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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.



What comes to mind when somebody says the word “physical activity”? Do you think of the walk you took to get from the garage to work this morning? Or the stairs you climbed on your way out of the subway?  What about the word “exercise”? If this word provokes different thoughts I am not surprised. You might have visions of sweating it out in spin class and loving every second of it, or maybe you have a feeling of dread as you picture dragging yourself to the gym. In celebration of May’s National Physical Fitness and Sports Month, I want to tell you that physical activity is what matters! You might spend an hour in the gym, but what happens during the other 23 hours is crucial. Picture your typical day, you sit as you eat breakfast, you may sit as you commute to work, sit at a desk, sit at lunch, go to the gym for an hour, then sit at the dinner table or in front of the TV. Even athletes can be considered sedentary if their only physical activity is during the hours when they are exercising!

This month, challenge yourself to think about physical activity as a way of life. What errands can you run on foot today? If you have a phone call to make, can you do it while walking or pacing? If you are stuck at your desk for hours in a row, can you make a point to stand up and stretch every hour? Can you stretch while you watch TV at night?

If you need some motivation…

Here are some fun facts on how physical activity can help prevent or reduce health conditions:

High blood pressure: Two brisk 10-minute walks a day can help to prevent high blood pressure. Think of this like your daily dose of movement medicine. As you start your walk, your body sends blood that contains oxygen and energy to your muscles so that they can propel you forward. This rush of blood exerts pressure on your veins causing them to loosen slightly so that more blood can flow through. By asking your veins to loosen twice a day every day, you are preventing stiffness!

High blood sugar: After you eat a meal that is high in carbohydrates your body will digest those carbohydrates and turn them in to sugar which will stay in your blood stream until your cells take it up for energy. If you have diabetes or pre-diabetes this state of high blood sugar can make you feel pretty icky. Luckily, physical activity can help you to bring down your sugar. Going for a walk after a large meal can help your cells to take up the sugar and leave you feeling much better!



If you don’t have endometriosis, you’ve probably heard of it – it affects about one in ten women of reproductive age. Although the condition’s two main symptoms are pelvic pain and infertility, both are treatable, and women with endometriosis often go on to have healthy pregnancies.

If you are having pelvic pain or trouble getting pregnant then you should schedule an appointment with your practitioner and we can refer you, if necessary, to a specialist.

What is endometriosis?

Endometriosis is a condition where cells from the endometrial lining implant and grow outside of the uterus (including on the ovaries, the pelvic cavity and the fallopian tubes), causing inflammation and scar tissue that can lead to pelvic pain and infertility.

What are the causes of endometriosis?

There are several potential causes, including:

  • Retrograde menstruation: During menstruation, while most of the blood and tissue flows out of the vagina, a small amount of blood and tissue travels up backwards through the uterus and fallopian tubes and into the pelvic cavity. In most women, the immune system gets rid of that blood and tissue. By contrast, the immune system of women with endometriosis is unable to fully eliminate the backflow. Therefore, tissue from the uterine cavity is able to stick to and invade areas outside of the uterus. This is the most common cause of endometriosis.
  • Blood or lymphatic system spread: endometrial cells can spread to other parts of the body (the pelvic cavity in particular) through blood.
  • Coelomic Metaplasia: in this case, cells in other parts of the body unrelated to the uterus turn into endometrial cells.

What are the symptoms?

Pelvic masses, pelvic pain and infertility are the main symptoms of endometriosis. All of them can be treated, but not necessarily at the same time. In some cases, women with endometriosis have no symptoms at all and are diagnosed only after they seek a reproductive endocrinologist’s help in getting pregnant.

How is the condition diagnosed?

While checking for symptoms and performing a physical exam is an important first step, the only real way to diagnose endometriosis is through a biopsy obtained during surgery. There is no blood test for endometriosis.

How is endometriosis treated?

When treating endometriosis, it is important to first identify whether a patient is mainly concerned with addressing her pain or treating infertility. It is not always possible to simultaneously relieve a patient’s pain and also help her to become pregnant. If a woman is not looking to conceive and just wants to alleviate her pain, over the counter pain killers like Advil or Motrin, as well as hormonal treatments like birth control pills or the Mirena IUD, can help.

Patients whose main concern is pregnancy will likely require treatment with fertility medications and either artificial insemination or in vitro fertilization (IVF). IVF is the most effective treatment for infertility in patients with endometriosis because it bypasses pelvic scar tissue and enables the sperm and egg to meet in a controlled environment. However, even in IVF, women with endometriosis have slightly lower pregnancy rates than other individuals with infertility.

So I can get pregnant if I have endometriosis?

Yes, you read that right! You might need a little help through IVF, but you can get pregnant.


24/Jul/2018

An article from RMA Philadelphia

What is infertility?

Infertility is defined as the inability to get pregnant after six months of trying for women aged 35 or older and after one year of trying for women under the age of 35. Women who have been pregnant previously and have been trying for six months also fall into this category.

When is it time to see a doctor?

If the above definition of infertility describes your situation, it may be time to see a reproductive endocrinologist. Women with a history of irregular periods, endometriosis, pelvic surgery or infection, as well as previous radiation or chemotherapy should not wait 6-12 months prior to seeking care from a fertility specialist. In addition, men with a history of testicular cancer, radiation or chemotherapy, as well as other medical conditions, should seek evaluation.

What happens at that first patient visit?

You’ll meet with your reproductive endocrinologist, who will ask about your medical and family history, as well as how long you’ve been trying to conceive.

The doctor will perform a pelvic exam and vaginal ultrasound to evaluate your uterus and ovaries, and tell you about additional testing, such as blood work, a semen analysis and a procedure to assess your fallopian tubes.

If you decide to pursue evaluation, you can have your testing completed within four weeks of your first visit, at which point you will meet with your doctor again to design a plan for you.

That plan could include using medication to boost ovulation coupled with Intrauterine Insemination (IUI) or require a more high-tech approach like In Vitro Fertilization (IVF).

Are my chances of getting pregnant good?

It depends on your age, your specific situation and the clinic you choose, but women can feel confident going to a successful fertility clinic, especially because major advances in technology and science have improved success rates and lessened risk.

I’m seeing older celebrities getting pregnant – why should I worry?

While doctors are getting better at helping infertile women get pregnant, the time on the biological clock has not changed: at 35 years of age, a woman’s fertility begins to significantly decline, and it gets harder to get pregnant. The risk of miscarriage also increases. So while celebrities are having babies at an older age, it’s unclear whether those babies came from eggs or embryos that they froze when they were younger, or from donor eggs. While it is possible for women in their 40s to conceive naturally or through IVF using their own eggs, is it is uncommon.

I’m ready to talk to a specialist now. What’s next?

Congratulations on taking a proactive step to begin your family. The doctors at Reproductive Medicine Associates of Philadelphia are here to help. Begin your fertility journey by making an appointment today: 855.762.4672 or visit www.rmaspecialists.com.



February is heart healthy month. There has long been a debate about which organ is more important, your heart or your brain. While both may take equal importance, February’s focus on the heart has us talking about what we can do to keep our heart healthy.

At the top of the list is exercise. Even if you do not need to lose weight, cardiovascular exercise for 30 minutes, five times per week will keep your heart healthy. Besides burning calories and helping with keeping your blood pressure controlled, cardiovascular exercise helps build extra blood vessels which can save your life if any blood vessel becomes occluded. By having alternative blood vessels supplying blood to the same area of the heart that is not receiving a normal supply of blood, you avoid any permanent damage to that part of the heart.

Next and just as important is getting the proper amount of sleep. Recent studies show that getting less than 7-8 hours of sleep nightly may cause hormonal dysfunction that contribute to weight gain and elevated blood sugars. Even more obvious is that your heart rate decreases while sleeping, giving your heart time to recover from your day.

Diet is also clearly another key aspect to keeping your heart healthy. It is widely agreed that the Mediterranean diet is a heart healthy diet. The key components of this diet are: low fat proteins (beans, white meat, Tahini, low fat cheeses), olive oil, whole grains, nuts, bread (whole grain), veggies and fruit (instead of dessert). These foods should be fresh, not processed. Adding Mediterranean spices decreases the need for higher amounts of salt. An added plus is that some spices like Coriander and Rosemary are also antioxidants. To top off the diet: wine – another proven antioxidant. Because this diet is healthier and lower in calories, it often times produces weight loss. Antioxidant-rich foods are also brain friendly which keeps your brain sharper.

Hydration is another key element of heart health, especially in females who typically have lower blood pressure than men. Not being well hydrated can damage all of your organs – especially your heart. If your blood pressure is low and you are not well hydrated, you are at higher risk of getting dizzy and passing out.

While going about your days in February, let the red around you remind you that just like the four chambers in your heart, there are four easy things that you can do every day to keep your heart healthy. By giving love back to your heart, it will keep you healthy and will lead to a happy body and heart relationship!



Move More

Exercise is one of the most powerful things that you can use in your day-to-day life to improve your cardiovascular health, manage your weight, strengthen your bones, reduce stress, and possibly even prevent certain types of cancer. I tell all of my patients that exercise is truly like medicine for your body and for your mind. The ultimate exercise goal is to get at least 150 minutes of moderate-intensity physical activity (i.e. brisk walking) or 75 minutes of vigorous-intensity activity (i.e. jogging or running) per week, in addition to muscle-strengthening activities on 2 days out of the week. This might sound intimidating at first, but the good news is that you can spread out this time over the week in a way that is most convenient for your schedule. Even exercising just 10 minutes at a time is beneficial. You can also get creative – brisk walking and jogging aren’t the only ways to exercise. Anything that gets your body moving counts as exercise, so find something that makes you happy – anything from aerial yoga to zumba – and roll with it!

Eat Better

New Years is always the time of year when trendy crash or fad diets start to surge in popularity. These are never the most effective or sustainable options and are often times flat-out unhealthy. When it comes to your diet, small changes over time can make a big difference. One of the simplest ways to modify your diet and improve your health is to focus on increasing your consumption of fruits and vegetables. It is well-known that a diet rich in fruits and vegetables can decrease the risk of heart disease, stroke, high blood pressure, and diabetes. Another strategy for the New Year is to cook at home more and eat out less. That way, you have control over portion size and also all of the ingredients (including salt, oils, butter, etc.) involved in preparing your meal. For further dietary guidance and support, you can always schedule an appointment with one of our nutritionists at RWWC.

Drink Less

Alcohol is everywhere in our culture, and drinking is encouraged on many levels. We are constantly bombarded with promotional messaging about alcohol and it can be easy to get caught up in drinking habits that might, in actuality, be harmful to your health. The Centers for Disease Control and Prevention define “heavy drinking” for women as 8 drinks or more per week. One drink is defined as either 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of hard alcohol. “Binge drinking” for women is defined as having more than 3 drinks on one occasion. Heavy drinking has many short-term and long-term consequences for women, and in many cases these consequences are more pronounced than they are in men. These include increased risk for alcohol-related liver disease, memory loss and shrinkage of the brain, osteoporosis, and breast cancer. There are, however, beneficial effects of certain types of alcohol that are well-documented, such as improvement in cholesterol and cardiovascular health – the key here is moderation.

Quit Smoking

It should be no surprise to anyone that smoking is extremely harmful to your health and will shorten your life. Any degree of tobacco use, whether it’s smoking a pack per day or social smoking, has serious consequences. Many are aware of the risks of lung and head/neck cancers caused by smoking, but some may not know that smoking damages many other organ systems. For example, smoking is the single most common preventable risk factor for bladder and kidney cancer, which are highly aggressive malignancies with few available treatment options. Toxic carcinogens inhaled during smoking do not only contact the upper airway and lung tissue, they are also absorbed into the blood stream and penetrate into virtually every organ. The kidney and bladder are particularly susceptible to damage from smoking because these toxins are concentrated in the urine and literally bathe the kidneys and bladder before they are excreted in the urine. Even if they are discovered early, often radical and disfiguring surgeries are required to control cancers of the genitourinary tract. With regards to women’s health in particular, cigarette smoking increases the risk of HPV-related cancers of the cervix and vulva and also increases the risk for recurrent vaginitis, especially bacterial vaginosis (also known as BV). If you smoke, quitting is the #1 best thing that you could do for yourself. We are here to help you if you are ready to quit smoking, so please do not hesitate to discuss this with your healthcare provider at your next visit.

Establish Care

If you have not had an annual wellness visit or gynecologic exam in some time, please be sure to put this on your to-do list for 2018. Even if you feel healthy and have not had any changes to your health in the last several years, there are likely to be preventive health measures that you might be missing out on. We can help to make sure you are up-to-date with your immunizations, cancer screenings, and routine bloodwork so that you stay as healthy as possible in the years to come.


10/Nov/2017

Gov. Tom Wolf signed a law legalizing medical cannabis in Pennsylvania in April, 2016. One of the medical marijuana facts for Pennsylvania that frustrated supporters of legalization was that it took so long to happen. The Pennsylvania Senate first approved a bill legalizing medical weed in 2015, but it was not approved by the entire legislature until March, 2016. Several technical changes needed to be made before both chambers could finally agree on a final bill.

In order to be able to recommend cannabis to their patients, physicians need to complete a four-hour course. They must sign a certificate stating that the patient not only has a qualifying condition, but also that the doctor believes that patient will be able to benefit from medical cannabis use.

There are several forms of cannabis that patients can use, including oils, pills, creams, ointments, liquids, gels and more. Vaporization is allowed, but not smoking of the plant. While dispensaries are not allowed to sell edible forms of weed, the law allows patients to mix medicinal cannabis into drinks or food in order to help them ingest it.

If you are a patient in another state, you are not allowed to access medical weed in Pennsylvania.



You have probably heard the phrase “Breast is Best” in reference to breastfeeding a newborn baby. The benefits of breast milk to an infant are widely touted and acknowledged. Such benefits include: decreased risk of sudden infant death syndrome, decreased risk of obesity in the child, and a decreased risk of asthma, allergies and infections including ear infections, respiratory infections and diarrheal illnesses. What are often not discussed are the benefits of breastfeeding to the mother. Here we bring you 7 important maternal benefits of breastfeeding.

1) Better healing post-delivery: The act of breastfeeding stimulates the release of the hormone oxytocin. This encourages the uterus to contract, returning to its pre-pregnancy size sooner and decreasing post-partum bleeding.

2) Greater calorie burn: This allows some women to lose the pregnancy weight a bit faster. Some studies have also demonstrated a lower amount of visceral fat in women who have breastfed. This is the fat that is stored around the abdominal organs and predisposes an individual to cardiovascular disease.

3) Decreased risk of cancer: Moms who have breastfed have a decreased risk of breast, ovarian and endometrial cancer. This benefit is even seen in patients with a family history of breast cancer.

4) Decreased risk of chronic disease: A number of studies have demonstrated a reduction in the risk of Type 2 Diabetes, high blood pressure and increased cholesterol among women who have breastfed. There is also some data to suggest a potential reduction in osteoporosis risk.

5) Provides a break from menstruation: While exclusively breastfeeding, ovulation is suppressed and menstruation is delayed. This is a convenience for the new mom and also helps with pregnancy spacing. (Though should not be considered a highly reliable form of birth control)

6) Promotes emotional health: Oxytocin and prolactin are important hormones in a mother’s stress response. The increased levels associated with lactation allow the mother to manage stress better and have a positive impact on social behaviors including maternal-infant bonding.

7) Saves money: It is estimated that breastfeeding an infant for the first year of life can save $400-$1000 even when accounting for the modest increase in food intake by a nursing mother. In addition, breast fed infants have less illnesses leading to less time away from the job for working parents.



There are two different types of IUDs: hormonal and non-hormonal.
We want to answer the 2 main questions that many women ask themselves when considering an IUD:  What is the difference? Which one is right for me?

Mirena
Mirena is the hormonal IUD that has been around the longest, and is currently approved for up to 5 years. Mirena was originally intended for women who have had children. However, studies have shown that it is perfectly safe and effective for women who have never been pregnant. Mirena is recommended to help manage women who suffer from heavy or painful periods. Most women on Mirena have reported that their periods get significantly lighter or go away completely. About one in five Mirena users stop having a period after a year, and one in three if they use it for a longer period of time.

Liletta
Liletta is very similar to Mirena. It contains the same dose of hormone and is approved for use up to 4 years. This IUD has also been approved for women who have never had children. Like the Mirena, your periods can get significantly lighter or go away completely.

Kyleena
Kyleena is smaller in size then the Mirena and has a lower dose of hormone then the Mirena/Liletta. Like the Mirena the Kyleena is approved for up to 5 years and about 1 in 8 women who use it will stop having periods after a year.

All hormonal IUDs prevent pregnancy by releasing a small amount of a progestin hormone called levonorgestrel each day. The progestin acts locally in the uterus to prevent pregnancy. Hormonal IUDs do not contain estrogen and typically have fewer hormonal side effects than methods that do contain estrogen.

Paragard
ParaGard contains no hormones and is approved for up 10 years. Since this device does not contain hormones, most people who use ParaGard can experience heavier, longer, or painful periods. Studies have shown that after 6 months, many ParaGard users’ periods return to normal. If you already have really heavy or painful periods, you will most likely benefit more from a hormonal IUD.

The non-hormonal IUD prevents pregnancy by using a tiny copper filament wrapped around the T. ParaGard, making the uterus a hostile environment.

IUDs are safe, effective, and reversible. There are many different kinds of IUDs and they are not a one-size-fits all. Call today to schedule a consultation with one of our nurse practitioners and together we can decide which is best for you!


25/Sep/2017

Low back pain is classified as acute (lasting less than 4 weeks), subacute (lasting 4-12 weeks) and chronic (lasting 12 weeks or more). Even though 84% of adults will develop back pain at some point in their lives, it is reassuring that for only 1% is life threatening systemic conditions.

The risk factors for developing low back pain are smoking, age, obesity, gender(being female), both sedentary lifestyle and physically strenuous work as well as psychologically strenuous work.

The red flags (this is the terminology that physicians use to signify things that should alert the physician that something serious may be causing the back pain) for low back pain are: new onset urinary retention, fecal incontinence, significant muscle weakness, having a history of cancer, fever and malaise. Other significant risk factors to be considered contributory are obviously severe trauma, presence of contusions and abrasions and prolonged use of corticosteroids, such asPrednisone and Methylprednisolone.

As serious as these symptoms may seem, the majority of patients will have ”nonspecific” low back pain, which means patients will have back pain that is not due to any specific underlying condition. Most of these cases are due to musculoskeletal pain that will improve within a few weeks.

As a result of these findings, radiological imaging is rarely needed unless the symptoms continue for more than 4 weeks or progress at any time. An additional consequence to imaging is that it may show abnormal findings that turn out to be not significant, but may lead further imaging or testing that was unnecessary, albeit warranted once the process is started. Interestingly enough, patients who have significant findings on radiology studies often times are asymptomatic. Patients who have seen me in the office often hear me say, that “medicine is not an exact science” and this is a clear example of this.

So, if you experience low back pain, when should you call in for an appointment to my primary care office? Certainly if you are having symptoms that significantly decrease your daily movement, contribute toloss of strength, loss of balance and fevers associated with lower back pain, you should certainly schedule an appointment with our office as soon as possible. Signs that things may be more serious and would warrant an ER visit would include fevers that are not improved with Tylenol or Ibuprofen, paralysis, inability to hold your urine or control your bowel movements and significant trauma. If ER physicians do not encounter any of these symptoms, patients may not even get a plain x-ray while they are in the ER and will be directed back to their PCP for further recommendations.

When low back pain persists for 4-6 weeks, plain x-rays can be used to show fractures, compression fractures, osteoarthritis, scoliosis and spondylolisthesis. Symptoms that are progressive or involve nerves may require an MRI, if plain x-rays are not conclusive. If a patient is unable to undergo an MRI, then a CT is ordered. There are additional imaging studies used to evaluate lower back pain, but they are used less frequently.

Thankfully, even though, there are very serious causes of lower back pain, the majority of cases can be treated in the primary care office with or without imaging. Most cases of lower back pain resolve within 4 weeks and do not proceed to become a chronic condition. More serious symptom certainly warrant a ER evaluation.


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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 for the summer

Saturday: Closed for summer

Sunday: Closed

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