MedicaLink, January 2015

The University Doctors

MedicaLink Celebrating 15 Years

Isn’t it too late to get a flu shot?

I often have heartburn following a meal.

Should I be worried?

My husband and I want to start a family.

Is there anything that we should do before I get pregnant to have a healthy baby?

January 2015

The secret to boosting vitamin D levels all winter Vitamin D is a wonder vitamin that seems to cure a whole host of ailments. Research has linked the vitamin, which comes from sunlight, seafood, and mushrooms, to lower rates of cancer, bone fractures, diabetes, heart disease, and even anxiety and depression. However, with all the time we spend indoors nowadays, 75 percent of Americans aren’t getting enough.

So what do we do? Turn to supplements. Effective, yes, but costly and potentially contaminated with heavy metals. There’s a much cheaper and easier way that Dutch researchers have just uncovered – getting outside, even in winter.

The researchers exposed 55 adults between ages 18 and 65 to an artificial light containing ultraviolet radiation (UV) equivalent to what they’d absorb in 10 minutes spent outside at noon on a summer day. Each person was exposed to the light over 88 percent of his or her body (basically, everywhere not covered by underwear) either once a week, once every two weeks, or once every four weeks over the course of 16 weeks, after which, the subjects’ blood was sampled and vitamin D levels measured.

As it turns out, it didn’t take much to keep vitamin D at healthy levels.

Though the people who received the weekly treatment saw their vitamin D levels increase, those who received the treatment once every two weeks achieved what were considered healthy levels, and they maintained those levels More information throughout the 16-week study.

U.S. Food and Drug Granted, surrounding yourself Administration has more with artificial light while standinformation on vitamin D ing in your underwear is one thing. It’s totally different to walk at www.fda.gov. around nearly naked outside when temperatures are hovering around 20 degrees. But you can still benefit from a daily walk in the winter. The UV dose used in this study is equal to two hours and 20 minutes outside under the weak winter sun.

That equals 10 minutes of sun exposure a day over the course of two weeks.

To make the most of your wintertime sun exposure

• Let as much of your skin show as you comfortably can.

• Aim for “solar noon” – the time the sun is at its highest point in the sky – whenever that is in your area.

• Use your skin as a cue. You’ve had the necessary amount of UV exposure when your skin starts to turn pink.

For adults, Michael F. Holick, MD, PhD, professor of medicine, physiology, and biophysics at Boston University School of Medicine, recommends a 1,000-IU supplement combined with a multivitamin that contains 400 IU more. This combination will help keep your vitamin D levels up throughout the year, especially during the winter, when they tend to drop with the waning daylight. The American

It seems as though there’s no end to the good deeds of vitamin D: It protects against cancer, diabetes, infections, heart disease — and now hip fractures in older adults, according to a study published in the Archives of Internal Medicine. Unfortunately, most of us aren’t getting enough of it.

The details

If sun exposure is just too hard to get where you are, supplements are a good backup. Because your body doesn’t absorb vitamin D from supplements as well as from sunlight, you generally need to take higher doses than you might get from sunlight. Aim for a 600-IU supplement of vitamin D3 (which is a more beneficial form of the vitamin than vitamin D2, another supplement you might see at the store). And look into supplements certified by US Pharmacopeia or ConsumerLabs.com to ensure you aren’t getting contaminated pills.

Source: HealthDay

Tips on increasing your vitamin D Strive for at least 1,000 IU/day

Getting Enough Vitamin D? Probably Not

Academy of Pediatrics recently raised its recommended levels for kids to 400 IU per day.

Don’t be too sun-shy

Between April and October (when UVB rays are strongest), spend 10 to 15 minutes outside without sunscreen on, arms and legs exposed, 2 or 3 times a week, says Holick. As soon as those 15 minutes are up, however, slather on the sunscreen. If you’re in a high-

risk group for skin cancer (fair-skinned with light hair, for instance), talk to your dermatologist about how much unprotected sun exposure is healthy for you.

Get fortified

It’s hard to get your recommended vitamin D levels from food, but do consume as many vitamin D – fortified foods as you can, such as milk and fortified bread and cereals.

In an analysis of 20 previous studies, researchers found that study participants who took more than 400 International Units (IU) of vitamin D per day had about a 20 percent lower risk of fractures at the hip or other nonvertebral site. A separate investigation published in the same issue of Archives revealed that more than 75 percent of Americans are vitamin D deficient, and that blood levels of vitamin D have declined by 20 percent over the last two decades. Increasing awareness about the detriments of sun exposure is the likely reason for that decrease. “Sunlight exposure through ultraviolet radiation is the major source of vitamin D for people, much more so than dietary sources,” says article coauthor Adit Ginde, MD, MPH, assistant professor in the Division of Emergency Medicine at the University of Colorado, Denver. “We do think that the trends we observed can be attributed to people wearing more sunscreen,” he adds; his article notes that SPF 15 lotion can block up to 99 percent of your body’s synthesis of vitamin D. That means most of us aren’t getting the D we need. The Institute of Medicine, which sets vitamin-intake recommendations, says that people should get 200 IU/day of vitamin D from birth to age 50, 400 IU/day for adults aged 51 to 70 years, and 600 IU/day for adults 71 years and older. But those levels were set 10 years ago and likely need updating. The results of the bonehealth study show, for example, shows that adults age 65 and older should be taking more than 400 IU/day.

The University Doctors MedicaLink Ask The University Doctors

I often have heartburn following a meal.

Should I be worried?

Dr. Donald McMahon, a gastroenterologist with The University Doctors, responds: irritating the lining and causing a burning sensation If you regularly experience heartburn, in the chest or throat. indigestion or an acidic taste in the GERD is usually easy to control, but establishing back of your mouth, a diagnosis can if these symptoms be difficult. In occur after meals the past, the and antacids provide diagnosis relied on only temporary relief, patient reported then you may have symptoms or gastroesophageal reflux diagnostic disease (GERD). It’s one of the most tests that were common gastrointestinal diseases, cumbersome and affecting up to 60 percent of the entire uncomfortable population over the course of the year. for patients.

GERD occurs when the muscle at the Those tests bottom of the esophagus malfunctions required either or does not close properly and stomach an endoscopy acid leaks back into the esophagus, that allowed the physician to view the lining of the esophagus or the insertion of a catheter into the esophagus to monitor acid levels there for up to 24 hours.

A new catheter-free test for diagnosing GERD is now being offered at the Kennedy Surgical Center in Washington Township, NJ. The Bravo® system is a catheter-free, ambulatory method for measuring Let us help treat your digestive health issues! the pH (acid) levels in the esophagus and monitoring John C. Chiesa, DO, FACOI gastric reflux. The Drew Chiesa, DO Bravo® system uses a Donald McMahon, DO disposable capsule placed Richard Walters, DO in the esophagus as an alternative to traditional Call for an appointment: 856.566.6853 or 856.218.0300 (Option 6) monitoring systems.

Research shows that traditional, catheter-based We offer G.I Services at these locations: studies affect patients’ daily Marlton • Mt. Laurel • Stratford • Washington Twp. • West Deptford activities, resulting in data theuniversitydoctors.com that is not reflective of acid levels a patient typically

We Trust our Gut Instinct

experiences. The patient-friendly Bravo® tool allows patients to maintain regular diet and activities, more accurately reflecting normal physiologic conditions.

Bravo® pH monitoring is the only commercially available, catheter-free ambulatory pH test featuring up to 96 hours data collection (catheter-based tests offer 24-hour data collection). During the Bravo® procedure, a small capsule is temporarily attached to the wall of the esophagus. The capsule then transmits data via radio frequency telemetry to a small, external, pager-sized receiver worn by the patient.

After the test is completed, natural digestive contractions propel the disposable Bravo® capsule through the gastrointestinal tract.

The Bravo® system offers several benefits – for both patients and physicians – over the traditional diagnostic methods, including: • Less invasive • Minimal outward indication of procedure, enhancing comfort and convenience • Easy to maintain regular diet and activities • Extensive data collection • Placement procedure is simple for physicians • Capsule position remains fixed for better accuracy While persistent heartburn or indigestion may seem no more than a nuisance to you, complications of severe or chronic GERD include inflammation, ulcers, and bleeding of the esophagus. As a result, scarring or narrowing of the esophagus may occur over time. A pre-cancerous condition, Barrett’s esophagus, may also develop as a complication of GERD. If you find yourself frequently reaching for the antacid bottle following a meal, or if you experience a persistent dry cough, asthma-like symptoms or trouble swallowing, it’s time to talk to your physician about GERD. To schedule an appointment with Dr. McMahon, please call 856.218.0300 for the Sewell Office located at 570 Egg Harbor Road, Suite C-2. Or, please call 856.566.7020 for the Stratford Office, located at 42 East Laurel Road, Suite 3500.

The University Doctors MedicaLink Ask The University Doctors

Isn’t it too late to get a flu shot?

Dr. Charlene Chick, a family physician with The University Doctors, responds: The spike in flu-related illnesses over the past few weeks should provide ample incentive for anyone who hasn’t yet gotten an annual flu vaccination. In a weekly flu report issued on January 5th, the U.S. Centers for Disease Control and Prevention (CDC) reported 43 states, including New Jersey, are experiencing “either high or widespread flu activity,” while statistics showed that only about 40 percent of people reported getting the vaccine.

Of particular concern this year is the fact that most of the reported cases so far were caused by “drifted H3N2 viruses.” That is a strain of the virus that was not included in this year’s vaccine.

A similar scenario has occurred three times in the past decade, with the most recent occurrence resulting in more than 381,000 people being hospitalized for flurelated illnesses. According to CDC report on January 5th, the incidence of flu-related hospitalizations for the last reporting week of December had reached nearly the same level seen during that outbreak.

Depending on the type administered, the annual flu vaccine is designed to protect against three or four different flu viruses that are expected to circulate widely. With a different strain of the virus appearing this season, the vaccine may not be as effective, but could lessen the severity of any symptoms if you do come in contact with the variant strain.

Flu season is long, lasting throughout the winter and into April or May. As we progress through the season, it is likely that the viruses that are covered by the vaccine will begin circulating more widely. So getting the vaccine now remains your best first line of defense against the flu. There is no shortage of flu vaccine nationally.

Seasonal flu may sound harmless, but it will cause thousands of illnesses and deaths this year. The flu virus is carried on droplets of an infected person’s coughs or sneezes. Because people will be contagious with the virus before they feel sick, they can easily pass the virus through a handshake, kiss or simply leave it behind on a doorknob or ATM keypad.

Here are some tips to protect yourself – and those around you – from the sore throat, high fever, body aches, and potentially life-threatening complications of the flu:

• Get a vaccine – today

It’s not too late to vaccinate and your body will maximize its ability to ward off the flu within two weeks. Flu season continues throughout the winter months and into mid-spring.

• Wash your hands, wash your hands, wash your hands Lather up for 20-30 seconds before rinsing.

Teach young children to sing the “ABC” song or two verses of “Happy Birthday” to approximate 20 seconds.

• Be a vampire Avoid spreading germs by doing a ‘vampire sneeze’ into your elbow or shoulder when tissues aren’t available. A bonus: kids may think this is fun to do.

• Don’t misuse tissues Have tissues handy wherever you go, and toss them out immediately after use.

• Avoid sick people Hard to do, but postpone visits to someone who has the flu, and try to keep six feet away from anyone who is coughing or sneezing.

• Don’t touch that face Touching your eyes, nose or mouth could allow you to become infected by viruses on your hands.

• Just say ‘no’ to work Everyone has “important” work to do, but going back to work or school before you have fully recovered increases the risk that you will spread illness to colleagues. You can infect others beginning one day before you notice flu symptoms and up to five to seven days after becoming sick.

To schedule an appointment with Dr. Chick, please call 856.566.7020. The office is located at 42 East Laurel Road, Suite 2100, Stratford, NJ 08084.

The University Doctors MedicaLink

WIRB 201314 #11683727.0

Information Resources & Technology

Need a family physician?

Comprehensive care for the entire family As your primary care office, we will manage and coordinate all of your medical care, including: • • • • • •

Routine preventive care Annual wellness physicals Acute care Chronic disease management Specialist referrals Follow-up visits

Stratford

Mount Laurel

856.566.7020

856.380.2400

Hammonton

Sewell

609.704.0185

856.218.0300

theuniversitydoctors.com

Convenient hours. Most insurances accepted.

The The SSOLSTICE OLSTICE clinical study istudy s evaluating the safety athe nd effectiveness an investigational clinical is evaluating safety andof effectiveness ofdrug an for investigational moderate to severe endometriosis pain symptoms. drug for moderate to severe endometriosis pain symptoms.

The study may last up to approximately 20 months and involve about 14 The study may last up to approximately 20 months and involve about 14 study visits.

study visits.

You You mmay ay be be able to join study you: able tothe join theif study

if you: • Are 18 to 49 years old and have not gone through menopause • Are 18 to 49 years old and have not gone through menopause • Have been surgically diagnosed with endometriosis in the past 10 years and past have p10 ain years symptoms • Have been surgically diagnosed with endometriosis in the

our period at other times in your menstrual cycle during andyhave painand symptoms during your period and at other times in your not taking pcycle ain medication to treat a chronic disease other than endometriosis • Are menstrual • Do n ot h ave a

h istory of osteoporosis or other bone daisease • Are not taking pain medication to treat chronic disease other than • Are n ot p regnant o r b reastfeeding o r p lanning to get pregnant within the next 24 months endometriosis • a history orsother bonewill disease There aDo re onot ther have requirements to bof e in osteoporosis the study that the tudy doctor discuss with you to determin • if you aAre re eligible to participate. not pregnant or breastfeeding or planning to get pregnant within

the next 24 months Study participation is voluntary. You will receive all investigational study medications and study-­‐related There are other requirements to be in the study that the study doctor will tests and procedure at no cost. discuss with you to determine if you are eligible to participate.

Study participation You will freceive all investigational study To learn more is or voluntary. see if you may qualify or the study, visit www.TheSolsticeStudy.com, Text and ENDO1 to 87888 or call Rowan Clinical rials office at 856-­‐566-­‐6474. medications study-­ related tests andUniversity procedure at Tno cost.

To learn more or see if you may qualify for the study, visit www.TheSolsticeStudy.com,

Text ENDO1 to 87888 or call Rowan University Clinical Trials office at 856-­566-6474.

The University Doctors MedicaLink Ask The University Doctors

My husband and I want to start a family. To have a healthy baby, is there anything we should do before I get pregnant?”

Dr. Jennifer Hummel, an obstetrician and gynecologist with The University Doctors, responds: Pregnancy is an baby‘s major organs will begin to develop. amazing journey for While it’s important to assess the both parents, but potential impact for the soon-to-be that medical mom, the path from conditions like conception to birth high blood is like no other. At no pressure or other time in life will a diabetes can woman feel so involved have on your and aware of the profound changes pregnancy, your occurring in her body. health care Throughout pregnancy, women provider will encounter both the expected and the also want to unexpected, but with knowledge and discuss other the help and guidance of a physician or health related midwife, a successful pregnancy is not concerns. only possible, but expected.

Your weight, Good prenatal care is essential to a activity level successful pregnancy, and, depending and nutrition on your age, that care could include are important different concerns on the part of you factors in your and your health care provider. Good current health prenatal care, however, begins even and will change before pregnancy. That is why, regardless as you proceed of age, every woman who is considering through your pregnancy should contact her physician pregnancy. Your or midwife to schedule a preconception physician will also want to discuss how checkup. lifestyle choices like smoking and alcohol One goal of this checkup will be to can affect your pregnancy and your baby’s identify any pre-existing or chronic health. medical conditions that could influence Being either overweight or underweight your ability to get pregnant or for your now could lead to complications during baby to get a healthy “Good prenatal care, however, begins even start once before pregnancy. That is why, regardless you are of age, every woman who is considering pregnant.

The first pregnancy should contact her physician or eight midwife to schedule a preconception checkup.” weeks of pregnancy are especially crucial to your baby’s your pregnancy – including preterm birth, ultimate health, as that is when your hypertension, gestational diabetes and

having a low birth weight baby – that could affect your baby’s health for years.

of maximum fertility for most women and have the lowest risk of miscarriage.

Your physician or midwife will also Your 20s also carries the lowest risk recommend that you begin taking a of developing pregnancy-related prenatal vitamin. Prenatal vitamins should include at least 400 micrograms of folic “If you are planning to start acid (a type of B vitamin), a nutrient that a family, you are going to want is essential to preventing certain types of to do everything possible to birth defects. Prenatal vitamins will also ensure that you and your baby provide additional iron that will help to ensure adequate blood and oxygen as your are healthy when you finally baby develops inside your womb. meet face-to-face. Making a While these are concerns that apply to preconception appointment all potential moms, there are some specific with your physician or midwife issues that will be dependent upon is the first step to making sure your age.

While there is no ‘best‘ time to become that day is everything you’ve pregnant, the decade of your 20s may dreamed of.” be better than most. These are the years

hypertension or diabetes. In fact, research indicates that a woman in her 20s has half the risk of developing gestational diabetes as a woman who is in her 40s.

After age 30, a woman’s fertility begins to gradually decline. At the same time, the risk of developing hypertension or gestational diabetes begins increasing, particularly after age 35. Once you are pregnant, your physician or midwife will likely recommend testing for Down syndrome or other chromosomal anomalies because these conditions tend to be more common among babies whose moms are in their 30s or older.

The incidence of miscarriage also increases among women older than 35 as does the chance of having twins or triplets.

Although it is becoming safer and much more common, fewer than one percent of all babies are born to women in their 40s. The risk of miscarriage is about one in three for women in this age group and the incidence of delivering a baby who has Down syndrome or a chromosomal abnormality increases steadily with the mom’s age.

If you are planning to start a family, you are going to want to do everything possible to ensure that you and your baby are healthy when you finally meet face-to-face. Making a preconception appointment with your physician or midwife is the first step to making sure that day is everything you’ve dreamed of.

To schedule an appointment with Dr. Jennifer Hummel, please call 856.589.1414. The office is located at 412 Ewan Road, Suite B, Mullica Hill, NJ 08062.

Expect The Best!

The best choice for your care.

Ob/Gyn & Midwifery Clinical Services For access to the most advanced Ob/Gyn and Midwifery specialists, call 856.589.1414 to make an appointment today.

412 Ewan Road - Suite B, Mullica Hill, NJ 08062 Dr. Jennifer Hummel and midwives: Sarah Appleby-Wineberg, CNM, MSN Robyn J. Carlisle, CNM, MSN Waverly Lutz, CNM, MSN Diane Reynolds, CNM, MSN Tuesday, Wednesday, Friday 8:15 am to 4:30 pm Thursday 1:00 pm to 8:00 pm Most insurances accepted.

Other locations: Washington Twp. 856.589.1414

Stratford 856.566.7090

theuniversitydoctors.com facebook.com/theuniversitydoctors • twitter.com/universitydocs The University Doctors MedicaLink is an Advertorial Supplement published by Rowan University School of Osteopathic Medicine (RowanSOM). RowanSOM staff: Mary Louise Bianco-Smith (editor), Julia Swope, Gerald Carey, Lynne Yarnell, Lucy McGorry, Bernardine Jones. Please send inquiries via email to: sominfo@rowan.edu or RowanSOM Marketing Department, University Doctors Pavilion, Suite 1300, 42 East Laurel Road, Stratford, NJ 08084, 856.566.6191.

The University Doctors MedicaLink Ask The University Doctors

My husband and I want to start a family. To have a healthy baby, is there anything we should do before I get pregnant?”

Dr. Jennifer Hummel, an obstetrician and gynecologist with The University Doctors, responds: Pregnancy is an baby‘s major organs will begin to develop. amazing journey for While it’s important to assess the both parents, but potential impact for the soon-to-be that medical mom, the path from conditions like conception to birth high blood is like no other. At no pressure or other time in life will a diabetes can woman feel so involved have on your and aware of the profound changes pregnancy, your occurring in her body. health care Throughout pregnancy, women provider will encounter both the expected and the also want to unexpected, but with knowledge and discuss other the help and guidance of a physician or health related midwife, a successful pregnancy is not concerns. only possible, but expected.

Your weight, Good prenatal care is essential to a activity level successful pregnancy, and, depending and nutrition on your age, that care could include are important different concerns on the part of you factors in your and your health care provider. Good current health prenatal care, however, begins even and will change before pregnancy. That is why, regardless as you proceed of age, every woman who is considering through your pregnancy should contact her physician pregnancy. Your or midwife to schedule a preconception physician will also want to discuss how checkup. lifestyle choices like smoking and alcohol One goal of this checkup will be to can affect your pregnancy and your baby’s identify any pre-existing or chronic health. medical conditions that could influence Being either overweight or underweight your ability to get pregnant or for your now could lead to complications during baby to get a healthy “Good prenatal care, however, begins even start once before pregnancy. That is why, regardless you are of age, every woman who is considering pregnant.

The first pregnancy should contact her physician or eight midwife to schedule a preconception checkup.” weeks of pregnancy are especially crucial to your baby’s your pregnancy – including preterm birth, ultimate health, as that is when your hypertension, gestational diabetes and

having a low birth weight baby – that could affect your baby’s health for years.

of maximum fertility for most women and have the lowest risk of miscarriage.

Your physician or midwife will also Your 20s also carries the lowest risk recommend that you begin taking a of developing pregnancy-related prenatal vitamin. Prenatal vitamins should include at least 400 micrograms of folic “If you are planning to start acid (a type of B vitamin), a nutrient that a family, you are going to want is essential to preventing certain types of to do everything possible to birth defects. Prenatal vitamins will also ensure that you and your baby provide additional iron that will help to ensure adequate blood and oxygen as your are healthy when you finally baby develops inside your womb. meet face-to-face. Making a While these are concerns that apply to preconception appointment all potential moms, there are some specific with your physician or midwife issues that will be dependent upon is the first step to making sure your age.

While there is no ‘best‘ time to become that day is everything you’ve pregnant, the decade of your 20s may dreamed of.” be better than most. These are the years

hypertension or diabetes. In fact, research indicates that a woman in her 20s has half the risk of developing gestational diabetes as a woman who is in her 40s.

After age 30, a woman’s fertility begins to gradually decline. At the same time, the risk of developing hypertension or gestational diabetes begins increasing, particularly after age 35. Once you are pregnant, your physician or midwife will likely recommend testing for Down syndrome or other chromosomal anomalies because these conditions tend to be more common among babies whose moms are in their 30s or older.

The incidence of miscarriage also increases among women older than 35 as does the chance of having twins or triplets.

Although it is becoming safer and much more common, fewer than one percent of all babies are born to women in their 40s. The risk of miscarriage is about one in three for women in this age group and the incidence of delivering a baby who has Down syndrome or a chromosomal abnormality increases steadily with the mom’s age.

If you are planning to start a family, you are going to want to do everything possible to ensure that you and your baby are healthy when you finally meet face-to-face. Making a preconception appointment with your physician or midwife is the first step to making sure that day is everything you’ve dreamed of.

To schedule an appointment with Dr. Jennifer Hummel, please call 856.589.1414. The office is located at 412 Ewan Road, Suite B, Mullica Hill, NJ 08062.

Expect The Best!

The best choice for your care.

Ob/Gyn & Midwifery Clinical Services For access to the most advanced Ob/Gyn and Midwifery specialists, call 856.589.1414 to make an appointment today.

412 Ewan Road - Suite B, Mullica Hill, NJ 08062 Dr. Jennifer Hummel and midwives: Sarah Appleby-Wineberg, CNM, MSN Robyn J. Carlisle, CNM, MSN Waverly Lutz, CNM, MSN Diane Reynolds, CNM, MSN Tuesday, Wednesday, Friday 8:15 am to 4:30 pm Thursday 1:00 pm to 8:00 pm Most insurances accepted.

Other locations: Washington Twp. 856.589.1414

Stratford 856.566.7090

theuniversitydoctors.com facebook.com/theuniversitydoctors • twitter.com/universitydocs The University Doctors MedicaLink is an Advertorial Supplement published by Rowan University School of Osteopathic Medicine (RowanSOM). RowanSOM staff: Mary Louise Bianco-Smith (editor), Julia Swope, Gerald Carey, Lynne Yarnell, Lucy McGorry, Bernardine Jones. Please send inquiries via email to: sominfo@rowan.edu or RowanSOM Marketing Department, University Doctors Pavilion, Suite 1300, 42 East Laurel Road, Stratford, NJ 08084, 856.566.6191.

Understanding seasonal affective disorder and its treatments Throughout the centuries, poets have described a sense of sadness, loss and lethargy which can accompany the shortening days of fall and winter. Many of us notice tiredness, a bit of weight gain, difficulty getting out of bed and bouts of “the blues” as fall turns to winter.

However some people experience an exaggerated form of these symptoms. Their depression and lack of energy become debilitating. Work and relationships suffer. This condition, known as Seasonal Affective Disorder (SAD) may affect over 10 million Americans while the milder, “Winter Blues” may affect a larger number of individuals.

The typical symptoms of SAD include depression, lack of energy, increased need for sleep, a craving for sweets and weight gain. Symptoms begin in the fall, peak in the winter and usually resolve in the spring.

Some individuals experience great bursts of energy and creativity in the spring or early summer. Susceptible individuals who work in buildings without windows may experience SAD-type symptoms at any time of year. Some people with SAD have mild or occasionally severe periods of mania during the spring or summer. If the symptoms are mild, no treatment may be necessary. If they are problematic, then a mood stabilizer such as Lithium might be considered. There is a smaller group of individuals who suffer from summer depression.

SAD is recognized in the DSM-IV (The American Psychiatric Association’s diagnostic manual) as a subtype of major depressive episode.

The classic major depression involves decreased appetite, decreased sleep, and often, poor appetite and weight loss. It has long been recognized that some depressed individuals had an “atypical depression” with increased sleep and appetite along with decreased energy. Some, but

not all of these atypical individuals also had a seasonal pattern. Some people with winter depression also have mild or occasionally severe manic mood swings in the spring and summer. If these episodes are severe, the individual might be diagnosed with Bipolar Disorder (formerly called manic depressive illness).

About SAD

About 70-80 percent of those with SAD are women. The most common age of onset is in one’s thirties, but cases of childhood SAD have been reported and successfully treated. For every individual with full blown SAD, there are many more with milder “Winter Blues”.

The incidence of SAD increases with increasing latitude up to a point, but does not continue increasing all the way to the poles. There seems to be interplay between an individual’s innate vulnerability and her degree of light exposure. For instance, one person might feel fine all year in Maryland but develop SAD when she moves to Toronto. Another individual may be symptomatic in Baltimore, but have few symptoms in Miami. Some individuals who work long hours inside office buildings with few windows may experience symptoms all year round.

Some very sensitive individuals may note changes in mood during long stretches of cloudy weather.

Theories about how light affects mood and sleep

In 1984, a psychiatrist at NIMH, Norman Rosenthal, published a paper on the use of bright light therapy in patients with this disorder. Since then, a large number of well-designed studies have confirmed and refined these findings. Researchers are still investigating mode by which bright light can lift depression or reset a sleep cycle. One theory is

that an area of the brain, near the visual pathway, the suprachiasmatic nucleus responds to light by sending out a signal to suppress the secretion of a hormone called melatonin.

Brain studies suggest that there is impairment serotonin function in neurons leading to the suprachiasmatic nucleus.

Initial theories suggested a pathway from the retina to the suprachiasmatic nucleus. However some recent research indicated that bright light applied to the back of an individual’s knee could shift human circadian rhythms (daily sleep-wake cycle). This suggests that the bloodstream, not just the neurons of the visual pathways, might mediate the biological clock.

How the light box is used Before embarking on a course of light treatment, it is best to have a complete psychiatric evaluation.

Sometimes a medical illness or another psychiatric condition can masquerade as depression. Discuss various treatment alternatives with your doctor. Light therapy does take time, and regular use. Like exercise, not everyone who would benefit from it will actually do it on a regular basis. Your doctor will discuss the various types of light boxes or visors available. The time spent in front of the light is related to the intensity of the light source and the distance one sits from the light. The light devices cost about $250 to $500 and often are not covered by insurance. I will often lend out a box for a month so that the individual can see whether it helps before purchasing a box.

Some individuals who use a 10,000-lux box may only need 30 minutes of daily light treatment.

However, the amount of light needed varies widely from individual to individual. The light treatment is most often done in the morning,

More information The National Institute of Mental Health has more on seasonal affective disorder at www.nimh. nih.gov. but studies have suggested that either morning or evening light can help SAD. Some people may get insomnia when they use the light in the evening. Initially, researchers felt that one needed full spectrum light.

Now, studies suggest that regular fluorescent lights will work as well.

UV (ultraviolet) light can damage eyes and skin, so it must be filtered out. It is best to buy a commercially built light box to be sure of the exact amount of light and to be sure that there are no isolated “hot spots” which could damage eyes. Many people still prefer full spectrum (minus UV) light because it is closest to natural lighting.

The individual measures the distance from her face to the light source. This measurement is important, and should be repeated daily for several days and occasionally

after that. The light needs to strike one’s eyes, but one does not need to look directly into the light source. It is fine to occasionally glance directly into the light. Many people read a book or eat breakfast while using the lights. Sitting still for 30 minutes to several hours is not an option for some people. For these people, the light visor is an option. Others are able to take one of the compact light boxes to work and use it for several hours. It is best to use the light source in an uninterrupted time block, but it can be helpful even with some interruptions.

Long term treatment compliance is often more difficult than one might initially anticipate. This is an important reason to have a professional monitoring. Having to account for your regular use (or the lack thereof) is a powerful motivator.

It is also helpful to have an outside objective individual to help monitor your response to the treatment.

Since one of the symptoms of SAD can be difficulty awakening in the morning, some find it helpful to have the light turn on just before they are supposed to wake up. Some individuals like to use a Dawn Simulator. This is a bright light that is programmed to gradually increase its intensity such that it reaches its full intensity a set period before the individual is scheduled to awaken. Although it is less gentle, some people will put their light box beside their bed and hook it up to a timer set to turn on shortly before awakening.

Some people like to use full spectrum light bulbs for everyday household use. There is no evidence that these low intensity bulbs affect mood or sleep phase. Your plant light will not cure your SAD. Your 10,000-lux light however, may be nice for some of your plants.

Source: HealthDay

Mediterranean diet gets kudos for bettering heart health

By KATHLEEN DOHENY HealthDay

Following the Mediterranean diet may help reverse a condition known as metabolic syndrome, new research suggests.

The study compared a low-fat diet to a Mediterranean diet — a diet rich in whole grains, vegetables, fruits, legumes, nuts, fish and olive oil. The Mediterranean diet was supplemented with either extra nuts or extra virgin olive oil.

The Mediterranean diet didn’t lower the odds of developing metabolic syndrome – a collection of risk factors for heart disease – compared to following a low-fat diet, the study found. But, the Mediterranean diet did increase the chance of reversing metabolic syndrome, said lead researcher Dr. Jordi Salas-Salvado, a professor of nutrition at the Universitat Rovira I Virgili and Hospital Universitari de Sant Joan de Reus, in Spain.

“It seems that the Mediterranean diet supplemented with nuts or virgin olive oil has similar effects on the metabolic syndrome reversal,” he said. Those on the Mediterranean diet with extra olive oil were 35 percent more likely than those on the low-fat diet to reverse the condition and those on the Mediterranean diet supplemented with nuts were 28 percent more likely to reverse metabolic syndrome, according to the study.

Research results were published online last fall in CMAJ a peer-reviewed general medical journal. The Spanish government funded the study.

A Mediterranean diet has been shown to be helpful for people with cardiovascular

More information To learn more about the Mediterranean diet, visit the American Heart Association at www. heart.org. disease, diabetes, high blood pressure and metabolic syndrome, according to background information from the study.

In the study, Salas-Salvado’s team looked at almost 6,000 men and women at risk for heart disease. At the start, almost two-thirds had metabolic syndrome, which increases the risk of heart disease, diabetes and death, according to the study.

Metabolic syndrome is diagnosed when three or more of five risk factors are found: large waist, high blood pressure, low “good” (HDL) cholesterol, high triglycerides and high blood sugar, according to background information in the study.

After a follow-up period of about five years, 28 percent of those who had metabolic syndrome at the start did not have it, the study found. Those who ate the Mediterranean diet were more likely to reverse the condition, the researchers reported.

How to stick to your diet If you’re one of the many Americans who plan to lose weight this year, there are a number of things you can do to improve your chances of success, an expert says.

“It should be clear by now that there is no one diet that works for everyone,” Jill Ashbey-Pejoves, lead dietitian at Northern Westchester Hospital in Mount Kisco, N.Y., said in a hospital news release.

“The best diet is the one that works for you. Don’t starve yourself or eliminate entire food groups,” she advised.

If you want to lose weight, you need to eat a healthy and well-balanced diet, she said. Deprivation diets don’t work because

depriving yourself of something just makes you want to eat it even more.

Plan what you’ll eat each day, so you won’t be forced into a quick decision and make a poor choice. Pack your own lunch and snacks. Eliminate unhealthy snacks and desserts from your home and replace them with fruit, Ashbey-Pejoves said.

Track your eating habits. Doing so keeps you focused and honest and helps you plan and see what works and what doesn’t.

Any weight loss effort should include exercise. A mix of aerobics, resistance training and stretching is best. Resistance workouts build muscle and muscle burns

Those who ate the Mediterranean diet also had a decrease in belly fat, which is known to increase heart disease risk, according to the study.

Many ingredients found in the Mediterranean diet can explain these effects, Salas-Salvado said. Monounsaturated fatty acids (MUFA), which are found in olive oil, replace saturated fatty acids in a Mediterranean diet, and this helps the cholesterol profile and insulin sensitivity (which decreases type 2 diabetes risk), according to the study.

Olive oil-rich diets have been shown to reduce blood pressure, he said. And most nuts are also rich in MUFAs, according to the U.S. Centers for Disease Control and Prevention.

The new findings add further proof that the Mediterranean diet “can play a role in overall health promotion, not just cardiovascular disease prevention,” said Connie Diekman, director of university nutrition at Washington University in St. Louis.

This study also replicates other research that suggested that the diet could have an effect on belly fat, she said. ‘’What is important, and this has been observed in other studies, is that the Mediterranean diet can aid the reduction in central obesity, a key factor in development of metabolic syndrome,” Diekman said.

It’s definitely possible for people in the United States to adopt the Mediterranean style diet, Salas-Salvado said. The foods are at hand, but Americans may need to devote more time to preparation and cooking, he said, as well as taking time to eat the foods so they enjoy them.

Source: HealthDay more calories. Doing only aerobics may not help you lose weight because that type of exercise stimulates appetite, Ashbey-Pejoves said.

Be sure to keep hydrated by drinking plenty of caffeine-free beverages.

Every meal should begin with a salad or broth-based vegetable soup. They help you feel full because of their high water content, but are low in calories. Many salad dressings are high in calories, so try seasoned rice vinegar instead, Ashbey-Pejoves said.

She also suggested that you use smaller plates; fill half your plate with non-starchy vegetables, put out a fruit bowl, and eat slowly and chew your food thoroughly.

DASH Diet tops 2015 list of Best Diet Plans The DASH diet came first among 35 diets reviewed in the annual U.S. News & World Report’s List of Best Diet Plans.

The U.S. government-approved DASH (Dietary Approaches to Stop Hypertension) diet scored 4.1 out of 5. The diet was created to combat high blood pressure, and received high marks for being heart-healthy, safe, nutritionally complete and its ability to prevent or control diabetes.

The diets were judged by a panel of health experts.

The second highest-ranked diet (score of 4) was the Therapeutic Lifestyle Changes (TLC) diet created by the U.S. National Institutes of Health. It’s particularly good at promoting cardiovascular health, but does require a more “do-it-yourself” approach than some commercial diets, the experts noted.

The Mayo Clinic Diet tied for third (score of 3.9) and received especially high ratings for its nutrition, safety and protection against diabetes.

It was judged to be moderately effective for weight loss.

Also scoring 3.9 were the Mediterranean diet — which emphasizes fare such as fruits, vegetables, olive oil and fish — and the Weight Watchers diet, which the judges said surpassed other commercial diets in many areas.

Other diets in the top 10 included the Flexitarian and Volumetrics (both 3.8), Jenny Craig (3.7), Biggest Loser and Ornish (3.6).

No evidence Paleo diet matches early human heating habits

There’s no proof that the popular paleo (Paleolithic) diet actually matches what early humans ate, a new study says.

The diet — heavy in meat, fish and vegetables and light in grain products and processed food — is supposed to be similar to how humans’ ancestors ate between 10,000 and 2.5 million years ago, ABC News reported.

But there is little evidence that early humans consumed a specialized diet or regarded any one food group as especially important, according to study author Ken Sayers, an anthropologist at Georgia State University.

“Whatever angle you chose to look at the diets of our early ancestors, it’s hard to pinpoint any one particular feeding strategy,” he told ABC News.

In fact, it’s more likely they were opportunistic feeders, Sayers said.

The study was published in the Quarterly Review of Biology.

Prevent snow shoveling and snow blowing injuries Snow removal is more than just another necessary household chore. All that bending and heavy lifting can put you at serious risk for injury. Snow removal can be especially dangerous if you do not exercise regularly.

According to the 2009 U.S. Consumer Product Safety Commission, approximately 16,500 people were treated in hospital emergency rooms for injuries that happened while shoveling or removing ice and snow manually. And more than 6,000 people were injured using snow blowers.

The most common injuries associated with snow removal include sprains and strains, particularly in the back and shoulders, as well as lacerations and finger amputations.

Proper lifting Try to push the snow instead of lifting it. If you must lift, do it properly. Squat with your legs apart, knees bent, and back straight. Lift with your legs. Do not bend at the waist. Scoop small amounts of snow into the shovel and walk to where you want to dump it. Holding a shovelful of snow with your arms outstretched puts too much weight on your spine. Never remove deep snow all at once. Do it in pieces.

Safe technique Do not throw the snow over your shoulder or to the side. This requires a twisting motion that stresses your back.

General tips for safe snow clearing

Never stick your hands in the snowblower If snow jams the snow blower, stop the engine and wait more than 5 seconds. Use a solid object to clear wet snow or debris from the chute.

Beware of the recoil of the motor and blades after the machine has been turned off.

Proper supervision Do not leave the snow blower unattended when it is running. Shut off the engine if you must walk away from the machine.

Safe fueling Add fuel before starting the snow blower.

Never add fuel when the engine is running or hot.

Do not operate the machine in an enclosed area.

Avoid the engine Stay away from the engine. It can become very hot and burn unprotected flesh.

Watch the snow blower cord If you are operating an electric snow blower, be aware of where the power cord is at all times.

No tampering Do not remove safety devices, shields, or guards on switches, and keep hands and feet away from moving parts.

Watch for motor recoil Beware of the brief recoil of motor and blades that occurs after the machine has been turned off.

Keep children away Never let children operate snow blowers.

Keep children 15 years of age and younger away when snowblowers are in use.

Understand your machine Read the instruction manual prior to using a snowblower. Be familiar with the specific safety hazards and unfamiliar features. Do not attempt to repair or maintain the snow blower without reading the instruction manual.

Check with your doctor Because this activity places high stress on the heart, you should always speak with your doctor before shoveling or snow blowing.

If you have a medical condition or do not exercise regularly, consider hiring someone to remove the snow.

Dress appropriately Light, layered, water-repellent clothing provides both ventilation and insulation. It is also important to wear the appropriate head coverings, as well as mittens or gloves and thick, warm socks. Avoid falls by wearing shoes or boots that have slip-resistant soles.

Start early Try to clear snow early and often. Begin shoveling/snowblowing when a light covering of snow is on the ground to avoid dealing with packed, heavy snow.

Clear vision Be sure you can see what you are shoveling/ snow blowing. Do not let a hat or scarf block your vision. Watch for ice patches and uneven surfaces.

Tips for Snow Shoveling

Warm-up your muscles Shoveling can be a vigorous activity. Before you begin this physical workout, warm-up your muscles for 10 minutes with light exercise.

Pace yourself Snow shoveling and snow blowing are aerobic activities. Take frequent breaks and prevent dehydration by drinking plenty of fluids. If you experience chest pain, shortness of breath, or other signs of a heart attack, stop the activity and seek emergency care.

Proper equipment Use a shovel that is comfortable for your height and strength. Do not use a shovel that is too heavy or too long for you. Space your hands on the tool grip to increase your leverage.

Tips for snowblowing

Source: U.S. Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS 2009 data and estimates) based on injuries treated in hospital emergency rooms.

Be careful walking on snow and ice

Every winter, many Americans suffer broken bones, muscle tears, sprains and strains from shoveling snow or falling on icy sidewalks and streets.

• One suggestion is to ask your doctor about strengthening exercises that will improve your balance, which can make a big difference when walking on ice.

• Try to avoid icy spots. But if you have to venture over them, remember that walking in a shuffle or moving your feet only slightly apart will give you better balance than using your normal stride. Keeping a slight bend in your knees also helps.

• If you’re walking on an ice-covered hill, turn sideways and avoid crossing one foot over the other. Instead, take sidesteps in which you bring your other foot along to meet your lead foot. Keep your knees bent for better balance.

• Always check for icy patches when walking, or getting out of cars, buses and trains or when going up and down outdoor stairs.

• To protect your dominant arm if you fall, carry an object or bag in your dominant hand.

This will make you more likely to use your non-dominant arm to break a fall.

More information

The U.S. Centers for Disease Control and Prevention has more about winter health and safety at www.cdc.gov.

Experimental infertility treatment seems effective, cheaper

By MAUREEN SALAMON HealthDay A crucial part of conventional in vitro fertilization (IVF) — the incubation of embryos in a laboratory dish — can instead take place in a device inside the vagina, new research suggests.

Scientists from the United States and Colombia contend that the device, called an INVOcell, might sharply cut costs for pricey IVF procedures among certain women. It could also make the technology more accessible to those who don’t live near big-city assisted reproduction centers, the researchers said.

In a small U.S. study, pregnancy rates were nearly identical between women whose eggs were conventionally incubated with sperm in the lab for five days and those whose eggs and sperm were placed in the INVOcell device for the same amount of time.

Once thought of as producing “test tube babies,” IVF is one of the most prominent forms of assisted reproduction and has been used in the United States since 1981.

About 65,000 babies were born in the United States in 2012 through 176,000 assisted reproduction cycles, typically costing upwards of $10,000 apiece, according to the U.S. Centers for Disease Control and Prevention.

“One reason assisted reproduction is limited is because of cost, and part of that is the incubation systems we use ... which are complex devices that require calibration and daily quality control checks,” said study author Dr. Kevin Doody, founder of the Center for Assisted Reproduction in Bedford, Texas.

“We think we’ve been able to simplify the IVF process to require minimal monitoring with a high pregnancy rate,” Doody added.

Optimal candidates for the INVOcell technique are infertile women able to produce many viable eggs using ovulation-stimulating hormones, experts said.

Manufactured by INVO Bioscience of Medford, Mass., the small, cylindrical device can be held in place in the vagina with a diaphragm, where the vaginal environment is expected to maintain the right temperature, pH and other conditions necessary for fertilization and early embryo development. After three to five days, the

device is removed and embryos can be recovered and transferred to the uterus.

Doody’s study divided 33 infertile women between ages 18 and 38 into two groups. After egg retrieval, each patient’s eggs were incubated in a petri dish with sperm for two to four hours, after which up to 10 eggs per patient were either placed in the INVOcell device or moved to the next stage of conventional lab incubation.

Embryos resulting from both methods were of comparable quality, and similar pregnancy rates resulted: 10 of 17 women from the INVOcell group and 10 of 16 from the incubator culture group reported ongoing pregnancies.

“My impression is wow, this is really interesting stuff,” said Dr. Timothy Hickman, chief of reproductive endocrinology at Houston Methodist Hospital in Texas.

“IVF tends to be a highly complex process ... and here’s a novel way to try to provide something for a certain population that can benefit. This is never going to replace an IVF lab, but maybe for a certain population it may work out right.”

A second study on the INVOcell device presented at the reproductive medicine meeting indicated that the technique is also effective when eggs need to be manually injected with sperm to achieve fertilization, a procedure called intracytoplasmic sperm injection.

Dr. Elkin Lucena, scientific director and founder of Colombian Fertility and Sterility Center in Bogota, led research on couples who underwent 172 cycles of IVF in which their embryos were incubated in the INVOcell device for three days, with an average of two embryos transferred into the uterus afterward.

Pregnancy resulted in 40 percent of embryo transfers — roughly the same rate as conventional IVF. “Especially from a psychological impact, couples feel they’re participating in conception too and carrying their own [offspring] inside of them instead of in a lab,” Lucena said.

“And the cost is lowered a lot, which is making it easier for people to access these techniques.”

The INVOcell vaginal device, currently under review by the U.S. Food and Drug Administration, is already approved for use in Canada and several other countries.

Doody, who said he owns about $10,000 of publicly traded stock in INVO Bioscience, said he thinks using the device could halve the cost of a typical cycle of IVF treatment.

“My guess is that at least two-thirds of IVF patients could be treated with this type of [technique],” Doody said.

One difference between the conventional treatment and the INVOcell approach is that eggs and sperm are placed together in the intravaginal device before knowing if fertilization has occurred.

“That is a waiting game for the patient,” said Doody. “But in all the cycles we’ve done, we’ve not had any cases where we didn’t have embryos [created] to transfer back to the uterus,” he added.

Source: HealthDay

More information The U.S. National Library of Medicine has more about IVF.

Fertility treatments have low complication rates

Assisted reproductive technology — or fertility treatments — to help conceive a baby is growing safer in the United States and is now a low-risk procedure, according to a new study.

The researchers found the risk of complications was low for both “autologous procedures” – where women use their own eggs – as well as donor-assisted procedures.

As the use of assisted reproductive technology (ART) in the United States increases, efforts have been made to improve patient safety. These safety measures include using less aggressive medication regimens to stimulate ovulation. And egg retrieval before ovulation is no longer done through laparoscopic surgery, but through a less invasive vaginal procedure, according to background information with the study.

To gain a better understanding of how these changes have improved ART complication rates, the researchers examined statistics and trends in reported complications from both patients and donors involved in fresh (not frozen) assisted reproductive technology.

The findings were published in the Jan. 6th issue of the Journal of the American Medical Association.

The decade-long review, led by Dr. Jennifer Kawwass of the Emory University School of Medicine in Atlanta, spanned the years 2000 to 2011. It was based on a surveillance system established by the U.S. Centers for Disease Control and Prevention, the study authors noted in a journal news release.

The researchers said reported complications had to be directly related to assisted reproductive technology and take place within 12 weeks of the procedure. Possible problems included infection, bleeding, complications related to anesthesia, hospitalization, and death.

Among nearly 1.2 million ART cycles where women used their own eggs, the most commonly reported patient complications were ovarian hyperstimulation syndrome (OHSS) – an overreaction to ovarian stimulation – and hospitalization.

“Increased awareness of the most common complication, OHSS, may prompt additional study to characterize predictors of this and other adverse events to inform the development of effective approaches necessary to decrease complication occurrence,” the study authors wrote.

The researchers noted that rates of all other complications remained below 10 per 10,000 cycles.

The study authors said they identified 58 deaths associated with ART during the study period. Of these, 18 deaths were related to ovarian stimulation and 40 others occurred before delivery. Overall, the death rates for women who had an ART-conceived live birth ranged from 14.2 per 100,000 in 2004 to 1.6 per 100,000 in 2008.

More information

The U.S. Centers for Disease Control and Prevention has more about assisted reproductive technology at www.cdc.gov.

The University Doctors MedicaLink Treating every generation, teaching the next generation since 1976

The University Doctors of Rowan University School of Osteopathic Medicine (RowanSOM) is a committed team of physicians and health care professionals dedicated to serving the South Jersey community. With expertise in multiple medical disciplines, we focus on treating patients at all stages of life.

As faculty members at RowanSOM, The University Doctors are in tune with the latest treatments and advances in medicine. We are committed to excellence in health care and to being your partner in wellness.

CAMDEN • CHERRY HILL • FORKED RIVER • GLASSBORO • HAMMONTON • MARLTON • MOUNT LAUREL MULLICA HILL • STRATFORD • VOORHEES • WASHINGTON TWP. • WEST DEPTFORD 856.309.DOCS • theuniversitydoctors.com • facebook.com/theuniversitydoctors • twitter.com/UniversityDocs

Kennedy University Hospital is the principal hospital of the Rowan University School of Osteopathic Medicine. Other affiliated hospitals and health systems include Lourdes Health System, Inspira Health Network, Cooper University Hospital, Meridian Health System, Christ Hospital and Atlantic Health System.