Going Back to School?

As a recent graduate student, this is the first Fall in a LONG time that I am not going back to school!

Throughout my educational career, every year before returning in the fall, I would go through my checklist of must do’s.  This included everything from getting school supplies, to preparing for the onslaught of health risks I was soon to encounter.

It has been proven that academic success is strongly linked to the health of the student.  It is our responsibility as health care providers, parents, and the student to give ourselves every chance to be successful - and step one is our health!  As the school year draws near, I thought I would share my checklist with you: 

1.      Required immunizations:  Since our academic success starts with our health, let’s do all the prevention that we can! 

·         Ages 10 and 11 are very important years to update your vaccinations, typically including  tetanus, diphtheria, whooping cough, meningitis, and human papillomavirus (HPV).  Typically, students will not be able to enter the 6^th grade without these important vaccinations.

·         Teens, generally around 16, will need a booster to protect against meningitis.  Check out this schedule of recommended immunizations for kids ages 7 – 18, provided by the CDC – it’s a great reference tool!

·         Entering college is another important year when you must see your physician to get the proper vaccinations.  These include vaccinations against meningitis, pneumonia, tetanus,  hepatitis B and the HPV vaccine.  Here is the recommended immunization schedule for adults, again provided by the CDC.

2.      School’s medication policy:  For those of us that have chronic health concerns such as Asthma or allergies, it is essential that we contact the school to ensure we can have our medication with us, or at school, at all times.  So, just remember that if you have inhalers or EPI pens, you must contact the school to ensure the medication is available in case of an emergency.  

3.       Eating Healthy:  Eating the right foods not only helps the waistline, but evidence proves that proper nutrition can improve academic success! 

·         Eat Breakfast.  We have all heard that “breakfast is for champions,” and it really is!  Breakfast improves our concentration, creativity, and mental alertness.   According to KidsHealth, “Kids who skip breakfast feel tired, restless, or irritable,” they continue to describe, “choosing breakfast foods that are rich in whole grains, fiber, and protein while LOW in added sugar may boost kids’ attention span, concentration, and memory,” – all of which are needed to learn!   In addition, kids who eat a healthy breakfast are more likely to make healthy choices throughout the day, leading to a healthier body weight, lower blood cholesterol levels, healthier immune systems, and fewer absences from school.  

·         Foods to Avoid.  There are also a couple of foods that we should avoid because they can impair our academic performance by interfering with sleep and concentration.  For example SUGAR and CAFFEINE can cause hyperactivity, difficulty with concentration, and may interfere with sleep.  American Academy of Pediatrics states, “Each 12-ounce soft drink contains approximately 10 teaspoons of sugar and 150 calories. Drinking just one can of soda a day increases a child's risk of obesity by 60 percent.”  Restrict your child's soft drink consumption!

4.      Sleep:  We all know that proper amounts of sleep are important for our overall well-being. Typically, during the summer hours, most of us like to sleep in and stay up late (if we are not going to school or work).  I would suggest that 1-2 weeks prior to starting school, begin going to bed early and waking up at the time you will need to get up for school.   This will allow for a much easier transition and full alertness starting on day one!

5.      Transportation Safety Tips:  There are many ways we come and go from school, but it is always a good idea to review some basic important safety tips with your child.

·         Riding the Bus.  Always wait for the bus to come to a complete stop.  Children should always board and exit the bus at locations that provide safe access to the bus or to the school building.

·         Riding in a Car.  Everyone in the car needs to wear a seat belt and/or an age appropriate booster.   

Teens: many crashes occur while young drivers are going to and from school.  A Couple of helpful hints: limit the number of passengers, no eating or drinking, and stay off of the cell phone – that includes TEXTING while driving!  These all cause a lot of distractions and lead to accidents.  It’s often a good idea to discuss these important issues with your teens and possibly develop a parent-teen agreement. Click here for a sample parent-teen driver agreement. 

College Students: Yes, the drinking age is 21, but as many of us know, there is a lot of underage drinking on college campuses.  Parents need to discuss this important topic with their children, touching on the importance of avoiding alcohol and what to do in certain situations.  And, most importantly, explain the importance and implications of driving while intoxicated and/or getting in a car with someone who has been drinking!   A recent article in USA TODAY states that “About 1,400 college students are killed every year in alcohol-related accidents.  Motor vehicle fatalities were the most common form of alcohol- related deaths.”

·         Riding a Bike:  Please wear a bicycle helmet, no matter how short or long the ride (and that goes for skate boarding, roller blading, any other form of non-motor toys).  Learn the rules of the road to keep yourself safe!  

6.      Homework and Study Habits:  Everyone has something a little different that enhances their study time.  For me, it was my amazing study group and my spot in the library!  But, it is important to create an environment that is conducive to doing homework. Youngsters need a permanent work space in their bedroom or another part of the home that promotes study – it should be quiet and without distractions. 

A few helpful hints: schedule ample time for homework.  Establish household rules regarding homework.   For example, no TV or no cell phone use during homework time.  Parents want to supervise the computer and Internet use. 

7.      Supplies:  Last, but certainly not least, don’t forget to shop for all of your school supplies!  This was always my favorite – and yes, supplies include back-to-school clothes!

Wishing you and your family a successful and healthy back-to-school season!

-Posted by Carleigh Kessler, MSN, FNP

Is Diabetes Synonymous with Overweight?

When patients are first diagnosed with diabetes, I’m often asked “Why do I have a sugar problem?  I’m at a healthy weight and only eat brown rice and tofu; how is this possible?  Isn’t diabetes a disease for overweight people?”   

What most patients don’t realize is that there are 2 types of diabetes and a number of non-modifiable risk factors for developing the disease (i.e. age, family history, genetics, etc.).   

Type 1 diabetes is where the body does not produce insulin.  It is the less common form (only accounting for approximately 5% of all diagnosed cases of diabetes) and is usually developed before the patient turns 40 – often in early adulthood or teenage years.  There is no known way to prevent type 1 diabetes, and patients can be normal or even underweight when diagnosed.  Weight has no direct correlation with this disease.    

Type 2, on the other hand, is where the body does not produce enough insulin for proper function, or the cells in the body do not react to insulin (insulin resistance).  According to the CDC, type 2 diabetes accounts for about 90 – 95% of all diagnosed cases of diabetes.  It is associated with older age, obesity, family history of diabetes or gestational diabetes, impaired glucose metabolism, physical inactivity and race/ethnicity.   

With overweight and obesity rates on the rise in the U.S., the incidence of type 2 diabetes is increasing dramatically.  Excess weight gain will certainly increase your risk of developing this disease – especially if you carry extra weight around your waist line.  If you go to the American Diabetes Association Web site, you can do the risk test to see your chances of getting diabetes.

As mentioned above, your race/ethnicity also factors into your risk of developing type 2 diabetes.  For example, if you are Asian, your healthy weight range is different than someone who is Caucasian.   A healthy weight for an Asian patient is less than 23 on the body mass index (BMI) scale as opposed to 25 on the BMI scale for a Caucasian patient.  A healthy waist line for an Asian patient is less than 31 inches for women and 35 inches for men as opposed to 35 inches for women and 40 inches for men among Caucasians (Joslin Diabetes Center & Joslin Clinic).  So, as little as a five pound weight gain could put an Asian patient at risk for insulin resistance!    

African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Native Hawaiians or other Pacific Islanders are at particularly high risk for type 2 diabetes and its complications as well.

So, while we can’t change our non-modifiable risk factors such as ethnicity/race, age, genetics, and family history, we can change modifiable risk factors such as our eating habits and increasing our daily physical activity to help prevent this chronic disease.  Remember that portion control is key for controlling your weight – too many healthy foods can actually make you gain weight!

If you’d like some more pointers for reducing your risk level for developing type 2 diabetes, I encourage you to schedule an appointment with me!

-Posted by Haesun Hwang MS, RD, CDE

We Can't All Be Olympians, But We All Can Exercise!

While watching the 2012 London Olympic Games, I think we all had a great admiration for the courage and sheer athleticism of the competing national and international Olympic athletes.  

While that level of elite fitness is admirable, it is not possible for most of us to attain such a high level of physical skill and conditioning.  However, it is possible to emulate the Olympic spirit and motivate towards a goal of becoming more active and optimizing aerobic fitness.

In a recent study published in the Lancet (July 18, 2012), researchers  found  strong evidence that shows physical inactivity increases the risk of coronary artery disease, diabetes, colon and breast cancer,  and shortens life expectancy.  

These findings probably do not come as a surprise to most physicians or patients.  One of the more alarming findings from this study, however, was the fact that physical inactivity seems to have a similar level of risk to that of smoking.   To think that NOT exercising on a regular basis can be as harmful to your health and well-being as smoking a pack of cigarettes for your whole life is somewhat surprising.

The American College of Cardiology recommends that patients should incorporate a minimum of 150 minutes of moderate intensity exercise into their weekly schedule.   Taking into account the results of this study, surely, can’t we find a way to squeeze 15-30 minutes of brisk walking into our day?  Exercise is on everyone’s list of positive health behaviors, but it is not as high as it should be. 

“The most important thing is not to win but to take part,” – perhaps this Olympic motto can inspire us to set aside enough time in our busy schedule and take part in improving our health through exercise.

-Posted by Christopher Connolly, MD

What is a Doctor?

I am writing the first blog of my lifetime.  The word 'blog" was not part of my lexicon until the past decade.  That thought caused me to think about how I define the role of a doctor and how a doctor's life ensues.

When I first contemplated becoming a doctor, I asked my mother what she thought I should do for a career.  I grew up in Eastern Canada on an Irish potato farm and am the youngest of eight children.  Women had a very different role than men and were not deemed to be a lot of help on the farm.  My mother responded, “Well, you are a girl, so you could be a teacher, a secretary, or a nurse.”  I asked my best friend if I was smart enough to be a doctor and she replied, “No, I don’t think you are.”  So, I decided to make an appointment with the family doctor and ask him for direction.  I found his answers more helpful.

He encouraged me to apply to Dalhousie University in Halifax, Nova Scotia, an old, respected British University.  With that in mind, I completed the application by myself and sent the stamped envelope in the mail.  Much to my pleasure, I received an acceptance letter a few months later.  With no alternative back-up plan, I was on my way to start a new life, trying to get into medical school.

I thought that I wanted to be a doctor because I liked science and I felt joy from helping others, including animals.  My view of a doctor was similar to the Norman Rockwell picture.  Dr. Goodine, my family doctor, represented all of the positive virtues that an “All-American” or “All-Canadian” doctor could represent.  He cared for the entire family, diagnosed the myriad of health conditions that exist, and was a person you could trust and ask for guidance or talk to about life’s challenges.

I moved to Halifax at the age of 17.  I was a country girl, and everyone at Dalhousie looked smarter and better dressed than me.  There were 1,200 people in my first year biology class.  Little did I know that when I would show up for year two, there would only be 100.  Well, I was on my way making it through the pre-med requisites.  Not telling a soul that I would apply to medical school due to the fierce competition and my very realistic fear of not making the cut.

The day that the acceptance letter from Memorial University School of Medicine in Newfoundland arrived, I called and spoke with my father.  I was eager to learn the results and asked him to read it for me.  He asked for me to wait until my mother returned from her hair appointment so she could read it.  Feeling desperate to learn the news, I pressured him into opening it.

Having to quit school in the 3^rd grade to help support his 14 siblings, my father was embarrassed by his poor reading skills, but nonetheless slowly read the formal letter.  I felt so sorry that I had embarrassed and pressured him into showing me this.  I dealt with the emotion of feeling so honored that he was willing to disclose this deficit in light of how much it mattered to me.  Yes, I had been accepted to medical school.  I thought I had won the lotto!

After completing four years in Newfoundland, my vision of being a doctor changed a bit.  I was not living the “image of the country doctor” anymore.  Instead, I was someone who trained in a large, up-to-date medical facility in a city located in the far north, serving the residents of Newfoundland, Labrador, The Northwest Territories and anyone visiting the northeastern part of Canada.

Being a graduate of MUN meant you would be someone that would make the med school proud.  You would show humility, care for your patients, and be grateful for having had the opportunity to do so every day of your life.  You would have had a lot of hands on experience.  In med school, I had delivered over 100 babies, was able to reduce a simple fracture, run a code, suture a laceration, and perform a history and physical.  With this experience, I then decided to move to the USA and study Internal Medicine in Akron, Ohio.  Surely, I was well prepared.

When I started my internship in Akron, my first patient was a man who had tried to end his life with a gun and we were to harvest his organs.  I had never seen a gunshot wound, let alone something that was this terrible.  I came to learn what “clinic patients” were.  I thought that the residency program had saved the sicker patients for us since we were studying Internal Medicine.  I soon realized that these were people with Medicaid or no insurance.  They were just sicker because they were so poor.  Not sure if I understood, but I loved caring for these people.

By the end of the three year residency, being a doctor meant running the ICU/CCU, resuscitating people, taking care of very sick people in the hospital and sometimes working 36-48 hours straight.  Being the only woman in my program initially felt strange.  Most of my role models were men, and that was fine.  All in all, it was good, but different than I had expected.

When I graduated at age 28 as a Board Certified Internal Medicine Specialist and started private practice, being a doctor meant working all night, taking care of in-hospital patients, and working all day, taking care of outpatients.  Sometimes, I would leave the office for an emergency and get to come back and care for those patients who had no choice but wait.

When my son David was born, the next door office became a nursery.  Being a doctor then meant caring for my patients and a baby, while running a practice.  David would accompany me to the hospital on rounds as he grew.  Nurses were terrified to see this new woman doctor coming to the hospital and ICU with her baby.

With one year of bed confinement from the complications of overzealous use of IVF medications, I would have the time to learn other ways to heal.  Boredom forced me to take a distance learning Complimentary Medicine Course.  I would learn how to help patients in ways that were not restricted to drugs and surgery, and I would listen to the science and studies supporting these claims.  After bringing three more children into the world, I would learn a very new way to be a doctor.  I would learn over time how to help people in an integrative manner.  Busy times.

Now, I am 53 years old.  I have been a doctor for 28 years.  I do not go to the hospital anymore.  All patients are outpatient.  My concept of being a doctor has changed yet again.  I think that being a doctor requires us to help people help themselves, live their optimal life, avoid drugs and surgeries if possible, stay fit in body and mind, and find life-work balance.

Occasionally, making a new diagnosis improves a patient’s life.  More often, talking with him/her and helping that person sort his/her life out brings relief.  Rather than just reaching for another pill, I can refer to the highly skilled team of Integrative Providers at Nova to help the patient find the best way for them to achieve wellness.  What I treat is no longer the mere absence of disease.  My greatest teachers have been my coworkers and my patients.

I have the privilege to work with 150 wonderful people at Nova who support me and the patients every day.  In their specific jobs and with their unique training and experience, the team of caregivers and support staff cause Nova patients to feel cared for and respected.  Being a doctor has allowed me to learn so many things other than medicine.

I wonder what I will think being a doctor is in five years, or even 10 years?  It really is the best career I could have ever had.  Thanks to an admission committee that believed in me, too.    

In Health,

Grace L. Keenan, MD   

"I Just Want to Lose Weight!"

If we all could get a nickel for every time we’ve heard the expression “I just want to lose weight,” we'd be pretty close to being millionaires!

I think most of us would like to be at our "ideal" body weight, or at least close to it.   But, how far are we willing to go to get there?   What is going to motivate us to stick to it if we slip?   Is the goal of "losing weight" a good objective?   I don’t think it is.  I think a plan "to lose" weight is a losing plan.

When we set our primary goal to be “to lose weight,” we're setting ourselves up "to lose."   We go on fad diets and engage in extreme work-outs with the objective "to lose" weight.   What does this do to the psyche when we enter into these temporary measures "to lose?"    So, what happens if we lose the weight?   Do we stay on the fad diet?   Do we keep doing the extreme work-out?   Or, what if our objective "to lose" fails?  Do we say “Forget about the diet and the exercise?”  I believe there is a better way.

Why don’t we switch gears just a bit and set our primary goal to be "I want to live a healthier lifestyle."   Imagine if, in setting that goal, we decided to incorporate a healthy, well-balanced diet of smaller, more frequent meals.   Imagine if we decided to incorporate regular exercise that didn't involve herculean effort.   What would happen if we "Just Do It?"  I think we’d meet our goal!

Once we start to live healthier lives, we’ll start to feel better and have more energy.   We’ll also enjoy the probable by-products of weight loss and the control of chronic medical conditions.   Since we see these positive reinforcements, we’re more apt to jump back on the “healthy lifestyle wagon” when we fall off.   It continues to motivate us.

So, what do you want to do?   Do you want to plan "to lose?"   If not, check out the many options at Nova that can help set you on your path towards a healthy lifestyle.

-Posted by Damion Hardison, MD

Stop the Weight Gain Roller Coaster!

If you are like me and over 35, you may have noticed over the years that it gets more and more difficult to stay fit and lean every year.  I anticipated a few grey hairs and some wrinkles... I did not anticipate my pants getting tighter and having the metabolism of a snail!  As my friend once said, “When I was in my 30’s, I could walk briskly to stay fit.  Now, in my 40’s, I have to run...!”

What’s going on here?  Unfortunately, as we age, our metabolism slows down – about 2% every year over age 30...of which on average, half of that is the loss of muscle mass!   Why are we losing muscle mass, you ask?  Because we are couch potatoes! 

We work long hours, eat junk, and sit around!  We surf the web and shop online, play video games and check email and texts.  We are not as active as our ancestors and this sedentary lifestyle leads to loss of muscle.  Muscle burns calories.  The less muscle we have, the less calories our bodies burn, and the more likely we are to get fat!   Combine that with the high sugar, high calorie American diet and this is a recipe for disaster!

The rates of obesity in America have been on the rise for decades.   In 2012, it is anticipated that nearly 70% of adults and 30% of children in the U.S. will be considered overweight or obese.  Not only does this mean the average U.S. dress size is on the rise, but these statistics have serious and potentially tragic health consequences!  Being overweight increases one’s risk of major chronic illnesses such as diabetes, hypertension, heart disease and stroke.

Studies show that even a modest weight loss of 5-10% of one’s body weight can have tremendous impact on health and overall well-being.

So, how does one control this madness?  Here are 5 helpful tips:

1. Eat less – especially sugar!   This includes most carbohydrates from cakes and cookies to white breads and pastas.  These types of foods are quickly turned into glucose, causing the body to make a surge of insulin for energy.  When this happens, we stop burning fat and start storing it.

 

2. Eat more Protein.  Multiple studies show that a diet high in protein causes more sustainable weight loss – it curbs our appetite, resulting in decreased calorie consumption.  (Notice how you can’t eat just a few potato chips or fries?)

3. Drink at least 2-3 liters of water every day.  If you’re busy drinking all that water, you won’t have room for that Frappuccino or sweetened tea!

4. Exercise.   Try to fit in hour of moderate intensity exercise most days of the week.  In general, lead an active lifestyle.  Change it up.  Ride your bike one day, run the next, participate in seasonal sports & activities.  AND, don’t forget to WEIGHT TRAIN to add back some of that muscle!

5. Lastly, get enough sleep.  When we are sleep deprived, we seek out quick energy fixes and are more likely to consume those chocolate covered donuts in the break room!

If you’re still looking for some weight loss guidance, talk to your medical provider or schedule an appointment with a registered dietitian for nutritional counseling.   If your a patient of Nova Medical Group, you may also be interested in reading more about Nova’s 12-week Integrative Wellness & Weight Loss Program – check it out!

-Posted by Sandra Valentine, MSN, FNP

Everyday Stress Management

Stress: it surrounds us every day in so many different ways – the first day of school or a new job, marriage, moving, having a baby, financial problems, meeting new people, coping with an illness, the death of a loved one, or simply having too many things to do in too little time!   

We’ve all been there, right?  All of these situations can be considered “stressors” – they create stress and elicit a bodily response.  Some stressors are happy occasions while others are scary and make us more anxious or uncomfortable.  Then, there are those that are life threatening and cause intense fear. 

Determining whether stress is good or bad depends on the individual – how he or she views the situation and how that individual is wired to deal with it.  I can tell you, some stress is even lifesaving.     

Let’s look at a stressful situation as an example: the wedding of a child – something I just went through!   

The stress of finding the right place for the reception, the hunt for the perfect dress, getting the venues in line for the preferred dates and times, picking out invitations and favors, finding the best photographer, baker and DJ, wondering if those invited will come… the list goes on and on!  And, of course, can I afford all of this?   

A super happy occasion, but, all of these dilemmas are a source of stress and cause different responses in each individual involved.  Whether stress is good or bad, it can evoke the same physical reactions.   

So, what are some of the reactions to stress?   

You may find yourself in fight-or-flight mode with your adrenaline raging.  This is good if you are in a situation where you need to have increased strength or stamina to avert disaster, such as an accident or a fire.   

Other times the reaction is more subtle.  You have an upset stomach, headache, chest pain, or trouble sleeping.  Maybe you feel tense all over or you feel anger or resentment.   Or, maybe you find yourself totally wiped out – you’ve reached your limit.   We’ve all been there at one time or another!

So, what are the consequences of stress?   

Limited stress can be of no consequence because the body has many built in compensatory forces.  Too much stress or a poor stress response can lead to crippling physical or mental illness.   For this reason, it is imperative that we all learn to recognize our stressors and find ways to deal with those stressors, keeping us in homeostatic heaven.   

I found this information provided by the Mayo Clinic to be helpful – it gives you some great ways to help relieve stress.  Nova Medical Group also has a Cognitive Behavioral Therapist on site who can help you with stress management and coping mechanisms.   

So, what you do to relieve your stress?   

-Posted by Diane Fenlason, MSN, FNP