These days it’s hard to glance at a health magazine, flip past the cooking channel, or chat with your one vegan friend without hearing the word “superfood”. It seems like they just keep coming up with new ones. One week its kale, the next its acai, then before you know it you’re on amazon wondering if you should order some Maca powder from the Andes because apparently it’s a natural energy booster and you can sprinkle it in your smoothie. It’s hard to keep up without getting swept up. So, many people (rightfully so) regard superfoods with a healthy amount of skepticism. A superfood is “a nutrient-rich food considered to be especially beneficial for health and well-being.” That’s a pretty broad definition– it’s no wonder they keep announcing new ones! But please read on about walnuts.
This week I read two interesting articles about walnuts and their correlation to reduced cancer deaths. The British Journal of Cancer recently published an article written by a Harvard researcher reporting that his research had shown that tree nuts in general were found to reduce a man’s chances of dying from prostate cancer. Tree nuts include walnuts, almonds, cashews, macadamias and pine nuts. Now, prostate cancer is typically a slow-growing cancer that occurs later in men’s lives. Interestingly, most men who have it will not die from it, but will die from a completely unrelated cause as the disease is very often asymptomatic. However, after lung cancer, prostate is still the second leading cancer killer among men. It’s an extremely hit-or-miss cancer, to say the least, and so we have to ask: how can men reduce their chances of suffering prostate cancer’s fatal effects? The study looked back at 47,000+ men and found that those who ate tree nuts five times per week had a 34% lower chance of dying from prostate cancer than men who ate nuts less often. Let me be clear: both groups had the same rate of diagnosis of prostate cancer regardless of how many nuts they ate. The tree nuts don’t appear to keep men from developing prostate cancer, but they do seem to make them less likely to die from it.
If you think that sounds bizarre, researchers were pretty puzzled too. The research remains largely inconclusive as to exactly why tree nuts correlate to lower prostate cancer deaths, but several other studies have noticed and documented this relationship as well. The next study I read was published in Cancer Prevention Research and was actually performed on mice not humans, but it still offered some new insights on the topic. Some mice had walnuts added to their standard diet- either a diet of typical mouse kibbles or a Western diet. The mice who consumed walnuts were found to have fewer colon cancer tumors (2.3 fold fewer in the western diet group). The researchers then analyzed the stool of all the mice in the study and found that the mice that had eaten walnuts, especially the males, had more diverse gut biomes than the mice that had not been fed walnuts. More definitive research is needed to determine whether the change in the gut flora is behind the decrease in tumor development or whether it is just yet another benefit of the walnuts. Regardless, the walnuts seem to have had a surprisingly beneficial impact.
So what is it in the nuts that contribute to our health? Is it the B vitamins? The magnesium? Or a plant-specific type of chemical that offers protection against inflammation and cancer and encourages the growth of healthy gut bacteria? Nobody’s totally sure, but I’ll be sure to keep eating Waldorf salad, snacking on walnuts, and adding them to my baked goods any chance I get.
Nakanishi M, Chen Y, Qendro V, et al. Effects of walnut consumption on colon carcinogenesis and microbial community structure [published online May 23, 2016]. Cancer Prev Res (Phila). doi:10.1158/1940-6207.CAPR-16-0026
Wang W, Yang M, Kenfield SA, et al. Nut consumption and prostate cancer risk and mortality. Br J Cancer. 2016 Jun 9. doi:10.1038/bjc.2016.181. [Epub ahead of print]
As a resident of Washington, DC you may be wondering… What is your risk for contracting Zika virus?
We have all heard about the risks of travelling to the tropical areas of the Caribbean, Central and South America. We have heard from athletes who are avoiding the Olympic Games this summer in Brazil due to the risk of being infected by a mosquito bite while there. We know that the Zika virus can also be transmitted by sexual contact with someone who has the virus. This past week we also learned that there are likely two cases of Zika in Florida (they are being confirmed) where the patient did not travel out of the country nor did they have sexual contact with anyone who did. These are believed to be the first two cases in the continental United States where the infection came directly from a mosquito on US soil. We have also learned of a case in New York State where for the first time we have confirmed transmission of Zika from a woman who returned from the tropics, and had sexual contact with her male partner that day of return. She developed symptoms the next day and her partner developed symptoms a few days after that. And more concerning, we learned of a case in Utah, where a family member who was caring for someone with Zika developed the virus themselves. Research is still being done to determine the method of transmission in that case. We are still learning about the virus and transmission every week as scientists around the world are looking into it.
What do you need to do to reduce your risk?
- The type of mosquito that transmits Zika (Aedes) is active both day and night and it lives in our area. Each mosquito does not travel far and often lives its entire life in or around one home. So wear an effective insect repellent when you’re outside, make sure your window screens are in good repair so that you don’t invite mosquitos into your home, and avoid having standing water in the area around your home (anything that catches and collects water from a toy to furniture to a low area in the yard).
- Use a condom with each sexual encounter. Unless you are in an exclusive long term monogamous relationship you should be using barrier protections- male or female condoms or dental dams.
- If you are not using reliable birth control- get started now to avoid the possibility of transmitting Zika to an unborn child. Even in a monogamous relationship, if a partner in the relationship is capable of becoming pregnant then condoms should be used if a partner travels to tropical areas of the US (like Florida), Central or South America.
So stay educated through trusted sites such as the CDC (Centers for Disease Control and Prevention) and read future blog posts from us about Zika, Dengue, and Chikungunya disease. If you or someone you know has questions about risk or possible infection call for an appointment or have a walk in visit to assess your risks or start testing and treatment if necessary. Kelly Goodman Group is here to help.
Whoever your Primary Care Provider is, they essentially have one central goal: to have your back and ensure you are always getting the best available care. Primary Care providers are the only ones who look out for total physical and mental health, coordinate care with specialists, and keep records of all your medications, labs, and imaging. Sure, you know you want a Primary Care Provider in your life, but here’s why you should see us here at Promenade.
We are highly accessible. With our convenient location in L’Enfant Plaza, we are served by 5 different metro lines. Little known fact: we are also the only primary care office in the entire Southwest quadrant of the city. But even if we had some competition, we are confident we would still be the clear choice for your primary care needs.
As a private independent practice, we take the time to get to know our patients. We are a local, family practice and we like to keep it friendly, personal, and simple. We don’t employ medical assistants or techs, so you will only ever deal with two people at our office: our front desk assistant and your provider. Upon checking in for an appointment, your provider (one of our lovely NP’s) will escort you to the exam room, measure your vital signs, discuss your symptoms or concerns, examine you, and if necessary, draw your blood themselves. You will see 1 room and 1 person per visit. And since we draw your labs ourselves, you will never need to go to an outside lab and sit in another waiting room to see another stranger.
We know how much continuity of care matters to our patients, and since we are a private, locally owned practice you can expect to see the same provider for most, if not all of your visits. Unlike a visit to any walk-in clinic or urgent care center, here at Promenade, each patient establishes a real relationship with his/her provider, and this helps us ensure that your health concerns are never forgotten or overlooked from one visit to the next.
Promenade Primary Care and our other location, Kelly Goodman NP & Associates in Bethesda, have streamlined your healthcare experience because we know your time is valuable. Check out our graphic and see how we have engineered our appointments to be as personalized and efficient as possible compared to other doctor’s offices.
Anthony, age 51, sees his cardiologist religiously and follows all of his recommendations- except for having a primary care provider. If he takes his medications as directed and his blood pressure is under control, why does he need primary care?
In our last post, we discussed the importance of primary care by using the example of Jessica, age 28 (a fictional patient to protect privacy). We used this patient as an example because she is a healthy young person, with only a few minor, sporadic illnesses. Once Jessica found a primary care provider, her health care was safer, less expensive, and more convenient for her and she had a person to turn to for future health concerns.
This time, we will look at a fictional patient, Anthony, age 51. Anthony is married, lives in the suburbs of Washington DC with his wife and children, and works in downtown Washington DC. A few years ago he saw a primary care doctor he didn’t like very much, and he had a physical where he was diagnosed with high blood pressure (hypertension). His wife, out of concern for her husband, encouraged him to see an expert for his condition, a cardiologist, in downtown Washington DC, near his workplace. Anthony likes his cardiologist and takes his medications as directed, and goes to follow up appointments there every 6 months as directed. His cardiologist has encouraged him to find a primary care provider, but Anthony has put this off and does not want to return to the provider he saw previously. No matter how attentive and smart his specialist is, it is not his role to provide primary care. While the cardiologist may be ordering labs pertinent to his heart health, like cholesterol and others, he is not ordering a full panel of labs that is recommended for a man over 50 years old. A primary care provider will look at Anthony’s blood pressure medications, receive reports from the cardiologist visits, and evaluate his past labs. But she will also order a complete blood count, liver and kidney function tests, thyroid function, iron, Vitamin D, and HIV and Hepatitis C (if he has not been tested for HIV and Hep C previously or if he has had a new sexual partner). She will also add other labs based on their discussion during his physical and any signs and symptoms he is experiencing. Given his high blood pressure, his family history, and the fact that he is overweight, his primary care provider adds a hemoglobin A1c to check his diabetes risk. She also adds a hormone panel when he mentions that he is having some erectile dysfunction symptoms. If these tests are normal she will prescribe an ED (erectile dysfunction) medication that best fits with his lifestyle. If they are abnormal she may order an MRI of his brain to look at his pituitary gland or she may refer him to an endocrinologist for further workup. He also has a history of aggressive prostate cancer in his family (his uncle died from it at 68). Therefore he and his provider decide to look at his PSA (prostate specific antigen) to monitor the possibility of this type of cancer. Finally, he receives a referral for a colonoscopy. Although no one enjoys the preparation for this procedure, nor the time off work, Anthony understands that colonoscopies save lives by finding cancer at more easily treatable stages.
So what does Anthony get out of seeing a primary care provider? Why can’t he just keep seeing his cardiologist as his main doctor? Because when Anthony has a primary care provider, he has someone to coordinate his care across specialists. He has someone he can trust who can help him prevent and if necessary treat illness across multiple body systems. Because while heart disease is the leading cause of death in the US, and is the cause of 1 in 4 deaths, it is not the only killer. Primary care is essential for the health of your entire body and mind.
I’ve heard many people say that since they are healthy they don’t need a primary care provider. They are wrong. Primary care is not just for people with chronic health conditions, although everyone with a chronic concern like high blood pressure or asthma should definitely have a primary care provider. Let’s look at a fictional typical young and healthy patient and see how they are cared for with and without primary care.
Jessica is 28 years old. She is in good health overall and moved to Washington, DC two years ago for a job. Since arriving she has gone to an Urgent Care twice for a UTI (urinary tract infection) and once for a sinus infection. She knows she is allergic to penicillin but can’t recall the names of the antibiotics she has taken for these infections. She has also seen a dermatologist for a skin issue twice. She has not been to a gynecologist since she moved here. She does not have a primary care provider. She relies on Google and Yelp reviews to find healthcare and so far this approach is working for her as far as she is concerned. Her copays are 75$ for each Urgent Care visit and $40 for the dermatologist or other specialists.
Let’s imagine Jessica begins to see a primary care provider (PCP). She schedules a physical every one to two years with a copay of $0 (it’s fully covered by insurance). These visits focus on preventative health and in addition to the physical exam, screening lab tests, and review of vaccination status her provider collects a family history, list of allergies and medications, and social history that includes her lifestyle. Jessica discusses her recent fatigue and the dietary changes she is making as she trains for a team triathlon. Her PCP orders a B12 test and the results show a low level of B12 and with supplementation she notices a significant improvement. She tells her provider about her healthcare visits from the past two years and signs a release to have her records transferred to her primary care office. Now all of her records are in one place. The PCP recommends a “well woman exam” for Jessica so she also has the recommended Pap smear and STD screening as her PCP takes care of her GYN needs as well. Her primary care provider is looking out for her overall physical and mental health.
Now, when she needs refills of her dermatologic cream, she requests them from her primary care office, saving $40. When she awakens one morning with symptoms of another UTI she calls her PCP and gets a same day appointment where she is prescribed an appropriate antibiotic given her allergy and the medications and culture results of her past infections, paying only $20 instead of $75. Further, she is screened for STDs regularly, protecting her fertility for when is ready to start a family. When she plans a vacation to Asia with her friends she is able to get the vaccines she needs to travel safely, and medications including antibiotics and motion sickness prevention to bring with her just in case.
So again, why does Jessica need primary care if she is a healthy young person? A good primary care provider offers holistic and preventative healthcare for people of all ages and in all states of health. Having a primary care office is the healthiest, most efficient, and cost effective way to take care of your health. At Promenade Primary Care we will take all of your past and current health issues into consideration as well as your lifestyle and health goals to provide you with the best care possible. Since we are a small private practice, we can truly personalize your care and establish close provider/patient relationships. And we will make it easy.