May is National Osteoporosis Month and we wanted to take the opportunity to share information on this condition which affects many women.

Osteoporosis is defined as a progressive loss in bone mass and density which can cause the bones to become thin and weak. When bones weaken, they can easily fracture, especially on the spine, hips, and forearms. Fractures caused by osteoporosis can lead to significant decrease in quality of life and increased risk of mortality.

Of the 10 million estimated Americans who have osteoporosis, about 80% of them are women. Women naturally have smaller and thinner bones than men, but are also at greater risk of bone loss after menopause due to lower levels of estrogen. This is because estrogen helps to protect and maintain bone density, so the decreasing levels of estrogen that occur in menopause lead to increased risk of osteoporosis.

Fortunately, there are plenty of preventative, diagnostic and treatment measures to help maintain, detect, and/or increase bone density. We will primarily discuss the preventative measures available to help maintain or increase your bone density.

The optimal diet for preventing and treating osteoporosis requires consuming adequate calories, as well as, appropriate amounts of Calcium and Vitamin D. The current nutritional recommendations for Calcium and Vitamin D are:

Calcium:

• Pre-menopausal women should consume at least 1,000 mg of Calcium per day, which includes foods, beverages, and supplements
• Post-menopausal women should consume 1,200 mg per day
• It is not recommended to take over 2,000 mg of Calcium per day due to risk of side effects
• The best sources of Calcium in our diet are: milk, yogurt, cottage cheese, hard cheeses, and green vegetables, like kale and broccoli

Vitamin D:

• Pre-menopausal women should consume about 600 International Units (IU) of Vitamin D each day
• Post-menopausal women should consume 800 IUs per day
• Milk supplemented with Vitamin D is one of the largest sources of dietary Vitamin D. Other good sources are salmon, cod liver oil, mackerel, and tuna fish

Another important preventative measure for bone health is exercise. Physical activity helps to increase bone mass, as well as increase muscle strength which reduces the chances of falling due to weakness. Most experts recommend exercising for at least 30 minutes three times per week for bone health.

It is also important to note things to avoid if you are at risk for Osteoporosis:

• Alcohol: Drinking alcohol excessively (average of more than 2 drinks per day) can increase the risk of fracture due to increased risk of falling and poor nutrition
• Smoking: Smoking cigarettes is known to speed bone loss. One study suggested that women who smoke one pack per day throughout adulthood have a 5 to 10 percent reduction in bone density by menopause, resulting in an increased risk of fracture

The risk of Osteoporosis is evident in women, especially in post-menopausal years. To further discuss prevention, detection, and treatment of this condition, please schedule an appointment with one of our medical providers today.

There’s no denying that gluten, a protein found in wheat and other related grains such as rye and barley, has gained a bad reputation in recent years. So much, it seems, that gluten-free food products are a fixture on many restaurant menus and grocery store shelves, and gluten-free diets and cleanses are now ingrained in popular culture. Despite its ubiquity, however, a gluten-free lifestyle is not necessarily warranted and may even be harmful for those without a known predisposition to gluten sensitivity, such as Celiac Disease. May is Celiac Disease Awareness Month, and now is a better time than ever to bring our attention to gluten and understand its activity in the digestive tract.

Celiac Disease is a chronic autoimmune medical condition that is triggered by the ingestion of gluten in those who are genetically predisposed. The presence of gluten in the small intestines of people with Celiac Disease induces an inflammatory response, which, over time can cause structural changes in the intestinal wall and lead to malabsorption of important dietary vitamins and minerals. Other possible manifestations of Celiac Disease are numerous and include gastrointestinal symptoms such as abdominal bloating and pain, chronic diarrhea, foul-smelling stool, and myriad possible extraintestinal symptoms such as chronic migraine, peripheral neuropathy, fatigue, mood changes, and rash. Celiac Disease can also be asymptomatic. In such cases, a diagnosis is made after patients who are at-risk are screened. Risk factors include having a first-degree relative with Celiac Disease or a personal history of other autoimmune disease such as Type 1 Diabetes or a thyroid disorder. Diagnostic testing consists of serum antibody measurement and/or genetic testing in addition to biopsy of the small intestine. Celiac Disease is somewhat rare in the general population, affecting approximately 1 in 100 people, and there are currently no recommendations that support universal screening for this disorder. The only treatment for Celiac Disease is strict adherence to a gluten-free diet.

A related condition that is still poorly understood, yet thought to be caused by an immune response to gluten is called Non-Celiac Gluten Sensitivity. People with Non-Celiac Gluten Sensitivity will exhibit similar symptoms as those with Celiac Disease, but will test negative for Celiac Disease on blood testing and biopsy. Furthermore, their symptoms will resolve after excluding gluten from their diet. The prevalence of Non-Celiac Gluten Sensitivity and the demographic characteristics of affected patients are currently unknown, but further investigations are underway to help better understand this clinical entity.

Despite the hype, gluten is innately harmless for those without a known history of Celiac Disease and those who do not have gastrointestinal or extraintestinal symptoms that resolve on a gluten-free diet. Further, gluten-free versions of common foods such as bread and other baked goods may actually be less nutritious than the original. Gluten-free foods often contain higher amounts of calories and might lack fortification with important micronutrients like folate, thiamine, and riboflavin when compared to their gluten-containing counterparts.

If you are concerned about the possibility of Celiac Disease or Non-Celiac Gluten Sensitivity, please talk to your healthcare provider about ways to diagnose and manage these conditions. If you are already adhering to a gluten-free diet for any reason, a Registered Dietician may help guide you towards full and well-balanced nutrition and a healthy life.

April is Sexually Transmitted Infection month. Typically the nicer weather that comes with Spring causes an upsurge in STI’s. People are getting out more and meeting more people which may lead to more sexual encounters.

Chlamydia is the most common sexually transmitted infection, especially in males and females between the ages of 20-25. Often times patients may not even have symptoms, but if left untreated in females it can lead to infertility. Once diagnosed, it is easily treated with antibiotics.

Gonorrhea is another common STI. In addition to it being found in the mucus membranes of the cervix, uterus and fallopian tubes, it can commonly infect the mucus membranes of the mouth, throat, eyes and rectum. . Prolonged or undiagnosed gonorrhea infections can also lead to infertility, however this infection can also be treated fully with antibiotics once diagnosed.

Chlamydia and Gonorrhea cause 30-50% of a very serious complication of infections called Pelvic Inflammatory Disease. Symptoms of PID include lower abdominal/pelvic pain, increased discharge, irregular menstrual bleeding, fevers, pain with intercourse, urinary frequency and pain, cervical motion tenderness and inflammation. In addition to being sexually transmitted, these infections can be transmitted through pregnancy/delivery to newborns.

Trichomoniasis is a lesser known STI, but this infection seems to be on the rise. It is also treated with antibiotics. Fortunately, this parasite is not transmitted to newborns through pregnancy/deliveries. All of the above infections are diagnosed with a vaginal swab or urine test in females.

Syphilis is a less common infection these days. In addition to being transmitted sexually, it can also be transmitted through contact with blood products and with pregnancy. Unlike the previous infections, symptoms may (but don’t have to)include a rash and sores in the genital, rectal and mouth areas. Once diagnosed it is treated with antibiotics, but if left untreated it can lead to serious neurological complications.

Another infection that may present with genital lesions is Genital Herpes. This is a viral infection, and unlike the previous infections mentioned above, it is not curable. Antivirals will resolve acute symptoms and future outbreaks. These medications also suppress transmission to future partners. This infection can also be transmitted to newborns with pregnancy/delivery. Currently, the only way to diagnose this infection is with a culture of the lesion (usually obtained by a swab, but this has to be taken during an outbreak).

Hepatitis C has also been considered a sexually transmitted disease in the past, however newer studies show us that sexual transmission of this virus is not very effective. That being said, hepatitis C is still more likely to be transmitted sexually in people with other illnesses (such as HIV or diseases requiring dialysis) and those who may have wound-healing issues. The most common mode of transmission for HCV is parenteral through sharing needles or other instruments. This infection can also go undiagnosed for decades due to the varying severity of viral symptoms. Newer treatments can cause the virus to be undetectable.

Human Immunodeficiency Virus (HIV) is another sexually transmitted infection. In addition to being sexually transmitted it can be passed along in blood products and with pregnancy/delivery. At this time there are multiple regimens that will keep the infection under control or make the virus undetectable.

Syphilis, Hepatitis C and HIV can be diagnosed with a blood test. When anyone is diagnosed with any of the infections mentioned so far, physicians are required to report the infection to the local health department. The local health department is in charge of preventing the spread of these infections as well as tracking the number of people being infected.

Human Papilloma Viral infections are transmitted with vaginal, rectal and oral sex. There are numerous strains that can cause cervical, rectal and laryngeal cancer. Certain strains also cause warts in these areas. There is no treatment for the infection, but this virus is the only virus which has a vaccine that can be used to prevent the common strains that cause Cervical, Vaginal, Vulvar, Anal, Throat and Penile Cancer. HPV vaccines are recommended for males and females from ages 9-26.

At this point this summary has probably caused a lot of anxiety about being sexually active. It is important to remember that condom use with every sexual encounter can prevent most transmissions of these infections. Obviously, coming in for regular screenings for cervical cancer or STI screenings, even though they can be scary or painful, is important to you and your partner’s health. The safest thing to do is to Know Your Status! If you have not had STI screenings in some time and have been sexually active without protection – please don’t hesitate and schedule an appointment with one of our providers today. Do not hesitate to take the time to ask any questions that you are uncertain about. Having knowledge about your STI status and what infections are out there can help you make educated decisions about your health!

A seizure is a type of abnormal or excessive electrical activity in the brain that results in changes in a person’s awareness and/or behavior. Seizures can be triggered by different mechanisms–head trauma, stroke, infection, tumor, low blood sugar, and excessive alcohol are some causes–and they often come without warning.The person who has a seizure may be injured during the seizure, and s/he may be confused or embarrassed afterward. Awareness of what happens and what to do during a seizure can help to keep the person seizing safe and calm.

There are many types of seizures. Tonic-clonic, or Grand Mal, seizures are what most people think of when they hear the word “seizure”, and this is the most common seizure situation in which first aid is needed. In this situation, a person loses consciousness for anywhere from seconds to a few minutes. The person typically becomes stiff and will have severe jerking movements. Often they lose control of their urine or have a bowel movement. Frequently they have very shallow breathing or may appear to not be breathing at all. Afterwards, the person will have a period of confusion, with no memory of what has happened. The person will likely be scared and embarrassed.

When a person has a Tonic-clonic seizure, it is important to remain calm. Delegate someone to call 911. The person should be eased to the ground and rolled to his/her side, with the mouth facing downward to allow saliva to drain so s/he can breathe easily. The area should be cleared of any sharp or hard objects that could injure the seizing individual. Eyeglasses should be removed, tight clothing (like a necktie) should be loosened, and a soft item, like a pillow or jacket, should be placed under the head to prevent injury. You should NOT restrain the seizing person, nor should you place anything in the person’s mouth while they are seizing, even if you think they are not breathing. People who are seizing CANNOT swallow their tongue, but they can choke on or be injured by other things that are placed in the mouth. If someone does stop breathing during a seizure, it is appropriate to start performing CPR only AFTER the seizure is over. Try to keep track of how long the seizure lasts, if possible. Keep crowds away, so the person seizing will not be overwhelmed when s/he returns to consciousness. When the seizure is over and the patient becomes more alert, explain in simple terms what has happened. You should stay with the person until they have fully recovered and/or until medical help arrives.

Having a seizure is a frightening and dangerous occurrence; as a bystander, remaining calm and knowing what to do in this situation can help to prevent further injury to the seizing individual, and bring much-needed comfort to him/her at a critical time.

February is American Heart Month. There has been a long debate in medicine about which organ is more important, the heart or the brain. I am not sure we have reached a conclusion, but your heart is a vital organ. Prolonged elevated blood pressure is one of the main factors contributing to heart disease (as well as kidney disease).

Your blood pressure reading is made up of two numbers. When either or both are elevated this is called hypertension. Your systolic blood pressure (the top number in your blood pressure) is a reflection of the pressure in your heart when the blood is returning to your heart. The Diastolic blood pressure (bottom number of your blood pressure reading) is a reflection of the pressure your heart is pushing against to get the blood out of your heart to the rest of your body.

• Normal blood pressure: systolic <120 mmHg and diastolic <80 mmHg
• Prehypertension: systolic 120 to 139 mmHg or diastolic 80 to 89 mmHg
• Stage 1 hypertension: systolic 140 to 159 mmHg or diastolic 90 to 99 mmHg
• Stage 2 hypertension: systolic ≥160 mmHg or diastolic ≥100 mmHg
• Isolated systolic hypertension: blood pressure of ≥140/<90 mmHg
• Isolated diastolic hypertension: blood pressure <140/≥90 mmHg

There are multiple factors that impact your blood pressure. Genetics, age, weight, stress and diet can all contribute to causing hypertension. Obviously, you cannot do anything about your genetics and aging. However, we know our blood pressure may go up with weight gain and it can go down with weight loss. Caffeine, alcohol, processed foods, spinach, canned soups, red meat and licorice can increase your blood pressure also. Alternatively foods like flax seed, dark chocolate, olive oil, beets, pistachio, broccoli, bananas, yogurt, white beans, red bell peppers, citrus, seafood, whole grains, and kiwi can lower your blood pressure. Many of the blood pressure lowering foods are high in Calcium, Magnesium and Potassium (Also known as the DASH diet).

Aside from diet, there are additional ways to decrease your blood pressure:

• Exercise and meditation
• Controlling stress and anxiety
• Treating any other illnesses you have that may impact blood pressure – such as diabetes.

In turn, your blood pressure can impact other organs. Elevated blood pressure can enlarge your heart, damage your blood vessels (which can, in turn, increase your blood pressure even more), affect your eyes and kidneys. Significant damage to these organs can lead to strokes, kidney failure and heart attacks.

So during American Heart Month, be kind to your heart. Focus on watching your diet, exercising and keeping your stress level down and you know you will have done all that you can to control your blood pressure. And in turn you will have one less risk factor for heart disease.

More than 3,500 people died from drug overdoses in Pennsylvania in 2015, a thirty percent increase from the previous year. In most of these deaths, numerous drugs were present. But opioids such as heroin and prescription painkillers were present in nearly sixty percent of the overdoses.

Many people don’t understand why or how addiction and overdose happens. They think that those who use drugs lack moral principles or willpower and that they should be able to make the choice to stop using. Understanding addiction and being educated on the disease is key in prevention.

Addiction is a complex and chronic disease characterized by drug seeking and use that is compulsive and difficult to control, despite consequences. Drugs and alcohol change the brain in ways that challenge an addict’s self-control and interfere with their ability to resist urges. These brain changes can be persistent, which is why addiction is considered a “relapsing” disease.

Addiction not only has a major impact on the addict, but also their families and the community. The effects of drug and alcohol abuse are cumulative; significantly contributing to costly social, physical, mental and public health problems. These problems include:

• Pregnancy
• HIV/AIDS
• Sexually Transmitted Diseases
• Domestic Violence
• Child Abuse
• Motor Vehicle Crashes
• Crime
• Homicide/Suicide
• Overdose

Research has shown that prevention programs involving families, schools, communities and the media are effective for preventing or reducing use and addiction. Although personal events and cultural factors affect drug use trends, when young people view drugs as harmful, they are more likely to not take them.

Therefore, education and outreach are key in helping people understand abuse and addiction. Teachers, parents, and health care providers have a crucial role in educating the younger population and preventing abuse and addiction.

National Drug and Alcohol Facts Week is a national health observance to counteract the myths about drugs and alcohol that teens may get from social media, TV, movies or even friends and family. The National Institute of Drug Abuse and Alcohol Abuse hold educational events in communities this week so that teens can learn what science has taught us about abuse and addiction. Help our community by promoting National Drug and Alcohol Facts Week January 23-29, 2017 and together we can “SHATTER THE MYTHS.”

If you are struggling with drug (prescription or illicit) and alcohol use, know that any information you provide to your healthcare provider is confidential. Your PCP can help you find the treatment you need to get on the road to recovery. Substance abuse can harm not only our physical health, but your mental and financial well-being as well as the health of your friends and family. If you need help but are not ready to talk to your physician you can call SAMHSA’s helpline at any time: 1-800-662-HELP (4357) or attend an alcoholics or narcotics anonymous meeting (NA meetings: http://naworks.org/find-a-meeting/ AA meetings: http://www.aasepia.org/meetings/). Friends and family of substance abusers who need help coping with related trauma can also attend meetings designed for family members: http://www.nar-anon.org/find-a-meeting/.

Don’t wait for recovery to come to you; starting your journey to recovery is just a phone call away.