Screening for Breast Cancer

By: Monica Duvall, M.D., Board Certified Physician

Breast cancer, we are taught, is an illness that all women need to be aware of, and be screened for.   But how do we most effectively screen for it?  This question is not as straightforward as one would think, as the recommendations for different screening modalities are always evolving, based on new assessments of available evidence.  Traditionally, women were advised to do monthly self-examinations in the shower as a front-line defense against breast cancer.  But in recent years, these exams have not been shown to consistently prevent breast cancer deaths (which is, after all, the goal of any screening program).  Therefore, most expert groups now either recommend against self-exams entirely, or they recommend encouraging "breast awareness", which means each woman should be aware of her own body, so that she can recognize potentially alarming changes--this could include a traditional breast exam, but not necessarily.

Another mainstay of breast cancer detection has been the clinical breast exam, performed annually by a physician at the time of the gynecological examination.  While the American Cancer Society (ACS) and the American College of Obstetricians and Gynecologists (ACOG) recommend these exams every 1-3 years for women ages 20-39 and annually for women thereafter, the US Preventive services task force (USPSTF), an independent government-sponsored organization, notes that there is insufficient evidence for these exams, as well.

Mammography is recognized by most women as the most important tool we have for breast cancer screening, and most medical societies agree, recommending annual mammograms for all women beginning at age 40.  A few influential groups, though--notably the American College of Physicians (ACP), the American Academy of Family Physicians (AAFP), and the USPSTF--feel that the evidence for mammography in women between the ages of 40 and 49 is not as strong as for women 50 and older, and they have therefore departed slightly from this recommendation.  They advise instead that for these women, mammograms may be performed every 1-2 or every 2 years, and that the decision can be individualized for each woman in this age group.  Annual mammography is recommended by many societies to continue throughout the later years of life, but again there is some variability--the AAFP advises screening only until age 74, the USPSTF recommends stopping at age 75, and ACOG recommends individualizing the decision to screen after age 75.

So where does all of this conflicting evidence leave doctors and patients?  There is not an absolute correct answer for how to screen--but it is important that patients do what makes them feel most comfortable, that doctor assess the evidence various expert groups use in making their recommendations, and that both groups communicate their preferences and concerns about screening to one another.

Summer Workout Mistakes to Avoid

By: Kathryn Pontius, Certified Personal Trainer

It is no secret this summer is gearing up to be a hot one! After such a brutal winter, it is wonderful to finally be able to exercise outdoors. But with this comes added risks like dehydration, sunburn, or chafing. Here are a few common mistakes to prevent unhealthy or uncomfortable workout sessions.

1.     Drinking coffee before a work out

Coffee can actually dehydrate you. Stick to water to hydrate pre-workout

2.     Sleeping in

While it is tempting in the hot summer months to stay up a little later, since it stays light later, don’t let that keep you from your morning workout. Temperatures rise earlier in the day in the summer, putting off your workout, even by an hour, can cause overheating. Try to work out early or in the evening once the temperatures have fallen.

3.     Wearing Dark or loose fitting clothing

Dark clothes absorb heat and put you at risk for overheating. While some people don’t like form fitting clothes or think tight clothes don’t allow for ventilation, loose clothes combined with sweat can make for some very uncomfortable workouts.

4.     Not re-fueling post workout

Both water and food need to be replenished within 30 minutes of a workout session. When it’s hot, people tend not to want to eat big meals, but try something small and nutrient rich.  

5.     Not bringing water to a pool workout

Your body loses water during a pool workout just like it does on land and it is easy to forget that. Staying hydrated is just as important at the pool as anywhere else.

6.     Only hydrating during your workout

It is very important to pre hydrate and post hydrate as well!

Enjoy the warm weather and summer freedom, but stay smart and healthy by not making these common mistakes. For more help with your personal fitness goals make an appointment to see a fitness specialist at RWWC today!

How To: Keep Summer Celebrations Healthy

By: Theresa Shank, Registered Dietitan 

July 4th and other summertime celebrations are meant to be celebrated and enjoyed, but you don’t have to sacrifice your health or beach body every time you attend a BBQ or picnic this summer.

Use these helpful tips from our Registered Dietitian to keep your health and body in check during your summer time celebrations.

1. Use small plates

Studies have clearly shown that by eating off of smaller plates you are likely to consume up to 50% less calories than you would consume by eating off of a larger size plate. Try borrowing a plate from the kids table or the dessert tray to slash your calorie intake in half.

2. Eat the healthy options first

Fill up on fruit salads or veggies tray options before heading over to the grill for a hamburger or hotdog. Fruits and vegetables have lots of fiber, which is a nutrient that keeps you feeling full longer and more satisfied. After you get your dose of fruits and vegetables, choose a lean protein such as grilled chicken or tuna salad to reduce your intake of saturated fat, because ladies, we all know, saturated fat is not our friend!

3. Skip the refined carbohydrates

Refined carbohydrates are the worst things you can eat because they offer little satisfaction and loads of calories. BBQs are filled with wonderful food, so do yourself a favor and save your calories for the really good stuff.

Not saying that you have to eat your burger without a bun, but pass on the pointless chips and other snacks that lure you when you’re not thinking.

4. Watch your toppings!

Skip toppings like cheese, mayonnaise and bacon on your favorite grilled options and choose healthier toppers such as Dijon mustard, avocado or sliced tomatoes and lettuce.

5.  Bring a healthy version of your favorite July 4th dessert

Everyone loves brownies or strawberry short cake to end their July 4th meal, but why not be the friend that brings a crowd pleasing dessert that doesn’t hurt the waistline? Try our registered dietitian, Theresa Shank, favorite July 4th dessert recipe for a healthy ending to your celebration.

This flag cake recipe has less saturated fat and calories than regular versions. Theresa enjoys this recipe because it replaces some of the butter with healthy oil and uses reduced fat cream cheese and Greek yogurt to replace full fat cream cheese for the delicious frosting. Enjoy!  Recipe is from

Flag Cake Recipe

Makes: 20 servings

Serving Size: 20 servings

Active Time: 1 1/4 hours

Total Time: 3 hours


  • 1 1/4 cups granulated sugar
  • 1/3 cup canola oil
  • 4 tablespoons unsalted butter, at room temperature
  • 4 large eggs, at room temperature (see Tips)
  • 2 cups whole-wheat pastry flour (see Tips) or all-purpose flour
  • 1 cup cake flour
  • 1 1/2 teaspoons baking powder
  • 1/2 teaspoon baking soda
  • 1/2 teaspoon salt
  • 1 cup buttermilk
  • Zest and juice from 1 lemon
  • 2 teaspoons vanilla extract
  • 1/2 teaspoon almond extract

  • 12 ounces reduced-fat cream cheese (Neufchâtel), at room temperature
  • 1/2 cup confectioners’ sugar plus 2 tablespoons, divided
  • 3 tablespoons low-fat plain Greek yogurt
  • 1/2 teaspoon vanilla extract
  • 1 1/2 cups raspberries
  • 1/2 cup blueberries
  • 2 cups strawberries, sliced

1.     To prepare cake: Preheat oven to 350°F. Line the bottom of a 9-by-13-inch baking pan with parchment paper; coat the paper and sides of the pan with cooking spray.

2.     Beat granulated sugar, oil and butter in a large mixing bowl with an electric mixer on medium speed until well combined. Beat in eggs, one at a time, until just incorporated.

3.     Whisk whole-wheat (or all-purpose) flour, cake flour, baking powder, baking soda and salt in a medium bowl. Combine buttermilk, lemon zest, lemon juice, 2 teaspoons vanilla and almond extract in a measuring cup. With the mixer on low speed, add the dry ingredients to the mixing bowl alternately with the buttermilk mixture, beating just until incorporated after each addition, scraping down the sides as necessary. Spread the batter in the prepared pan.

4.     Bake until a toothpick inserted in the center comes out clean, 28 to 34 minutes. Let cool in the pan on a wire rack for 15 minutes. Turn out onto the rack and let cool completely, about 1 hour.

5.     To prepare frosting: Beat cream cheese, 1/2 cup confectioners’ sugar, yogurt and 1/2 teaspoon vanilla in a mixing bowl until smooth.

6.     To decorate: Invert the cake onto a platter. Spread the frosting over the top and sides. Mark 3 horizontal lines for the white “stripes” and a rectangle in the upper lefthand corner for the “blue rectangle.” Gently pat berries with a paper towel to dry. Make 3 “stripes” of raspberries on the marked lines. Place half of the blueberries in the “blue rectangle,” leaving space between each berry. Sift the remaining 2 tablespoons confectioners’ sugar over the raspberries and blueberries to make them the white “stripes” and “stars.” Fill the rest of the “blue rectangle” with the remaining blueberries. Place strawberries between the rows of raspberries as the red “stripes.”

Food for Thought

By: Ashley Greenblatt, Certified Personal Trainer

Has your appetite for love made you gain unwanted weight? When we sink our teeth into a new relationship, we often neglect to mind our munchies. Upon entering the dating scene, nerves have a way of crushing any cravings for delectable dishes. Emotions have a peculiar way of affecting our eating habits, so here’s the skinny on how to avoid eating your heart out:

Competitive Eating. You do not need to keep pace with your partner's eating habits. Chances are his/her caloric needs far exceed yours. I’m not suggesting you order a piece of lettuce and a crouton for dinner, rather be mindful of your portion size. I have heard countless tales of weight gain woes from clients and girlfriends a-like who attribute their tight jeans to non-stop, “I’ll have what he/she is having,” eating. The easiest way to gauge what your portion size should be is to make a fist. No I am not suggesting beating up your sweetie, rather mimic your serving after the size of your fist.

The Dish on Dining Out. When a restaurant advertises dishes to be “endless, bottomless or all-you-can-eat,” know that you are in for a potentially high calorie feast. While it may be a great value for the amount of mashed potatoes you are can pile on your plate, it will translate into a lot of unnecessary calories. Enjoying a great bread basket, dressing-drenched lettuce, beer battered appetizers, decadent desserts, family-style portions and alcohol are definitely acceptable in moderation, however when dining with your honey fun and food can sometimes become synonymous. Try not to fall into this trap.

Me, Myself and I. When on the road to love, we often have tunnel vision in terms of where our energy and time is concentrated. Previous priorities such as an evening run, a good night’s sleep or even time with friends, are now a thing of the past. Couples time cuts into personal time, resulting in potential unhealthy lifestyle adaptations. After a long and arduous day at the office, it is tempting to throw on a pair of sweats, watch an episode of The Office and commit carbocide with your partner in crime. Down time is great and essential, however it is important to throw some healthy habits into the mix and not forget to take care of numero uno – you! Make gym time a couple’s activity, or find a healthy recipe that you can have fun whipping up together. Plus, exercise helps you look better naked, need I say more?

A full heart does not have to translate into a bloated belly. Live your best life for you and the one you love.

For more health tips and fitness information, please schedule an appointment with Ashley!

The Benefits and Dangers of Soy: What You Need to Know

By: Christina Ushler, Registered Dietitian

Soy seems to be a hot topic lately. The pending question seems to be whether or not we all should consume it or not. Certain authorities are recommending to avoid it altogether while others are stating it is a safe food for a healthy diet. Here are the facts.

Soy is a big business in our country and can actually be found in most processed foods.  Marketing claims discuss the health benefits of soy even though research is conflicting. Asian’s eat soy as a condiment rather than a staple food, something marketers fail to mention. It also is being used in various and questionable forms today. Questionable forms include soy oil, soy lecithin, soy flour, soy concentrate, hydrolyzed soy protein, and soy isolates. Soy oil has become a base for many vegetable oils. Soy lecithin is the waste product left over when the soybean is processed and is used as an emulsifier. Soy flour appears in baked and packaged goods. According to one article, soy protein isolate has been invented for use in cardboard and is found today in many processed foods ( Soy also is a food most likely to cause an allergic reaction (in addition to wheat, corn, eggs, milk, nuts, and shellfish). It is hard to digest for many people and it contains phytates that could reduce mineral absorption.

In addition, soy is said to interfere with hormones in the body because of their phytoestrogens (“phyto” means plant). Phytoestrogens act similarly to hormones and can cause an endocrine imbalance. They bind to hormone receptors and interfere with the production of hormones as well. Timing and exposure of phytoestrogens in important. Times to be cautious of your intake of soy include during pregnancy, infancy, puberty, reproductive years and around menopause because of your fluctuating hormone levels.

Soymilk and soy infant formula is very questionable. Soymilk contains hard to absorb supplemental calcium and it contains vitamin D2 (we need D3). To make this even more confusing, research on soy is conflicting. There is research that shows soy can have a therapeutic effect.

The bottom line is soy is safe in it’s whole-food form: edamame, miso, tempeh, and natto as these have less processing. Tofu has slightly more processing than the aforementioned but is still considered safe in moderate amounts. You should check the ingredient labels for all soy foods, especially veggie burgers, soy nuts, soy snacks, soy shakes, and soymilk. Soy in moderate quantities (a few times per week) can be beneficial and healthful. However, always opt for higher quality, whole and organic soy. Genetically modified soy is controversial as well and has higher levels of pesticides. Excessive soy consumption causes question and you shouldn’t eat soy more than 3 times per week.

Osteoporosis and Fitness: Reduce Your Risk

By: Kathryn Pontius, Certified Personal Trainer

 As women, we are at a higher risk than men for developing the age-related bone density disorder, Osteoporosis. Osteoporosis causes our bones to become thinner and more porous. This makes us less able to support our own body weight. Osteoporosis can affect our quality of life as well as limit our ability to be independent. Bone density loss happens rapidly after menopause, and by the age of 50, about half of all women and men will break a bone because of Osteoporosis.

Don’t worry, there are a few things you can do to help reduce your risk of developing Osteoporosis. A diet full of calcium and vitamin D is helpful, as well as participating in physical activity. Studies show weight bearing exercises not only prevent bone density loss but also encourage bone growth. Shoulder, wrist, and hip joints as well as your spine are common sites where bone density loss occurs. These are great areas to strengthen through exercise.

If you have Osteoporosis, consult a physician before beginning an exercise program. If you are hoping to reduce your risk, be sure to start slow and work with someone who can show you the proper way to work out.

An ideal work out would include aerobic weight bearing exercises, resistance training, and flexibility exercises. It is important to note that these exercises should be done to improve muscle strength, therefore conserving bone mass, and should not generate joint pain. Exercises should be performed at low to moderate intensities.

If you have any questions or want to start reducing your risk of Osteoporosis, call and make an appointment with one of our fitness specialists today!

Obesity and Weight Loss

By: Stephanie McKnight, M.D.

The number of Americans who are overweight and obese has reached epidemic proportions.  This year the CDC estimates that 2/3rds of US adults are overweight (BMI >25) and 1/3 of the population meets the classification of obese (BMI >30).  Rates have risen dramatically from 1990 through the current time period.  Many factors play a role in this increase which includes an overall decrease in daily activity with increased access to and consumption of high calorie low nutrient foods, fast foods, and processed foods.  Being overweight and obese is associated with many negative health consequences including (but not limited to) elevated blood pressure, high cholesterol, diabetes and pre-diabetes, metabolic syndrome, arthritis, back pain, PCOS, infertility, irregular menstrual cycles, vitamin D deficiency, depression, skin tags, colon, breast , and endometrial cancers (among others), sleep apnea, worsening asthma, and fatigue.  There is good news, however!  Health effects from obesity are dramatically diminished with even moderate weight losses.

 While I would encourage everyone to aim for a BMI in the “normal” range, a maintained loss of 10-20% of maximum body weight produces significant health benefits and risk reduction.   The National Weight Registry is a research database that has tracked successful “loosers” for over 20 years.  These individuals shed at least 30 pounds and kept it off over 1 year.  The most common habits of successful maintainers are eating breakfast, exercising daily (average 1 hour per day), keeping a daily food log, and weighing themselves weekly.   Most of these successful individuals also lost their weight gradually at an average of 1-2 pounds per week.  Making sustainable lifestyle changes is the key to success!  There are many tools from food logs, support groups, individual counseling, pre-packaged meals, medications, and surgery that can help achieve goals.  I would encourage anyone who could benefit from weight loss to take action!  Not sure where to start?  Consider making an appointment with your doctor to assess your risks and start you on a healthier path. 

Spring Cleaning: A Few Recommendations

By: Maria Mazzotti, D.O. 

As the weather starts to give us a break, I would like to give you a few reminders to help you stay healthy and enjoy the rest of your year.

1. If you have not started your allergy medications, I would high recommend doing that immediately.  Getting started early may make a big difference in controlling you allergies.  That goes for Singular as well, since it take about for this particular medication to start working effectively.  Also keep in mind that Ventolin, commonly used for asthma, has a short half life.  So once you open the foil package, you need to discard it after 6 months, even if you have not finished all of the inhalations.  If you have severe allergies, you want to make sure your Epipen  has not expired.  This is also a good time of the year to have your carpets cleaned of all of the debris that accumulated over the winter and you can keep the windows open to make sure the carpets dry well.

2. Make sure you are up to date with your Tdap vaccine.  You may know this vaccine as the Tetanus shot, Pertussis vaccine or whooping cough vaccine.  This vaccine protects against 3 different infections.  This time of the year, when we start gardening and hiking, this vaccine is important because it protects you against “Lockjaw” if you get a bad cut, burn or step on something rusty.  Also Whooping Cough season is from June to September.  It takes a few weeks to kick in, so you still have time.

3. This is also a good time of the year to clean out your medicine closet.  Do not keep any medications that you are actively using.  It is better to write down any medications that you are allergic to or have side effects from, then to keep the medication bottle hand for reference.

4. Now is also a good time to schedule those tests that you were forced to cancel due to the bad weather (mammogram, colonoscopy, blood work, PAP, physical, DEXA Scan, etc) before the steamy weather hits.

5. Make sure your sunscreen is not expired.  Remember to apply it at least 30 min before stepping out for it to be more effective.

6. If you have not already, make sure you sign up for Obamacare.  This is the first time in our nation’s history that everyone can have healthcare.  Having insurance saves us all money, and more importantly keeps us healthy.

7. Also you should change your heating filters when you start using your AC.  It may also be a good time to get you system cleaned/inspected if you did not do so in the fall.

8. As you get ready to be more active outside, make sure your sneakers are not worn out.

9. This is also a good time to start juicing, since a lot of your favorite fruits are coming in season.

10. Most importantly, this is a good time to focus on getting heart healthy.  Whether you need to loose weight or not, you should be doing at least 30 min of a cardiovascular workout five times per week.  Keep it fun, have friends join in, but do not work through pain.  Exercise is also an effective way to help with anxiety/stress/depression and difficulty sleeping.  And if you loose weight along the way, it is a plus.  

8 Tips for Cleaning Up Your Diet This Spring

By: Theresa Shank, Registered Dietitian

The arrival of spring is certainly a reminder that you have one more season to clean up your diet before summertime arrives! Maybe you let your healthy diet habits hibernate over the long drawn out winter we just had but this month it’s time to spring clean your diet and life style to get back on track! Instead of trying a new fad diet, detox or meal replacement regimen, try these 10 tips to make sure you are bikini ready and feeling healthy by summer.

1.Drink at least 48 ounces of water a day:It is important to stay hydrated throughout the day for various reasons. Staying hydrated not only helps with your alertness, controlling appetite, and improving physical activity, but it also keeps everyday symptoms like fatigue, headaches and dry skin at bay.

2.Incorporate a color into every meal: Eating a diet with plenty of fruits and vegetables has been linked to improved health, and for good reason. Veggies and fruits (both fresh and frozen) are loaded with vitamins, minerals, fiber (a satiating nutrient) and antioxidants. In addition to bursting with healthy nutrients, fruits and vegetables are low in calories, which make both a great choice for the waistline.

3.Avoid processed carbohydrates:  Consuming processed carbohydrates such as white flours in breads, pastas, cookies, cakes etc can contribute to weight gain due to the effects that they have on blood sugar levels. Try to only consume whole wheat/ whole grain products when eating carbohydrate sources other than fruits. Examples of whole wheat/whole grains sources include breads made with 100% whole wheat flour, brown rice, whole wheat pasta, popcorn (unsalted and non-buttered), oatmeal, quinoa, millet, barely, couscous, whole wheat pitas and tortillas. When choosing whole grain wraps, crackers or breads, aim to find bread that lists the first ingredient as 100% whole wheat flour and contains at least 3 grams of fiber. 

4.Eat vegetarian once a week for all three meals:Cutting down on your animal consumption helps to slash saturated fat and cholesterol intake in the diet which can help reduce risk of cardiovascular disease, diabetes and obesity while trimming your waistline of fat and calories. Some delicious vegetarian protein options include tofu, seitan, brown rice with beans and tempeh. My personal favorite vegetarian protein dish is Whole Foods “General Tso Chicken”, which is made with seitan. I promise you will not regret trying it!

5.Add a source of protein to your snacks:To truly satisfy your hunger in between meals, add some protein options into the mix. Opt for a non fat plain Greek yogurt, string cheese, almonds, cottage cheese , hummus or nut butter along side of a piece of fruit or serving of raw vegetables.

6.Incorporate yogurt into your routine:Yogurt is a wonderful source of protein, calcium and gut friendly bacteria that helps keep your GI system healthy by alleviating constipation and diarrhea. Try non fat plain regular or greek yogurt and add your own fruit for a sweet touch

7.Aim for 3 servings of whole grains per day:Eating whole instead of refined grains substantially lowers total cholesterol, low-density lipoprotein (LDL, or bad) cholesterol, triglycerides, and insulin levels. Not only are whole grains beneficial to the heart but they will keep your hunger at bay between meals. Try having oatmeal for breakfast, add quinoa to your salad at lunch and incorporate couscous into your evening meal to reap all the benefits that whole grains offer to your diet.

8. MOVE MORE:Even though this is not a diet tip, it’s a statement to live by when trying to lose weight. By moving more you will burn more calories and build muscle. Aim to incorporate at least 10,000 (about 5 miles) steps per day which is equivalent to moderate exercise. If you are really trying to lose weight, I recommend that you engage in atleast 250 minutes of exercise per week.

5 Tips for Spring Fitness

The snow is melting, the sun is shining, and it is beginning to get warmer and warmer each day! During the winter you may have taken some time off from your exercise routine to take shelter from the cold, but here are some helpful tips from our wellness specialists and personal trainers to help you get back on your feet and into a healthy fitness routine this spring.

1.       Be Realistic : First and foremost, you should always set a schedule of how many days a week you want to workout. You may want to hit the gym 7 days a week from the start, but with work, school and a family, this presents road blocks. Get comfortable taking baby-steps, and accommodate goals to your lifestyle and current fitness status to prevent injury.  A realistic schedule would be 3 days a week for 30 minutes each.

2.       Team up with a friend: Surround yourself with friends who are looking to spring clean their fitness routine and healthy lifestyles as well. Working out with a friend can help you encourage each other, keep you on track, and can be the fuel to a fun fitness routine.

3.       Revamp your playlist: Listening to the same tunes day in and day out can get monotonous and boring, especially during an intense workout. Check out pinterest for some new and uplifting songs that can rejuvenate your workout, and help get your body and mind moving. 

4.       Avoid the couch: After a long day at work, a comfy recliner may call your name. To avoid derailment from your new routine, pack a gym bag with you each day so that you have one less excuse not to get your workout in right after work hours.

5.       Record your progress: Keeping a fitness and food journal is a nice way to track your progress as well as the way you feel after each workout. A journal will also be sure to keep you conscious of your daily activities and habits (good and bad) including food selections.

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