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It is after hours and you are experiencing health-related concerns. Your PCP is not available; you have two options: urgent care or emergency room.  What is the difference and which one should you choose?

Simply put, the difference is the severity of the health problem. If the condition is life-threatening and your care may require rapid or advanced treatments, go to an emergency room. If you have a minor illness or injury that needs to be treated right away, but is not a true emergency, go to an urgent care.

At Rittenhouse Women’s Wellness Center, we encourage all of our patients to contact us if you are experiencing any type of health related issue. While in most cases we will recommend you come into our office to be evaluated, sometimes we will not be able to see you as quickly as an urgent care or an emergency room would. Even if we cannot be the ones to see you, we want to help you make a decision on what to do next.

As a guide…

Here are symptoms that are best evaluated in an urgent care:

  • Fever without a rash
  • Vomiting or persistent diarrhea
  • Abdominal pain
  • Wheezing or shortness of breath
  • Dehydration
  • Moderate flu-like symptoms
  • Sprains and strains
  • Small cuts that may require stitches

Here are symptoms that are best evaluated in an emergency room:

  • Chest pain or difficulty breathing
  • Weakness/numbness on one side
  • Slurred speech
  • Fainting/change in mental state
  • Serious burns
  • Head or eye injury
  • Concussion/confusion
  • Broken bones and dislocated joints
  • Fever with a rash
  • Seizures
  • Severe cuts that may require stitches
  • Facial lacerations
  • Severe cold or flu symptoms
  • Vaginal bleeding with pregnancy


Even though it is often referred to as, “the most wonderful time of the year,” the holiday season can also be very challenging for many.

While the festivities and the advent of a new year are fun and exciting, the holidays also present an endless amount of demands — parties, shopping, baking, cleaning, and entertaining, to name just a few.  As a result, many people find that they are faced with an increase in stress, anxiety and depression throughout the holiday season.  In fact, according to a poll by the American Psychological Association, eight out of ten people anticipate increased stress over the holidays. In some cases, the increase in stress and anxiety may even lead to depression.

However, there are many ways to minimize stress, anxiety and depression so you can relax and enjoy this time of year.  Try out some (or all!) of these tips for a happy and healthy holiday season:

  1. Be intentional with your actions and time. The first step toward discipline begins with you getting organized. Using a schedule is your best friend. But, each thing that fills a slot on your scheduling needs to be for a particular reason, not “just because.”
  2. Be selfish … in prioritizing your well-being. You can’t take care of others if you aren’t taking care of yourself! One of the first things people let go around this time of the year are their healthy routines and behaviors.  You don’t need to be perfect with your routine, but strive for consistency.
  3. Be health-conscious. Don’t let the holidays become a free-for-all. Overindulgence only adds to your stress and guilt.
  4. Get plenty of sleep. Make sure you are getting at least 7-8 hours of sleep per night.
  5. Get moving! Incorporate regular physical activity into each day. Even a 20 minute walk can help with fighting off anxiety and stress.
  6. Make some time for yourself. Find something that reduces stress by clearing your mind, slowing your breathing and restoring your inner calm.
  7. Be realistic about your expectations. The holidays don’t have to be perfect or just like last year. Life is messy, and beauty lies in the unexpected.
  8. Seek professional help if you need it. Despite your best efforts, you may find yourself feeling persistently sad or anxious, plagued by physical complaints, unable to sleep, irritable and hopeless, and unable to face routine chores. If these feelings last for a while, talk to your doctor or a mental health professional.


Winter is just around the corner—the days are getting shorter and the holidays are upon us. Winter can be a depressing time of year for many as the holidays wrap up, the hours of darkness increase, and the temps continue to drop. However, cooler temps have a number of health benefits including: the ability to burn more calories, fight infections, and clear up skin—all of which can make the holiday season and winter months a little brighter.

When exposed to the cold our bodies are constantly working to keep us warm and regulate our core body temps. This process uses a significant amount of energy and burns calories in the process. Exposing your body to cooler temps also helps to increase your amount of brown fat. Brown fat is mitochondria rich fat which helps to boost your metabolism making it easier to burn more calories and indulge in a few extra holiday treats.

Throughout the winter we are exposed to more viruses, such as the common cold and the flu. However, cold winter weather enhances our immune system. Studies have shown that stress-inducing conditions, such as exposing yourself to cold temperatures, activates the immune system. Additionally, during the winter months allergies are low and sleep is enhanced further increasing the body’s ability to fight infections. While we may be more at risk, we are better able to fight off infections in the winter months.

Lastly, cooler temps make for clearer skin. When skin is exposed to moderately cool temps the blood vessels constrict, meaning there is a decrease in blood flow to the vessels closest to the skin. This constriction leads to less redness and inflammation. Plus, during colder months your skin naturally produces less oil and sebum the culprit of acne breakouts. Despite these benefits winter can also be very drying to the skin so it is extremely important to continue to moisturize throughout the winter as much as possible to give your skin that nice flawless winter glow.

To read more about the health benefits of clearer skin you can follow this link.

https://www.netdoctor.co.uk/beauty/a27237/reasons-why-the-cold-weather-is-actually-good-for-your-skin



As Climate Week comes to an end, I would like to share some of the things I have learned over the past six months thanks to my daughter Julia and her increased involvement in preserving the environment. Not only was it a great excuse to spend time working on this article together, but we were able to collect categorized recommendations on how to alter everyday habits to better help the environment. While we are sure we have not covered everything, these tips are a great place to start.

Beauty Recommendations

  1. Use shampoo and conditioner bars. This will save on water, packaging and money since the bars last longer.  Some of the manufacturer’s include Lush (they will give you a free container of a face mask if you return 5 empty face mask containers!) Human Kind, Sterling Soap Company, Skin & Company, and Naples Soap Company.
  2. Use Safety Razors. These razors do not rust, are cost efficient, and are not plastic, therefore can eventually be recycled.
  3. Dental products. You can use Bamboo toothbrushes in place of plastic toothbrushes.  Tooth tabs can replace your toothpaste.  Biodegradable floss is also available.   If you are resourceful, you can make your own toothpaste, mouth wash, and deodorant.

Food

  1. Meatless Mondays. Cutting back on meat will contribute to less water waste and decreases your carbon footprint.
  2. Composting companies. There are entities that will pick up your compost (for a small monthly fee) or you can drop it off at a facility.  Two recommendations are Bennet Compost and Circle Compost.  Typically, there are composting areas located at Farmer’s Markets.
  3. Buying locally sourced foods and in season foods. This is healthy because there is not as much cost and carbon expense involved.  This also helps support local and often smaller businesses.
  4. Buy in bulk! This means that you can go to a local bulk store or Whole Foods (call ahead, not all of them have this option), whichever is more convenient.  Bring your own glass container or cloth produce bag, which can be an amazing way to stop using small plastic bags.  These containers can be used for cereal, vegetables, pasta, nuts, beans, etc.  If you are wondering what products can come in bulk, it is basically anything that a vegan could eat… grains, oils, candy, flour, and everything else I mentioned earlier! By doing this it cuts down one use plastic packaging.

Storage

  1. Water bottles. Metal water bottles are always the best option, because by using a single-use plastic water bottle, you are exposing yourself to microplastics that will contaminate the water by seeping into it. They are also extremely cost efficient. The average human spends over 1000 dollars on single-use plastic bottles per year, but you can change that by buying a good quality metal bottle that will last for an extremely long time.
  2. Bring your own supplies. I have to admit this takes getting used to. I remember being very surprised when I watched my daughter pull out a metal teaspoon from home so I would not use a plastic spoon supplied by the local ice cream vendor.   Bringing a reusable bag cuts down on needing to use a single-use plastic bag.   Other states and countries charge for supplying plastic bags, which is a good deterrent.  It has been nice to see stores supplies these reusable bags instead of paper or plastic bags.
  3. BUY GLASS/METAL. Seek out metal cans or foods stored in glass containers.  By buying items in these containers, you allow them to be recycled unlike buying the same product in a plastic container that will not biodegrade.

Miscellaneous:

  1. Earthhero is a good source for zero waste products. Like wax storage wrap, zero waste gum (it does not contain plastic and artificial ingredients like traditional gum) and bamboo or glass straws.
  2. Using the real stuff when you can. What I mean by this is, if you have access to silverware, glasses and plates, use them instead of plastic or paper plates.  Remember, paper plates have a plastic layer to keep them from breaking down easily, hence, not making them biodegradable.
  3. Using public transportation or carpooling whenever possible is an obvious way to cut down on our carbon footprint.
  4. Keep in mind that even when we recycle, these products needs to be stored or burned somewhere and this also contributes to pollution. Frequently, this takes place in poorer neighborhoods.  The goal is to have zero waste, so no one would be subject to extra pollution.

I would also like to recommend looking into joining some organizations that are helping to push these changes locally.  A group started by young activists is the Sunrise Movement and Philly Thrive is working to keep the pollution down by fighting to keep the local refinery closed.  Keep in mind, that any individual mindfulness is always going to be helpful, but the bigger changes need to come through industry changes, and we can be more successful as a group.


25/Sep/2019

I frequently get asked about what you can do to help with bags under the eyes. We are born with three fat pads under our eyes, and as we get older this fat can start to herniate. Swelling in this area can also be an issue with fluid accumulating around your eyes. The good news is, there are a few different options to treat bags under the eyes!

I always recommend starting with the least invasive treatments, and if you aren’t getting the results you wish, then you can move to the next option.

At-home Remedies that can help with bags under the eyes:

  1. Cool compresses. – Put 2 spoons in your freezer, and every morning place the spoons over your eyes for 5 to 10 minutes.
  2. Stay hydrated! This might mean to also cut back on your alcohol.
  3. Allergies can cause puffiness around your eyes. If you suffer from allergies, trying taking a Claritin or Zyrtec during the day and Benadryl at night.
  4. Sleep with an extra pillow so your head is elevated a bit more. This helps prevent the pooling of fluid in your face and around your eyes.
  5. SLEEP! It’s so important to get 8 hours of sleep!
  6. Cut back on the salty foods! Salt causes fluid retention and can make you puffy everywhere not just your eyes.

Next Step –> Skin treatments:

Microneedling – This treatment stimulates collagen and also helps with tone and texture of the skin. With this treatment, you won’t get instant gratification. You will need 3-6 treatments spaced about 1 month apart. The downtime is about 48 hours, in which you are red and should not wear any makeup. You also need to be careful about sun exposure after this treatment. To expedite the healing process and for better results, you can opt to include PRP (Platelet-Rich Plasma), also known as the Vampire Facial.

Next Step –> Injections:

HA (hyaluronic acid) Fillers are great for bags and hollowness under the eyes. It is the only form of filler that is safe to inject in this area. My favorite product to use for under eyes is Restylane. This procedure takes about 15-30 minutes and costs roughly $600. The results last about 1 year and you can expect 40%-60% improvement. It is extremely important you are being treated by someone with the correct credentials as well as someone who has been performing this treatment for years. There is potential for bruising so you want to make sure you don’t have any events coming up within the next two weeks. Results are instant but you can have a little extra swelling from the injections, this can take a few days up to two weeks to completely go away.

Next Step –> Surgery:

If all else fails, there is a surgery that you can have done that removes these 3 fat pads under your eyes. It’s called a Lower Blepharoplasty. Some Plastic Surgeons require you to have general anesthesia for this procedure, and others perform this procedure under conscious sedation. The actual procedure itself takes roughly 10-15 minutes per eye, there are no sutures and scaring as they make the incision inside your eyelid. You can expect to have a great deal of bruising and swelling in this area that can last a few weeks. The nice thing about this treatment, the results are fantastic and they are permanent



One of the top reasons patients come in to see their primary care provider is because they are having musculoskeletal pain or chronic pain. It is common for patients to want a “quick fix” or something that will take away their pain immediately, but non-pharmacologic pain management often has better outcomes and better long-term pain control. Additionally, it has been shown that the long-term use of pain medications have diminishing effects over time and can cause other chronic health problems.

Pain, especially chronic pain, does not always correlate to the physical state of the body but there are many contributing factors including sleep, nutrition, stress, and emotions. A non-pharmacologic approach to pain management includes, but is not limited to, physical therapy, exercise, acupuncture, and psychotherapy.

  • Physical therapy: Physical therapists are highly trained and skilled in assessment and diagnosis of causes of pain. They can prescribe exercises targeting your specific impairments and help you with lifestyle modifications and pain management strategies that can safely decrease pain symptoms. The results from physical therapy often have long-term benefits
  • Exercise: It is often thought that when in pain resting is the best method to ease discomfort, but it is actually shown to increase pain and cause weakness in the area. Gentle movements and walking can successfully decrease pain and prevent the area that is causing discomfort to become stiff or weak.
  • Acupuncture: Alternative modalities and holistic approaches to pain management have varying degrees of efficacy but many studies show that acupuncture is clinically proven to reduce pain with long-term benefits. Many insurance companies are now covering acupuncture services as pain management therapy.
  • Psychotherapy: Pain is often rooted in depression, anxiety or mental stress. Seeking care from a mental health professional or engaging in cognitive behavioral therapy can greatly reduce pain symptoms.


Before we get into all the reasons why an IPL photofacial is great, let’s cover the basics. For starters, an IPL (Intense Pulsed Light) therapy is used to treat sun damage, wrinkles, stretch marks and age spots. IPL is also known as photorejuvenation or photofacial. Treatments can be used to erase mild sun damage, brown spots, freckles or irregular pigmentation on the face, neck, chest, hands, arms, shoulders, back and legs. If you suffer from severe acne and experience issues combating the redness and inflammation caused by acne, IPL treatments can help. IPL can help eliminate large pores and thus reduce the appearance of acne on your skin without the need to constantly apply topical products that dry out the skin.

If you suffer from rosacea or any other type of skin condition that diffuses redness into the skin, IPL photofacial therapy is a great treatment solution for reducing the appearance of redness and helping create an even and natural complexion. Have you noticed any broken capillaries around your nose or on your cheeks? We can treat those with an IPL photofacial!

While IPL isn’t necessarily an anti-aging solution, it does have lasting effects in helping reduce the signs of aging such as wrinkles, sunspots and other indicators of aging. By treating a deeper layer of the skin, IPL stimulates collagen growth and helps improve the skin’s texture, reducing the appearance of fine lines and wrinkles.

Another great benefit of IPL photorejuvenation procedures is that they can be done in conjunction with other treatments such a microdermabrasion, chemical peels, Microneedling, and other facial skin treatments that target the outermost layer of the skin. Since IPL treatments target the deeper layers of the skin, they can safely be performed with other treatments that target the outermost layer of skin.



Getting an appropriate amount of restful sleep is important for a variety of reasons. Sleep effects our mental and cognitive function, our immune systems, and our general overall health. If we are not getting enough sleep, we may experience poor health outcomes including new or worsening anxiety and depression, obesity, and cardiovascular disease. Adults should get 7-9 hours of sleep each night. Unfortunately, about 1/3 of adults in the United States are not getting enough sleep.

There are many things that we can do to help improve our quality and duration of sleep. If you are struggling to get adequate sleep, try to incorporate at least a few of the following recommendations into your daily bedtime routine:

– Have a sleep schedule: Try to go to sleep and wake up at the same times each day.
– Avoid naps, especially later in the day.
– Limit caffeine during the day, especially within 4 to 6 hours of bedtime.
– Exercise daily: The current recommendations are to get 150 minutes per week of moderate-intensity exercise.
– Avoid using electronics at least 30 minutes before bed.
– Create a relaxing sleep environment: this may include a cool bedroom, blackout curtains or an eye mask, and a sound machine or ear plugs.
– If you wake up in the middle of the night and have trouble falling back asleep, go into a different room and participate in a relaxing activity until you feel drowsy enough to fall asleep again.



Many of us look forward to the summer: the warmer weather, the vacations, the longer days, the extra sunlight.

But for some, the summer months are not a relief from the seemingly endless winter months. For some, summertime brings on depression. Sometimes, summer depression has a biological cause, like a chemical imbalance, while other times, the particular stresses of summer can pile up and bring on feelings of sadness and depression.

It can be even more frustrating to feel like you are supposed to be happy and enjoying life because it’s the summer and instead, you are bogged down by depression.

Many are familiar with “seasonal affective disorder,” or SAD.  SAD typically causes depression as the days get shorter and colder.  What is less known is that people with SAD can actually get it in the reverse — the onset of summer triggers depression symptoms.

Specific symptoms of summer depression often include: loss of appetite, trouble sleeping, weight loss, and feelings of agitation or anxiety. Summertime depression can also create an increased feeling of isolation.

Here are some things that may cause an increase in summertime depression:

  • Disrupted schedules in summer. Our schedules can get shifted during the summer time months and often times, that disruption can offset depression especially with people who need a reliable routine to keep balanced.
  • Body image issues. Feeling unhappy and self-conscious about one’s looks in summer clothing can also increase depression.
  • Financial worries. Summers can be expensive. With vacation, meeting up with friends for a night out, dinners out, etc. spending can increase and thus, results in increased worry and depression.
  • The heat. It’s not enjoyable for everyone. It can be very oppressive physically and mentally.

So what do you do if you think you are suffering from summertime depression?

  • Get help. If you think you’re getting depressed, no matter what time of year, get help. See a psychologist, talk to your PCP, share with family and friends about how you are feeling.
  • Keep up with your exercise. Regular physical activity can help keep the risk and/or symptoms of depression down. But be careful not to overdo dieting and fitness.
  • Protect yourself. Don’t overextend yourself. Don’t feel obligated to do anything and everything. Take time for yourself.
  • Talk to your doctor about medication and/or adjusting current medications.


For many of us, summer is a wonderful time of year—the days are longer, offering more time to spend with family/friends, our moods improve, there are expanded opportunities for exercise, we go on vacation. At the same time, there are health considerations that we do not face during the rest of the year that can interfere with our enjoyment of these activities, if we’re not being careful.

For starters, there is the threat of sunburn and skin cancer, which most people are now aware of. To recap, you should apply a sunscreen with an SPF of 15 or higher 30 minutes before you will be out in the sun. Reapply completely every 2 hours or any time spent in the water. Try to avoid being out during the hottest hours of the day, between 10am and 2pm. Seek out the shade and stay covered when possible—hats, umbrellas, and clothing with an SPF factor are your friends!

Many people notice that they become more fatigued in the summer. This is due to a combination of factors. First of all, your body is working harder to maintain a safe body temperature in the heat. This is done primarily by sweating, which cools the body as it evaporates, and vasodilation, which dilates blood vessels near the skin and diverts more blood to this area to cool it down. Your heart rate and metabolic rate both increase to accomplish these efforts, utilizing more energy than your body normally does. In addition, if you are exercising in the heat, your body is also trying to divert adequate blood to your skeletal muscle to deliver oxygen to the working muscles. Combined with a lower blood volume (from sweating), this puts even more strain on your cardiovascular system. These changes also make exercise more difficult in the summer months, making you feel more fatigued after a workout. For some people, this fatigue can last for hours.

Finally, Exertional and Nonexertional heat illnesses, including Heat Exhaustion and Heat Stroke, are a real threat in the summer months. Heat exhaustion is characterized by the body’s inability to maintain adequate cardiac output (blood flow/delivery), combined with high body temperatures (101-104 degrees) and sometimes, dehydration. This typically manifests by collapse. Heat stroke is more serious, consisting of high body temperatures (>104 degrees) and central nervous system dysfunction, such as seizures or confusion, and multi organ system damage (heart, kidneys, muscle, etc.). This is an immediate medical emergency. The initial treatment for both of these conditions is rapid cooling of body temperature (most important), fluid/electrolyte replacement, and more aggressive medical intervention if needed.

So how do we avoid unpleasant or dangerous outcomes from the heat? Common sense measures, such as those noted above, combined with staying well hydrated (with water, smoothies, juices, and fruits/veggies that replace minerals lost through sweating) are key. Wear loose clothing that is designed to breathe. Limit outdoor workouts to earlier or later in the day, decrease the intensity of your usual workout, and consider shortening your workouts for a couple of weeks in the early summer to give your body time to acclimate to the hotter temperatures (this allows your body to expand blood volume, improve blood flow to the skin, and decrease the threshold at which sweating starts, among other adaptations that help to manage the heat). Be aware of factors that can decrease your heat tolerance and increase the risk of poor outcomes. Those at risk for heat illness include people who have sweat gland dysfunction, those who have viral/bacterial illness, those who use alcohol before/during time in the heat, and those on certain medications that interfere with cardiac function, heat response, or fluid/electrolyte balance. Such medications include blood pressure medications like ACE inhibitors or ARBs, antihistamines/decongestants, stimulant medications, and beta-blockers.


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1632 Pine Street
Philadelphia, PA 19103
Phone: 215-735-7992
Fax: 215-735-7991
Email: info@rwwc.com

Hours

Monday – Thursday:  8am – 8pm

Friday: 8am – 4pm

Saturday: 9am – 2pm

Sunday: Closed

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