Blog

Is Medical Marijuana right for you?

By: Bruce Saltzman M.D.

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 Syndrome
·         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. 

 

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.

National Suicide Prevention Awareness Month

By: Dr. Liggera

September is National Suicide Prevention Awareness Month.  It's an opportunity to promote resources and awareness around the issues of suicide prevention, how to help others, and how to talk about suicide without increasing the risk of harm.


Suicide is a national epidemic, and it’s getting worse.  Not only is suicide the second-leading cause of death for all Americans between the ages of 15 and 54, but the age-adjusted suicide rate in the U.S. also increased a staggering 24 percent from 1999 to 2014.

For a variety of reasons, suicide largely remains a taboo topic in our society.  When it does receive media attention, the reaction is typically to blame the victim, and to brand it a cowardly act.   Unfortunately, this type of response is off-base, and it sidesteps the relationship between suicide and mental health and addiction. 

We all should strive to understand this epidemic better, to identify those who need help, and to provide help to those who seek it.  

There’s no single cause for suicide, nor does it discriminate on age, gender or background.  Suicide most often occurs when a person suffering from a mental health condition is unable to cope as a result of being overwhelmed by current stressors.  Depression is the most common condition associated with suicide, and it is often undiagnosed or untreated.  Mental illnesses like depression, anxiety and substance problems, especially when unaddressed, increase risk for suicide.  Yet it’s important to note that most people who appropriately manage their mental health illnesses through various treatments like medication and therapy, lead fulfilling lives.

A suicidal person may not ask for help, but that doesn't mean that they don't want help.  People who take their lives don't want to die—they just want to stop hurting.  Suicide prevention starts with recognizing the warning signs and taking them seriously.  It is not uncommon for someone who thinks a friend or family member is considering suicide to be afraid to bring up the subject.  But talking openly about suicidal thoughts and feelings can save a life.

Here are common warning signs according to Suicide Awareness Voices of Education (SAVE):

  Ø  Talking about wanting to die or to kill oneself

  Ø  Looking for a way to kill oneself

  Ø  Talking about feeling hopeless or having no purpose

  Ø  Talking about feeling trapped or being in unbearable pain

  Ø  Talking about being a burden to others;

  Ø  Increasing the use of alcohol or drugs

  Ø  Acting anxious, agitated, or reckless

  Ø  Sleeping too little or too much

  Ø  Withdrawing or feeling isolated

  Ø  Showing rage or talking about seeking revenge

  Ø  Displaying extreme mood swings

It's important to note that suicide can be prevented through education and awareness.  The warning signs can be subtle, but they are there. 

The first step for prevention is bringing the topic out of the closet and facing it head on.  First, pay attention and notice when someone is showing signs that they could be at risk.  Second, take the time to let this person know that you care.  Too often, people see suicide as something they can do nothing about, but this is rarely true. Everyone can play a crucial role in helping those around us who struggle with these thoughts and feelings on this journey to survival.

If you believe a friend or family member is suicidal, the best way to help is by offering an empathetic, listening ear.  Let them know that they are not alone and that you care.  Don't take responsibility, however, for making them well.  You can offer support, but you can't make it better for a suicidal person.  They have to make a personal commitment to recovery. 

If you or someone you know may be suicidal, call the National Suicide Prevention Lifeline -
1-800-273-8255.

Meet Our Providers


Dr. Dana Shanis Board Certified Gynecologist 


Dana Shanis M.D. is a Board Certified Gynecologist and active researcher at the National Institutes of Health. She joins us from the Hospital of the University of Pennsylvania, where she honed her procedural skills, and was active in medical student and resident education. 

Dr. Shanis received her medical degree from Temple University School of Medicine and completed her Ob/Gyn residency at Sinai Hospital of Baltimore. She attended fellowship at the National Institutes of Health, where she studied the gynecologic care of cancer survivors and other medically-complicated women. Since fellowship, Dr. Shanis has remained involved in her research, publishing articles and presenting at meetings and conferences across the country. In 2011, she was honored with the American College of Obstetricians and Gynecologists Cervical Cancer Prevention Award for her work with cancer survivors.

Dr. Shanis provides individualized care to women through all stages of life and strives to educate and empower each patient to be active in her healthcare decisions.

See Dr. Shanis' CV.

Allison Andrews Board Certified Women's Health Nurse Practitioner

Allison_gradientsm.pngAllison Andrews, WHNP, is a board certified women’s health nurse practitioner. She graduated from Thomas Jefferson University with her Bachelor’s of Science in Nursing. Her career as a nurse began at Kennedy University Hospital Emergency Department where she has spent five years providing urgent and emergent medical care to all patient populations. While working in the ED, she expanded her background and was on staff as a labor and delivery nurse at the Hospital of the University of Pennsylvania.

Allison gained outstanding clinical experience in gynecology, obstetrics, urogynecology, breast and gynecologic oncology and graduated from Drexel University with her Master’s of Science in Nursing. Allison is a member of The National Association of Nurse Practitioners in Women's Health's and Sigma Theta Tau International Honor Society of Nursing.

Allison is excited to join Rittenhouse Women’s Wellness Center and is dedicated to building an open and trusting relationship with her patients. She believes in empowering women through education and encourages women to take an active participation in their healthcare.

Dr. Monica Duvall Board Certified Family Physician

monica_duvall.jpg
Monica Duvall, M.D., is a board certified family physician with over 10 year experience. She joins us from the University of Pennsylvania Health System where she practiced medicine and held a faculty position.

Dr. Duvall received her Doctorate in Medicine from Temple University’s School of Medicine and completed her Family Medicine residency at the Hospital of the University of Pennsylvania where she was a Benjamin Franklin Scholar and received a general honors certificate. Her professional interests include: preventive medicine as well as women’s medicine.

Dr. Duvall is an active member of the American Academy of Family Physicians and The Union League of Philadelphia  Dr. Duvall currently resides in Gladwyne section with her husband.

See Dr. Duvall's CV.

Elizabeth Galbrecht Board Certified Women's Health Nurse Practitioner

Elizabeth Galbrecht, MSN, AGNP-C, WHNP-BC, is a dual board-certified Adult-Gerontology and Women's Health Nurse Practitioner.  She received her Master of Science in Nursing from Yale School of Nursing and joins Rittenhouse Women’s Wellness Center from a community health center in New Haven, Connecticut, where she has spent two years providing primary care and gynecologic services to her own panel of patients.  Prior to becoming a Nurse Practitioner, Elizabeth received her Bachelor's degree in biology from Macalester College in St. Paul, Minnesota and then went on to spend two years serving as a Peace Corps Volunteer in Mozambique.  It was during her time as a Peace Corps Volunteer that she was exposed to the unique complexities of women's health needs and decided to pursue a career path that would allow her to help women meet their own health goals by providing high-quality and patient-centered care.  While obtaining her Master of Science in Nursing at Yale, Elizabeth worked as a Registered Nurse at a family planning clinic and was also involved in several student organizations.  She directed the reproductive health department at a student-run free clinic, co-directed a student organization that provided free diabetes and hypertension screening to patrons of a local soup kitchen, and was actively involved in a student organization that advocates for the inclusion of reproductive health education and training in nursing schools around the country.  Elizabeth is especially interested in gynecology, reproductive and sexual health, and family planning.  She is also experienced in providing preventive medicine, chronic disease management, and full-scope primary care.  She is looking forward to providing all of these services to the patients of Rittenhouse Women's Wellness Center.

Dr. Maria Mazzotti Board Certified Physician

Maria Mazzotti, D.O., is a board certified physician with over 15 years of experience. Patients describe her as “caring, professional and compassionate” Prior to joining our practice, she practiced at Penn Care’s Spruce Internal Medicine.

Dr. Mazzotti received her Doctorate in Osteopathic Medicine and completed her residency at the Philadelphia College of Osteopathic Medicine (PCOM). Between 1996 and 1997, she also held the position of Chief Resident of Family Medicine at PCOM. Her professional interests include: family medicine and community health.

Dr. Mazzotti is a member of the American Osteopathic Board of Family Physicians, American Academy of Family Physicians and the American Osteopathic Association. She currently resides in Philadelphia with her husband and children.

See Dr. Mazzotti's CV.

Catherine McGinty Board Certified Nurse Practitioner

Catherine D. McGinty, MSN, FNP-BC, is a board certified family nurse practitioner. She attended Villanova University where she received her Bachelor of Science degree in Nursing as well as completed their Navy ROTC program. After graduating with her Bachelors degree, she went on to work on an inpatient surgical floor at the Naval Medical Center of San Diego where she provided care to wounded warriors, other military personnel and their families. She deployed to Camp Buehring, Kuwait where she provided emergency and general medicine to deployed troops and defense contractors. After serving in Kuwait, she went on to serve two years at the United States Naval Hospital in Guantanamo Bay, Cuba where she was Charge Nurse. During this time, she was awarded the Navy Achievement Medal for outstanding training and implementation of hospital wide electronic medical record system ensuring, training compliance as well as a smooth transition.  In 2013, she went on to receive her Masters of Science degree in Nursing from George Mason University in Fairfax, Virginia. While working toward her Masters of Science degree, Catherine held a staff nurse position at George Washington University Hospital in Washington, D.C. She joins us from CVS Minute Clinic after working there as a Family Nurse Practitioner, where she performed routine services such as physical assessments, vaccinations and diagnosing and treating illnesses. 

Catherine is a member of the American Association of Nurse Practitioners. She brings the Rittenhouse Women’s Wellness Center a great deal of experience and hopes to offer her patient’s the finest in medical care.

Dr. Lauren O'Brien Board Certified Family Physician

Lauren O’Brien, M.D., is a board certified family physician with years of experience. She joins us from Hatboro Medical Associates where she practiced family medicine for the past 5 years. Patients describe her as professional and personable.

Dr. O’Brien received her Doctorate in Medicine from Georgetown University School of Medicine and completed her Family Medicine residency at York Hospital where she held Chief Resident position. While completing her residency at York Hospital, she received the Society of Teachers of Family Medicine Resident Teacher Award. Her professional interests include: women’s health and dermatologic procedures.

Dr. O’Brien is an active member of the American Academy of Family Physicians, Pennsylvania Academy of Family Physicians and Abington Hospital Medical Staff.

See Dr. O'Brien's CV.

Dr. Jillian Rowbotham Board Certified Internist

Jillan Rowbotham, D.O., a board certified internist, was first exposed to medicine while volunteering for Hospice of Lansing during her third year of college, and it was a life-changing experience that made her want to become a doctor. She went on to earn her medical degree from the Philadelphia College of Osteopathic Medicine. She received her training in Internal Medicine at Main Line Health’s Lankenau Hospital in Wynnewood, Pennsylvania where she was one of the top residents in her program “Dr. Rowbotham remains one of our best residents. She is absolutely dedicated to the well-being of her patients and is a wonderful communicator with patients and their families.” Dr.  Rowbotham’s schedule began filling up weeks in advance with women patients and this gave her the experience and solid grounding to focus on women’s health. Her professional interests include gastroenterology, weight management, nutrition and food policy.

Dr. Rowbotham completed her undergraduate work at Michigan State University, earning a B.S. in Human Biology with High Honors. Prior to completing her residency training, Dr. Rowbotham volunteered to travel to Guayaquil, Ecuador where she assisted in reconstructive surgeries.

Dr. Rowbotham is the co-founder of Physicians for Humanity; and is also an active member of the American Medical Association, American College of Physicians, The Obesity Society and has been awarded the William Dickerson Memorial Award. As an undergraduate, she was also selected as the Academic Woman of the Year.

See Dr. Rowbotham's CV.

Preconception tips for optimal fertility and a healthy pregnancy

By: Dana Shanis, Gynecologist

Trying to conceive is an exciting time and a little preparation can help improve your experience and the likelihood of a healthy child. Good health before and during pregnancy will ensure the safest environment for your baby to grow. Here are some tips that can help prevent problems that may affect you or your child’s future health:


Exercise

One of the best things you can do to help your long-term health, including during pregnancy, is to exercise. This decreases inflammation, reduces stress levels, and has been shown to decrease the risk of pregnancy complications, such as gestational diabetes or hypertension. Physical activity does not increase your risk of miscarriage, a low birth weight baby, or early delivery. If you have any medical problems, it is important to discuss with your provider what types of exercise may be suitable for you. 

Balanced diet and vitamins

Eating a well-rounded diet including adequate fruits and vegetables will help prevent a nutrient-deficiency, such as iron or vitamin D, which can cause problems for you in pregnancy. Most women are able to get adequate nutrition in their diet. For women with a modified diet, like gluten-free or vegan, it may be beneficial to supplement other nutrients and should be discussed with your healthcare provider or a nutritionist. In the month prior to attempting pregnancy, regardless of diet, it is helpful to start supplementing 400 micrograms of folic acid daily, which has been shown to decrease the likelihood of neural tube defects in the baby.   

Healthy weight

Maintaining a healthy weight is important to optimize your reproductive system. Obesity has been shown to decrease fertility and increase the risk of pregnancy complications for both mother and child. Underweight women also experience effects on fertility and increase the risk of a low birth weight baby, who is at risk for problems during labor and may have behavioral or health problems that last through childhood. Your provider can offer recommendations to help you reach a healthy weight range.

Control stress

Stress hormones can affect your menstrual cycle and have been shown to decrease fertility. In addition, studies have shown women in stressful jobs, have higher rates of preterm delivery and preeclampsia, a potentially dangerous complication of pregnancy. While it is impossible to remove all sources of stress, learning how to limit and physically handle stressors can decrease their impact. 

Limiting caffeine

Significant caffeine intake can increase your heart rate, lead to dehydration, and increase stress hormone levels. In small doses, likely less than 200mg or 12oz of normal strength coffee, these changes are unlikely to affect your health or the pregnancy. Spacing out the caffeine intake and drinking enough water can help prevent issues.

Work to stop drinking, smoking or other drugs

Pregnancy can be a great motivator to decrease use of harmful substances, as many have been shown in studies to cause adverse outcomes in pregnancy. There is no level of alcohol use that has been proven to be safe in pregnancy so it is recommended to abstain. Alcohol use can also decrease both male and female fertility for some. Smoking cigarettes while pregnant can increase the likelihood of having a low birth weight baby and other adverse events. 

See your healthcare provider

Most women would benefit from a preconception visit with a healthcare provider. This visit can help assess any medical problems, medications, personal or family history that could affect your pregnancy or your ability to get pregnant. Your provider will help to determine what testing, vaccinations, and medication changes may be recommended, as well as any other risk factors that require intervention. She can also review your menstrual cycle and determine the best time for you to discontinue your current contraception or time intercourse to promote fertilization.

Optimizing your health prior to trying to conceive will give you the best chance for a healthy mother and child, and our providers are here to help get you ready.

Emotional well-being, dementia and nutrition

 
By: Marissa Martino, RD, LDN

Not everyone may realize, but nutrition has everything to do with our mental health. In fact, all body functions are connected and intertwined in one way or another. The recognition of the brain-gut axis, or connection, has been on the rise and we are finally acknowledging the importance of a healthy gut. And by gut, we don’t mean the “stomach, belly or tummy”, we mean the GI tract- specifically the small and large intestines. To many, it’s a foreign concept that our overall health lies in the condition of our gut.


Alzheimer’s, which is just one form of dementia, has actually been termed Diabetes Type 3 due to the correlation of dramatic decline in cognitive function and chronic insulin resistance… Lot’s of big words. Let’s back up a minute. What causes insulin resistance in the first place? Well, we have three macronutrients that fuel our bodies- Carbs, Proteins, and Fats. Can you guess which one is related to diabetes? 

You guessed it- Carbs. 

All carbs eventually turn into glucose, which raises our blood sugar. Insulin then is released to allow the digested sugar into our cells. However, eventually our cells become insulin resistant and stop absorbing glucose, leaving sugar in the blood stream. Uncontrolled insulin resistance leads to type 2 diabetes. 

So what about the previously mentioned “Type 3”? Well first off, increased sugar in the body causes chronic inflammation. This means that our gut, which has also been termed our “second brain”, is so inflamed that it cannot properly absorb any nutrients from the food that we’re eating- assuming that we are even eating nutrient dense foods.  

Free flowing sugar also means sticky, or viscous, blood. Increased viscosity can impair blood flow to the brain which affects how much oxygen and nutrients the brain cells are receiving. When circulation in the brain is compromised, you are at an increased risk of stroke and the development of dementia. In addition, insulin resistance impairs signaling to the brain and prevents brain cells from properly utilizing glucose for energy. Overall brain functioning suffers as a result of this.1  Ever have difficulty thinking straight due to low blood sugar? This is the same concept- except a bit more deep-rooted. 

The gut-brain axis is complex yet fascinating. We have discounted the association for so long but recently are coming to terms with just how powerful the health of our gut is, (or lack thereof). “The gut–brain axis seems to influence a range of diseases, and researchers have begun to target communication pathways between the nervous system and the digestive system in an attempt to treat metabolic disorders specifically.” 2

Have you ever been nervous, felt nauseous or had butterflies in your stomach? This is because the GI tract is sensitive to emotions, which go hand in hand with the hormones that are regulated by the brain.3 The connection goes both ways since over 90% of serotonin (the happy hormone) is produced in the gut. Therefore, if your gut is inflamed from an unhealthy diet, say goodbye to serotonin and hello to mood swings, anxiety, and depression! 

If you’re interested to find out if you have a healthy gut, before you spend the copay on a very uncomfortable endoscopy or colonoscopy, see a registered dietitian who can assess whether your daily intake is helping or hurting you.

 1 http://dlife.com/type-3-diabetes/

2 https://www.scientificamerican.com/article/metabolism-in-mind-new-insights-into-the-gut-brain-axis-spur-commercial-efforts-to-target-it/

3 http://www.health.harvard.edu/diseases-and-conditions/the-gut-brain-connection

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