Managing Diabetes During Ramadan

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Polycystic Ovarian Syndrome (PCOS)

PCOS affects a wide variety of females. Some common characteristics of it include acne, excessive hair growth, multiple benign ovarian follicles on ultrasound, irregular periods (specifically infrequent periods or longer-lasting ones), and being overweight or obese. However, not all of these characteristics may be present in every woman with the diagnosis. The “formal” diagnosis is made if at least 2 of them are present. Some other common medical problems that may be present include having a history of gestational diabetes, nonalcoholic fatty liver disease, or a family history of diabetes.

If PCOS is left untreated, it can increase your risk for developing infertility or more serious medical problems such as metabolic syndrome, type 2 (or adult-onset) diabetes, and heart disease. More about metabolic syndrome in a minute**. Some other complications can be diabetes or high blood pressure during pregnancy, miscarriage, nonalcoholic fatty liver disease, and sleep apnea.

Unfortunately, we don’t know what causes PCOS. However, some possible causes include obesity, family history, or insulin resistance. Insulin resistance is when your body doesn’t use insulin like it should, so your blood sugar increases.

While there’s no specific test for PCOS, there are several things that make the diagnosis more likely. These include any of the symptoms that are mentioned above. There are some blood tests that we do to make sure there are no other hormone abnormalities present. We also check your blood sugar and cholesterol levels.  An ultrasound may show enlarged ovaries or several ovarian follicles, although this is not required to make the diagnosis.

The best treatment is with lifestyle changes that help you get healthier and lose weight if needed. Even a small amount of weight loss can regulate your periods and cause you to ovulate. Taking birth control pills can also regulate your menstrual cycle and help with the acne and hair growth. Other medications that might be useful include Metformin, which is also a medicine that we use for diabetes. However, this medicine might also cause you to start ovulating regularly, which increases your risk of getting pregnant. Because of this, if you don’t want to become pregnant, it’s important to also use a type of birth control.

If you are trying to get pregnant, making lifestyle changes is even more important. They can not only increase your chances of ovulating, but can make you healthier for when you do become pregnant. For medication, Metformin is a good choice to start with, and it’s safe to be taking if you do become pregnant. You don’t need to see a specialist right away unless you still don’t become pregnant after a few months.

It’s important to remember that all medications have side effects, so if you can improve things on your own, just by changing your lifestyle, it’s much healthier for you in the long run.

**Metabolic syndrome is a broad diagnosis which consists of several components. Not all of these are needed to make the diagnosis, but the “technical” definition is made if at least 3 of the following are present:
large waist circumference, elevated triglycerides (fatty acids), low HDL (good) cholesterol, increased blood pressure, and increased fasting blood sugar

The reason it’s important to know if you have actual metabolic syndrome is because it can increase your risk for developing type 2 (adult onset) diabetes or heart disease.


Healthy Lifestyle Changes

Making healthy lifestyle changes isn’t just about doing it to help you lose weight. Even thin people need to make changes if they are eating unhealthy food and not exercising. To do this isn’t easy. But once you start, you will feel definitely feel healthier and have more energy.

There are several “diets” or diet products that you always see advertised. However, you have to be careful because often these push you to buy products that may have serious side effects or result in serious health problems. While many of these may cause you to lose weight, once you stop taking them, you will probably gain it back again. Plus, they don’t address the bigger issue of getting healthier.

There are 2 specific diets that have been shown to have health benefits. One is called the DASH diet. This stands for Dietary Approaches to Stop Hypertension. The other one is called the Mediterranean Diet, named after the region of the world where it comes from.

The DASH diet emphasizes low sodium foods, fruits, vegetables, whole grains, and low fat dairy products. It also includes a maximum of 6 ounces of meat a day from either skinless chicken, lean meat, or fish. It allows you to eat sweets and fats or oils, but only in very small servings, and it encourages you to eat a small amount of nuts several days a week.

You can get whole grains mainly by substituting these for regular “white” products. Some examples include whole grain bread or pasta and brown rice instead of white. You should try to eat at least 6 servings of whole grains a day. One serving would be something like 1 slice of bread or half a cup of rice or pasta.

You should also try to eat 4 servings daily of both fruits and vegetables. One serving of fruit is equal to one medium-sized piece of fruit or half a cup of fresh or frozen fruit.  A serving of vegetables would be half a cup of either raw or cooked vegetables. The DASH diet also recommends 2-3 servings a day of fat free or low-fat dairy products. One serving is like a cup of skim milk or low-fat yogurt.

The Mediterranean and DASH Diets are pretty similar in a lot of ways. However, one main difference is the Mediterranean’s higher emphasis on whole grains, fruits and vegetables, and nuts compared to the DASH Diet, and its lower emphasis on meat. It consists of eating lean red meat no more than a few times a month and instead, for meat, eating fish or skinless chicken at least a couple of times a week. It also uses seasonings like herbs and spices instead of salt, and olive or canola oil for cooking instead of butter or animal fats.

Margarine or butter is not used with bread in the Mediterranean area. Instead, most people eat bread either plain or with a little bit of olive oil on the side to dip it in. The mainstay of the diet in this region is whole grains, fruits and vegetables.

The Mediterranean diet also includes the added component of exercise. I think maybe this is because, as in other parts of the world, walking there is much more common. Although this is starting to change, many people don’t think twice about walking to the grocery or to do routine errands. However, the biggest focus is on food and specifically tasty food. People who live in the Mediterranean region would be appalled if they knew how much fast food is consumed here!

No matter how you choose to do it, it’s never too late to make some healthy lifestyle changes. These changes will stick with you in the long run to keep you healthy.


Health Screenings

Health Screenings

Here is a list of the most common health screenings that we should all do!

However, keep in mind that all of these are also based on your personal risk factors and on your provider’s recommendations.

  1. Cervical cancer. The new guidelines are that Pap smears are not needed for women under 21. For women ages 21-29, they are recommended every 3 years. For those between 30-65, they are recommended every 3 years or every 5 years if combined with an HPV test. Over age 65 or if any of these Pap smears are abnormal, you will need them more frequently.
  2. Breast cancer. The new guidelines are women ages 40-49 should have a mammogram based on individual risk factors and your provider’s recommendations. Women aged 50-74 should have at least one mammogram every 2 years. Of course, again, this varies with certain risk factors and based on a discussion with your provider.
  3. Prostate cancer. PSA tests are no longer recommended as a screening test unless your provider recommends one.
  4. Colon cancer. This should be done for anyone over the age of 50. The main screening recommendation is to have a colonoscopy every 10 years, or based on the findings of your first one. An alternative option is yearly tests to check for blood in your stool.
  5. Osteoporosis. Bone density tests are recommended every 2 years for women over age 65 and for men over age 70. They should also be done sooner for anyone with risk factors for osteoporosis, such as regular steroid use.
  6. High cholesterol. Cholesterol should be checked yearly for men over the age of 35 and women over the age of 45. It should be checked at a younger age, including in childhood, if you have risk factors such as obesity, family history of early heart disease or high cholesterol, diabetes, high blood pressure, and smoking.
  7. Vaccines. All children should get the recommended vaccines based on their age. All children and adults should get the flu vaccine yearly. Young men and women can get the HPV vaccine up to age 26. Adults should also get at least one Tdap and a tetanus booster every 7-10 years. Adults over age 65, or younger based on your provider’s recommendations, should get the pneumonia vaccine. Adults over 65 should also get the Zostavax to prevent shingles.
  8. Diabetes. Blood sugar should be checked yearly over the age of 40. It should be done sooner in individuals, including children, with risk factors for diabetes. These risk factors include having diabetes during pregnancy (even if it is diet controlled), having a family history of diabetes, obesity, or certain findings on a physical exam.
  9. HIV. This should be done at least once or more frequently, if you have risk factors such as having a new sexual partner, using IV drugs, or having multiple sexual partners.
  10. Lung cancer. Annual low dose CT scans are recommended for smokers or previous smokers ages 55-80 based on your provider’s recommendations.

Viral vs. Bacterial Infections part 2

So we left off after talking about antibiotic resistance. Now, we need to talk about what you can do to help you feel better (and at least be able to work) when you have a virus.

If you get a stomach “bug” with nausea, vomiting, and diarrhea, the good thing is that those usually get better after 24-48 hours. But the bad thing is that during those 24-48 hours, you feel miserable. When you are sick, it’s important to make sure you don’t get dehydrated. If you don’t feel like drinking water, use ice chips instead. You can buy medicine like Pepto Bismal or Kaopectate to help with the diarrhea, and your medical provider can give you something for the nausea and vomiting, if you need it. If you prefer more “natural” remedies, ginger helps with nausea, and plain yogurt can help with diarrhea.

If you do get these stomach problems, it’s important to see your medical provider if: you don’t get better after 3-4 days, you get a fever that won’t go away, or you recently returned from an international trip. Those could all be signs of something more serious than a virus.

For colds, there are a lot of different things you can do to help you feel better. The “old-fashioned” things like Vicks Vaporub, tea with honey for a cough, chicken noodle soup, and using a humidifier or vaporizer can help a lot. There are different nose sprays you can use for congestion, and allergy medicine like Loratadine can help with a runny nose and sinus drainage. The cough medicines that you can buy may help a little, but usually work better at night. Tylenol helps with a sore throat or muscle aches. And, like always, it’s important to drink plenty of fluids (water, not soda!).   If you do smoke, when you have a cold is the perfect time to quit. If you are not even a little better after a week, or if you feel like you are getting worse, it’s important to go ahead and see your medical provider.

Make sure that everyone in your family gets their flu shot. This is really important, because the flu is caused by a virus, so it cannot be treated with antibiotics like penicillin. Now, studies have shown that even if you have a mild allergy to eggs, it’s safe for you to get the vaccine. And you CANNOT get the flu from the flu shot.

My sister always asks me why no one has found a “cure” for the common cold. Well, the problem is that colds are, unfortunately, caused by a lot of different viruses that change rapidly. Because of this, we cannot develop a vaccine since by the time we do, it would be no longer useful.




Viral vs. Bacterial Infections, part 1

Tis the season for all of us to start getting those irritating colds again. As we all suffer through these, it’s important to be able to tell the difference between viruses and bacterial infections.

The most common causes of acute infections such as colds or the stomach “flu” is viruses. It’s very easy to get viral infections confused with bacterial ones. A lot of things have changed in medicine, including how we diagnose and treat both of these types of infections.

We used to think that all sore throats, stomach infections, and sinus infections were caused by bacteria and should be treated with antibiotics like penicillin. We now know that that isn’t true and, in fact, these are almost always caused by viruses, except in a few cases.

Because we used to treat all infections with antibiotics, this caused a new problem called “antibiotic resistance”. Unfortunately, we are now seeing more and more cases of problems like pneumonia or skin infections that are resistant to most antibiotics, which means that the bacteria causing them can only be treated with a few antibiotics, many of which are either expensive or IV only.

Why does this matter to you? Surely, a healthy young person is not going to end up with a pneumonia or other disease that cannot be treated with just any antibiotic… or so we think. However, think of it this way. There are some bacteria that are naturally resistant to certain antibiotics or others that can become resistant thru another type of bacteria. You can also get antibiotic resistant infections from other people thru coughing or unwashed hands. If you do get one of these infections, you could even end up in the hospital which can be very expensive. Even if you do have insurance, you will still be missing several days of work.

This is what we mean by “antibiotic resistance”. The most important thing to remember is that viruses, unfortunately, have to get better on their own, so you don’t want or need to take antibiotics like penicillin for these. The good thing about viruses is that you usually feel back to normal in a week or so. The bad thing is that during that week, especially the first few days, you feel miserable. But there are lots of things you can do to at least help with some of your symptoms. To be continued in part 2…


Chronic Pain, Part 2

The treatment of chronic pain has been in the news a lot lately because of the increase in overdoses from opiate pain medications. There have also been reports of individuals who become addicted to prescription opiates such as hydrocodone or oxycodone; then, when they can’t get these anymore, they transition to using heroin.

There are many opiate medications that are used to treat pain. Even with short term use, it is easy to become dependent and/or addicted to these medications. It can start as early as adolescence and can even happen in the elderly. If you are prescribed an opiate pain medication after an acute injury or after a surgery, it’s best to take it as infrequently and for as few days as possible. If you have some pills left, don’t keep them. You can take them to the Harrisonburg Public Safety Department where they will dispose of them.

My approach to chronic pain is pretty straight-forward. Since I am not a specialist, I tend to treat with non-narcotics until these don’t seem to be working anymore. I think physical therapy is invaluable in helping to build up strength and mobility, which helps improve your quality of life and also helps your pain. If you reach the point where these more conservative measures aren’t helping, then the next step is a referral to a pain specialist or whatever specialist you may need to see. I do the same thing with every patient I see who has a chronic disease. Once I see that their disease is progressing to the point that I am no longer comfortable treating it, I send them to a specialist. Based on the recommendations of the specialist, I will treat accordingly.

Opiate side effects include: drowsiness, confusion, constipation, itching, dizziness, nausea, vomiting, and decreased testosterone levels. They also increase your risk for developing respiratory depression (which means that you can stop breathing), liver disease, decreased blood cells, kidney disease, and addiction. Seriously, would you take an antibiotic or high blood pressure medication if it had that list?

One other thing about opiates to remember is that medical providers are not stupid. When someone comes in to our office with pain, who has “tried everything” but it still hasn’t gone away or who has an “allergy” to every non-narcotic pain medication possible, we don’t just write a prescription for a narcotic. There are a lot of other interventions to try first: muscle cream, physical therapy, medications that target specific types of pain, or referral to a pain specialist (or another specialist if indicated).   Also, there are certain rules that we have to follow if we start patients on an opiate that we anticipate they will be taking for a long time.


Chronic Pain

Chronic non-cancerous pain is a difficult condition to treat, and I won’t even begin to claim to be an expert at doing so. What makes it more challenging is that pain is different than other chronic diseases such as diabetes or high blood pressure. There are specific measures we can look at to determine how we should treat those, if we need to be more aggressive or back off on some medications. But it’s hard to quantify pain.

Basing a patient’s pain on an MRI report, for example, isn’t always accurate. I once had a patient come in with a back MRI that looked like he should have been in a wheelchair, but he didn’t want medication; all he wanted was a prescription for a cane. Another person may have a small rotator cuff tear which results in a significant amount of pain and limits his or her daily activities.

The most important thing to do when you have pain depends on the nature of the pain. If you had an injury before it started, such as a fall or accident, you should seek medical care. The vast majority of patients who walk into our office with pain, just want advice on how to deal with it and reassurance that it will go away by itself after a few days or weeks.

The most important thing to do when you have pain depends on the nature of the pain. If you had an injury before it started, such as a fall or accident, you should seek medical care. The vast majority of patients who walk into our office with pain, just want advice on how to deal with it and reassurance that it will go away by itself after a few days or weeks.

Believe it or not, the best way to start treatment for chronic pain is with no medication at all. All medications, even over the counter ones, have side effects. The best things to do instead are to apply heat or ice to the site of your pain, do regular stretching, try massage, or even see a chiropractor. If you need something stronger, you can use muscle cream such as BenGay or Icy Hot. Exercise and strengthening are invaluable to controlling pain.


10 Tips to Help You Get (or Stay) Healthy

  1. Eat your fruits and vegetables. Fresh is always better, but frozen is ok, too. Canned vegetables are ok, as long as you rinse them off first. Try to get at least 5 servings a day, which isn’t as hard as it sounds. Examples of one serving are: half a banana or apple, half a cup of any fruit or vegetable, one cup of 100% fruit juice, etc.
  2. Eat breakfast every day. There’s a reason we say that breakfast is the most important meal of the day. Studies have shown that when you skip it, by mid-morning, your body’s metabolism goes down (which means you don’t burn as many calories), and you also have difficulty concentrating and staying on task.
  3. Don’t be tempted by fad diets or by thinking that skipping meals is the way to lose weight. When your body does not get enough calories and nutrition, it causes your metabolism to go down, which is why you don’t lose weight and you may even gain some. Instead, eat healthy and in moderation.
  4. Do not buy or drink soda. Period. I don’t care if it tastes good or if it’s cheap. I don’t even care if it’s a penny a can. There is absolutely no nutritional value in soda. You might as well eat a cup of sugar or sugar substitute. Also, do not buy junk food like chips, candy, sugary cereals, ice cream, etc. If you don’t have it, you won’t eat it, and neither will your kids. It’s as simple as that. When you or they get hungry, you’ll eat anything, so if you only have healthy foods around, you won’t have any other options.
  5. Get up and move around. It doesn’t matter what you do as long as you do it. Do some crunches or stretches while you’re watching TV. Purposely leave something up or downstairs, so you have to make another trip. Touch your toes 10 times while you’re waiting for the microwave or toaster. Anything is better than not doing anything at all. I once had a patient who weighed 300 pounds and had joint pain due to arthritis, so she couldn’t do vigorous activity. But she still lost 24 pounds over about 6 months, just by changing her diet and moving around more.
  6. Exercise. Try to get at least 15-30 minutes of more vigorous physical activity a day, or at least several days a week. It doesn’t have to be all at once; you can do 10 minutes, twice a day. Exercise can be whatever you enjoy doing: walking, going to the gym, playing basketball or tennis, taking the dog for a walk, etc.
  7. Take 5-10 extra minutes on the weekend (or on your day off) to make a menu of meals for the week, and then you won’t be as tempted to stop and pick up fast food. I know those places are right on the way home, I know it just takes a few minutes and little energy to go inside (or thru the drive-thru), I know the food is cheap. But…grocery stores are usually right on the way home, too. If you have a list, it can literally take less than 15 minutes to go inside and get what you need. There are lots of home cooked, healthier meals that take 20 minutes or less to make. And there are also lots of healthier recipes/ meals that cost under $3 per serving. Here’s an example: grilled cheese sandwiches on whole wheat bread with a few pieces of baby spinach and a couple of tomato slices on them, plus corn on the cob. For dessert, mix some frozen cherries with plain yogurt. Voila! Ten minutes and about $2 each! And just like that, everyone also got in 3 servings of fruits and vegetables with just one meal!
  8. Eat smaller portions. According to studies on obesity, the size of our average plates has increased, and the size of restaurant portions has ballooned over the last few decades, as has the number of all-you-can-eat buffets. Doing something as simple as eating on a smaller plate can make a huge difference. If you do eat out, order 1-2 appetizers or something from the children’s menu. You can also ask the waiter right away to go ahead and pack up half your entree, so you won’t be tempted to overeat. And, whatever you do, try to avoid the buffets.
  9. Sleep. Studies have shown that individuals who sleep an average of 6-8 hours a night are usually healthier. If you have a hard time sleeping, talk to your medical provider. They can always give you some healthy tips.
  10. Stay mentally healthy. Be sure to try to take some time for yourself, even if it’s just 2 minutes before you sleep. Doing a quick, 2-minute meditation when you first wake up, is a great way to start the day. By meditation, you don’t have to sit in a specific position and hum. All you need to do is set the timer for 2 minutes, sit or stand, close your eyes, and don’t think of anything at all.




Summer Sun

Finally, the weather is warmer, and summer is here. A lot of people dread the long, hot days of summer. Then there are those of us who can never seem to get enough of the hot weather and sun. However, that being said, no matter what type of person you are, it is vital to protect yourself from the sun’s harmful UV rays.

In the winter, you can get by with less sunscreen because there are only certain areas of your skin that are exposed to the environment. As the weather gets better, we all tend to spend more time outdoors and strip more of our clothes away.

Here are some vital things to remember as the seasons transition.

You need to wear sunscreen no matter what color your skin is. There is a myth that once you develop a tan, you can get rid of the protection. There is also a myth that those of us with darker skin are protected automatically. However, this could not be further from the truth. In fact, quite the opposite. Unfortunately, skin cancer is also common in dark-skinned individuals and is also more difficult to detect, meaning that it can be further along when it gets diagnosed.

Some other necessities: You need to wear sunscreen even on cloudy days, and you need to wear it no matter what time of day it is.

You also need to wear sunscreen no matter how much time you are outside. So many patients tell me that they are only outside long enough to go from their house to car or from their car into the store. This might be true. However, we tend to underestimate how much time our skin is actually exposed to the harmful UV rays.   Plus, we often have to park at the end of a parking lot, which means that we get a lot more sun than we expected.

And avoid tanning beds at all costs. So many people use them at the onset of summer to get tanned for the beach or other outdoor venues. There are a lot of over the counter healthier products that you can apply to your skin to get that same glow, and that look much more natural than the fake-tan appearance you get from either a tanning bed or from being outside without sunscreen.