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.

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.    

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.

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 loss.  Contact us today for an appointment.

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 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.

Diabetes

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

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 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

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.