- 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.
- 26 January 2016
- Skin Care Blog
The holiday season has passed, but the cold weather remains, these extreme temperatures can be wreaking havoc on your skin. With more cold months ahead, it is important to adjust your daily skin care routine and switch to a winter regime which includes staying hydrated, exfoliating, bumping up the moisturizer, and continued use of SPF.
Combating dry, dehydrated skin in the winter starts from the inside. Dehydration can make the skin appear dry therefore wrinkles will be more prominent.
Stay hydrated by drinking plenty of water. Also, incorporating professional treatments such as Chemical Peels, Micro Planning, Microdermabrasion and Micro-needling allows for greater penetration of at-home products. These treatments work by exfoliating dead skin cells and creating micro channels in the surface, which in turn helps to create a healthier more vibrant complexion.
It is also important to switch out your moisturizer. It is common to use a light, non-oil based moisturizer in the Summer however, when the temperatures drop, it is a bit harder to keep moisture locked in the skin. Therefore, using a creamier, heavier textured moisturizer will be beneficial in keeping your skin smooth and hydrated.
For ultimate results, combining professional treatments with your at-home regime will help protect your skin from these harsh winter months. For the month of February we will be featuring the Avene product line at a discounted rate. These products are proven to be excellent for soothing, calming and hydrating the most sensitive skin.
Last but not least, the continued use of an SPF is always recommended. We are continuously being exposed to sun rays which can potentially cause sun damage and premature aging. UV rays reflected by snow increase these risks.
The skilled Medical Aestheticians at the Dermacenter Medical Spa can help customize a treatment plan and at home regime to battle the effects of winter skin. Please call us with any questions or to set up your complimentary consultation.
- 29 December 2015
- Nutrition Blog
Obesity rates have more than doubled in adults and children with an estimated 64% of women being classified as overweight or obese (NIH, 2009). Obesity is measured by the body mass index (BMI) which takes into account one’s height in relation to their weight. A BMI greater than 30 is considered to be overweight.
Being overweight can increase your risk for developing many diseases including but not limited to the following: coronary heart disease, Type 2 diabetes, hypertension, sleep apnea and respiratory problems, joint disease, gynecological problems such as infertility and more. Weight loss can be the cure for many of those diseases, so it is important to take control of your health and seek help and treatment when it is necessary.
Many diet programs advertised online, in magazines or on television are available at your fingertips, but do they really work and if they do, how long can you keep that weight off?
The weight management program at Rittenhouse Women’s Wellness Center is designed to help educate you on the right way to lose weight for the long-term. Whether or not you have a chronic disease or could just stand to lose a couple pounds, our program is available to individually tailor your needs to meet realistic weight loss goals.
The program consists of 6 months of nutrition counseling with Angela, one of our Registered Dietitians, who will do a formal assessment that includes an analysis of your current diet, nutrition education, and meal planning advice. The program also includes 2 comprehensive follow up appointments with Catherine, one of our Nurse Practitioners, who will monitor your weight, blood pressure, and any laboratory work as needed, in order to help you see the progress in your overall health as you lose weight.
Unlike fad diets that can be restrictive and difficult to maintain, RWWC’s weight management program will focus on three essential components: healthy eating, lifestyle modifications, as well as ways to incorporate physical activity into your daily routine that will help you lose weight and keep it off.
If you are interested in losing weight, have chronic conditions like PCOS, diabetes, or high blood pressure, or have a BMI over 30, please contact the front desk or your provider to see if this program is right for you.
- 29 December 2015
- Nutrition Blog
Hypertension, also known as high blood pressure, is when the blood flow through your blood vessels and arteries is too strong. As your heart beats, it pumps blood through your arteries to the rest of your body. As our blood pressure rises, the blood pushes harder against the walls of your arteries. This is natural during certain periods of your day, including when you first wake up and during exercise. However, prolonged high blood pressure strains the heart, damages vessels and kidneys, and increases risk of a heart attack and stroke. Heart disease is the leading cause of death for both men and women; however, it can be controlled and even prevented with a healthy diet.
The most common regime you will see for hypertension is called the DASH diet, or Dietary Approach to Stop Hypertension. This diet focuses mostly on limiting salt intake. The reason we monitor salt in regards to high blood pressure is because salt retains water. The more water we have present in our blood, the higher the volume of blood. Thus, more pressure is put on our vessels to transport the blood. The average recommendation for salt intake is <2,300 mg a day, but the DASH diet recommends <1,500 mg daily. This means inspecting our food labels since salt is added to the majority of processed foods. The DASH diet also includes eating more fruits and vegetables, whole grains and fiber, along with limiting saturated fats, cholesterol and trans fats, and sweets. It’s also important to make sure that there is enough potassium in the diet since this vitamin balances the salt in our bodies.
You may also notice that the DASH diet suggests the consumption of fish. This is because fish contain Omega-3’s, which are healthy fatty acids. These type of polyunsaturated fats help lower our bad cholesterol (LDL), and raise our good cholesterol (HDL). DASH is almost identical to the Mediterranean diet, which equates to a high consumption of fruits, vegetables, beans, nuts/seeds, and whole grains, and little to no red meat or dairy products.
Helpful tips on controlling blood pressure include following the DASH diet, maintaining a healthy weight, increasing physical activity, learning how to read a nutrition label and consider keeping a sodium diary to monitor your daily intake. Cooking and preparing your own foods is always better than eating out since you have complete control over the amount of sodium being added. You can also use spices and herbs rather than salt to flavor your foods. Be sure to have your blood pressure checked by your doctor and work with a dietitian to assess what behavioral changes are benefitting you so that you can improve your health and feel your best.
- 29 December 2015
- Skin Care Blog
Many women's New Year's resolutions include losing weight, getting toned, eating better and overall implementing a healthier lifestyle. Proper nutrition, fitness, and even skincare are all factors to consider in making these resolutions a reality. The aesthetic skincare treatment, Vela Shape can help you achieve your goals by contouring the body and smoothing out unwanted cellulite leaving the area looking tighter, smoother and overall more toned.
Cellulite is commonly found mostly on women, causing an unpleasant dimpling effect due to fat beneath the skin that is trapped between connective tissue. Vela Shape combats the "orange peel" appearance by using combined RF and IR energy followed by a vacuum manipulation which for many clients feels like a hot deep tissue massage. Treatments are typically done on a weekly basis for a minimum of 5 sessions and take about 45 minutes depending on how large the area is.
If you have further questions regarding Vela Shape or if you would like a complimentary consultation to see if Vela Shape would be appropriate for you please call the Dermacenter at 215-735-7990.
- 27 November 2015
- Internal Medicine Blog
I’d like to address some common misconceptions about daily medications used to treat depression and anxiety. These medications are classified as antidepressants or antianxiety medications, and work by affecting the neurotransmitters in the brain, chemicals that help transmit signals. One person can have mostly depressive symptoms and benefit from the same medication as a person who has crippling anxiety but doesn't feel a bit depressed. Though lifestyle changes and seeing a therapist can help many with mild symptoms, if your depression or anxiety persists despite this (or it prevents you from being able to take these steps) it does not mean that you failed or that you just didn't try hard enough. Sometimes you need some additional help for a time and that is okay.
Like most medications antidepressants or anti-anxieties come with a long list of potential side effects, but the doctor will review the most serious and most common ones with you before prescribing. Everyone is different - you may experience a lot, some, or none of the side effects. These medications are not “happy pills,” nor are they intended to make you feel numb or like a zombie; if you are feeling this way then it may be a sign that it is not the correct medication or dose for you. The goal is to make you feel more like yourself!
Often I will hear people say that they don’t want to use these medications because they see them as a crutch. I like to think of them more like a cast; they help hold everything in place while you do the work of healing. Then you take them off.
Many people worry if they start taking a pill then they will be on it their entire life. Though there are people who continue to take daily medication for decades, a vast majority will be on it for a much shorter time. Part of the process is a regular and ongoing reassessment. When a medication is first started, your doctor will have you come back in about six to eight weeks to see how it is working. Once they have found a medication and a dose that works for you we generally have you follow up every six months or so thereafter to see how you are doing. Timing, of course, varies from case to case. If things are going well then you may feel like it is a good time to stop the medication. If things are still not that great then you should continue the medication and check back in in a few months. These are not medications you want to stop abruptly; they can have some pretty unpleasant withdrawal symptoms, so your doctor will wean you off of them by incrementally decreasing the dose over a period of time.
Medications are not for everyone but having correct information is a great first step in determining if something is right for you. If you would like to learn more about treatments or talk over how you have been feeling please come in, the doctors at Rittenhouse Women’s Wellness Center are always here to talk and to listen.
- 25 November 2015
- Emotional Well-Being Blog
Shopping, baking, cooking, visiting, feasting, attending parties, drinking alcohol, money woes, loneliness, expectations for connection and fulfillment. What do these words all have in common? They are descriptors of our daily lives during the holiday season.
These words and the following video give a great summary of what usually causes stress around the holidays. "Stress" is the body's reaction to being overstimulated for extended periods of time. While our bodies are designed to withstand short bursts of mobilization, days on end of late hours, overeating, worry or a feeling of isolation can produce symptoms of moodiness, fatigue, pain, headaches and more.
Luckily, this video also gives some great tips going through the holidays and minimizing wear and tear on our brains, our bodies and our emotions. As a psychologist, I would also like to add a couple of tips gained from talking to people about their stress for the 33 holiday seasons of my career:
1) Take breaks from group and chronic activities. Allowing time for your body to recuperate from chronic stimulation will help it respond to stress with more resilience.
2) Consider staying in a nearby hotel if possible instead of staying with your family. This will provide natural breaks for rest and to maintain perspective.
3) Hydrate well. This helps to keep your energy up, maximize a feeling of fullness that helps curb overeating, and counteracts the possibility of overindulging with alcohol.
4) Make aspirations BEFORE the holiday season as to what values are most important for you to live out during this time (for example generosity, connection, being even tempered, demonstrating love or thoughtfulness). Write down your aspirations where you can see them each morning, to remind you of what you are striving for.
5) Be realistic. None of us live the lives of people in T.V. shows or novels. Each of us have quirks and imperfections, and most days are highly imperfect! Expect some stress and imperfection each day to decrease your possible disappointment.
Randi Platt, M.Ed. is a Psychologist, the head of psychology services at the Rittenhouse Women's Wellness Center, the Executive Director of Hornstein, Platt and Associates Counseling Centers, and a teacher of meditation at Thomas Jefferson University who has enjoyed being a healer in Philadelphia for the last 33 years.
- 25 November 2015
- 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!
- 02 November 2015
- Internal Medicine Blog
Contraceptive care is an integral part of women’s health and family planning. The choice to plan to bear children or not is an important decision, and the outcome can have life changing effects. According to the National Conference of State Legislature, almost half of pregnancies in the U.S. are unintended. Most women nowadays graduate college and are career driven. They would prefer to plan their pregnancies – and this is possible through the use of contraceptives. It is critical to understand your insurance coverage under changes in health care laws, which have pushed to expand women’s’ health care since January 2013 by requiring coverage of certain preventative health services and screenings, including contraception. Despite comprehensive coverage required by law, some employers have the ability to not offer contraceptives.
Required contraceptive care can be bypassed by employer’s plans that have been “grandfathered” in as well as those who opt out due to religious beliefs. Churches and other houses of worship are not required to include birth control coverage to their employees. Non-profit organizations that object to offering birth control because of religious reason may also do so, but women may still have access directly from their insurance company. You may remember the Hobby Lobby controversy, in which the for-profit “family-owned” corporation was able to refuse birth control coverage. In this case the Supreme Court decided that certain “closely-held” for-profit corporations can deny coverage on religious grounds. Figure out what your employer’s insurance plan allows and if it is in accordance with the law.
As mentioned earlier, most insurance plans now allow women to select an option to include contraceptive benefits at no additional cost. If you are sexually active and not looking to have children at this point in your life, (and your employer does not offer this benefit) you may want to talk to you Human Resources Director to see if this benefit can be added for you. Once you are ready to have children, you may talk to your health care provider about discontinuing your contraceptive care.
The bottom line: When you visit your health care provider regarding birth control, be sure you have contraceptive coverage and you should not have to pay a co-pay for your oral contraceptive.