Almost half of the U.S. adult population suffers from hypertension, or high blood pressure.  Many people don’t have symptoms, so they don’t realize they have it.  Hypertension is called the silent killer because it puts individuals at risk for heart disease, stroke, kidney failure, and other serious medical conditions.

How is blood pressure measured?

Blood pressure refers to the blood pushing against the arteries.  Blood pressure is measured in two numbers – systolic pressure and diastolic pressure.  The first number, systolic, measures the pressure in the arteries when the heart beats.  Diastolic pressure, the second number, measures pressure in the arteries when the heart rests between beats.  A normal blood pressure reading is less than 120/80 mmHg.

Tips for managing high blood pressure

If you have been diagnosed with high blood pressure, it’s important to take steps to help manage the condition.  The following lifestyle changes can help:

• Physical activity – Strive for 30 minutes of exercise five days a week.  Examples include walking, cycling, swimming, dancing, tennis, and gardening (including mowing and raking leaves).
• Maintain a healthy diet and weight – Eat a diet rich in fresh fruits and vegetables, whole grains, poultry without the skin, fish high in omega-3 fatty acids, nuts, legumes, olive oil, unsalted seeds (pumpkin, flax, sunflower), and low-fat dairy products.  Limit saturated fats and trans fats, salt, red meat, sweets, sugary drinks, fried foods, and process foods.  Limit alcoholic beverages.  Cut down on portion size and lose a few pounds, if necessary.  People who are obese may want to consider a medical weight loss program.
• Don’t smoke – Nicotine raises blood pressure and heart rate, narrows the arteries, and hardens their walls.  If you are a smoker, get help to quit.
• Get enough quality sleep – Blood pressure goes down during sleep.  Being awake for longer periods means blood pressure stays elevated.  Six to eight hours of uninterrupted sleep is recommended.
• Manage stress – Chronic stress and anxiety can contribute to high blood pressure.  Find ways to reduce stress such as meditation, hobbies, reducing caffeine, and regular exercise.

Next Steps

Sometimes lifestyle changes are not enough to lower blood pressure.  Prescription medications are available to bring blood pressure down to acceptable levels.  The physicians at RMD Primary Care can evaluate your blood pressure and answer any questions you may have.  If it has been a while since your last physical exam, contact us today to schedule an appointment.

Fall offers a bountiful harvest of healthy seasonal produce to incorporate into your diet.  Not only are these fruits and vegetables delicious, but studies have shown that many are packed with vitamins, minerals, antioxidants, and dietary fiber.  They may also help protect against heart disease, diabetes, and obesity.  Most fall produce is readily available at grocery stores and local farmers markets, and it stores well at home until you are ready to use it.

The following fall season fruits and vegetables are among the best nutritional choices:

Apples

Hundreds of varieties of apples are available and at their best in the fall.  Apples contain  vitamin C, potassium, and antioxidants.  They are rich in dietary fiber, which aids in digestive health and moderates blood sugar levels.  Apples are delicious eaten raw or cooked.

Pears

Pears are another fall season fruit rich in fiber, vitamins, potassium, and copper.  The antioxidants in pears support immune health, reduce inflammation, and may help improve insulin sensitivity.  Pears can be eaten raw, baked, grilled, or in salsas.

Dark Leafy Greens

This category includes spinach, kale, Swiss chard, arugula, and collard greens.  These vegetables are low in carbohydrates, cholesterol, sodium, and calories.  They are good sources of vitamins, minerals, antioxidants, and fiber.  Besides salads, these greens can be added to soups, pesto sauce, stir-fry, wraps, or steamed as a side dish.

Broccoli

This fall vegetable contains many vitamins including A, D, E, K, and B vitamins.  One cup of broccoli provides as much vitamin C as an orange.  Broccoli is also a source of calcium, iron, potassium, and zinc.  The sulforaphane in broccoli has been shown to have anti-cancer properties.

Carrots and Parsnips

These closely related vegetables are good sources of fiber, vitamins C and K, and other nutrients.  They contain both soluble and insoluble fiber, which aids in digestion.  They can be prepared in many ways and used in salads, soups, stews, purees, and casseroles.  Although parsnips are usually eaten cooked, they can be eaten raw.

Brussels Sprouts

Brussels sprouts are related to cabbage, kale, and broccoli.  They are low in calories and a good source of protein.  In addition, brussels sprouts are high in calcium and vitamin K.  Roasting them in the oven reduces the harsh taste that some people dislike.

Winter Squash

Although the name suggests another season, winter squash becomes available in early fall.  Technically a fruit and not a vegetable, they have a long shelf life and can be stored for several weeks.  Popular varieties include acorn, butternut, delicata, and pumpkin.  Winter squash is rich in vitamins A and C, potassium, fiber, and antioxidants.  The seeds can also be roasted and eaten.

Next Steps

The physicians at RMD Primary Care are happy to answer questions about maintaining a healthy diet.  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.

Urinary tract infections (UTIs) can occur at any age, but the incidence increases as people age.  It is among the most common infections in older adults, particularly those living in nursing homes and other long-term care facilities.  The infection is more prevalent among women than men, although men with an enlarged prostate are also at greater risk.

 What causes UTIs?

UTIs are caused from bacteria entering the urinary tract.  The infection can affect any part of the urinary tract, although most infections typically involve the bladder and urethra.  More than 90 percent of bladder infections, or cystitis, are caused by E. coli bacteria from the intestines.  A serious UTI can spread to the kidneys.

Why are UTIs common in the elderly?

Many elderly have weakened immune systems.  That makes it more difficult for them to fight infections.  Diabetes and other diseases can weaken the immune system.  The elderly may not be drinking enough fluids, especially water.  Fluids help people urinate more frequently, allowing bacteria to be flushed from the urinary tract.  The elderly may fail to change urinary incontinence pads when wet.  Seniors that have a urinary catheter are also more prone to develop UTIs.

What are symptoms of UTIs?

Younger people who develop a UTI may have symptoms that include a frequent urge to urinate, pain or burning when urinating, pain in the lower abdomen, cloudy or odorous urine, blood in the urine, and fever.

Elderly adults can develop these same symptoms, but they may also have some entirely different symptoms that many don’t associate with a UTI.  Other symptoms in older adults can include a sudden change in behavior, poor motor skills, loss of coordination, falls, restlessness, agitation, confusion, delirium, and hallucinations.  Doctors are not sure why some of these symptoms differ so much from younger people with UTIs. 

How are UTIs treated?

UTIs are treated with antibiotics to kill the bacteria.  It’s important to take all the medication, even if feeling better.  Elderly adults with symptoms such as confusion or delirium, are sometimes given antipsychotic medication to reduce stress and agitation.

Older adults with UTIs may need the help of family members to ensure they take their medication and receive proper care to prevent reinfection.  Those living in long-term care facilities will have to depend on staff and caregivers to help them heal and take preventive measures to prevent recurring infections.

Next Steps

UTIs are a common health problem for older adults, and they particularly affect women’s health.  The physicians at RMD Primary Care are happy to answer your questions about urinary tract infections.  Contact us today to schedule an appointment.  

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

• 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.

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. 

According to the Georgia Department of Public Health, tick-borne illnesses increase during the spring and summer months.  Ticks are more active as the weather gets warmer.  They live near the ground in wooded and brushy areas and attach to people as they walk through these overgrown areas.  People who camp, hike, hunt, and participate in similar outdoor activities are at risk of exposure to ticks.

There are several tick-borne diseases that can affect Georgians.  Some may be familiar while others are lesser known illnesses.

Rocky Mountain Spotted Fever

This bacterial infection is carried by wood ticks and dog ticks.  A characteristic symptom is a red rash that starts on the wrist and ankles and then spreads up the arms and legs to the trunk.  Other symptoms include a high fever, fatigue, severe headache, chills, muscle aches, and joint pain that start within a week after the tick bite.  The infection is treated with antibiotics.

Ehrlichiosis

This bacterial infection causes flu-like symptoms including moderate fever, chills, severe headache, vomiting, diarrhea, loss of appetite, and sometimes a rash in children.  Can be treated with antibiotics but causes serious complications if left untreated.

Anaplasmosis

Although caused by a different bacteria, this disease has symptoms similar to those of ehrlichiosis.  A rash is rare with anaplasmosis.  Can be treated with antibiotics.

Lyme Disease

Deer ticks spread the bacteria that causes Lyme disease.  Prevalence in Georgia is low, although people that visit New England, mid-Atlantic states, and the upper mid-west may become infected.  The characteristic symptom is a red rash at the site of the bite that resembles a bulls-eye.  Other symptoms include fever, headache, tiredness, muscle aches, and joint pain.  Lyme disease can be successfully treated with antibiotics in the early stages.

Heartland virus

Scientists at Emory University recently confirmed that this tick-borne disease has been found in lone star ticks in Georgia.  These ticks have a distinctive white spot on their backs.  Symptoms include high fever, diarrhea, muscle pain, and low white blood cell and platelet counts.  Cannot be treated with antibiotics.

Prevention of Tick Bites

Stay on clear paths as much as possible.  Wear long sleeved shirts and pants with pants legs tucked into socks. Light colored clothing makes it easier to spot ticks before they attach.  Use insect repellant and shower soon after coming indoors.  Conduct visual checks on the body for ticks.

Tick Removal

Grasp tick firmly with tweezers and pull until tick releases from skin.  Clean the bite with soap and water and wash hands thoroughly.  Use alcohol on the bite site.

When to Call the Doctor

Contact RMD Primary Care if the tick has been attached more than 24 hours or if the entire tick cannot be removed.  Call if the bite becomes infected or if symptoms such as fever, headache, unusual fatigue, joint pain, or stiff neck develop.  The medical staff at RMD Primary Care is happy to answer your questions about tick bites. 

Urinary incontinence is a bladder issue affecting nearly twice as many women as men.  It’s often called overactive bladder.  It can be an embarrassing problem since the loss of bladder control can lead to leaking urine.  A strong, sudden urge to urinate occurs when the bladder muscles tighten and sphincter muscles around the urethra, the tube through which urine leaves the body, are not able to hold the urine in.  Male incontinence may be brought on by an enlarged prostate, diabetes, or Parkinson’s disease.  Women are more likely to develop urinary incontinence because muscles may have been weakened during pregnancy and childbirth.  Hormonal changes due to menopause can also cause incontinence, making it a common women’s health issue.  Aging may also be a factor, but incontinence is not an inevitable part of the process.

Two common types of urinary incontinence are stress incontinence and urge incontinence.

Stress Incontinence

Stress on the bladder causes urine to leak out.  Coughing, sneezing, laughing, sudden movements, and physical activity can put enough stress on the pelvic floor muscles to cause urine leakage.  Women of any age can be affected.  Kegel exercises that strengthen the pelvic floor muscles can help reduce problems with incontinence.

Urge Incontinence

Leakage may occur after a strong, sudden urge to urinate.  It sometimes happens as people are sleeping.  Others feel the urge to urinate more frequently, typically more than eight times per day.  When they do use the bathroom, not much urine comes out, or they are unable to empty their bladder completely.

Are there treatment to help?

Some surgical and non-surgical treatments are available.  Pelvic floor exercises, vaginal inserts, medications, and avoidance of caffeine and alcohol are some of the first-line treatments that may be recommended.  Caffeine can irritate the bladder and alcohol acts as a diuretic.  Natural products including cranberry tablets and turmeric may help relieve symptoms of overactive bladder.  If conservative treatments have not worked, surgery may be an option for some women.  Severe symptoms may be improved by a sling procedure to support the bladder or a bladder neck suspension procedure.  The recommended procedure will depend on the patient’s type of incontinence.

It is not recommended to limit water intake as water keeps the body hydrated.  Dehydration causes the urine to be more concentrated, which actually irritates the bladder.  Drinking water also helps prevent urinary tract infections.  However, people dealing with incontinence may want to limit their fluids right before bedtime to prevent accidents during the night.

Next Steps

It may be time to talk to your doctor if urinary incontinence is negatively impacting your quality of life.  If you are embarrassed by leakage or avoid certain activities to prevent urinary leaks, it isn’t something you just have to learn to live with.  The physicians at RMD Primary Care are here to help.  Contact us today.

These medical conditions that sound alike are both aspects of diverticular disease, a disorder that affects the large intestine, or colon.  Diverticulosis is the less serious of the two conditions.  Approximately half of people over age 60 have diverticulosis, and the rate increases with age.  Many people are unaware they have it since they may not have noticeable symptoms.

What is diverticulosis?

Diverticulosis means that small bulges or sacs have formed in weakened areas along the walls of the colon.  It is not known why they form.  These bulges may be discovered when a patient has a routine colonoscopy, a procedure that is done to look for early signs of cancer of the colon or rectum.  These bulges are not dangerous, don’t usually cause a problem, and don’t typically need any treatment.  Doctors often advise patients to eat more fiber, fruits, and vegetables in their diet as a preventative care measure.  Fiber helps soften the stool and makes them easier to pass.  It reduces constipation, which puts greater pressure on the colon.  Drinking plenty of water each day also helps prevent constipation.

What is diverticulitis?

Diverticulitis occurs when one of the bulges or sacs becomes inflamed or infected.  Bacteria can grow in the sacs, which triggers inflammation.  Some of the complications of diverticulitis include intestinal blockage, bleeding, perforations or tears in the intestine, abscesses in the abdomen, and peritonitis.  Diverticulitis can be quite serious.  Surgery may be required in some cases.  Symptoms of diverticulitis include abdominal pain on the lower left side, nausea, vomiting, fever, chills, constipation, and rectal bleeding or black tarry stools.

Treatment for diverticulitis

Treatment may include pain medication, antibiotics, clear liquid diet, and bowel rest.  Hospitalization may be necessary if there is a perforation, so that the patient can receive intravenous antibiotics and fluids.  A CT scan with contrast may be used to diagnose the condition and later check for healing after a course of antibiotics.  A complicated attack of diverticulitis is often followed by a colonoscopy in 4-6 weeks to rule out colon cancer.  Chances of a full recovery are very good when the patient receives prompt medical care.

Who is at risk?

Risk factors for diverticular disease include the following:

• Being over age 50
• Eating a diet low in fiber and high in animal fat
• Obesity
• Lack of exercise
• Regular use of non-steroidal anti-inflammatory drugs such as ibuprofen, naproxen, high-dose aspirin, diclofenac, and celecoxib.  Use of opioids.
• Smoking

Next steps

The physicians at RMD Primary Care can answer your questions about diverticular disease.  Contact us today for an appointment.

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 loss.  Contact us today for an appointment.

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.

Smoking

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.

Diabetes

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.

Obesity

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.