The Importance Of Breastfeeding Around The World

By: Dana Shanis, MD

Breastfeeding has many benefits to both mother and child, benefits that have been well studied and consistently shown for decades. Babies who are breastfed have lower rates of respiratory illnesses, gastrointestinal and ear infections, as well as lower rates of allergies, SIDS, diabetes and many other illnesses that can impact their life-long health. Breastfeeding mothers also experience health benefits, from decreased postpartum bleeding and depression to long term decreases in diabetes and breast cancer.

While infant formula has been improved over the years and offers an alternative for women who are unable or choose not to breastfeed, even in the best circumstances it has disadvantages. Formula is expensive and can cost families several thousand dollars a year in direct costs. Increased illnesses in formula fed babies also result in higher healthcare costs and loss of wages for parents who have to miss work to take care of their child. By increasing breastfeeding to optimal rates in the US, up to $13 billion a year could be saved on these indirect costs, according to analyses by the U.S. Department of Agriculture, Food Assistance and Nutrition Research. As a result of the importance of health and economic benefits, the American Academy of Pediatrics urges that breastfeeding be viewed as "a public health issue and not only a lifestyle choice".

The impact of formula feeding on poor and developing countries can be even more profound than what is seen in the United States. Many women in these countries are malnourished and falsely believe they would be unable to produce milk with adequate nutrition for their children. Aggressive marketing by the formula industry, a multi-billion dollar industry, often focuses on poor areas and promotes this and other inaccurate information about the benefits of formula. This misinformation can be particularly dangerous as many of these women do not have access to clean water to mix with the formula, resulting in higher rates of water-borne illnesses in these areas. Due to the high cost, many women end up diluting the formula to extend its use, which also results in higher rates of illness and even death. A 2016 series in The Lancet journal estimated that worldwide 800,000 formula-fed infants a year could be saved by breastfeeding, mostly due to reducing rates of diarrhea, respiratory infections and malnutrition from formula dilution.

In 1981, the World Health Organization voted 118 to 1 adopt a non-binding resolution promoting the dissemination of accurate information on breastfeeding worldwide, as well as restrictions on inaccurate formula advertising and direct marketing and kickbacks to health providers. 130 countries have adopted the ban on the promotion of formula, and in countries where these laws are enforced, such as Brazil, the rates of breastfeeding are typically higher than those that do not. During the World Health Assembly (WHA) each year, this resolution has been reaffirmed and in 2016, the United States, under Obama, supported strengthening the resolution. Despite these efforts, in the past year alone, more than 800 violations of these practices have been noted by formula companies around the world. Funding for formula industry lobbyists has also remained high, with one company, Abbott Pharmaceuticals (makers of Similac and other formulas), spending more than $790,000 on lobbying efforts, including contributions to President Trump’s inauguration ceremonies. In the most recent WHA, our president sided with the formula industry in trying to oppose the existing regulations that would limit the negative effects of inaccurate formula advertising and direct marketing to healthcare providers. The US administration went as far as threatening the US contribution to funding for WHO to oppose this resolution.

Whether or not to breastfeed is a decision that each woman needs to make for herself and her family. Providing accurate information on options, as well as support for the challenges that new mothers will experience is the best way to optimize the health of future generations.

Infertility FAQ

An article from RMA Philadelphia

What is infertility?

Infertility is defined as the inability to get pregnant after six months of trying for women aged 35 or older and after one year of trying for women under the age of 35. Women who have been pregnant previously and have been trying for six months also fall into this category.

When is it time to see a doctor?

If the above definition of infertility describes your situation, it may be time to see a reproductive endocrinologist. Women with a history of irregular periods, endometriosis, pelvic surgery or infection, as well as previous radiation or chemotherapy should not wait 6-12 months prior to seeking care from a fertility specialist. In addition, men with a history of testicular cancer, radiation or chemotherapy, as well as other medical conditions, should seek evaluation.

What happens at that first patient visit?

You’ll meet with your reproductive endocrinologist, who will ask about your medical and family history, as well as how long you’ve been trying to conceive.

The doctor will perform a pelvic exam and vaginal ultrasound to evaluate your uterus and ovaries, and tell you about additional testing, such as blood work, a semen analysis and a procedure to assess your fallopian tubes.

If you decide to pursue evaluation, you can have your testing completed within four weeks of your first visit, at which point you will meet with your doctor again to design a plan for you.

That plan could include using medication to boost ovulation coupled with Intrauterine Insemination (IUI) or require a more high-tech approach like In Vitro Fertilization (IVF).

Are my chances of getting pregnant good?

It depends on your age, your specific situation and the clinic you choose, but women can feel confident going to a successful fertility clinic, especially because major advances in technology and science have improved success rates and lessened risk.

I’m seeing older celebrities getting pregnant – why should I worry?

While doctors are getting better at helping infertile women get pregnant, the time on the biological clock has not changed: at 35 years of age, a woman’s fertility begins to significantly decline, and it gets harder to get pregnant. The risk of miscarriage also increases. So while celebrities are having babies at an older age, it’s unclear whether those babies came from eggs or embryos that they froze when they were younger, or from donor eggs. While it is possible for women in their 40s to conceive naturally or through IVF using their own eggs, is it is uncommon.

I’m ready to talk to a specialist now. What’s next?

Congratulations on taking a proactive step to begin your family. The doctors at Reproductive Medicine Associates of Philadelphia are here to help. Begin your fertility journey by making an appointment today: 855.762.4672 or visit


What is the difference between ThermiVa and O-Shot?

By: Allison Andrews, WHNP

What is the ThermiVa®?

ThermiVa® is a non-surgical, safe and effective procedure that uses radiofrequency heat to tighten loose, sagging skin and increase blood flow and nerve sensitivity in the vaginal area. 

What are the benefits of the ThermiVa®?

Ø  Vaginal and labial laxity 

Ø  Vaginal dryness

Ø  Urinary incontinence and overactive bladder

Ø  Painful sex 

How is it performed?
During the procedure, a small wand is slowly moved over the areas of concern, gradually heating the tissue.  The procedure takes less than an hour, during which most women report feeling only a warm sensation and no pain.  There is no down time once completed, women can return to exercise and sexual activity immediately. 

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

Ø  Leaking urine

Ø  Painful sex

Ø  Vaginal dryness

Ø  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.  

If you would like to learn more about these procedures, schedule a consultation with one of our Women’s Health providers.

Hosting a Healthy Independence Day Party

By: Beth Auguste MS, RDN, CSOWM

Summertime is party time. We often associate summertime with beach trips, cookouts, and, less than healthy food and beverage choices. The biggest cookout of all, Independence Day, is quickly approaching. Feel your best this 4th of July by using some of these tips to healthify your holiday:

1. Make burgers with grass fed beef -

Grass fed beef does not increase cholesterol in the same way as traditional grain fed beef. Eating grass fed beef can benefit your body by increasing circulating omega-3 fatty acids (aka good, anti-inflammatory fats), introducing vitamin A and E precursors, and providing cancer fighting antioxidants.

2. Offer options for hydration -

Fruit, fruit and more fruit. Your body gets 20% of it’s hydration from food and fruit is a big source! In addition to sliced watermelon, make a fruit salad with berries and dress it up with lime and honey. Offer a third fruit option in the form of a Fourth of July themed infused water. Fill your punch bowl the day before the party with club soda, strawberries, blueberries and mint leaves and leave overnight to maximize flavor. Lastly, don’t forget to make water generally available, throw some bottles in to your beer and soda coolers.

3. Do the cafeteria trick and put the salad at the front of the buffet-

Food service organizations are good at influencing customer behavior. They put the salad at the front of buffets because they know that patrons will take the largest serving from the first food they encounter. These organizations want to trick you in to filling your plate with the cheapest food item so that they can save money. As a party host, you can use this concept to trick your guests (and yourself) in to eating more of the healthy stuff!

4. Create a space for physical activity -

If you want your guests to have a great time at your party, get them moving. Physical activity after eating can lift endorphins (more energy!) and can help stabilize blood sugar to avoid that ‘crash’ feeling. Set up lawn games or play some dance music to inspire guests to get their bodies in motion.

5. Attending a party as a guest? Be the person who brings the healthy thing-

Don’t worry, somebody else will show up with the chips and dessert. Party goers will thank you for your nutritious addition. Try making a mayo-free Russian style coleslaw with a vinegar base.

There is always an event around the corner that will challenge your healthy diet goals. Don’t wait to get started, just incorporate some healthiness in to the unhealthy fun and it won’t be so hard to get back on track after the party is over

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.

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