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29/May/2013

Summer has arrived and for many of us that means getting out and about on vacations and weekend getaways! RWWC wants to remind all of our patients looking to traverse the globe that we are here to provide you with the preventative care and information that you need to ensure a trip focused on destination and not illness!

This summer (and all year-round) you can make an appointment with us to review your itinerary and medical history, provide necessary vaccinations and prescriptions as well as get advice on staying healthy throughout your trip. We have also recently subscribed to a data source to make sure our patients also get the most up-to-date news on not only health risks but also any domestic problems in the country of their destinations. What better way to care for our patients than to try and ensure their health AND safety?

Since many insurance companies do not cover travel medicine, the cost of the visit is $75 plus the cost of any vaccinations that you may require. Many vaccines (Hepatitis A and B as well as the Tetanus vaccine) are covered by most insurances, but some are not and some insurance plans have limited coverage. We recommend you schedule your appointment six weeks before your departure so that you have ample time to get all of your vaccines as well as allowing you time to call your insurance after the appointment if you have any questions about coverage for vaccines that your physician recommends.

Special Vaccinations

When calling us to make an appointment, please make sure to tell the receptionist your itinerary so that the doctor can prepare for your appointment. Certain vaccinations, including those against rabies, Japanese encephalitis and Yellow Fever are only available at specialized travel clinics. We’ll help you determine whether you need any of these vaccines and direct you to the appropriate clinic. Travelers to equatorial Africa and parts of South America will require proof of vaccination against yellow fever, so be sure to follow through with any referrals your doctor recommends.

We hope that you are planning some wonderful adventures this year, but please make sure you come and see us first!



After lung cancer, breast cancer is the second deadliest cancer in all women, and periodical screenings are the best way to control it. Several medical studies have shown that being screened for breast cancer effectively lowers the mortality rate for women affected by this disease.

While different medical groups offer a wide range of recommendations, it is generally accepted that women between the ages of 50 and 70 should be screened.  Screening should continue if the patient is in good health, until the patient’s life expectancy is less than 5 to 7 years.  While it is agreed that routine screening mammography can be stopped at age 75, the age at which to start screening varies anywhere between 40 and 50.  At that time, the decision should be shared between the patient and the medical professional, and should take into consideration all potential benefits and complications.  This includes the individual’s level of breast cancer risk, established by medical history and by use of a risk prediction model. The most commonly used one is the Breast Cancer Risk Assessment Tool (Gail model), available online at www.cancer.gov/brisktool/ .

Studies show that breast cancer in women between 40 and 49 is usually more aggressive than breast cancer diagnosed in someone 50 or older.  Therefore, if it is agreed by the patient and their doctor that breast screening be started at age 40, it should be performed yearly until age 49.  Starting at age 50, the screening can take place every 1 or 2 years, depending on the risk of disease.

While there are obvious benefits to being screened, there are also two uncommon, but significant drawbacks:

  • False positive results – when a mammogram suggests that a woman may have cancer and she does not.  This may lead to more unnecessary testing and increased anxiety.  This is more likely to happen in women under 50 years of age.
  • Radiation exposure – because the mainstay of testing is mammography, this procedure exposes patients to radiation.  However, studies show that the number of lives saved by catching then onset of cancer early greatly outweighs the small risks that come from radiation exposure.

There are several specific symptoms to keep in mind when being vigilant about breast cancer:

  • Breast pain or tenderness – while breast pain and tenderness are commonly associated with hormonal and dietary changes, as well as with stress, breast pain that is continuous and does not change with your cycle is a little more concerning.
  • Nipple discharge – if you are having a discharge from one or both of your nipples, you should see your doctor.  It is common that healthy women can squeeze out a small amount of yellow, green or brown fluid from their nipple.  Clear or bloody discharge is more worrisome and should be followed up with a visit to your doctor.
  • Inverted nipples – while it is normal for women to have inverted nipples when breasts develop or after breast feeding, if the change occurs without having breastfed, you should also see your doctor.  This may be the first sign of breast cancer.
  • Breast skin changes – changes in breast skin can be signs of a rare but very serious form of breast cancer called inflammatory breast cancer.

Worrisome  symptoms include:

Skin that feels warm or hot
Color changes—skin looks pink, red or purple.
Thicker skin
Dimples or pits on the skin (like the rind of an orange)
A flat nipple
A nipple that turns red
A crust or blister on the nipple.
A nipple that points in (if it pointed out before)
Painful, swollen breast

There are a few lifestyle factors that can be introduced or modified to reduce your risk of breast cancer:

  • Increased physical activity – exercise seems to protect against the disease in both premenopausal and postmenopausal breast cancer.  Weight gain and obesity are mostly associated with an increased risk of postmenopausal breast cancer.
  • Alcohol consumption – as few as 3 drinks per week of any type of alcohol increases your risk of breast cancer.
  • Smoking – both passive and active tobacco exposure has been associated with an increased risk of breast cancer, especially among premenopausal women.
  • Diet – there appears to be evidence that a diet high in fruits and vegetables is associated with a lower risk of breast cancer.  Conversely, eating more than five servings of red meat per week may cause an increased risk of hormone-positive premenopausal breast cancer.  Diets low in calcium and Vitamin D have been associated with higher risks of breast cancer in premenopausal women.

While there are many non-modifiable risk factors that contribute to breast cancer, the most significant  is the BRCA1 and BRCA2 mutation.  Luckily, only 20 percent of women affected have a history of breast cancer involving a first-degree relative.  If anyone in your family has had breast cancer, it is well worth looking into being tested for this genetic risk.  This can be done with your medical professional.



Now that the season has changed into summer, I am sure a lot of you are looking for ways to “healthify” your diets. The warm weather has finally arrived and with its arrival, I encourage all of our patients to take a close look at their eating habits and simplify their diet. Try concentrating on consuming foods that make your body feel best and cutting back on saturated fats, refined carbohydrates, sugar, salt and processed foods.

For a fresh start to your summer, slice your fat intake in half. Foods high in saturated fat such as whole milk dairy products, meats and butter increase your “bad” LDL cholesterol levels which can pack on the pounds and damage your arteries, ultimately leading to an increased risk for heart disease. Try to avoid animal fats and swap them for healthier unsaturated fats from plant foods like nuts, avocados and olive oil.

When trying to eat clean, avoid eating refined carbohydrates such as white bread and pasta, white rice, fruit juices, and all sweeteners, such as white sugar, corn syrup, fructose, and cane juice. I recommend that patients aim to only consume whole grains when eating carbohydrates. Examples of whole grains include breads made with 100% whole wheat flour, brown rice, whole wheat pasta, popcorn (unsalted and non-buttered), oatmeal, quinoa, millet, barely, couscous, whole wheat pitas and tortillas. Choose whole grain wraps, crackers or bread, aim to find options with 0 grams of sugar and at least 3 grams of fiber.

Most of us eat too much sugar. The average American consumes 30 teaspoons of added sugar a day, which is more than 400 extra calories! The American Heart Association recommends that women consume no more than 6 teaspoons (24 grams) of added sugar a day. To limit your added sugar intake, check labels on processed foods. Most processed foods have hidden sugars in them; opt for choosing items with < 5 grams of sugar per serving. When buying yogurt try to avoid brands with fruit on the bottom. The fruit in yogurts are fruit concentrates, which is just a hidden name for simple sugar. Sweeten your yogurt with fresh or frozen fruit to cut out added sugars and reap more nutrition. Another way to cut back on added sugars is to substitute sparking water with a squeeze of lemon for your daily sodas. All of these changes can go a long way when trying to detox your body!

A little bit of spice goes a long way! Ditch the salt and rely on healthy flavor packed ingredients, such as herbs and spices to enhance the taste of your food. Most restaurants are accustomed to adding salt during the cooking process so try to prepare food within your home so that you can control your intake of sodium at meals. Lastly, it is important to read labels! The magic number to aim for is less than 500 mg of sodium for a meal and less than 150 mg for a snack.

The last tip to clean up your eating is to cut down on processed foods with loads of ingredients. By cutting out processed foods, you can easily minimize your intake of saturated fat, refined carbohydrates, added sugars, and salt! Go through you cabinets and apply the following guidelines to determine if you’re consuming too many unhealthy convenience foods:

Rules of thumb for selecting healthy food items:

Sugar < 5-8 grams per serving

Fiber > 3 grams per serving

Sodium < 240 mg per serving

Total Fat < 3g/100 calories

No Trans Fat

Ingredient list: avoid partially hydrogenated oils, high fructose corn syrup, food coloring/dyes; limit artificial sweeteners

Now, who would have thought a 5 step detox could be this easy. Happy summer!


02/May/2013

Simple Cold Blueberry Oatmeal Breakfast

Makes 3 servings

  • 2 1/2 cups rolled oats
  • 1 cup fat free plain Greek yogurt
  • 2 tbsp chia seeds
  • 2 cups blueberries (fresh or frozen)
  • 2 cups unsweetened almond milk
  • 4 scoops vanilla Whey To Go protein powder (optional, available at whole foods)

Directions

  1. Combine all the ingredients in a large mixing bowl.
  2. Mix thoroughly until protein powder has dissolved.
  3. Portion, equally, into 3 mason jars.
  4. Cover mason jars and place in the refrigerator. It is best to let them sit for 60 minutes before eating so that the oats can soak up the liquid, overnight is better.

Strawberry Avocado Smoothie

  • ¼ Cup fat free milk
  • ¾ Cup Greek yogurt
  • 1 Whole banana
  • 1 ½ Cup frozen strawberries
  • ¼ avocado
  • ¼ tsp Vanilla extract

Directions

Pour the milk onto the blades of the blender, followed by the yogurt. If you want a thinner consistency, add more milk. Add the peeled banana and avocado, and then blend the mixture. When the mix is completely blended, add the frozen strawberries and blend until smooth.

Peanut Butter and Banana Smoothie

Ingredients

  • 3/4 Cup Greek yogurt
  • 2 Tbsp All Natural Peanut Butter
  • 1 Banana
  • 1/8 Cup milk
  • 3/4 Cup ice

Directions

Add the milk, yogurt, and banana; blend. Add the peanut butter (smooth or crunchy) and blend again. Lastly, blend in desired amount of ice; the more ice, the thicker the consistency.

Broccoli Blueberry Smoothie

Ingredients:

  • 1 cup of frozen blueberries
  • 1/2 cup of steamed broccoli
  • 1/2 cup of unsweetened cranberry juice
  • 1/2 cup of plain non fat Greek yogurt

Directions

Blend and combine to make 1 smoothie. Add strawberries or blackberries for an additional burst of nutrition.

Sweet Veggie Smoothie

Ingredients:

  • ½ cup apple juice
  • 1 cup of sliced apple
  • 1/4 cup unsweetened applesauce
  • 1/2 cup sliced carrots
  • 1/2 cup of cucumber (peeled and sliced)
  • 2 cups of ice
  • 1 dash of nutmeg or cinnamon (optional)

Directions

Blend this vegetable smoothie until smooth. Adding the nutmeg and cinnamon will give it great fragrance.

Berry Berry Good Smoothie

Ingredients:

  • 1/2 raspberries
  • 1/2 cup strawberries
  • 1/2 cup blueberries
  • 1 cup fat free milk
  • 2 cups ice
  • 1 small shredded carrot

Directions

Blend until smooth

An Apple A Day Green Smoothie

Ingredients

  • 3/4 cup yogurt
  • 1/4 fat free milk
  • 1 apple, cored
  • 3″ cucumber (about 1/2 cucumber)
  • 1 cup spinach
  • 1/4 cup cashews
  • 1 tsp vanilla
  • 1/2 tsp cinnamon
  • 1/8 tsp nutmeg, cardamom, allspice (optional)

Directions

  1. Add all the ingredients to a blender
  2. Start on a low speed, slowly increasing to high
  3. Blend until smooth


Now that the weather has (finally!) started to improve, many of us are focused on getting outside for some fresh air and fitness. But what’s the best way to do this safely, with the maximum benefits to our health? Variety and moderation are the keys.

Exercise is any physical activity designed to improve/maintain some aspect of physical fitness. The benefits of exercise are numerous–risks for diabetes, high blood pressure, osteoporosis, cardiovascular disease, and stroke are all reduced in those who exercise regularly. Mood is improved, and life expectancy is increased. Although every individual’s exercise program should be tailored to her own preferences, abilities, and lifestyle, the health goals are basically the same for all. There are 4 main types of physical activity that help to achieve these goals:

  1. Aerobic exercise: increases the blood flow to your heart and conditions the heart muscle. This type of exercise includes running, walking, swimming, etc. You should aim to get 30 minutes of moderate aerobic activity 5 days a week (this may be broken up into 10-minute intervals throughout the day) for maximal benefit.
  2. Weight training: strengthens muscles and supports bone strength. This is the type of exercise that prevents osteoporosis and bone fractures. At least one set of twelve repetitions for each major muscle group is recommended, two or three times weekly.
  3. Stretching: improves flexibility and balance and reduces the risk of injury. You should stretch each joint and hold for at least 10 seconds. Yoga is a great example of a stretching program.
  4. Avoidance of inactivity: refers to a multitude of choices made throughout the day to be active instead of sedentary. A number of studies have shown that reducing the amount of time spent sitting–watching TV, etc,–has active health benefits above and beyond traditional forms of exercise. So get up and do the dishes, even if you have a dishwasher. Take the stairs instead of the elevator. Fidget!

Most people can begin an exercise program slowly and safely and work up to a level that is well-tolerated and sustainable. However, anyone with diabetes or cardiovascular risk factors should discuss the need for stress testing prior to initiating a new exercise program. Other health concerns can be discussed with your doctor on a case-by-case basis, to make sure that your regimen does not aggravate existing conditions. Of course, it is always important to stay well-hydrated when exercising, and make sure you are appropriately attired for the type of exercise and the conditions in which you will be exercising. Finally, it is important to be aware of warning signs that could be a sign of a serious problem while exercising–such as chest pains, difficulty catching your breath, dizziness, extreme fatigue, or joint pains–stop exercising if you have these symptoms, and seek medical attention. By being smart and sensible, and creating a well-rounded exercise program, you can improve your overall level of fitness and wellness.

Good luck!



Spring has sprung! Winter is over, flowers and trees are starting to bloom, it is time to do some spring cleaning, and it’s time to do some spring training!

After hibernating this winter, your body may be in need of a make-over in time to get tight and fit for bathing suit weather.

Dust off those running shoes, pump up your bike tires, and get out that water bottle.

While this time of year is exciting, invigorating, and teeming with new life and energy, it is important to remember some tips for training that you may have packed away with your shorts and tank tops.

First of all, be sure to start slow. If it has been a while since you last took a run outside, take some time to stretch. Also, while running on a treadmill does give you the cardio benefits, running outside on different terrains can work your muscles and joints in different ways. Be sure to start at a slower pace than you are running inside and build as your body readjusts.

Protect your skin. People are so excited to be outside in the beautiful weather that they often forget that it may have been a while since their skin had been exposed to so much sun. Before a jog on the trail or a walk in the park, make sure you apply sunscreen to any exposed skin to prevent sun damage and premature aging.

Prepare for all weather. Spring weather is unpredictable. This means check the forecast and dress in layers! Don’t let changes in weather deter you from your training. Be flexible and willing to improvise to keep on track.

Be aware of spring allergies. Lots of people are affected by the change in allergens between the dead winter months and the blossoming spring months. If you are susceptible to these allergens be sure to check pollen forecasts and talk to your doctor before starting any outside fitness programs.

Most importantly, have fun. Spring is a great time to be physically active and enjoy the outdoors! Plan a hike with your friends, bike ride to a river bank for a picnic, keep moving and enjoy!

If you would like some help creating a personal fitness program, the trainers at Rittenhouse Women’s Wellness Center are a phone call away! Make your appointment today!



In this age of search engines one can easily find hundreds of thousands of articles, forums and blogs about nutrition. However, making use of a limitless source of information isn’t as easy as it sounds. With so much misinformation out there, how do you know what you can trust? Where can you start?

A great way to find your starting point is by watching credible documentaries. Over the last decade there has been a barrage of documentaries that place the spotlight on various aspects of our food industry.

Have you ever thought about where the meat in your cheeseburger comes from? How about the tomato in your salad? Do you question the long term affects of consuming too much added sugar? If you find yourself wondering the answers to these questions then I highly encourage you to view these influential documentaries. Each documentary unveils eye opening footage, provides one-one interviews with multiple health professionals and undoubtedly motivates viewers to make healthier choices in their lives.

1. Forks Over Knives: The feature film’ Forks Over Knives’ examines the profound claim that most, if not all, of the degenerative diseases that afflict us can be controlled, or even reversed, by rejecting animal-based and processed foods.”

2.  Food Inc.: This documentary takes a look inside corporate America’s food industry.

3.  Hungry for Change: ‘Hungry For Change’ exposes shocking secrets the diet, weight loss and food industry don’t want you to know about. Deceptive strategies designed to keep you craving more and more.

4. Fat, Sick and Nearly Dead:.100 pounds overweight, loaded up on steroids and suffering from a debilitating autoimmune disease, Joe Cross is at the end of his rope and the end of his hope. ‘ Fat, Sick and Nearly Dead’ is a documentary that follows the 60-day journey of Joe Cross across the United States as he follows a juice fast to regain his health under the care of Dr. Joel Fuhrman, Nutrition Research Foundation’s Director of Research.

5. Food Matters: Food Matters’ features is a hard, fast paced look at our Nation’s current state of health. ‘Food Matters’ seeks to uncover the business of disease and at the same time explores the safe, cheap and effective use of nutrition and supplementation for preventing and often reversing the underlying causative aspects of the illness.



Spring is officially here and it is a good time to reflect on your health goals and progress made for the year so far. It is time to look forward to warmed weather and longer days. It is also a good time to clean up your life, both physically and mentally. Spring cleaning is not just for your home anymore – it’s just as important for us to clean up other parts of our lives, especially our diets!

Greens are associated with spring – a time to renew and refresh vital energy. They aid in purifying the blood, strengthening the immune system, fighting depression, clearing congestion, improving circulation and keeping your skin clear and blemish free. They also are important for improvements in liver, gall bladder, and kidney function.

Some foods in season for the spring are listed below. Eating seasonal food does not have to be boring or bland. It also does not have to be complicated with long hours of prep-work. Start small and try to cook 1 new recipe per week. Experiment and crowd the diet with spring foods, and notice how your body feels. Soon you will begin to wonder how you ever lived without them! Right now is a perfect time for cleansing and detoxing from the long and cold winter months.

Vegetables in season include:

  • artichokes
  • asparagus
  • peas (garden, snap, and snow)
  • rhubarb
  • sprouts
  • turnips

Greens in season include:

  • collards
  • kale
  • mustard greens
  • swiss chard

Fruits in season include:

  • apricots
  • berries
  • blood oranges
  • grapefruit
  • kiwi
  • lemon
  • pomegranates
  • strawberries

Recipe of the month:

Kale Salad with Spicy Peanut Dressing

Ingredients:

  • 1/2 head of kale, chopped into bite-size pieces
  • 2 Tbsps mint, finely chopped
  • 2 Tbsps peanuts, roughly chopped
  • 1-2 scallions (green parts only), thinly sliced
  • 1 Tbsp all-natural, organic peanut butter
  • 2 Tbps tamari
  • 2 Tbsps mirin
  • juice of 1 lime
  • dash of cayenne

Directions:

Add the kale, mint, peanuts and scallions to a salad bowl. Massage the mixture a bit with your hands just to soften the kale. In a blender or food processor, combine the peanut butter, tamari, mirin, lime juice and cayenne.  Pour the dressing over the salad and combine so all of the greens are saturated. Refrigerate and allow it to marinate in the dressing for up to 30 minutes before serving.

 

© Integrative Nutrition



In today’s stress filled world, everyone could benefit from mind clearing, muscle stretching and body strengthening Yoga. Research shows Yoga can help to maintain or control many medical anxieties including arthritis, asthma, back pain, high blood pressure, diabetes, heart disease, carpal tunnel syndrome, chronic fatigue, depression & anxiety disorders, epilepsy, chronic headaches, multiple sclerosis, stress, as well as many other conditions and diseases.

Yoga:

  • Improves muscle tone, flexibility, strength and stamina
  • Reduces stress and tension
  • Boosts self esteem
  • Improves concentration and creativity
  • Lowers body mass index and targets fat
  • Improves circulation
  • Stimulates the immune system
  • Creates a sense of calm and total wellbeing

Yoga helps those practicing get in touch with their ‘true self.’ Between work, home and general life stressers, it is easy to lose track of oneself. We women are not only their jobs, daily demands, the car we drive, the house that we live in, the emotions that we feel, the sole provider paying the bills, or the ‘crazy stressed out lady’. We are so much more than those things. When you feel stress, think of all of the ways it affects your body. Your heart rate increases, your blood pressure goes up, you may start to sweat. You cannot concentrate on anything other than what is stressing you out. You may forget things– creating more stress, snap at people—making you feel regretful, tired and agitated.

None of this is good for your body. As difficult as it may be in the beginning to clear your, forget your stressors, and just concentrate on your breathing, calming yourself and getting a breath of good, clean oxygen into your body will make you feel like a new Woman! You will find yourself dealing with stress better and it not affecting you the same way. You will realize that it is not you, but the environment putting stress on you, that has become the issue.

So, through a continuous practice, dealing with people and things from a clear perspective, you can transform not only yourself, but those around you. People will notice the change, you will feel better. You may even halt those furrows and frown lines from slowly imprinting on your face.

So, find a good Yoga instructor, put on your comfy, stretchy clothes, and leave your stresses behind.

Namaste



Do you find yourself at times overeating until your plate is cleared and your stomach is stuffed? Many of the habits that drive overeating are unconscious behaviors that people have repeated for years. The process of mindful eating allows a person to wake up and be aware of what they’re doing. By following the principles of mindful eating, you can help yourself improve your current eating behaviors, induce weight control, prevent chronic disease and foster a healthful relationship with food.

Our dietitian, Theresa Shank, likes to use the Mindful Eating Cycle as a guidance tool to help her patients become conscious of their eating patterns that are causing them to overeat. Next time you sit down to eat a meal, ask yourself the following questions…..

  • “Why do I eat?” may include an exploration of triggers such as physical hunger, challenging situations, or visual cues, which often spring from stress, fatigue, or boredom.
  • “When do I want to eat?” The answer may depend on the clock, physical hunger cues, or emotions.
  • “What do I eat?” examines the factors people consider when choosing food, such as convenience, taste, comfort, and nutrition.
  • “How do I eat?” Is eating rushed, mindful, distracted, or secretive? In our technological, on-the-go society, exploring the process of eating can be eye-opening.
  • “How much do I eat?” Quantity may be decided by physical fullness cues, package size, or habit.
  • “Where does the energy go?” Eating may be invigorating, cause sluggishness, or lead to guilt and shame. How is the energy used during work or play?

A Note from RWWC

“Since our founding in 2008, our goal has been to provide primary care for women. Our team of physicians and nurse practitioners are dedicated to providing preventive care, diagnosis and treatment of acute and chronic disease(s) and coordination of care with specialists.”

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