Blog

Healthy New Year's Resolutions for 2018

By: Elizabeth Galbrecht, MSN, AGNP-C, WHNP-BC

Move More

Exercise is one of the most powerful things that you can use in your day-to-day life to improve your cardiovascular health, manage your weight, strengthen your bones, reduce stress, and possibly even prevent certain types of cancer. I tell all of my patients that exercise is truly like medicine for your body and for your mind. The ultimate exercise goal is to get at least 150 minutes of moderate-intensity physical activity (i.e. brisk walking) or 75 minutes of vigorous-intensity activity (i.e. jogging or running) per week, in addition to muscle-strengthening activities on 2 days out of the week. This might sound intimidating at first, but the good news is that you can spread out this time over the week in a way that is most convenient for your schedule. Even exercising just 10 minutes at a time is beneficial. You can also get creative – brisk walking and jogging aren't the only ways to exercise. Anything that gets your body moving counts as exercise, so find something that makes you happy – anything from aerial yoga to zumba - and roll with it!

Eat Better

New Years is always the time of year when trendy crash or fad diets start to surge in popularity. These are never the most effective or sustainable options and are often times flat-out unhealthy. When it comes to your diet, small changes over time can make a big difference. One of the simplest ways to modify your diet and improve your health is to focus on increasing your consumption of fruits and vegetables. It is well-known that a diet rich in fruits and vegetables can decrease the risk of heart disease, stroke, high blood pressure, and diabetes. Another strategy for the New Year is to cook at home more and eat out less. That way, you have control over portion size and also all of the ingredients (including salt, oils, butter, etc.) involved in preparing your meal. For further dietary guidance and support, you can always schedule an appointment with one of our nutritionists at RWWC.

Drink Less

Alcohol is everywhere in our culture, and drinking is encouraged on many levels. We are constantly bombarded with promotional messaging about alcohol and it can be easy to get caught up in drinking habits that might, in actuality, be harmful to your health. The Centers for Disease Control and Prevention define “heavy drinking” for women as 8 drinks or more per week. One drink is defined as either 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of hard alcohol. “Binge drinking” for women is defined as having more than 3 drinks on one occasion. Heavy drinking has many short-term and long-term consequences for women, and in many cases these consequences are more pronounced than they are in men. These include increased risk for alcohol-related liver disease, memory loss and shrinkage of the brain, osteoporosis, and breast cancer. There are, however, beneficial effects of certain types of alcohol that are well-documented, such as improvement in cholesterol and cardiovascular health - the key here is moderation.

Quit Smoking

It should be no surprise to anyone that smoking is extremely harmful to your health and will shorten your life. Any degree of tobacco use, whether it's smoking a pack per day or social smoking, has serious consequences. Many are aware of the risks of lung and head/neck cancers caused by smoking, but some may not know that smoking damages many other organ systems. For example, smoking is the single most common preventable risk factor for bladder and kidney cancer, which are highly aggressive malignancies with few available treatment options. Toxic carcinogens inhaled during smoking do not only contact the upper airway and lung tissue, they are also absorbed into the blood stream and penetrate into virtually every organ. The kidney and bladder are particularly susceptible to damage from smoking because these toxins are concentrated in the urine and literally bathe the kidneys and bladder before they are excreted in the urine. Even if they are discovered early, often radical and disfiguring surgeries are required to control cancers of the genitourinary tract. With regards to women's health in particular, cigarette smoking increases the risk of HPV-related cancers of the cervix and vulva and also increases the risk for recurrent vaginitis, especially bacterial vaginosis (also known as BV). If you smoke, quitting is the #1 best thing that you could do for yourself. We are here to help you if you are ready to quit smoking, so please do not hesitate to discuss this with your healthcare provider at your next visit.

Establish Care

If you have not had an annual wellness visit or gynecologic exam in some time, please be sure to put this on your to-do list for 2018. Even if you feel healthy and have not had any changes to your health in the last several years, there are likely to be preventive health measures that you might be missing out on. We can help to make sure you are up-to-date with your immunizations, cancer screenings, and routine bloodwork so that you stay as healthy as possible in the years to come.

Cannabis Education


Gov. Tom Wolf signed a law legalizing medical cannabis in Pennsylvania in April, 2016. One of the medical marijuana facts for Pennsylvania that frustrated supporters of legalization was that it took so long to happen. The Pennsylvania Senate first approved a bill legalizing medical weed in 2015, but it was not approved by the entire legislature until March, 2016. Several technical changes needed to be made before both chambers could finally agree on a final bill.


In order to be able to recommend cannabis to their patients, physicians need to complete a four-hour course. They must sign a certificate stating that the patient not only has a qualifying condition, but also that the doctor believes that patient will be able to benefit from medical cannabis use.

There are several forms of cannabis that patients can use, including oils, pills, creams, ointments, liquids, gels and more. Vaporization is allowed, but not smoking of the plant. While dispensaries are not allowed to sell edible forms of weed, the law allows patients to mix medicinal cannabis into drinks or food in order to help them ingest it.

If you are a patient in another state, you are not allowed to access medical weed in Pennsylvania.

The different types of IUDs

By: Allison Andrews WHNP

There are two different types of IUDs: hormonal and non-hormonal.
We want to answer the 2 main questions that many women ask themselves when considering an IUD:  What is the difference? Which one is right for me?

Mirena
Mirena is the hormonal IUD that has been around the longest, and is currently approved for up to 5 years. Mirena was originally intended for women who have had children. However, studies have shown that it is perfectly safe and effective for women who have never been pregnant. Mirena is recommended to help manage women who suffer from heavy or painful periods. Most women on Mirena have reported that their periods get significantly lighter or go away completely. About one in five Mirena users stop having a period after a year, and one in three if they use it for a longer period of time.

Liletta
Liletta is very similar to Mirena. It contains the same dose of hormone and is approved for use up to 4 years. This IUD has also been approved for women who have never had children. Like the Mirena, your periods can get significantly lighter or go away completely.

Kyleena
Kyleena is smaller in size then the Mirena and has a lower dose of hormone then the Mirena/Liletta. Like the Mirena the Kyleena is approved for up to 5 years and about 1 in 8 women who use it will stop having periods after a year.

All hormonal IUDs prevent pregnancy by releasing a small amount of a progestin hormone called levonorgestrel each day. The progestin acts locally in the uterus to prevent pregnancy. Hormonal IUDs do not contain estrogen and typically have fewer hormonal side effects than methods that do contain estrogen.

Paragard
ParaGard contains no hormones and is approved for up 10 years. Since this device does not contain hormones, most people who use ParaGard can experience heavier, longer, or painful periods. Studies have shown that after 6 months, many ParaGard users’ periods return to normal. If you already have really heavy or painful periods, you will most likely benefit more from a hormonal IUD.

The non-hormonal IUD prevents pregnancy by using a tiny copper filament wrapped around the T. ParaGard, making the uterus a hostile environment.

IUDs are safe, effective, and reversible. There are many different kinds of IUDs and they are not a one-size-fits all. Call today to schedule a consultation with one of our nurse practitioners and together we can decide which is best for you!

7 Maternal Benefits of Breastfeeding

By: Lauren O’Brien, MD

You have probably heard the phrase “Breast is Best” in reference to breastfeeding a newborn baby. The benefits of breast milk to an infant are widely touted and acknowledged.  Such benefits include: decreased risk of sudden infant death syndrome, decreased risk of obesity in the child, and a decreased risk of asthma, allergies and infections including ear infections, respiratory infections and diarrheal illnesses.  What are often not discussed are the benefits of breastfeeding to the mother.  Here we bring you 7 important maternal benefits of breastfeeding.

1) Better healing post-delivery: The act of breastfeeding stimulates the release of the hormone oxytocin. This encourages the uterus to contract, returning to its pre-pregnancy size sooner and decreasing post-partum bleeding.

2) Greater calorie burn: This allows some women to lose the pregnancy weight a bit faster.  Some studies have also demonstrated a lower amount of visceral fat in women who have breastfed.  This is the fat that is stored around the abdominal organs and predisposes an individual to cardiovascular disease.

3) Decreased risk of cancer: Moms who have breastfed have a decreased risk of breast, ovarian and endometrial cancer.  This benefit is even seen in patients with a family history of breast cancer.

4) Decreased risk of chronic disease: A number of studies have demonstrated a reduction in the risk of Type 2 Diabetes, high blood pressure and increased cholesterol among women who have breastfed.  There is also some data to suggest a potential reduction in osteoporosis risk.

5) Provides a break from menstruation: While exclusively breastfeeding, ovulation is suppressed and menstruation is delayed.  This is a convenience for the new mom and also helps with pregnancy spacing. (Though should not be considered a highly reliable form of birth control)

6)  Promotes emotional health: Oxytocin and prolactin are important hormones in a mother’s stress response. The increased levels associated with lactation allow the mother to manage stress better and have a positive impact on social behaviors including maternal-infant bonding.

7)  Saves money: It is estimated that breastfeeding an infant for the first year of life can save $400-$1000 even when accounting for the modest increase in food intake by a nursing mother.  In addition, breast fed infants have less illnesses leading to less time away from the job for working parents.  

Is Medical Marijuana right for you?

By: Bruce Saltzman M.D.
Board Certified Anesthesiologist

At Rittenhouse, we believe that medical marijuana may be useful in the treatment of the following conditions and you should be discussing these conditions at your visit:

·         Amyotrophic Lateral Sclerosis
·         Autism
·         Cancer
·         Crohn’s Disease
·         Damage to the nervous tissue of the spinal cord with objective neurological indication of intractable spasticity
·         Epilepsy
·         Glaucoma
·         HIV (Human Immunodeficiency Virus) / AIDS (Acquired Immune Deficiency Syndrome)
·         Huntington’s Disease
·         Inflammatory Bowel Disease
·         Intractable Seizures
·         Multiple Sclerosis
·         Neuropathies
·         Parkinson’s Disease
·         Post-traumatic Stress Disorder
·         Severe chronic or intractable pain of neuropathic origin or severe chronic or intractable pain in which conventional therapeutic intervention and opiate therapy is contraindicated or ineffective
·         Sickle Cell Anemia

The State of Pennsylvania has legalized the use of medical marijuana.  Starting sometime next year, dispensaries will be opening and patients with the following serious medical conditions will be able to get medical marijuana. To purchase medical marijuana, a patient will need to be under the continuing care of a physician who is registered with the Department of Health. The physician may then provide a signed certification to the patient stating that the patient has a serious medical condition. The patient must then apply to the department for an identification card. Once the patient receives an identification card, he or she can purchase medical marijuana at an authorized dispensary.  In the upcoming months we will be discussing many of the below conditions and how medical marijuana may be useful in their treatment, and how to obtain the patient certification from our practice.
                                             
Cannabis, also known as marijuana is a psychoactive drug from the Cannabis plant used medically and recreationally.  The main psychoactive chemical of cannabis is tetrahydrocannabinol (THC) (THC); one of 483 known compounds in the plant, including at least 65 other cannabinoids.   Cannabis can be used by smoking, vaporizing, within food, or as an extract.    As early as 2737 B.C., the mystical Emperor Shen Neng of China was prescribing marijuana tea for the treatment of gout, rheumatism, malaria and poor memory.   The criminalization of Marijuana by the Harrison act inhibited medical research on the plant.  The new research on marijuana in the 21st Century has led to the characterization of two receptors for cannabis in humans, CB1 and CB2. These receptors work through a unique feedback  mechanism on G protein–coupled receptors(GPCRs), again too complex for this setting.  GPCRs, which transduce extracellular signals into intracellular effector pathways, include about 900 members and represent the most prominent family of validated pharmacological targets in biomedicine.  Advair and Abilify are among the drugs that work with this receptor.  ~4% of the protein coding genome is devoted to these receptors. 

Dr. Saltzman’s background in Pharmacokinetics and the dynamics of medications has led to him researching the significant benefits of medical marijuana and he has received his certification from the state of Pennsylvania and will be seeing patients at our office for medical marijuana evaluations.







Breast Cancer Awareness Month

By: Catherine McGinty

We may recognize that it is October by the smell of pumpkin spice, but if you look carefully, you should also see the pink ribbons of breast cancer awareness month. We wanted to take the opportunity this month to go over preventative measures and risk factors, screening recommendations and signs of the disease that hits close to home for so many of our patients.  


Preventing Breast Cancer

While there is no sure way to completely prevent breast cancer, there are lifestyle recommendations which can help decrease your risk of developing it.  Many of these recommendations may sound familiar; they are the same as the ones our providers counsel our patients on at annual wellness exams!   These include:

  • Alcohol:  Some studies have shown a link to an increased risk in breast cancer, as well as many other cancers, when women consume alcohol excessively.  For this reason, The American Cancer Society recommends that women drink no more than 1 alcoholic beverage a day.
  • Weight:  Research has shown that women who are overweight after menopause or women who carry more excess fat around their waist may increase their risk of breast cancer. Therefore, it is recommended that all women try to maintain a healthy weight by regularly exercising and maintaining a balanced diet.
  • Exercise:  Regular physical activity, especially after menopause, has been shown to decrease one’s risk of breast cancer.  The amount of physical activity to decrease this risk is not clear, but The American Cancer Society suggests at least 150 minutes of moderate exercise a week.
  • Children:  Women who have never had children or have their first child after age 30 may have a greater risk of certain breast cancers.
  • Breastfeeding: Some studies support that breastfeeding can decrease the risk of breast cancer.
  • Birth Control:  Research has shown that there may be a small increased risk of breast cancer in women who take contraceptives containing hormones compared to those who do not; these include birth control pills, the shot, and IUDs.  This risk seems to decrease after stopping the medication.  The choice to start or continue all forms of birth control are taken very seriously and weighed against other risk factors and benefits and should be discussed individually with your healthcare provider.
  • Hormone Replacement: Combined hormone therapy which contains estrogen and progesterone that is used for the treatment of menopause and osteoporosis has been linked to a risk of breast cancer.  This risk can decrease after 5 years of stopping the medication.  

Early Detection and Diagnosis

Many women never have symptoms before the diagnosis of breast cancer, making screenings one of the most vital components of early detection and treatment.  The American Cancer Society recommends the following screenings for women at average risk of breast cancer:

  • Mammograms: Age 40-44 may choose to start annual mammograms.  Age 45-54 should get annual mammograms. Age 55 and older may switch to every other year mammograms or continue with annual mammograms, and should continue for as long as a woman is in good health or expected to live for at least another 10 years.
  • Clinical and self breast exam: There has been little evidence to support that physical breast exams by a clinician, or individually, can detect breast cancer earlier than Mammograms.  However, it is recommended that women be familiar with their breasts in how they feel and look, so they may detect any changes as soon as possible.

Breast Cancer Signs and Symptoms

Like mentioned previously, self and clinical breast exams should not replace screening mammograms since screening tests can detect breast cancer before symptoms appear.  However, here are a list of symptoms that would warrant further evaluation:

  • A new lump or mass, especially if it is painless, hard, or has irregular edges
  • Swelling to part or all of a breast
  • Skin dimpling or changes including redness, thickening, or scaling of the breast tissue or nipple
  • Breast or nipple pain
  • Nipple retraction or nipple discharge

As October is Breast Cancer Awareness Month, we wanted to take the opportunity to remind all of our patients that there are many opportunities to decrease your risk of breast cancer or detect it early so that treatment is initiated swiftly and effectively. We encourage you to continue to maintain your healthy lifestyles of limiting alcohol to one serving a day, maintaining a well balanced diet, exercising at least 150 minutes a week, mammograms (for those in recommended age brackets) and self breast awareness.  As always, please schedule an appointment with one of our providers if you have any new symptoms or concerns.




Laser Hair Removal

By: Shireen Mustafa, Aesthetician

Laser hair removal is one of the most popular cosmetic procedures in the DermaCenter.  It's fast, convenient and affordable.  Laser hair removal targets the hair follicles melanin with bursts of intense light energy. This damages the hair follicle, reducing unwanted hair. There are a handful of different effects included with this treatment; therefore it is important to consult with a certified laser technician to provide you a safe and effective treatment.

There is a common misconception that people believe that laser hair removal is permanent. It provides hair reduction, but not permanent hair removal.

Clients should expect to have treated hairs fall out in one to three weeks. Clients can expect to lose 10% of hairs in each treatment session. The melanin of your skin varies and determines how many treatments you should sign up for. Most clients require 6 to 10 treatments spaced 4 to 8 weeks apart to see a 70% to 80% reduction.  Typically, annual maintenance treatments are needed for a few years. Every client is different; some may notice regrowth in a few months, while others may never need to shave again.

The question I am commonly asked is if facial hair removal and body hair removal are the same. Facial hair is very different than hair on the body.  The body will yield faster results.  Keep in mind lasers cannot completely prevent more hair growth because our bodies are constantly changing as we age, some people will lose body hair and some may grow more in new places. Lasers can destroy your hair follicles but cannot prevent new ones from developing.

Results vary by hair color, eye color and skin type.  Red, white and grey hair cannot be removed with laser treatment as they lack pigment that the laser needs to be attracted to. Laser hair removal works best on fair skin and dark hair because the laser can target the melanin of the hair follicle. A simple way to find out if you’re a good candidate for the treatment is to pluck your hairs to determine if your hair follicles are dark. If you find this in more than 3 to 5 follicles in the area you’re interested in, then you are safe to book your appointment. However if you are not sure, you are always more than welcome to come in for a free consultation.

To get the most effective laser hair removal results is to:

1) Stay out of the sun 4 weeks prior to treatment.

2) Shave as much as you can to give the hairs a chance to grow through thicker and more pigmented.

3) Shave the area 24 hours before treatment so the laser/light will focus on the follicle underneath the skin and not the hair shaft

3) Stick with intervals 4 weeks to 8 weeks apart in booking your next appointment.

4) Lather up on sunscreen for protection and to prevent discoloration or irritation.

5) Exfoliate the area to prevent ingrown hairs.

Low Back Pain

Low back pain is classified as acute (lasting less than 4 weeks), subacute (lasting 4-12 weeks) and chronic (lasting 12 weeks or more).  Even though 84% of adults will develop back pain at some point in their lives, it is reassuring that for only 1% is life threatening systemic conditions.

The risk factors for developing low back pain are smoking, age, obesity, gender(being female), both sedentary lifestyle and physically strenuous work as well as psychologically strenuous work.

The red flags (this is the terminology that physicians use to signify things that should alert the physician that something serious may be causing the back pain) for low back pain are: new onset urinary retention, fecal incontinence, significant muscle weakness, having a history of cancer, fever and malaise.  Other significant risk factors to be considered contributory are obviously severe trauma, presence of contusions and abrasions and prolonged use of corticosteroids, such asPrednisone and Methylprednisolone. 

As serious as these symptoms may seem, the majority of patients will have ”nonspecific” low back pain, which means patients will have back pain that is not due to any specific underlying condition.  Most of these cases are due to musculoskeletal pain that will improve within a few weeks. 

As a result of these findings, radiological imaging is rarely needed unless the symptoms continue for more than 4 weeks or progress at any time.  An additional consequence to imaging is that it may show abnormal findings that turn out to be not significant, but may lead further imaging or testing that was unnecessary, albeit warranted once the process is started.  Interestingly enough, patients who have significant findings on radiology studies often times are asymptomatic.  Patients who have seen me in the office often hear me say, that “medicine is not an exact science” and this is a clear example of this.

So, if you experience low back pain, when should you call in for an appointment to my primary care office?  Certainly if you are having symptoms that significantly decrease your daily movement, contribute toloss of strength, loss of balance and fevers associated with lower back pain, you should certainly schedule an appointment with our office as soon as possible.  Signs that things may be more serious and would warrant an ER visit would include fevers that are not improved with Tylenol or Ibuprofen, paralysis, inability to hold your urine or control your bowel movements and significant trauma.  If ER physicians do not encounter any of these symptoms, patients may not even get a plain x-ray while they are in the ER and will be directed back to their PCP for further recommendations.  

When low back pain persists for 4-6 weeks, plain x-rays can be used to show fractures, compression fractures, osteoarthritis, scoliosis and spondylolisthesis.  Symptoms that are progressive or involve nerves may require an MRI, if plain x-rays are not conclusive.  If a patient is unable to undergo an MRI, then a CT is ordered.  There are additional imaging studies used to evaluate lower back pain, but they are used less frequently. 

Thankfully, even though, there are very serious causes of lower back pain, the majority of cases can be treated in the primary care office with or without imaging.  Most cases of lower back pain resolve within 4 weeks and do not proceed to become a chronic condition.  More serious symptom certainly warrant a ER evaluation.

O-Shot

By: Dr. Dana Shanis, Board Certified Gynecologist

What is the O-Shot®?


The O-Shot® is a non-surgical, minimally invasive procedure that can help improve a woman’s sexual desire and orgasm, decrease urinary incontinence and treat a chronic skin condition called lichen sclerosus.   Up to half of women experience low sexual desire and many others experience issues with arousal, lubrication and orgasm.  The O-Shot® uses platelet-rich plasma (PRP) that contains growth factors from the woman’s own blood, and is injected into the clitoris and vaginal wall.  This increases the blood flow, nerve sensitivity and collagen formation in the area, leading to improved sexual function.

What are the benefits of the O-Shot®?

This injection can increase a woman’s sexual desire and arousal, as well as improve the number or quality of her orgasms.  In addition, this procedure can help with

  • Leaking urine
  • Painful sex
  • Vaginal dryness
  • Decrease symptoms and long-term consequences of lichen sclerosus

How is it performed?

Blood is drawn from the patient and then using a special double-spin process the red blood cells are removed, leaving the plasma which is full of growth factors.  Numbing cream is then placed onto the areas that will be injected, and a lidocaine injection is performed to ensure there is minimal to no discomfort during the procedure.  The PRP is then injected into the clitoris and vaginal wall.  The procedure takes less than an hour.  

What are the risks?

Some women experience spotting from the location of the injections, as well as temporary soreness.  Infection or significant bleeding is unlikely. While most women tolerate the procedure well, there are reports of women with prolonged numbness of the clitoris or hypersexuality after the procedure. If this happens, it typically will resolve within the first few days.

What is the recovery?

There is no downtime after the procedure, you can immediately resume all physical activity and even intercourse that same day.  The full effect of the O-Shot® is reached around 3-4 weeks after the procedure.  Depending on the reason for the injection, the results can last for more than a year with a single injection.  Women with lichen sclerosus will often need additional treatments to continue its benefits.

Is it right for me?

If you suffer from low sexual desire, unsatisfactory arousal, lubrication, orgasm, urinary incontinence or lichen sclerosus, then the O-Shot® may be for you.  At Rittenhouse Women’s, our gynecologist and women’s health nurse practitioners are trained to address these issues and determine if this procedure is your best option for treatment.

It is important to discuss all concerns with your provider, as they may also be signs of other medical problems.  




Tips For Overeating

By: Dr. Monica Duvall

One of the most common eating disorders in U.S. women is Binge Eating Disorder with a lifetime prevalence of 3.5%.   Binge Eating Disorder is characterized by episodes of eating larger-than-normal amounts of food until uncomfortable or full, coupled with a feeling of lack of control.  It may also include eating faster than usual, eating when not hungry, eating alone out of embarrassment, and/or feeling guilty after eating.  Frequently, individuals will have patterns of restrictive eating in between episodes.  Episodes occur at least once a week for a period of three months, can impair social functioning or potentially cause health problems.

For many people, overeating is an occasional or less dramatic occurrence, not meeting the above clinical criteria.  It is not clear why some people develop binge eating disorder, but there is a high prevalence of comorbid psychiatric conditions in people with this disorder, including depression, anxiety, and phobias.  About 50% of those with Binge Eating disorder are overweight, about the same as in the general population.  For those who are trying to optimize their eating habits overall for better health, recognizing triggers and becoming more educated about food and nutrition is useful.  Meeting with a nutritionist to discuss healthy food choices and appropriate portion size is a good start.   Having a plan ahead of time for a holiday or special occasion meal, such as not having second helpings or focusing more on the healthier parts of the meal can also help.   For anyone who feels their overeating is causing personal distress, or has evolved onto the spectrum of Binge Eating Disorder, the most successful treatment strategy is Cognitive-Behavioral therapy, either in a group or individual setting.  Medications can be used as a second-line therapy, usually the SSRI antidepressants.  The first step is to recognize if your eating behaviors have gotten out of your control, and to seek assistance from your provider to determine the best treatment option for you.

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