection or pregnancy, and help you recover from the event. We can also provide you with resources to help you if you decide you would like to report the event.
Additional resources available in the event of any sexual assault are:
- The Sexual Assault Hotline 1-800-656-4673
- Women Organized Against Rape: Philadelphia’s Rape Crisis Center 215-985-3333
- Pennsylvania Victims Compensation Assistance Program (VCAP) to receive compensation for expenses incurred as a result of a crime www.pccd.pa.gov/Victim-Services or 1-800-233-2339
- 28 March 2016
- Emotional Well-Being Blog
By: Courtney Liggera, Psy. D.
I was wondering why the ball was getting bigger.
Then it hit me.
We have all heard the saying “laughter is the best medicine” – and there is more than a nugget of truth in it.
Laughter has a significant effect on our bodies and our minds. Laughter triggers the release of endorphins and serotonin, which creates feelings of happiness, love, and euphoria. Laughter also initiates a psychological phenomenon called “facial feedback,” whereby a certain expression can cause a person to have the corresponding emotion. Just the simple act of smiling from laughing can improve one’s mood.
As a result, laughter can be a powerful tool in everyone’s lives. It makes people feel good, and that good feeling remains even after the laughter stops. Laughter helps people maintain positive and optimistic outlooks even through difficult situations, disappointments, and losses. Even more significant and powerful than getting relief from sadness and pain, laughter gives people courage to find hope in difficult times. A laugh, or even just a smile, can help a person overcome significant obstacles.
There are several links between laughter and mental health. Laughter helps to temper distressing emotions like anxiety, sadness, and anger. Laughter helps you relax and recharge by decreasing stress, increasing energy, and helping you stay focused and accomplish more. Laughter also helps change perspective by permitting people to see situations in more realistic and healthy ways. It creates psychological distance which in turn, helps people avoid becoming overwhelmed.
We all can benefit from incorporating more laughter in our lives. Here are some simple ways bring it on home:
1. Smile. A smile is the beginning of laughter and like laughter, it is contagious.
2. Count your blessings. Make a list of good things in life which will distance you from negative thoughts which can be a barrier to laughter.
3. When you hear laughter, go to it. People are often more than happy to share something funny because it gives them a chance to laugh again.
4. Spend time with fun, playful people. These are people who laugh easily, both at themselves and at life and find humor in everyday things. Their happy points of view and laughter are contagious.
By focusing on a few small changes and welcoming laughter into your life, you can make significant steps towards improving your overall mental health.
- 28 March 2016
- Nutrition Blog
Have you ever had a really stressful day at work, then decided to take a jog, attend your yoga or kickboxing class, or even go lift some weights at the gym? Chances are you felt much better afterwards, and the stress from earlier that day melted away. This is because exercise actually has both short term and long term effects on mood. Research shows that moderate exercise enhances mood within just 5 minutes of activity. Many studies have also shown that exercise can help and prevent anxiety disorders, also known as fight-or-flight responses. Those who participate in exercise have a decreased response to anxiety sensitivity than those who are sedentary.
Some have the idea that exercise will wear them out and be tiring, when actually the opposite is true. Exercise boosts energy. During exercise, blood flows more freely throughout your body, delivering oxygen and nutrients to important organs, tissues and muscle. Your body also releases chemicals called endorphins during moderate exercise. Endorphins interact with the receptors in your brain that trigger a positive feeling. Ever felt a post workout high, or general sense of well being and confidence after exercise? That is your body responding to these feel-good chemicals being released during your workout.
If you don’t belong to a gym, or don’t know where to start in regards to exercise- first and foremost, get outside! Take advantage of the beautiful weather and walk or jog along a trail. Incorporate some jump squats or walking lunges to increase heart rate and blood flow. If you are at home, you can create your own plyometrics or HIIT (high intensity interval training) circuit. Sprint up the stairs in your apartment building, hold yourself in a plank position, use your body weight for wall-sits, squats or pushups. The options here are endless.
In conclusion, the benefits of daily exercise are remarkably valuable in so many ways- including weight control, improvement of mood and sleep, boosts energy and combats health conditions such as diabetes, heart disease and high cholesterol. Need any more convincing to get up and move? Remember, sweat is free!
- 29 February 2016
- Internal Medicine Blog
By: Maria Mazzotti, D.O.
Lead poisoning presents with very non-specific symptoms such as abdominal pain, constipation, irritability, anemia, difficulty concentrating and especially in children, developmental delays, learning difficulties and vomiting. Although it seems to be more prominent in children than in adults, repeated slow exposure in adults can also be very critical. Lead exposure in adults can lead to increased risk of hypertension, renal damage and cognitive decline if gone undetected.
Children are more likely to get it by inhaling or swallowing lead in dust. It may also be in paint chips in houses built before 1978. We have also learned that certain toys that are manufactured outside of the US contain lead. Finally, we were recently reminded that water that travels through lead piping could also carry dangerous amount of lead particles.
Interestingly, in adults it seems to be more likely to occur in men than women, due to occupational exposure such as in the manufacturing of batteries, cable wires, car radiators and batteries, cosmetics, tin cans, glazes, paints and ceramic ware. Obviously, if you are remodeling an older home you should be wearing a mask. It is important to tell your physician if you work in any of these environments.
It is even more important if you are pregnant or breastfeeding. If there is concern, the blood from the baby’s umbilical cord should be tested at birth or the baby’s blood at 2 weeks. Since lead poisoning can also be transmitted through breast milk, and if there is concern, it is recommended that mom and baby be tested.
Lead poisoning can be prevented. Obviously, if you are aware of lead in your house, there are lead abatement professionals that can come into the house to eliminate the lead. Nutritionally speaking, you can have a diet rich in calcium, vitamin D and iron to prevent lead poisoning. Children especially should take a multivitamin with iron on a daily basis.
When your lead levels are high enough, you will need to undergo a treatment called Chelation. Chelation involves taking a medication that helps the elimination of lead from your body. It is important to keep in mind that since Chelation does not reverse the long-term effects of lead on learning and intelligence, patients should only be treated if they are no longer exposed to the lead environment.
- 29 February 2016
- Nutrition Blog
By: Marissa Martino, RD
Our bodies are composed of over 60% water, which means that this essential nutrient is vital to our health. Water plays many roles and has a variety of functions, along with maintaining a certain homeostasis in each of us. A deficiency in water can result in noticeable symptoms, such as dry mouth, eyes and nose. But it can also affect parts of our body on a cellular level that we can’t necessarily detect right away- such as carrying nutrients and oxygen to our blood. Water regulates our body temperature, lubricates and cushions our joints, aids in digestion by preventing constipation and also helps to put less of a burden on our kidneys and liver by flushing out our systems.
A very generic number for water intake is 64 oz a day. This number changes in regards to how physical our job is, our sweat rate, and the temperature of the weather. It’s important to make sure we are at minimum, replenishing the amount of water we lose each day. More than 1.5 liters of water are lost just by perspiration, breathing and urine output. This amount is before any physical activity! If we are dehydrated during physical activity, we don’t sweat as much which can cause our body to overheat.
Some simply forget to drink throughout the day, and others just don’t prefer to drink plain water. There are many ways to fix these problems! First, go out and splurge on a nice water bottle. This will give you an initiative to have it with you throughout your day. Place your water on your desk and set little goals for yourself- for example, by 10 am you will have drank the first half of your water bottle, and by 12pm you will have finished your first bottle and refill at lunch time. There’s also unlimited ways to flavor your water without adding sugar or artificial flavorings. Fruits such as citrus, berries, even mango and pineapple infuse awesomely in water bottles to give a little natural sweetness and vitamin boost to your water. Or you can go the herbal route with mint, lemongrass, rosemary, basil, or sage which mix very well with veggies like cucumbers. You could try a refreshing blend like citrus, mint and cucumber or you could energize your afternoon with raspberry and black tea infused water. If you are craving a bit more sweetness, a drop or two of stevia will do the trick. If bubbles help quench your thirst, add these flavorings to carbonated seltzer water. The combinations are endless!
- 29 February 2016
- Internal Medicine Blog
Philadelphia’s drinking water is sourced from the Delaware and Schuylkill rivers. It is monitored and regularly tested throughout the treatment process before it reaches your faucet. This includes a corrosion control treatment to help reduce the amount of lead leached from pipes and testing for more than 100 contaminants, including lead. The Philadelphia Water Department also does lead-specific tests in more than 50 “vulnerable” homes that may have lead exposure or lead pipes. The results help to determine if the corrosion control treatment technique is successful and verify that there is a minimal amount of lead leaching from the plumbing. Current tests shows these levels are minimal and that Philadelphia’s water quality continues to meet all State and Federal standards.
However, there is some skepticism with the way the Water Department tests for lead, saying that current testing may mask the problems. This controversy states that the testing of water differs from the way residents use tap water, and true levels are not represented in results. The removal of the aerator, a small filter, and “pre-flushing” running cold water to clean out the system prior to testing, alter results and make levels seem safer than they are. The Philadelphia Water Department has responded saying flushed samples are not what is tested. Guidelines state residents in high-risk homes to flush their faucets in an effort to clean their pipes of the chemical, not as a method to rid potential samples of it. Increased interest in Flint and questions about Philadelphia’s water quality has led Councilwoman Helen Gym to hold future hearings to discuss prevention of a Flint level catastrophe happening here. Gym says, "I don't think Philadelphia is Flint, but, we need to be vigilant."
There are many ways to reduce you and your family's risk of lead contamination. If you’d like to get your water tested, at-home tests are available from home improvement stores, but may not be accurate. The EPA recommends using a certified laboratory for testing. Lists of approved labs in the Philadelphia area are available from the Pennsylvania Department of Environmental Protection. Call 717-346-7200 to find a lab close to your home. Most labs will either send out a testing kit or schedule a test at your home. The PWD can also send someone to test your home.
Warm water increases the chances of leaching from your pipes, so before use, run the faucet on cold for a few minutes to flush any lead and bring fresh water into your pipes. When using tap water for drinking and cooking use cold water as well. You could also filter your water, unfortunately, commonly used filtered water pitchers may not do much to remove lead. A reverse osmosis filter is recommended if you suspect you may have lead contamination. Remember, even if you have lead plumbing it does not mean you have high levels of lead in your water, due to the city’s methods of preventing lead corrosion.
If you’d like to help the residents of Flint, Michigan, there is a multiple ways to do so. There are a number of established organizations bringing aid to those residents that are accepting donations, including The Flint Water Fund by United Way of Genesee County, The Flint Child Health & Development Fund of The Community Foundation, Catholic Charities of Shiawassee and Genesee Counties, and other organizations like Water We Fighting For. You could also support the research team, Flint Water Study, aiming to keep the residents informed about what is really happening with their water. Last but not least, you could sign the petition asking Gov. Rick Snyder to stop making Flint residents pay for poisoned water!
- 26 January 2016
- Internal Medicine Blog
We have all seen the commercials. A patient in obvious pain is shown with a terrible looking rash over a significant portion of his or her body. They are asking questions such as “why me?” and “what could I have done to prevent this?”. These patients have been diagnosed with shingles, and the suffering pictured can be accurate. Here’s what you needs to know about this disease and how to prevent a severe outbreak.
Shingles, also know as Herpes Zoster, is caused by the Varicella Zoster Virus (VZV). This is the same virus that causes chicken pox (varicella). After a patient has had the chicken pox or received the varicella vaccine, the VZV continues to reside in the nerve roots indefinitely. The VZV can then be reactivated, leading to a case of shingles. Any patient who has had the chicken pox or the Varicella vaccine is therefore at risk for shingles.
While most severe cases are seen in patients over the age of 60, shingles can occur at any age. Generally, individuals will only have one case of shingles in a lifetime, but recurrent cases are possible. Those who are immunocompromised are at higher risk of recurrence.
The hallmark symptoms of shingles are pain and rash. Approximately 75% of patients have pain prior to the rash developing. This pain is usually described as burning, throbbing or stabbing and can occur days to weeks prior to skin lesions.
The shingles rash starts as red papules (bumps) and evolves into grouped vesicles or blisters. After about 3-4 days the lesions may become pustular and will crust over at 7-10 days. Once these lesions are dry and crusted, the patient is no longer contagious. Because the virus resides in the nerve roots, the rash tends to involve a limited area on only one side of the body. The most dreaded shingles infection involves the trigeminal nerve located in the head. Infection here can lead to Herpes Zoster Opthalmicus, which can be sight-threatening. An individual with this manifestation will have lesions around one eye and the tip of the nose.
The most common complications of shingles include: post-herpetic neuralgia and bacterial superinfection of the skin lesions. Post-herpetic neuralgia is pain that persists at the sight of the rash for months to years following infection. It occurs in 5-20% of those with shingles and is more common in patients over the age of 60.
When discussing shingles with patients, the most common questions I hear relate to transmission and contagiousness of this disease. Let me try to break it down simply for you. You cannot give someone else a case of shingles. The VZV can be passed from contact with the skin lesions and is generally not airborne in an individual with shingles. Only people who have not had chicken pox or the varicella vaccine, or are immunocompromised are at risk when in contact with a shingles patient. If one of these individuals comes in contact with the active shingles lesions, they could go on to develop chicken pox, but NOT shingles. I am often asked about pregnant women and exposure to shingles. If the pregnant woman has had chicken pox or the vaccine in the past, there is very little risk present. That being said, I would recommend that a patient with an active shingles infection avoid infants, pregnant women and the immunocompromised until lesions have crusted over. It is advised to keep the rash covered and wash hands frequently to prevent transmission.
For older patients, there is a vaccine available to help prevent shingles. Though this vaccine will not prevent 100% of cases, it has the potential to reduce the severity of an infection and prevent the dreaded post-herpetic neuralgia. This vaccine is recommended in patients 60 and over (though it is FDA approved for those over 50). It can and should be given even if a patient has had a history of shingles. Talk with your doctor to see if the shingles vaccine is right for you.
In summary, the vast majority of the population is at risk for shingles. It is most common in older patients and those with weakened immune systems. The VZV responsible for this disease can be transmitted through contact with the skin lesions, but only those who have not had chicken pox or the varicella vaccine or the immunocompromised are at risk. If you are older than 50 talk with your doctor about getting the shingles vaccine.
- 26 January 2016
- Internal Medicine Blog
Whether you just get a pimple or two the day before your period or have a constant struggle, acne is a frustration that can cause embarrassment and anxiety for many women. Acne can be triggered by excess oil production, which can clog pores and promote bacteria growth. Many treatments exist, both topical and oral, that target different portions of the process leading to acne. One very effective treatment is birth control pills. Combined birth control pills (those containing both estrogen and progesterone) have been shown in many studies to cause decreased acne flare-ups, fewer pimples, less inflammation and less severe acne.
HOW IT WORKS
Birth control pills work to improve acne mainly by reducing the amount of androgens (male-type hormones, including testosterone) in your bloodstream. This occurs as a result of your liver increasing its production of a protein called sex hormone-binding globulin, which binds androgens making them inactive. This is beneficial, as oil-producing glands in the skin are stimulated by androgens. For some, the pill will also decrease the amount of androgens made by the ovary, additionally decreasing oil production in the skin. It can take a few months on the pill to maximize these effects.
WHICH PILL IS RIGHT FOR ME?
There has been an explosion in the number of new birth control pills in the past decade and few have been directly studied for their effect on acne. Currently, only 3 types have been FDA approved for treating acne: Ortho Tri-Cyclen, Estrostep and Yaz. However, all combined pills will likely have some effect. The degree of improvement can depend on the type of progesterone in the pill, since some types directly cause more androgen-like effects than others.
While birth control pills are a safe and effective way to decrease acne (and prevent pregnancy) for many women, there are some side effects and risks of this hormonal treatment. Some women experience headaches, nausea, breast tenderness and mood changes, which may improve or resolve with switching to a pill with a different dose or type of progesterone. All combined birth control pills can mildly increase the risk of blood clots, such as a deep vein thrombosis or stroke. This increase is small overall, but may be of concern if you have another risk factor for clots such as smoking, obesity or a significant family history of clots. Recent studies also indicate that some types of progesterone may have a higher risk of clotting than others, although these differences are likely very small.
OTHER BENEFITS OF THE PILL
Birth control pills have other benefits, such as decreasing amount of menstrual bleeding, cramping and premenstrual symptoms, and have also been shown to cut the risk of ovarian cancer in half if taken for >5 years. If you are interested in learning more or think birth control pills might be a good option for you, come in for a discussion with your doctor or nurse practitioner.