Sunscreen vs. Covering Up

By: Catherine McGinty MSN, FNP-BC

After what seemed like another long winter, summer is finally here! Before you head outside to soak up some of that Vitamin D, we wanted to go over some facts about sunscreen and covering up, and explain the benefits and challenges of each.


To start, everyone should be wearing sunscreen at least on their face every day, no matter what. But how much protection are you getting from daily sunscreen use? That all depends on the sun protective factor (SPF) and if the sunscreen is “broad-spectrum,” which means that it protects against UVA and UVB rays. Sunscreens that are less than SPF 15 and are not broad-spectrum are able to prevent sunburn, but they are not protective against skin cancer or skin aging. So, it is important to look for sunscreens that are at least SPF 30 and broad spectrum. With that, no sunscreen is 100% effective. This is because it acts as a filter and cannot block all UV rays, even if used correctly. For example, sunscreens with a SPF of 100 only filter out about 99% of UVB rays.

Sunscreen is also not as effective if you are not applying enough, which is a common mistake. The recommendation is at least one ounce (about a shot glass worth) to all exposed areas of the body and reapply every 2 hours to maintain protection. If you are swimming or sweating excessively, you should reapply even sooner. That amount of sunscreen application can be tough when you are on the go!

Lastly, most sunscreen products are only good for 2-3 years, and those that have been exposed to extreme heat conditions (e.g. your car’s glovebox) can become less effective. So, make sure you are not using that BB cream from 4 years ago that you got on sale at Target, it likely is not providing the same protection it once did.

Covering Up

Most clothing can provide some level of UV protection, so if you are unable to wear sunscreen on exposed body parts, it is recommended to “cover up.” The most effective types of clothing are those that are dark colored and tightly woven, which are not usually the types of fabrics one likes to wear during summer months. Some companies have started to make sun-protective clothes that are light-weight and provide protection even when wet. These types of clothing can get expensive, but if you are planning to go hiking on a sunny day, for example, and do not feel like reapplying sunscreen every 1-2 hours, it could be a good investment. As a rule, you can get an idea of how much protection you are getting from your clothing if you can see light through the fabric. If light can get through, so can UV rays.

Other ways to cover up when outside is to wear a hat and sunglasses. Sunglasses protect not only your eyes, but also the skin around your eyes (warding off crows feet just a little bit longer). Baseball caps can protect the top and front of your head, but leave your neck and ears exposed, so consider also wearing a bandana around your neck (Madewell has some cute ones in their stores right now!). Straw hats are also not usually as protective because they are not tightly woven, so it is better to wear a hat with tightly woven fabric that has at least a 2-3 inch brim, or a “shade cap” with fabric on the sides and down the back for better protection.

In summary, neither option provides 100% protection against skin cancer, so you should do your best to use a combination of both. You should wear sunscreen on your face every day, weather it is underneath your make up or if you have found a moisturizer that contains at least an SPF of 30 in it. Add on a cute wide brimmed hat and some sun protective clothing and you are ready to head outside and protect yourself from skin aging and cancer!

PTSD Awareness Month: Treatment with Medical Marijuana

By: Bruce Saltzman M.D.

June is post-traumatic stress disorder (PTSD) awareness month.

PTSD is a severe, potentially chronic and disabling disorder that develops in some persons following exposure to a traumatic event involving actual or threatened death, serious injury, or sexual assault. Some common symptoms include intrusive thoughts, nightmares and flashbacks of traumatic events, avoidance of trauma reminders, hypervigilance, and sleep disturbance. These symptoms can be highly distressing and substantially impair social, occupational, and interpersonal functioning. The intensely distressing and impairing symptoms of traumatic stress are highly prevalent immediately following traumatic exposure and dissipate over the following days and weeks in most people. Persistence beyond one-month post-trauma suggests PTSD [1].

The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition stipulates that for an individual to be diagnosed with posttraumatic stress disorder, he or she must have experienced or witnessed a life-threatening event and reacted with intense fear, helplessness, or horror. The traumatic event is persistently reexperienced (e.g., distressing recollections), there is persistent avoidance of stimuli associated with the trauma, and the victim experiences some form of hyperarousal (e.g., exaggerated startle response). These symptoms persist for more than one month and cause clinically significant impairment in daily functioning. When the disturbance lasts a minimum of two days and as long as four weeks from the traumatic event, Acute Stress Disorder may be a more accurate diagnosis.

The prevalence of PTSD in the U.S. population is approximately 8%, with incidence as high as 17% in primary care patients. PTSD can become chronic in as many as 40% of cases [2]. 50% of women in the United States have experienced a traumatic event, with the majority reporting trauma exposure also reporting two or more traumatic events. The National Comorbidity Survey Replication estimated the lifetime prevalence of PTSD among adult Americans to be 6.8%. Current past year PTSD prevalence was estimated at 3.5%. The lifetime prevalence of PTSD among men was 3.6% and among women was 9.7%. The twelve-month prevalence was 1.8% among men and 5.2% among women. However, PTSD only develops in 10% of those exposed to trauma, a finding that has prompted intense research efforts in identifying risk factors and early intervention to prevent or reduce the development of PTSD [2]. Populations at risk for PTSD include refugee victims of torture, combat veterans, persons released from incarceration, victims of sexual assault, and adults who endured repeated sexual or physical abuse as children">[4].

Explanatory models of PTSD have been proposed to better understand psychotraumatization processes and PTSD. Explanatory models of PTSD have been proposed to better understand psychotraumatization processes and PTSD. [5] These perspective models include:        

1.     Disease/Illness Perspective [6-11]-

2.     Dimensional Perspective

3.     Cognitive-Axiologic Perspective [12,13][6]

4.     Behavioral Perspective [6]

5.     Spiritual/Transcendental Perspective [14]

6.     The Narrative Perspective [15]

PTSD is viewed as a maladaptive response to a traumatic stressor, characterized by altered fear-related learning (fear conditioning) and extinction, behavioral sensitization and kindling, and alterations in brain regions and neurotransmitter systems closely linked to these processes. The hypothalamic-pituitary-adrenal (HPA) axis is the primary system activated as a stress response and a potential source of vulnerability to trauma-related psychopathology such as PTSD. Normal response to stress exposure initiates a neuroendocrine cascade in the HPA axis, leading to adrenal gland hypersecretion of the glucocorticoid cortisol. HPA axis activity is tightly controlled through complex regulatory mechanisms of glucocorticoid negative feedback. Glucocorticoids regulate the secretion of hypothalamic corticotropin-releasing factor (CRF) and pituitary adrenocorticotropic hormone. HPA axis activity is also regulated by glucocorticoid receptors (GRs) in the hippocampus and prefrontal cortex [[16,17] HPA stress response pathways are intimately linked with neurotransmitter systems and key brain regions in PTSD. The neural circuitry that mediates fear memory involves complex interactions among three brain centers: the hippocampus, involved in short-term memory and contextual fear; the amygdala, involved in conditioned fear response; and the medial prefrontal cortex, which mediates suppression of subcortical (e.g., amygdala, hippocampus) responses. Several neurotransmitter systems serve as chemical messengers in this neurocircuit. Alterations in these transmitter systems reflect a dysregulated stress response and substantially impact conditioned fear response and the consolidation and retrieval of traumatic memories [18,19].

Treatment of PTSD is aimed at interfering with this persistence of traumatic memories. The treatments of PTSD are varied and diverse including:

1              Psychosocial

2              Rehabilitation

3              Somatic and Alternative Therapy

4              Pharmacotherapy

In 2002 Marsicano found that the CB1 receptors in the amygdala are required for the extinction of fear memories [20]. A further study by Hillard in 2015 showed that following chronic stress signaling in the endocannabinoid system (ECS) is downregulated [21]. This downregulation impaired reversal learning (the ability to be trained differently to two stimuli based on reward or punishment response) in mice and as anticipated induced perservatory behaviors.  The study also found that the effects of chronic stress were reversed when an exogenous CB1 agonist was applied.  Hill found Reductions in circulating endocannabinoid levels in individuals with post-traumatic stress disorder following exposure to the World Trade Center attacks [22]. These studies showed that there may be a scientific rational behind the use of marijuana by veterans to reduce PTSD. Medical marijuana has been shown to be an effective adjuvant in the treatment of PTSD. It may even be possible to treat PTSD without the side effects caused by THC.

If you think that you might have PTSD or would like to discuss the possibility of Cannabinoid therapy, please speak with me or your primary care physician.

1.       American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association Press; 2013.Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey.Arch Gen Psychiatry. 1995;52(12):1048-1060.

2.       National Center for PTSD. How Common is PTSD? Available at Last accessed February 16, 2018.

3.       Phoenix Australian Centre for Posttraumatic Mental Health. Australian Guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder. Available at Last accessed February 16, 2018.

4.       Jakovljević M, Brajković L, Jakšić N, Lončar M, Aukst-Margetić B, Lasić D. Posttraumatic stress disorders (PTSD) from different perspectives: a transdisciplinary integrative approach. Psychiatria Danub. 2012;24(3):246-255.21. McHugh PR, Slavney PR. The Perspectives of Psychiatry. 2nd ed. Baltimore, MD: John Hopkins University Press; 1998.

5.       22. Tyrer P, Steinberg D. Models for Mental Disorders: Conceptual Models in Psychiatry. 3rd ed. Chichester: John Wiley & Sons; 1998.

6.       23. Summerfield D. Cross-cultural perspective on the medicalization of human suffering. In: Rosen GM (ed). Posttraumatic Stress Disorder: Issues and Controversies. Chichester: John Wiley & Sons; 2005: 233-245.

7.       24. Frueh BC, Elhai JD, Kaloupek DG. Unresolved issues in the assessment of trauma exposure and posttraumatic reactions. In: Rosen GM (ed). Posttraumatic Stress Disorder: Issues and Controversies. Chichester: John Wiley & Sons; 2005: 63-84.

8.       25. Herbert JD, Sageman M. First do no harm: emerging guidelines for the treatment of posttraumatic reactions. In: Rosen GM (ed). Posttraumatic Stress Disorder: Issues and Controversies. Chichester: John Wiley & Sons; 2005: 213-232.

9.       26. Friedman MJ. PTSD and related disorders. In: Stein D, Friedman M, Blanco C (eds). Post-Traumatic Stress Disorder. 1st ed. Chichester: John Wiley & Sons; 2011.

10.   27. McNally RJ, Frueh BC. Why we should worry about malingering in the VA system: comment on Jackson et al. (2011). J Trauma Stress. 2012;25(4):454-456.

11.   28. McNally RJ. Conceptual problems with the DSM-IV criteria for posttraumatic stress disorder. In: Rosen GM (ed). Posttraumatic Stress Disorder: Issues and Controversies. Chichester: John Wiley & Sons; 2005.

12.   29. Reivich KJ, Seligman MEP, McBride S. Master resilience training in the U.S. Army. Am Psychol. 2011;66(1):25-34.

13.   30. Maguen S, Litz B. Moral injury in veterans of war. PTSD Res Q. 2012;23(1):1-6.

14.   31. Amendolia RA. A Narrative Constructivist Perspective of Treatment of PTSD with Ericksonian Hypnosis and EMDR. Available at Last accessed February 16, 2018.

15.   Morris MC, Compas BE, Garber J. Relations among posttraumatic stress disorder, comorbid major depression, and HPA function: a systematic review and meta-analysis. Clin Psychol Rev. 2012;32(4):301-315.

16.   George SA, Stout SA, Tan M, Knox D, Liberzon I. Early handling attenuates enhancement of glucocorticoid receptors in the prefrontal cortex in an animal model of post-traumatic stress disorder. Biol Mood Anxiety Disord. 2013;3(1):22.

17.   Ressler KJ, Mayberg HS. Targeting abnormal neural circuits in mood and anxiety disorders: from the laboratory to the clinic.Nat Neurosci. 2007;10(9):1116-1124.

18.   Rauch SL, Shin LM, Phelps EA. Neurocircuitry models of posttraumatic stress disorder and extinction: human neuroimaging research—past, present, and future. Biol Psychiatry. 2006;60:376-382.

19.  Neumeister A, Corsi-Travali S, Green CR. The role of BDNF-TrkB signaling in the pathogenesis of PTSD. J Depress Anxiety. 2013;S4:006

20.  G Marsicano, CT Wotjak, SC Azad, T Bisogno. The endogenous cannabinoid system controls extinction of aversive memories. -Nature volume 418, pages 530534

21.  Maria Morena, Sachin Patel, Jaideep S Bains & Matthew N Hill. Neurobiological Interactions Between Stress and the Endocannabinoid System. Neuropsychopharmacology volume41, pages80–102 (2016)

22.  Hill MN1, Bierer LM, Makotkine I, Golier JA, Galea S, McEwen BS, Hillard CJ, Yehuda R. Reductions in circulating endocannabinoid levels in individuals with post-traumatic stress disorder following exposure to the World Trade Center attacks. Psychoneuroendocrinology. 2013 Dec;38(12):2952-61

23.  George Fraser, M.D., F.R.C.P.C., The Use of a Synthetic Cannabinoid in the Management of TreatmentResistant Nightmares in Posttraumatic Stress Disorder (PTSD). CNS Neuroscience and Therapeutics. 2009 February 13; Volume15, Issue1 Pages 84-88

Moderation On Vacation

By: Courtney Liggera, Psy. D.

“Be moderate in order to taste the joys of life in abundance.”-Epicurus

As summer approaches, many of us are looking forward to vacation. We have spent months saving and planning - and we cannot wait to relax and de-stress!

However, when you’re enjoying the time off, your healthy living habits don’t need to “check out.” Vacations can provide a convenient excuse to overindulge. Overeating, consuming more alcohol, falling off an exercise routine … and before you know it, extra pounds have become your vacation souvenir.  

You certainly don’t want to deprive yourself while you are on vacation, but thinking in moderation is critical. You can still enjoy your time away and do things in moderation. Here are some helpful tips for maintaining your healthy habits while vacation:

  1. Downsize. If you are out to eat and the portions are bigger than you normally consume, take some home for leftovers, split an entree with someone, or even order an appetizer instead of a full meal.
  2. Make healthy food choices. Ask for your entree to be served with fresh vegetables or a side salad. Instead of ordering something fried, see if it can be prepared in a healthier way like grilled, broiled or steamed.
  3. Remember that calories from alcohol count! Who doesn’t dream of having a tropical drink with an umbrella in it while lounging by the pool? Alternate adult beverages with other healthier choices like water, tea, coffee, club soda or unsweetened tea.
  4. Don’t overindulge with sweets. Have one scoop of ice cream instead of a sundae or share a dessert with the rest at the table.
  5. Consider your exercise plans. Opt for locations that will allow you to engage in physical activities you enjoy. Keep in mind that being physically active is the ticket to enjoying extra calories without weight gain.
  6. Plan fun fitness activities every day. Walk the golf course or take a jog on the beach, go sightseeing, or go on a nature hike. Remember that there are countless opportunities for you to work in a little exercise each day while on vacation.
In summary, vacation can still be a time to let loose, relax, and enjoy yourself. But it doesn’t have to be all-or-nothing. You can go on vacation, enjoy yourself, and still feel good when you get home, if you maintain a healthy balance.

Tis The Season For Skin Cancer

This time of the year is a good time to remind ourselves about skin cancer. There are three main types of skin cancer: squamous cell skin cancer, basal cell cancer and melanoma. I will review the most important information about each of these types to help increase your awareness.

Cutaneous squamous cell carcinoma (SCC) is very common. It is the second most common type of all cancers. Occasionally it can be aggressive and cause metastasis. The common areas that may contribute to reoccurrence include cancers that develop around the lips and ears. Immunosuppression, tumor diameter and nerve involvement may also contribute to reoccurrence.

Basal Cell Carcinoma is another common skin cancer, but the lesions are rarely metastatic. On the other hand, they do tend to invade/destroy the surrounding tissue. It is much less common in African Americans, and men are 30% more likely to develop BCC than women. The likelihood of occurrence increases as you get closer to the equator. The likelihood also increases with age, specifically between the ages of 55 to 75. Genetic and environmental risk factors are very important contributors in developing this type of cancer. Frequency and intensity of sun exposure are also big factors. Tanning beds can increase the likelihood of developing BCC. While exposure to psoralen plus ultraviolet light (PUVA) does increase its’ incidence, it is not as high of a risk as SCC. Medications that cause increased sun sensitivity also contribute to developing BCC. Chronic immunosuppression is too a contributor.

Melanoma is the most serious of skin cancers. Patients with stage I disease are likely to be cured. The other stages of Melanoma may develop metastatic disease.

Risk factors include:

1.    When the lesion, or a change in the lesion was noticed

2.    Personal/Family history of melanoma

3.    Severe sunburns in childhood

4.    Personal history of cancer-prone syndrome

5.    Immunosuppression

6.    Prolonged psoralen plus ultraviolet A (PUVA) therapy

Patients tend to have red or blond hair; light eye color; a fair complexion; and increased number of melanocytic nevi.

Important predictors of skin lesions likely to be melanoma are known as the ABCDE criteria (asymmetry, border, color, diameter >6, evolution). In addition, the ABCDE criteria was enhanced to include change (preexisting lesions, modification over time or new lesion, especially in individuals over 40).

It is very important to observe changes of the skin on your feet, hands and nailbeds. Unfortunately these are common areas that patients tend to skip when applying sun screen.

Obviously prevention is key for all of these different cancers. It is best to apply sun screen 20 minutes before being exposed to the sun. Tanning is not recommended. Since it is difficult to recognize skin cancer, make sure that you see a dermatologist for whole body skin checks. This significantly decreases the likelihood of developing any of these cancers.   While we as primary care physicians are trained to detect skin cancers, because of the complexity of some skin cancers and the lack of availability to technology that dermatologists use to help detect these cancers, these exams are best done with a dermatologist who can biopsy any lesions.

5 Ways to Spring Clean Your Health

By: Lauren O’Brien, MD

The sun is shining, the birds are chirping and spring has (finally!) arrived. This is the season of renewal, so what better time to clean up and refresh your health. Here are 5 easy ways to get started today!

1)      Get outside!

These warmer temperatures are just calling for a walk at lunchtime, a run down the Schuylkill River Trail, or a picnic in Rittenhouse Square. Though being active is important, just getting out into the fresh air can lead to greater happiness. Maybe give gardening a try. Even small city balconies can grow veggies in pots and containers and people who garden have reduced stress, get increased amounts of vitamin D and can have improved mental clarity. Plus, they tend to eat more fruits and veggies, which leads us to our next tip.

2)      Clean up your diet

With fresh fruits and veggies more readily available this time of year, it is a great time to embrace “clean eating”. This means incorporating fresh, real, whole foods into the diet and limiting overly processed foods with long, indecipherable ingredient lists. Ways to achieve clean eating include: increasing your intake of fresh fruits and veggies, eating the least processed grains (such as quinoa, wild rice, steel cut oats), avoiding added/refined sugar and going light on meat products. Choosing grass-fed/pasture raised options when you do eat meat is overall better for your health and the health of the environment.

3)      Clean out your medicine cabinet

You likely have medicines stored from old prescriptions that might be handy “someday”. This is a good time to get to work clearing out all of those medications that have outlived their use. Be sure to check expiration dates. Many meds lose efficacy after this date and some can become toxic. A good rule of thumb is to toss any prescription medicine that is over a year old. For safety and environmental reasons, it is best not to toss medications directly into the trash or down the toilet. Your local pharmacy, police station or DEA may provide opportunities to safely dispose of medications. If not readily available, you can place meds in a sealable bag (add water if pills or solid medications are present to dissolve them fully). Then add kitty litter, coffee grounds or saw dust to the bag. This makes the package less appealing to children and animals. Finally seal the bag and place in the trash. Be sure to remove all labels of medication bottles that are thrown away.

4)      Clean out your makeup bag

I know you might be very attached to that perfect shade of lipstick you have had for years, but old makeup can carry bacteria that can lead to infection. Here are some guidelines on when to toss those products: eyeshadow:3-6 months, Blush/bronzer: up to 2 years, Lipstick: up to 1 year, Mascara: 3 months. Be sure to also clean your brushes and make up bag regularly.

5)      Finally, if you have not done so already, make an appointment for your annual physical. At this appointment we can guide you with recommendations on diet and exercise and be sure you are up to date on all of your recommended screenings.

Happy spring, everyone!


By: Dana Shanis M.D.

Intrauterine devices (IUDs) have become an increasingly popular form of contraception in the US due to their convenience and effectiveness. However, the cost of these devices has been a barrier to some women. The Liletta is the first IUD created by a non-profit organization to provide a more affordable option that still has all the benefits of the more costly IUDs.

At Rittenhouse Women’s, we have decided to offer this IUD not only for the benefit to our patients, but also to the community. Liletta provides devices to the local health centers at almost no cost to help protect underprivileged and at-risk women from unintended pregnancy. We believe that better access to this device can improve lives and should be an option for all women.

Why choose the Liletta?

The Liletta is more than 99% effective at preventing pregnancy and can decrease the amount of bleeding and cramping you have with your periods. It is placed in the office in only a few minutes and can be removed at any time. Once removed, your ability to get pregnant returns right away. There is a low risk of complications during placement or significant side effects from the device. While newer than most other IUDS, Liletta has been evaluated in the largest IUD trial that has ever been conducted in the US. This study showed Liletta was also safe and effective for women who have never been pregnant before.

How does it work?

Liletta releases a small amount of progestin hormone in the uterus. This small amount of hormone thickens the mucus inside the cervix, which creates a barrier that sperm cannot penetrate. The progestin also may thin the uterine lining and slow movement of sperm through the fallopian tubes. Very little hormone gets into the blood stream, so most women continue to ovulate.

How long does it last?

Currently, Liletta is approved for 4 years of use, but can be removed any time sooner if desired. The device is currently being studied for longer use, and likely will get the 5 year approval in the near future. Ongoing studies are being performed and the device may be approved for up to 7 years in the future.  

What are the risks and side effects?

The most common risk is expulsion, or the IUD falling out on its own and the Liletta has similar rates to other IUDs for this issue. Also similarly to other IUDs, there is a small risk of uterine perforation (making a hole in the uterus) during insertion. This risk is extremely low and is unlikely to cause long-term damage if it occurs.   If you have an STI, such as gonorrhea or Chlamydia, during placement, there may be an increased risk of the infection going into the pelvis. However, once the IUD has been in for more than a month, it is likely the risk of pelvic inflammatory disease may actually decrease.

Most women will experience some spotting after placement, which can last up to 6 months or occasionally longer for some women. Some women will no longer have periods, which is a desired effect for some. Hormonal side effects are uncommon, but can occur.

There are many forms of contraception, including several options for long-acting reversible contraception we offer, so there is a good chance there will be an option that will work for you. It is important to discuss your medical history, periods, and experience with other forms of contraception in the past with your provider to find the right fit.

Scheduling Preventive Versus "Problem" Appointments

By: Monica Duvall, M.D.

At Rittenhouse Internal Medicine, we recognize that the health care and medical insurance industries can be confusing to navigate for many of our patients.  Our goal is to make the process of seeing a provider as smooth and as simple as possible.  Part of that process is ensuring that you, our patients, are aware of the different appointment types that we offer so that the proper appointment is scheduled to fit your needs at a given time.  We also recommend reviewing your insurance policy, so that you can be aware of how/if the different appointment types are covered ahead of time to avoid surprises (and large bills!).

"Annual Physicals", also called "Routine Medical Exams", "Health Maintenance Exams" or "General Checkups", are preventive health exams that are typically covered by an insurance provider no more than once a year.  The purpose of the annual physical is to is to review a patient's health history, family history, and social habits, to make sure she is caught up on routine vaccinations and recommended age-appropriate health screenings such as colon cancer screening, cholesterol testing, mammograms, etc.   It is also an opportunity for the provider to make specific recommendations that would reduce a patient's risk of poor health outcomes down the road--such as advising an increase in certain types of exercise, or cutting back on the amount of alcohol a patient is drinking.   The goal of this appointment type is to prevent disease by identifying factors in a patient's history/lifestyle that could put their health in jeopardy if not addressed and modified. 

The "Annual Gynecological Exam", also called a "GYN Exam" or "Women's Health Exam", is another type of preventive visit.  This type of appointment is also typically covered by insurance providers no more than once annually.  It differs from the Annual Physical in its more narrow focus; the exam exclusively focuses on preventing adverse gynecological health outcomes.   Items addressed in an annual gyn exam may include cervical cancer screening (the Pap smear), breast cancer screening, birth control/family planning, or preventing/screening for low bone mass.  

All visits that do not fit into the above categories are classified as "Problem" visits.  Most insurance companies do not put a limit on the number of problem visits that can be scheduled in a calendar year; but they typically will require you to pay a copay for each of these visits (even if the problems are addressed during a preventive visit--which we discourage, due to time constraints).   Problem visits (which may be referred to as "Follow up visits", "Sick visits" or "Annual medication checks", depending on the reason for the appointment) are made to address one or more specific health issues or symptoms.   Problem visits are not preventive health exams, and they are scheduled separately from preventive visits to allow adequate time for evaluation and management of the symptoms prompting the appointment.   These may be new, acute symptoms--such as a sore throat, a new rash, or a vaginal discharge--or chronic issues, such as high blood pressure, depression, or managing thyroid medication.   Additional testing or medication may be advised; these may or may not be covered by your insurance company (again, reviewing/knowing the details of your insurance plan coverage ahead of time is advised, as we are not privy to these details).  

Hopefully this is a helpful guide to scheduling your next appointment with us; our call center staff is always available to help you schedule the correct appointment type if you have any questions or need further clarification.

March is Patient Safety Month!

By: Maria Daly, Practice Manager

As March is patient safety month we wanted to share a few ways we work to ensure patient safety in our practice!
Although we are just a little internal medicine office and not a huge hospital, there are still plenty of steps we take to try and keep our patients safe.

  1)      Employee Training: All of our employees receive various trainings on an annual basis. We provide our staff with training on HIPAA so that they become highly familiar with how to treat private health information. We also host a CPR training for our staff so that we always have employees who are able to provide emergency care. On an as needed basis, our MAs also receive refresher courses on best practice for venipuncture and any other procedures.

  2)      Processes: As a medical practice we have a few processes in place to ensure patient safety. All of our MA stations have label machines connected to our EMRs that allow our medical assistants to print legible labels for any laboratory samples collected at our practice. This is the best way to reduce any possibility of mislabeled specimens and potentially giving patients incorrect lab results. We also have specific sterilization processes for our different instruments – weather they need to be packaged or cleaned at a different temperature – these processes ensure that instruments we use in the office are not a source of infection for our patients.

  3)      Equipment: You may have noticed that we have gloves available in all of our exam rooms – gloves are an important barrier to keep our patients safe as well as keep our staff safe! We also have hand sanitizer available all over the building which is our go-to, especially during flu season!

  4)      Building Safety: There are a few safety measures we have taken to make our facility safer for patients also. Our entryway steps now have treads which makes them much easier to walk on in wet weather; the same goes for our carpeted staircase. During snowstorms, our staff regularly shovels and salts the sidewalk in front of our building and we try to mop our waiting room regularly also to get up any water that had been trekked in so that there are no slips in our waiting room.

Although a lot of these items may seem obvious, they all go a long way in ensuring the safety and well-being of our patients. We review these processes regularly and consider employee and patient input to find any problems or improvements that can be made. Please know that we are always doing our best not only to treat you but also to keep you safe physically and psychologically whenever you visit our practice. Thank you for being our patient and have a safe and happy March!

Is Going Vegan Good For You?

By: Angela Luciani, Nutritionist 

Many people choose to go vegan for one reason or another – perhaps it is concern for the treatment of animals, environmental factors or perhaps they are trying to become healthier.

A vegan diet is a type of vegetarian diet that excludes all meat, fish, poultry and dairy products as well as foods that are processed using animal products. While becoming vegan can reap some health benefits, it is not for everyone and there are some important factors to consider before making the decision to switch.

Vegan diets are typically higher in nutrients such as fiber (which can help lower cholesterol), magnesium, potassium, vitamins C& E, iron, antioxidants and overall tends to be lower calorie and lower in saturated fat; however, it involves more planning and discipline to ensure you are getting all the nutrients you need.

Common nutrient deficiencies with a vegan diet include calcium, Vitamin D, omega-3, B12 and folate. Because you are eliminating food groups as a vegan, you are eliminating food groups that have these important nutrients. It is important to replace these nutrients so that your body is able to function properly. All vegans need to take some form of B12 whether it is through a supplement or nutrient rich food such as nutritional yeast.

Because a vegan diet is “plant-based,” there is the benefit of reducing risk of cardiovascular disease and the complications associated with diabetes.

Ensuring a well balanced meal by incorporating all of the essential nutrients to nourish your body is important for your health and just like any diet – failure to plan successfully and safely can lead to poor outcomes.

Four Ways To Love Your Heart Back

By: Maria Mazzotti D.O.

February is heart healthy month. There has long been a debate about which organ is more important, your heart or your brain. While both may take equal importance, February's focus on the heart has us talking about what we can do to keep our heart healthy.

At the top of the list is exercise. Even if you do not need to lose weight, cardiovascular exercise for 30 minutes, five times per week will keep your heart healthy. Besides burning calories and helping with keeping your blood pressure controlled, cardiovascular exercise helps build extra blood vessels which can save your life if any blood vessel becomes occluded. By having alternative blood vessels supplying blood to the same area of the heart that is not receiving a normal supply of blood, you avoid any permanent damage to that part of the heart.

Next and just as important is getting the proper amount of sleep. Recent studies show that getting less than 7-8 hours of sleep nightly may cause hormonal dysfunction that contribute to weight gain and elevated blood sugars. Even more obvious is that your heart rate decreases while sleeping, giving your heart time to recover from your day.

Diet is also clearly another key aspect to keeping your heart healthy. It is widely agreed that the Mediterranean diet is a heart healthy diet. The key components of this diet are: low fat proteins (beans, white meat, Tahini, low fat cheeses), olive oil, whole grains, nuts, bread (whole grain), veggies and fruit (instead of dessert). These foods should be fresh, not processed. Adding Mediterranean spices decreases the need for higher amounts of salt. An added plus is that some spices like Coriander and Rosemary are also antioxidants. To top off the diet: wine - another proven antioxidant. Because this diet is healthier and lower in calories, it often times produces weight loss. Antioxidant-rich foods are also brain friendly which keeps your brain sharper.

Hydration is another key element of heart health, especially in females who typically have lower blood pressure than men. Not being well hydrated can damage all of your organs - especially your heart. If your blood pressure is low and you are not well hydrated, you are at higher risk of getting dizzy and passing out.

While going about your days in February, let the red around you remind you that just like the four chambers in your heart, there are four easy things that you can do every day to keep your heart healthy. By giving love back to your heart, it will keep you healthy and will lead to a happy body and heart relationship!


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