If you’ve been looking at menus or walking through the grocery store, you’ve likely noticed more and more items labelled “gluten-free”. Why? Who is avoiding gluten and why are they doing it? Why was there a three-fold increase in gluten-free diets when there has been no increase in the medical diagnosis of related diseases?
In honor of National Celiac Awareness Day, we’re talking about gluten. Gluten is a protein found in grains- wheat, rye and barley- and helps give an elasticity to these flours in cooking and baking. These grains are found in breads, pastas, soups, cereals and other baked goods. People can be affected by gluten in a few ways.
First, some people have an immediate allergic reaction to wheat and/or another grain. This is a more obvious reaction and easier to diagnose by blood tests looking for antibodies and skin testing looking for skin reactions. These must be treated by avoidance of the grain. There are no medications or allergy shots for food allergies- yet.
Second, people can be affected by the gluten found in wheat, rye, and barley. This can be found in a serious autoimmune form known as Celiac disease or in a milder form called gluten sensitivity. Certain individuals, about 1 in 100 people, have Celiac, a genetic condition where the body attacks the small intestine when gluten is ingested. This can cause lifelong effects and increases one’s chances of having other autoimmune diseases. The only treatment is avoidance of gluten. Blood tests can be performed to help diagnose this disease. Gluten sensitivity is something we don’t yet have conclusive testing for, but studies have shown that people without Celiac can still have damage to their small intestines if they are sensitive to gluten. Therefore, these individuals should still avoid gluten.
Are you avoiding gluten, or limiting your intake? Is it for health or weight loss? Did you have fatigue, digestive or other symptoms that have improved since you went off gluten? Or are you being encouraged by a friend or family member to eliminate it for a month? If you have a family member with confirmed celiac, or if you have an autoimmune disease you should get tested for celiac before you stop eating it. The blood tests are accurate only when you are actively eating (or drinking) gluten.
Going gluten-free is much easier now than it was 16 years ago when a member of my family was diagnosed with a wheat allergy. We are happy to discuss these issues with you, do any appropriate testing, and manage any diseases that are found.
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.
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]
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.