Signs of Gallbladder Disease

People generally don’t give much thought to their gallbladder until they begin to have problems with it.  Many don’t know what the gallbladder does, other than it has something to do with digestion.  Gallbladder issues affect approximately 15 percent of the U.S. population and often require medical treatment.  Those at risk for gallbladder disease include people over age 40 who are overweight.  Women are twice as likely as men to have problems.  People with diabetes and those with a family history of gallbladder disease are also at higher risk.

What is the function of the gallbladder?

The gallbladder is a small organ located in the upper right of the abdomen, under the liver.  The liver produces a liquid called bile, which is stored in the gallbladder.  The stomach signals the gallbladder to release bile into the small intestine to help break down fats.  Bile is released through a series of tubes called bile ducts.

Two Common Gallbladder Problems

Gallbladder with stone.
  • Gallstones – These are bits of crystallized bile that can develop in the gallbladder.  They may cause no symptoms at all, or they can cause pain, inflammation, and nausea.
  • Cholecystitis – This is inflammation of the gallbladder, often caused by a gallstone blocking a bile duct.

Symptoms of a Gallbladder Attack

  • Abdominal pain in the upper right side, under the rib cage.  Pain can last several hours and may even be mistaken for a heart attack.
  • Nausea or vomiting
  • Fever and chills
  • Light-colored stools
  • Brownish urine
  • Yellowing of the skin or whites of the eyes (jaundice)

Treatment Options for Gallstones

  • Medication for pain
  • Antibiotics to treat infection
  • Medication to break down the stones
  • Lithotripsy – Non-surgical procedure using shock waves to break gallstones into pieces small enough to pass
  • Surgery to remove gallbladder. This can be done laparoscopically in a minimally invasive procedure.

Ways to Prevent Gallbladder Disease

  • Maintain a healthy weight through diet and exercise.  Obesity increases the risk factor.
  • Eat foods high in fiber including whole grains. 
  • Eat fresh fruits and vegetables.
  • Eat more foods that are low in refined sugars.
  • Avoid foods high in fats.  Choose low fat dairy and lean meats, fish, and poultry.
  • Avoid very low calorie diets and rapid weight loss.
  • Get regular exercise.

Next Steps

The physicians at RMD Primary Care are happy to answer your questions about gallbladder disease.  If it’s been a while since your last physical, it may be time to see one of our doctors for a checkup.  Contact us today to schedule an appointment.

Health Tips for Men Over 50

Men over age 50 can continue to enjoy healthy and active lives.  Sometimes this involves making lifestyle changes to address particular health concerns that often accompany aging.  Many older men develop chronic diseases such as high blood pressure, diabetes, and heart disease.  Some of the risk factors for these health issues are out of our control including age, race, and family history.  However, other risk factors and lifestyle choices can be controlled.  The following tips can help men over 50 to stay fit and healthy.

Stay Active

Regular exercise helps keep the body healthy and flexible.  It also relieves stress, elevates mood, and can improve brain function.  An active lifestyle improves heart health, helps maintain muscle strength, and reduces the risk of some diseases.  Aerobic exercise gets the heart pumping, and strength training builds muscle.  Men who have not been active should discuss any new exercise plan with their physician.  The CDC recommends 30 minutes of exercise, five days a week for men aged 50 and over.

Quit Smoking

Men who smoke should quit.  Those who kick the habit will have more energy and breathe better.  Quitting smoking reduces the risk of high blood pressure, stroke, and heart disease.  Those who have difficulty quitting should consult their doctor for help.

Lose Weight

Gaining weight is not a normal part of aging.  Obesity is a risk factor for diabetes, heart disease, and some types of cancer.  Excess weight puts stress on the bones, muscles, and joints.  Osteoarthritis of the hip and knee are associated with obesity.  Being overweight affects our ability to be active and negatively impacts quality of life.  Contact your doctor for help with medical weight loss.

Maintain a Healthy Diet  

A diet that is lower in fat, sugar, and sodium can reduce the risk of developing high blood pressure and heart disease.  Cut back on the amount of processed foods consumed, and eat more fruits, vegetables, and lean meats.  Eating complex grains and more fiber promotes regularity and colon health.  

Drink in Moderation

Alcohol should be limited to two drinks per day.  Alcohol use can worsen some health conditions including diabetes, high blood pressure, stroke, ulcers, osteoporosis, and memory loss.  Mixing alcohol with many medications can be dangerous.  In older adults, consuming too much alcohol can lead to balance issues and falls.

Get Regular Health Screenings

Men over 50 should see their doctors for regular checkups and health screenings.  Health screenings should including blood pressure, cholesterol, colon cancer (colonoscopy), prostate cancer (PSA blood test), and type 2 diabetes (Fasting plasma glucose test and A1C test).

Next Steps

If it’s been a while since your last physical, it may be time to see a doctor for a checkup and men’s health screenings.  The physicians at RMD Primary Care are here to answer your questions about men’s health issues.  Contact us today for an appointment. 

Menopause and Weight Gain

Many women have trouble maintaining their weight after menopause.  Post-menopausal women gain five extra pounds on average.  Weight gain can be the result of hereditary factors and lifestyle choices.  However, it may also be due in part to hormonal changes.  Lower levels of estrogen after menopause make women more likely to gain weight around the abdomen.

The body’s metabolism naturally slows down as women age.  Muscle mass decreases and fat increases.  Women often find that they will either have to decrease the amount they eat or increase their physical activity to maintain their weight at pre-menopausal levels.  A combination of aerobic exercise and strength training helps women maintain a healthy weight.  Healthy eating also plays a large role.  Women should eat 200 fewer calories a day after menopause and concentrate on a diet containing lean meats, fruits, vegetables, and whole grains.  They should stay away from processed foods, skip the sweets, and limit alcohol.

Health risks of weight gain after menopause

While weight gain at any time comes with potential health implications, there are certain health risks that come with weight gain after menopause.

  • High blood pressure – Hypertension increases the risk of heart attack and stroke.  It damages the blood vessels and overworks the heart.  Many people with hypertension don’t realize they have it since there are not always symptoms.
  • Diabetes – Hormonal shifts can contribute to blood sugar reaching problematic levels during and after menopause.  A reduction in levels of estrogen and progesterone affect how the body uses insulin and can lead to insulin resistance.  Diabetes can increase the risk for serious health implications for women including cardiovascular disease, kidney disease, blindness, and depression.
  • High cholesterol – Estrogen helps regulate cholesterol levels.  Reduced levels of estrogen following menopause may cause the bad cholesterol (LDL) to increase as well as triglycerides.  This is another risk factor for cardiovascular disease.
  • Cancer – Excess weight increases the risk of some types of cancer including breast and colon cancer.
  • Osteoporosis – There is a direct relationship between lower levels of estrogen and osteoporosis.  Bone loss increases the risk of fractures in post-menopausal women.   Early bone loss is called the “silent” disease due to its lack of symptoms.  Women who stay active, do weight bearing exercises, and quit smoking may reduce their risk for developing osteoporosis.
  • Heart disease – This is the number one cause of death for women.  Menopause doesn’t cause heart disease but does elevate certain risk factors including hypertension and high cholesterol.  Regular checkups with your healthcare professional can help women to identify potential risks before they become problems.

Next steps

The physicians at RMD Primary Care can answer your questions about women’s health, menopause, and medical weight lossContact us today for an appointment.

Protect Your Heart Health

February is recognized as American Heart Month, a time to raise public awareness of heart disease, or cardiovascular disease.  According to the American Heart Association, heart disease is a significant health challenge.  It accounts for one-third of deaths in the U.S.  Many of these deaths are the result of heart attacks, stroke, or coronary artery disease.  The CDC cites heart disease as the leading cause of death for people of most racial and ethnic groups in the U.S.

There are three key risk factors for heart disease:  high blood pressure, high cholesterol, and smoking.  Other conditions that contribute to the risk for developing heart disease include diabetes, obesity, a sedentary lifestyle, and heavy alcohol use.  Let’s examine how these factors increase our risk.

High blood pressure (hypertension)

Blood pressure is determined by the amount of blood the heart pumps and the amount of resistance to blood flow in the arteries.  When the arteries become narrow due to plaque buildup, blood pressure goes up.  The heart has to work harder than it should.  Uncontrolled high blood pressure causes serious heart complications including heart attack, stroke, aneurysm, and heart failure.  Some effective ways to reduce blood pressure to more normal levels include getting more exercise, losing weight, eating less sodium (salt) in your diet, quitting smoking, reducing stress, and taking medication.

High cholesterol

LDL is the bad kind of cholesterol that is the main source of plaque.  When plaque builds up along the walls of the arteries, it causes them to narrow.  If blood supply to a portion of the heart is completely blocked, the result can be a heart attack.  Cholesterol levels can be controlled through diet and medication.


Smokers are more likely than non-smokers to suffer heart attacks.  The nicotine in tobacco increases blood pressure, causes more blood clots, and results in less oxygen reaching the heart.


High blood glucose levels can be damaging to the blood vessels.  Diabetics are more prone to have other coronary risk factors such as high blood pressure and high cholesterol.


Being overweight is linked to high blood pressure, high cholesterol and triglycerides, and impaired glucose tolerance.  All these factors contribute to heart disease.

Sedentary lifestyle

Physical inactivity puts people at greater risk for heart disease.  Adults should get at least thirty minutes of moderate daily exercise.  This can include various activities including walking, swimming, biking, gardening, stair climbing, and dancing.  Exercise also helps maintain a healthy weight and lowers blood pressure.

Alcohol use

Heavy alcohol use and binge drinking can lead to cardiomyopathy, a type of heart failure.  Alcohol is high in sugar content, so heavy drinking can contribute to obesity and raise blood pressure.  Alcohol can also affect the way some medications work.

Lower your risk factors

Many lifestyle changes can lower the risk of developing heart disease.  If you are overweight, establish healthy eating habits and get more exercise.  A Medical weight loss plan through a physician can help people be more successful in dropping excess pounds.  Stop smoking.  Within a year of quitting, the risk of heart attack drops significantly.  Get enough sleep to help relieve stress.  Avoid excessive alcohol use.

The physicians at RMD Primary Care can answer your questions about heart disease and medical weight loss.  Contact us today for an appointment.

Lactose Intolerance or Dairy Allergy?

Having a sensitivity to dairy products is fairly common in the U.S.  It can occur in childhood but often becomes more noticeable as people age.  Two common conditions are lactose intolerance and dairy allergy.  What is the difference, and how can these problems be managed?

Lactose Intolerance

People whose bodies do not produce enough of the digestive enzyme lactase will be lactose intolerant.  This means they cannot break down the sugar, or lactose, found in dairy products.  The condition becomes more noticeable as people age, because some people produce less of the enzyme lactase as they get older.  According to the National Institutes of Health, more than one third of American adults are lactose intolerant.  This may prevent them from getting enough calcium and vitamin D in their diet.  Lactose intolerance can be annoying and uncomfortable, but it is not dangerous.

When the body can’t break down lactose, people usually begin experiencing symptoms within 15-30 minutes after eating dairy.  Typical symptoms are bloating, gas, abdominal pain, cramping, and diarrhea.  Some people may be able to eat small amounts of dairy without having problems.  However, when they eat greater amounts, the symptoms get worse.  Lactose intolerance does not involve the immune system.  No antibodies are produced, and there is no inflammatory response.  The symptoms are generally limited to the GI tract.

Lactose intolerance can be treated several ways.  One way is to avoid dairy products altogether.  Another option is to buy dairy products, such as milk and ice cream, that are “lactose-free”.  Dairy free products are also widely available in grocery stores.  In addition, there are special digestive enzymes, like Lactaid, that can be taken with meals containing dairy.  This allows those with lactose intolerance to eat dairy foods with little or no discomfort.

Dairy Allergy

A dairy allergy, or sensitivity, is an immune response to one of the proteins found in cow’s milk, typically whey or casein.  It usually results in histamines being released, which generates an inflammatory response in the body.  This can produce a range of symptoms including GI issues, skin rashes, eczema, hives, congestion, joint pain, headaches, wheezing, and a tightness in the throat.  Dairy allergies are more commonly diagnosed in children.  Those with a dairy allergy should avoid all foods containing dairy.  This includes reading food labels to determine if milk or any milk proteins are contained in the product.

Next steps

If you suspect you may have lactose intolerance or an allergy to dairy, talk to your healthcare provider.  There are medical tests that can be done to determine the cause of your problem.  The physicians at RMD Primary Care are experienced in diagnosing lactose intolerance and allergies.  Contact us today to schedule an appointment.    

Don’t Abandon Exercise During the Holidays

Getting enough exercise during the holidays can be hard.  We are all so busy with shopping, cooking, social events, entertaining, and holiday travel.  With so many things to accomplish and extra demands on our time, it’s tempting to skip the exercise routine and focus on other things.  The colder temperatures and shorter daylight hours provide us with excuses not to get outdoors.  In spite of these challenges, we know that there are many health benefits to getting regular exercise.  For a lot of us, the holiday season is a time when we actually need it the most.

Benefits of regular exercise

Here are some benefits of continuing your regular exercise routine during the holidays:

  • Prevents weight gain – Exercise burns calories and helps us maintain a healthy weight.  People tend to consume more calorie-rich foods during this time of year.  We attend parties, entertain friends and family, drink more alcohol, and buy extra treats.  This translates into added pounds unless we do something physical to burn off the calories.  In addition to preventing weight gain, exercise helps us maintain muscle mass and sustain metabolic rate.
  • Alleviates stress – Exercise provides stress relief and reduces anxiety.  Physical activity can improve mood by stimulating the body’s production of endorphins, hormones that help us cope with stress and pain.  These “feel good” chemicals increase feelings of well-being and improve self-esteem.  They help us feel more relaxed and may provide better quality sleep.  Moderate exercise three times per week can raise endorphin levels.
  • Counters depression – Some people are affected by seasonal depression during the late fall and winter.  Fewer hours of daylight and lack of sunshine can bring on the “winter blues”.  Exercising outdoors for thirty minutes a day, three days a week during daylight hours can improve symptoms.

How to fit in a workout

  • Allow time in your schedule.  It can be a challenge to find time to exercise during the holidays, so be purposeful about it.  Remind yourself that you’ll feel better and have more energy if you try to stick to your exercise routine.
  • Be creative with your workout.  If you don’t have time to go to the gym, find other ways to get exercise.  Take a walk around the neighborhood or enjoy a bike ride.  Park farther away at the mall so you’ll get more steps.  If you can’t make your aerobics class, turn on some music and do a short workout at home.  Even a few minutes of exercise can keep you motivated.
  • Track your activity.  Use an activity tracker, fitness watch, or the health app on your cell phone to track daily progress.  This helps you be more conscious of your activity level.

Continuing a regular exercise routine during the holidays helps keep us on track.  It provides stability, helps us maintain sleep schedules, and helps compensate for the extra calories we consume.  It improves our mood and reduces stress in this hectic time of year.  Abandoning our workouts now makes it that much harder to refocus in January.

The physicians at RMD Primary Care can answer your questions about the health benefits of a regular exercise routine.  Contact us today for an appointment.

Reversing Insulin Resistance

Insulin resistance is often an unseen change in the body.  Many people don’t realize they have it, and there is not a specific test to diagnose it.  Your doctor may look at several other blood tests to determine whether you may be at risk.  High blood sugar levels, high LDL cholesterol, low HDL cholesterol, and high triglycerides are warning signs.  No one knows exactly why some people will develop insulin resistance, but having a family history of type 2 diabetes seems to increase the risk.

What is insulin resistance?

Glucose is the main type of sugar in our blood.  The pancreas produces insulin, a hormone that helps the body absorb and process glucose.  Insulin resistance occurs when there is too much glucose in the blood, preventing the body from using insulin effectively.  People with insulin resistance are at risk for developing prediabetes or type 2 diabetes.

Risk factors

Risk factors for insulin resistance are the same as those for prediabetes and diabetes.  A major factor includes being overweight or obesity.  Excess abdominal fat makes the body less sensitive to insulin.  A sedentary lifestyle, smoking, and not getting enough sleep also contribute to insulin resistance.  Additionally, there is a study associating high blood pressure and insulin resistance.

Addressing insulin resistance

The following are some lifestyle changes that can help reverse insulin resistance.

  • Weight loss – Make healthy food choices and monitor portion control.  Eat a balanced diet to keep blood sugar levels in check.  Choose more fruits and vegetables, whole grains, and lean proteins.  Eliminate processed sugars, carbohydrates, and saturated fats.  Avoid skipping meals as this leads to unhealthy swings in insulin and blood sugar levels.  These dietary changes can aid in weight loss.
  • Physical activity – A daily routine of physical activity can help with weight loss.  Exercise helps muscles use blood sugar for energy.  The body is more sensitive to insulin when we are more active, and our muscles are able to use glucose more effectively. 
  • Lower blood sugar levels – Manage your carbohydrate intake to lower blood sugar.  A low carb diet prevents blood sugar spikes.  Increase fiber intake, as fiber slows carbohydrate digestion and sugar absorption.  Stay hydrated so the kidneys can flush out excess sugar through the urine.
  • Reduce stress – According to the National Institutes of Health, studies show that chronic stress plays a role in insulin resistance.  Stress can affect blood sugar levels.  Getting enough sleep and making time in your schedule for relaxation can help reduce stress.
  • Get enough sleep – Lack of sleep is associated with weight gain, and excess weight disrupts the function of insulin responsive cells.

The physicians at RMD Primary Care can answer your questions about insulin resistance and medical weight lossContact us today for an appointment.

Is Fainting Serious?

Fainting happens when a person loses consciousness for a short time because of a lack of oxygen to their brain.  The medical term for fainting is syncope.  It may occur suddenly, such as when someone moves from a sitting or reclining position to a standing position.  The person may feel dizzy, lightheaded, or even nauseous during the episode.  Someone who has fainted will usually regain consciousness and feel better within a short time.

Is fainting common?

Fainting is fairly common, particularly in the elderly.  Sometimes fainting can run in families.  It is often not serious, and the person may not require any medical treatment.  However, there are some medical conditions that may contribute to fainting, and they should be identified.  In addition, fainting in the elderly can lead to falls and injuries.

What causes fainting?

A drop in blood pressure usually causes fainting.  This can happen when someone changes position quickly.  People may also experience this type of fainting when having blood drawn, getting an injection, being dehydrated, skipping meals, or from an emotional stress such as receiving upsetting news.  This is usually not serious and will quickly pass.

Taking certain medications can increase the risk of fainting.  These include medications for anxiety, depression, and high blood pressure.  People having certain medical conditions may be more prone to fainting.  Examples are diabetes, heart disease, low blood pressure, and anemia.

Should you see a doctor after fainting?

A person with no prior history of fainting should be checked out by a doctor to rule out any serious medical conditions.  The doctor will want a full medical history along with the names of any medications and supplements being taken.  Tell the doctor what activity immediately preceded thefainting episode.  Most people will be given an EKG (electrocardiogram), which shows the electrical activity of the heart.

How to prevent fainting

People who have fainted previously should avoid certain triggers that may cause them to faint again.  When feeling dizzy or lightheaded, they should immediately sit down to prevent falling.  Sitting with their head between their knees may help.  They can also lie down and elevate their legs to increase the blood flow to the brain.  They should change positions slowly when standing up.  Staying hydrated and not skipping meals helps people to avoid feeling faint.

If someone has fainted, try to position them on their back and loosen any restrictive clothing.  Raise their legs a little, if possible.  Check to see if the person is breathing and make sure there are no apparent injuries if the person has fallen.  When they regain consciousness, don’t allow them to get up too quickly.  Call 911 if they don’t regain consciousness within a minute or so.  

Obesity and Health Risks

Obesity is on the rise in the U.S.  Research shows that one in three people in this country is obese.  It has even become a problem in children and adolescents aged 2-19 years.  Obesity has been linked to a number of different health issues of serious concern.  Many people have found that obesity has impacted their quality of life.

Obesity is determined by calculating a person’s Body Mass Index (BMI).  There are formulas available to calculate BMI based on height and weight.  A BMI of 30.0 and above is considered obese.

The following list contains serious health risks that are linked to obesity.

Heart disease and stroke

Obesity can cause a lowering of good cholesterol, an increase in bad cholesterol levels, and an increase in triglycerides.  Obesity is a major risk factor in coronary artery disease, which is a buildup of cholesterol plaque in the arteries of the heart.  Obesity puts individuals at risk for atrial fibrillation, an abnormal heart rhythm, and increases their risk for heart failure.  Even moderate weight loss can reduce the risks in these areas.


Obesity is the leading risk factor for type 2 diabetes.  Diabetes increases the risk for heart disease.  Excess abdominal fat can make the body less sensitive to insulin by disrupting the function of insulin responsive cells.  This is known as insulin resistance.  Weight loss is an important goal in treating type 2 diabetes and may reduce the need for medication.

High blood pressure

Obesity is linked to high blood pressure (hypertension).  Obese people need more blood to supply oxygen and nutrients to their bodies.  The heart has to work harder to accommodate the need.  High blood pressure is a common cause of heart attacks.

Sleep apnea

Sleep apnea is a sleep disorder in which breathing repeatedly stops and starts.  According to the Sleep Foundation, excess weight creates fat deposits in the neck that can block the upper airway during sleep.  Excess fat in the abdomen compresses the chest wall, reducing lung capacity.  Lack of sleep is associated with weight gain, making it a vicious cycle.


Osteoarthritis is a chronic, progressive joint disorder that is strongly associated with obesity.  Being overweight puts extra pressure on joints like the knees and hips.  This speeds destruction of the cartilage.  Fat cells also release proteins that cause inflammation.  This increases the risk of developing osteoarthritis in non-load bearing joints such as the fingers and hands.

Some cancers

Many people do not realize that some cancers have been linked to obesity.  These include colon cancer, esophageal cancer, stomach cancer, liver cancer, kidney cancer, and pancreatic cancer.  Obese people often have chronic low-level inflammation, which is a risk factor for certain types of cancer.

RMD Primary Care offers medical weight loss services.  If you are looking for a healthy approach to weight loss, contact us today for an appointment.

B Vitamins and Women’s Health

Portrait of girl preparing meal with mother at home. Smiling woman is teaching daughter to prepare food. They are sitting at kitchen island.

B vitamins are vital in maintaining good health.  They help promote a healthy metabolism, play a significant role in nerve function, help in the formation of red blood cells, and are linked to a reduced risk of stroke.  Certain B vitamins are essential for normal brain development and for ensuring the immune system functions properly.  Eight B vitamins make up the B Complex.  All of them work together and are necessary for our well-being.

Importance for pregnant women

pregnancy, healthy food and people concept – close up of happy pregnant woman eating vegetable salad for breakfast in bed at home

Vitamin B9 is essential during early pregnancy to prevent birth defects of the brain and spine.  Doctors often prescribe a prenatal vitamin supplement to ensure women are getting enough.  B vitamins can also help reduce PMS symptoms, reduce anxiety, improve mood, and improve memory.

B vitamins are water soluble, meaning they are not absorbed and stored in fat cells in the body.  Excess amounts are eliminated in the urine.  Many women don’t get enough B vitamins in their diet, although most are readily available in common foods.

The 8 B vitamins

Here are the eight B vitamins, ways the body uses them, and how to incorporate them into our diets.

B1 – (thiamin)  Helps the body properly use carbohydrates.  Found in whole grain cereal, nuts, beans, and meat.

B2 – (riboflavin)  Necessary for normal cell growth and function; boosts the immune system.  Found in eggs, dairy products, meat, nuts, and green vegetables.

B3 – (niacin)  Improves cholesterol levels; boosts good HDL and lowers triglycerides.  Found in meat, poultry, fish, eggs, and greens.

B5 – (pantothenic acid)  Necessary for hormone production; helps the body properly use carbs, proteins, and lipids.  Found in organ meats, vegetables, cereal grains, eggs, dairy products, and legumes.

B6 – (pyridoxine)  Necessary for proper growth and development of the brain, nerves, and skin; helps the body use sugars, fats, and proteins.  Found in cereal grains, bananas, beans, spinach, lentils, eggs, and meat.

B7 – (biotin)  Helps break down fats and carbs.  Found in eggs, dairy products, and bananas.

B9 – (folate and folic acid)  Involved in the production of genetic material, DNA.  Found in leafy vegetables, okra, bananas, orange juice, and tomato juice.

B12 – (cyanocobalamin)  Helps maintain healthy metabolism, blood cells, and nerves.  Found in organ meats, beef, tuna, salmon, clams, sardines, and dairy products.

Vitamin B deficiency can result in symptoms that include anemia, fatigue, depression, eczema, hair loss, muscle cramps, and loss of appetite.  Talk to the health care providers at RMD Primary Care to learn more about B vitamins and women’s health.

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