If you exercise all week can you drink all weekend? Maybe. The quote in British outlet the Mail Online is “Adults who booze regularly but exercise for five hours a week are no more likely to die than teetotalers.” That’s a simplification of course. There’s a large 10 year study published in the peer-reviewed British Journal of Sports Medicine that shows physical activity can counteract some of the ills of alcohol consumption. It’s a strong study looking at data that was collected from adults aged 40+ from national surveys in the United Kingdom. The study shows that while alcohol intake increases death from cancer especially but also from all causes, people who followed the recommended level of physical activity were no more at risk than the non-drinkers. Alcohol has been shown to increase one’s likelihood of cancer, in particular mouth and throat, esophagus, liver, colon and rectum, and breast cancers, according to the journal Addiction. And it is imperative to note that the study was looking at death from cancer and other causes, not diagnosis rates.
The researchers, who hail from the UK, Canada, Australia and also Norway, used data from England and Scotland from 1994-2006. There were 36,370 people, both men and women, who answered questions about a multitude of health behaviors, and categorized their level of exercise and alcohol. These participants were followed over time to see how their health changed. The researchers controlled for the most obvious factors like body size, smoking status, and sex/gender. They used MET (metabolic equivalent of task) hours to categorize exercise, where 1 MET is sitting at rest, and the more intense the exercise, the higher the MET. For example jogging for 1 hour is equal to 7 MET hours while calisthenics at home for an hour would be 3.5 MET hours.
It’s important to understand what the categories were for both exercise and alcohol. Bottom line, you can’t drink too heavily no matter how much you exercise. In this study they defined hazardous levels as 14-15 drinks per week for women and 19-21 for men. At this level the exercise still seemed to counter the alcohol. But above that level the benefits of exercise did not outweigh the impacts of alcohol. What about exercise levels? They considered inactive as less than 7 MET hours per week, lower active as between 7.5-15 MET hours and higher active as >15 MET hours per week. In practical terms that’s jogging for 30 min 4 times per week. This level of exercise also offered a protective effect against cardiovascular disease, confirming results we already know from a multitude of other studies.
While we can’t be certain that exercise alone reduced the risks associated with alcohol consumption- it could be other lifestyle factors that were not measured- it seems like a good assumption for now. We know we should exercise for our heart health, to reduce cancer risks, and to maintain strong bones and muscles. But if you are someone who drinks alcohol consider this a very strong push to make physical activity a priority. Get moving!
Visit Kelly Goodman Group to learn more about our practice and schedule an appointment at any of our locations.
We all hear horror stories from our friends and families about colonoscopies and the dreaded “prep”. Why are we doing this to ourselves? How can we reduce the number of times we need to do this test in our lifetime? Is there a way to avoid it completely?
First let’s talk about prevention as this is what really saves lives. In the US, colorectal cancer is the second deadliest cancer. Men have a 4.7% chance and women a 4.4% chance of being diagnosed with it.
There are risk factors you can’t change, like living longer than 50 years, having a family member with colon cancer or other cancer syndromes, polyps, Crohn’s or ulcerative colitis, having diabetes, or being in certain racial or ethnic groups (African American and Ashkenazi Jewish).
But there are risk factors that we can control- like alcohol consumption, smoking, sedentary lifestyle, obesity, and poor diet. Make sure to talk with your primary care provider about when to start screening if you have a family history of polyps, colon cancer, or a high number of other cancers. Hint: you need to be screened earlier- up to 10 years earlier even without symptoms depending on the situation.
We now have genetic tests to identify familial disorders that link many types of cancers, such as Lynch syndrome (this causes ovarian, uterine, pancreatic, kidney, brain, ureter and bile duct cancers). So we can test people for a genetic predisposition and make sure they are vigilant about screenings. But what if you have no risk factors? What are the screening rules in that case? Our federal government, as the USPSTF (US Preventive Services Task Force- they will be a recurring character in this blog) recommends screening all Americans between 50 and 75 years old. How often during that 25 year span depends on what is found during the screening. If you are minimizing your risk factors and have a normal colonoscopy you can avoid one for up 10 years at a time. That means a lifetime total of 3 at ages 50, 60 and 70. The upside? It’s a day off from work and maybe you even lose a stubborn pound or two with the clear diet leading up to the procedure. But is it possible to avoid the colonoscopy completely? Well the USPSTF and the AAFP (American Academy of Family Physicians) agree that the only methods that we can count on are colonoscopy, sigmoidoscopy (similar to colonoscopy but not as thorough), and stool testing that looks for blood. There are other newer tests such as a stool test that looks for cancer DNA rather than blood (Cologuard) and CT scans specifically for the colon/rectum. But these newer tests have not had time to prove themselves effective in a way that outweighs the risks- like an incorrect result or exposure to radiation.
If you use one of the stool tests or sigmoidoscopy and there is any uncertainty about being cancer-free, then you’ll need to follow up with a colonoscopy. Honestly, other than our skin, we can’t look at an organ directly to look for changes in the cells. Colonoscopy allows us to use a camera, equipped with tools, to look for and take samples of cells to analyze under a microscope. If you want to use the stool tests, you should repeat them yearly. Otherwise follow up frequency for colonoscopy depends on what was seen inside and under the microscope-usually 3-10 years.
Bottom line (pun intended), the same rules for healthy living apply to colon health as for the rest of our body. Don’t smoke, get exercise, eat lots of veggies, fruits, and whole grains, keep alcohol to a max of 1 drink daily for women or 2 for men, and stay at a healthy weight (BMI/ body mass index <25). And make sure to see your primary care provider to discuss your personal and family health history and come up with an individualized plan for your health each year. Call us or visit us at any of our Kelly Goodman Group locations to set up a visit.
We all deal with anxiety at times- it’s part of being human and serves a purpose in keeping us alert when something could have a bad outcome. But sometimes people develop feelings of anxiety that are too frequent, unrelated to a specific event, are out of proportion to a given event, or just don’t go away. More than 18% of Americans seek treatment for anxiety as adults. Unfortunately, only 41% of Americans with mental health symptoms seek medical care each year. Obviously these are terrible statistics in the abstract but when you imagine people actively suffering without access to care or not knowing how to get it, even though we have tools to help, it really brings it home. Don’t ignore your mental health! It’s just as important as your physical health and is interdependent with it. People with chronic physical illnesses are more likely to develop mental health problems and people with mental health problems have physical health ramifications if not physical health causes. Bottom line- these feelings of anxiety or panic are manifested physically in our bodies as part of our “fight or flight” response. So when anxiety is happening too often, this response really takes a toll on us. We can end up with problems like insomnia, headaches, muscle tension, trouble concentrating, as well as the irritability and worry or panic that comes with the feelings of anxiety.
A panic attack can happen when people have a constant low to moderate level of anxiety they are dealing with that will then explode in a panic attack. This includes feelings of doom, shortness of breath, heart palpitations, nausea, sweating and shaking. These attacks often come with no warning and are not related to a stressful or worrisome event. They can wake you up from sleep, happen at work or school, or even while trying to relax with family or friends. These attacks are terrifying and if you have not experienced one before you need to seek immediate medical attention to be sure that you are not in fact experiencing a heart attack, pulmonary embolism, or allergic reaction. Yes, panic attacks are that bad. Your body gives you signals that your life is at stake!
If you are experiencing symptoms of anxiety we want to help. There is a chance your anxiety symptoms are being caused by a thyroid, heart or lung issue so let’s make sure not to miss those. If your diagnosis is in fact an anxiety disorder, there are medications we can prescribe and monitor that can really help as well as excellent therapists who can teach you to manage symptoms. Let us know about your story, especially if these symptoms are interfering with your life- whether relationships, work, family responsibilities or health. We want to help you to live your healthiest life possible- physically and mentally. Kelly Goodman Group
In addition to its known benefits of improving bone and heart health, adding a natural supplement of Vitamin D may boost our immune system. So, we know that certain groups of people are deficient in D- like darker complexions, higher body fat, and indoorsy types. Fat cells absorb Vitamin D and keep it out of circulation so those of us who have any extra weight (and females have a higher body fat percentage anyways) are likely deficient. Also, if you have a darker complexion or use sunscreen outside it’s really difficult to absorb enough of the sunlight in our skin to make this vitamin. While we are still sorting out the ideal level of Vitamin D in our bodies, there is decades of evidence that this vitamin our bodies produce naturally is essential in achieving and keeping our optimum level of overall health. Our bodies make Vitamin D in our skin when we are exposed to sun. We’ve all been spending less time outside, and people who live in the northern half of the US (or similar latitudes around the world) don’t get enough sunlight.
You know how milk says “Vitamin D” on the label? Well, that’s because we can’t absorb calcium without Vitamin D so the milk producers add it to the milk. We have a tough time using that calcium to build bones without enough D. So while we all know calcium is essential to build and maintain bones and avoid osteoporosis in our later years, that calcium is not useful unless it has its helper- Vitamin D. This means people who follow a vegan diet are also at risk of low D (in addition to B12 and iron).
High blood pressure, heart attacks, strokes, and heart failure are all linked to low levels of Vitamin D as well. Huge clinical trials are being done right now so that we can determine how much of an impact supplementation has on improving heart health.
What we are also realizing is that we have Vitamin D receptors on our immune system cells. People with low D levels are more likely to have auto-immune disorders and increased risk of infection in general. Remember how people with Tuberculosis were sent to sanatoriums to go sit in the sun? And how cod liver oil has been used for centuries for general health? Well sitting in the sun and drinking cod liver oil both increase your Vitamin D level- they were on to something!
Come in and see us at any of our Kelly Goodman Group locations and we can check your Vitamin D level (our Nurse Practitioner draws your blood herself). Once we know your level we can advise you on how best to supplement this essential vitamin and prescribe a prescription strength Vitamin D if needed. Say no to colds and flu this fall and yes to bone and heart health!
Did you see the hashtag #FatSideStories on Twitter last week? A very sad story about being treated cruelly by health care providers was quite common. This really broke my heart. As a health care provider, it can be tough to talk to patients about weight because it is a sensitive subject for so many people. It doesn’t have to be. Let me tell you- this is one reason I love being a Nurse Practitioner. I feel that we really approach healthcare from a team perspective and without judgement. While we have the “expert” opinion to share with patients, we still want to be on the same personal level with them in terms of mutual respect. So, if someone comes to me to with a desire to discuss weight loss, I want to sort out what their story is. What is their day to day lifestyle that is keeping them from losing weight? If they come in with diabetes or blood pressure that is out of control, and weight is a factor, we will be discussing weight and the positive effect of even mild weight loss on those disease states. But if someone comes in for a cough, or STD/STI testing, or anything else unrelated to weight, there will be no discussion of a patient’s weight. When it is appropriate to have a discussion about weight, there is no judgement. If someone needs to lose weight because it is contributing to a chronic condition, we will talk about it. But it is not from a place of lecturing or scorn. It is an opportunity to gather some information from both the patient and the provider, and together come up with some options for treatment that the patient feels will work with their lifestyle, their family, and their personal beliefs and culture. There is no room for judgement in an honest and open relationship between patient and provider. It serves no purpose- whether the touchy subject is weight, sex, drugs, self harm, or anything else that is sensitive to someone. Our goal is to help people achieve their best possible health. So please don’t put off healthcare because you don’t want to deal with the lectures. Come see us instead. No lectures, no judgement, just health.
Are you experiencing recurrent UTI/bladder infections? Although most women (50% by age 32 according to Cleveland Clinic) experience a urinary tract infection, for some people these become a recurring concern. Studies claim anywhere from 20% to 40% of women who get one UTI will develop another. And of course they seem to come at inopportune times- the day before a big work event, on vacation, or with a new sexual partner. So what do you do when that first stab of pain occurs or the burning starts with urination? First, give us a call to stop by for a quick appointment that same day- even on your way to work! We can check a urine sample in office and start you on a safe antibiotic that has low resistance in our area and very low chances of side effects. We can send out a sample for culture to be sure we know exactly what it is and make any necessary adjustments to treatment to be sure it doesn’t come back. We can also prescribe medication that effectively numbs the urethra and soothes the pain (although it does turn your urine bright orange… can anything be subtle?).
So maybe this is your first UTI. In that case just be sure to use best practices to avoid another one: stay hydrated, empty your bladder regularly (including after sex), and wipe front to back after elimination and/or defecation.
But what if this is your second infection in recent memory? Or even your third or fourth? What then? Well you have some options. Let’s get a culture to determine if the germ is resistant to the medications you’ve been taking and simply was never treated effectively. Depending on the severity and frequency of infections, we can start you on various types of antibiotic regimens. However, many people would prefer to try to avoid the use of antibiotics whenever possible or are looking for more natural alternatives. In this case, please consider the use of two supplements. One is D Mannose and the other is lactobacillus.
We’ll start with the D Mannose– this can be used to treat an active mild infection and to prevent future infections. In fact a controlled study showed that patients treated with D Mannose went much longer (200 days vs 52 days) between repeat infections than those treated with an antibiotic (Bactrim orTMP/SMX- a sulfa type of antibiotic). This substance naturally occurs in fruits like red berries (such as cranberries) and fruits like apples and peaches. But it’s difficult to get enough through food sources alone to have an impact on urinary health. D Mannose helps keep the bacteria from attaching to the side of the bladder and so it can then be flushed out easily.
The other preventive treatment is lactobacillus aka probiotics. We hear so much about the countless benefits of probiotics for our immune system and digestive system. In this case, the lactobacillus family of probiotics (indicated by a lower case “L.” on the ingredient list) has been shown to reduce recurrences of UTIs by half, almost as much as an antibiotic regimen. If you also suffer from vaginal yeast infections this could be a wonderful way to reduce chances of another yeast infection or bladder infection.
Click on our website Kelly Goodman Group or give us a call at any of our locations to make an appointment. Stop going to Urgent Care over and over and come to Promenade Primary for your UTI so we can try to make it your last one!
Fatigue, muscle aches, rash, red eyes, mild fever. Is it Zika?
Now that the Zika virus has been transmitted by local mosquitos in Florida, we are all wondering when it will come to Washington DC. This city was built on a swamp and we have all experienced the mosquitos here. Our area has the right type of Aedes mosquito and we have lots of international travelers here, given that we are the nation’s capital. Two weeks ago we looked at risk factors for contracting Zika virus, as a resident of the District of Columbia. What happens if you have done your best to protect yourself but are starting to feel ill? How do you know if it’s Zika or just a run-of-the-mill virus? First, call us to schedule an appointment. We can test for Zika- we will draw your blood here and send it to a national laboratory for testing. Second, be on the safe side and only take Tylenol (acetaminophen) even if you’ve only been in the continental US. Given that Dengue has the same symptoms as Zika, and increases bleeding risk, don’t take Advil/Motrin (ibuprofen). If you have been out of the country recently we will discuss your risk factors, test for similar viruses such as Dengue fever and Chikungunya and determine the proper treatment for you. Above all, the treatment for Zika is supportive rather than curative- meaning lots of fluids, lots of rest, and time. The symptoms of the virus can last 2-7 days. Keep in mind that many, if not most, people who have Zika do not have any symptoms at all. That means that Zika can spread more easily, as infected people can remain active and exposed to mosquitos that will transmit the virus by biting an infected person and then an uninfected person and transferring the virus. Keep protecting yourself with insect repellent as needed and safe sex practices.
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.