University of Pennsylvania Health System

Penn Health and Wellness

Wednesday, November 18, 2015

Holiday Heartburn

Eileen K. Carpenter, MD, an internal medicine physician at Penn Medicine Washington Square, discusses how to avoid holiday heartburn and when you should get it checked out.

Eileen K. Carpenter, MD
Eileen k Carpenter, MD
Some food for thought: Every Thanksgiving night, there are many cases of emergency room visits due to chest pain.

Something else for you to chew on: Most of these visits can be prevented.

The most common reason for chest pain is gastro-esophageal reflux disease (GERD) – stomach acid washing backward up the esophagus (food pipe). And while the stomach is designed to handle strong acids, the esophagus is not. If the refluxing acid doesn’t get swallowed back down promptly, it can cause a painful chemical burn in the esophagus.

Thanksgiving is a perfect storm of GERD risk factors. People’s stomachs are way too full by the end of dinner. Then, they top the evening off with a late dessert of high-fat pie, ice cream and a cup of coffee. Caffeine and fatty meals predispose you to reflux, and if your stomach isn’t empty by the time you go to bed, gravity pushes the acidic stomach contents up the esophagus.

Can you prevent acid reflux?

refluxLuckily, you can prevent reflux pain. The best way is to fast for two to four hours before lying flat and by timing your fatty or caffeinated intake to occur earlier in the day. Liquid antacids, like Maalox, Mylanta or Milk of Magnesia, provide near-immediate relief of reflux, so it’s a good idea to have a bottle in the house for the holidays. (The effective dose is two tablespoons.)

If there has been significant irritation of the esophagus, the pain may return a few hours later, and acid-suppressing medications like ranitidine or omeprazole will help heal it. If it takes more than two weeks for a reflux flare-up to resolve, it’s time to see your doctor to make sure there’s nothing else going on.

It’s important to keep in mind…

Chest pain due to the heart is also more common during the holidays. People are away from home and their usual medication routine; they’re drinking more alcohol and enduring more stress. If you are traveling, make sure to bring your medications and continue to take them as prescribed. Limit alcohol to one to two drinks a day for women and two to three drinks a day for men, or abstain completely.

If you think you have chest pain due to reflux, but the liquid antacid doesn’t knock it out immediately, call 911 to make sure it’s not your heart.

Interested in learning more helpful health tips?

Foods that Can Trigger Headaches

Roderick Spears, MD, a neurologist at Penn Neurology Valley Forge, discusses which foods to avoid in helping to prevent headaches.

Roderick Spears, MD
Roderick Spears, MD
Is there anything worse than that moment a headache strikes? You know the one, when that throbbing pain makes it difficult to do virtually anything.

Headaches, a pain in the nerves and muscles of the head and neck, are by far the most complained about issue at the doctor’s office. They are classified into two types:
  • Primary (not associated with an underlying medical condition), and
  • Secondary (associated with infections, fever, injury, etc.). 
While most recognize the connection between headaches and illness, many struggle to understand why they may be feeling fine one moment and suffering from a headache the next.

Would you believe that the horrible pounding in your head may actually be caused by something you ate or drank? And we aren’t just talking about the morning after partying. Caffeine, smoked meats and even cheese can cause you to feel like someone is using your head as a bongo.

Below is a list of some lesser-known food and drink-related headache triggers.

Coffee and Chocolate

Coffee and chocolate can both be headache triggers and inhibitors. Regular caffeine consumption – found in both – can lead to a physical dependence, which manifests as withdrawal symptoms when a user abruptly stops their caffeine intake.

For example, a regular coffee drinker sleeps a little late on the weekend. She wakes up and decides she doesn’t need a cup of joe to get her day going. An hour passes and her head starts pounding. Why? Her blood vessels have dilated too much. When this occurs, caffeine can actually help to ease the pain.


When it comes to cheese, older isn’t always better… for headaches.

If eating cheese makes your head hurt, it’s likely an aged-type like Swiss, Parmesan, Brie or cheddar. Aged cheeses are high in tyramine, a natural chemical found in some foods. Tyramine can cause headaches by constricting and dilating blood vessels.


Tyramine is once again the culprit. Try avoiding pepperoni, salami, summer sausage and mortadella, and limiting processed meats to four ounces per meal. Processed meats, such as hot dogs, deli meats and bacon can also cause your head to hurt due to synthetic food preservatives.

Soy sauce

Soy sauce also contains tyramine and sometimes monosodium glutamate (MSG). MSG, which is used as an additive in many other foods, has been found to cause cramps, diarrhea and headaches. Additionally, soy has large amounts of salt, which can lead to dehydration – and, therefore, to headaches.

Ice cream

I scream, you scream, we all scream… ugh, brain freeze!

We’ve all felt the terrible sensation before. That big bowl of ice cream is placed on the table, and you just can’t wait to dive in. You take a scoop or two and – boom – you get hit with the mind-numbing pain.

Here’s the scoop on how you got that brain freeze (which is in fact a form of a headache). When something cold touches the center of the palate, it sets off certain nerves that control how blood flows to your head. The nerves respond by causing the blood vessels in your head to swell up. This quick swelling is what causes your head to hurt. Luckily, these particular headaches tend to only last about a minute, and there’s an easy way to prevent them: Eat slower!

We know that the foods and drinks listed here likely make up a significant portion of your diet. You don’t need to cut everything out, but it may be wise to keep track of when you get headaches and what you indulged in prior to the pain.

Interested in learning more helpful tips?

Avoid the Turkey Knockout

This Thanksgiving, millions of Americans will join family and friends around the table. We’ll share what we’re thankful for and engage in that time-honored Thanksgiving tradition of enjoying a huge meal of turkey, stuffing and mashed potatoes, followed by pumpkin pie… and a nap in front of the TV.

Along with those traditions comes one almost as popular: blaming turkey, specifically tryptophan, for the reason no one can seem to keep the party going.

So, are they right? Is turkey the culprit for Thanksgiving sleepiness?

What is tryptophan?

Tryptophan is an amino acid, an essential nutrient in our diet that the body can’t produce. The body uses it in the process of making vitamin B3 and serotonin. While vitamin B is important for digestion, skin and nerves, serotonin is a chemical that impacts our moods. Serotonin can help create a feeling of well-being and relaxation. And what do you tend to do when you are relaxed? Perhaps take a little snooze?

Tryptophan is not unique to turkey. It’s found in other meats, chocolate, bananas, mangoes, dairy products, eggs, chickpeas, peanuts and a slew of other foods. And, some of these foods, such as cheddar cheese, actually have more tryptophan per gram than turkey.

You’re probably thinking: I eat many of these other foods and don’t struggle to stay awake. Why is it that on Thanksgiving, I can’t wait to find a comfy spot to close my eyes?

What is to blame for our need to nap?

Well, there are actually a few things at play.

Because many of the foods associated with Thanksgiving are high in fat, the body redirects blood to your digestive system to allow you to digest it. Since you have less blood flow elsewhere, you feel less energetic.

Additionally, the holidays can be a bit stressful; the most relaxing part is once all the preparation, traveling and planning is over and you can eat. While eating, you have the opportunity to sit back and relax. Add alcohol to the equation and the result is you feeling drowsier than usual.

Can you fight the urge to snooze?

The easiest thing to do is eat less food. That’s probably not going to happen, so the next best option is to ease up on high-carbohydrate foods (potatoes, stuffing, etc.). These foods tend to cut short the insulin response that fights tryptophan.

Also, plan some type of activity after your meal, such as a brisk walk or a game of touch football. This will help you digest the food a bit better and reenergize you. And if the weather isn’t cooperating, simply volunteer to do the dishes just to stay on your feet and be active.

Any type of activity that keeps you moving will allow you to spend more time with your loved ones, and isn’t that what the holidays are all about anyway?

Happy Thanksgiving!

Interested in learning more helpful tips?

Friday, October 23, 2015

Fighting Bed Bugs and Their Bites

Eileen K. Carpenter, MD
Eileen K. Carpenter, MD
Eileen K. Carpenter, MD, an internal medicine physician at Penn Medicine Washington Square, discusses how to win the battle against bed bugs.

Aaaack! Insects that fly into your house to suck your blood in the night, leaving itchy red skin bumps, and carrying multiple potentially deadly diseases!

Actually, that paragraph was describing mosquitoes. Bed bugs don't carry diseases, only fly via commercial airlines, and can be successfully eradicated from your home.

You've been living with mosquitoes your whole life and have learned to cope with them, and bed bugs aren't nearly as bad. One of the reasons bed bug infestations cause so much difficulty is that people panic, take unnecessary steps to get rid of them, and end up making things worse.

Know your enemies

Bed bugs are here to stay, and most people are going to make their acquaintance from time to time. Take a few deep breaths, get to know their habits and weaknesses, and you will have more success avoiding, containing and eliminating them. Most mistakes are made within the first 24 hours after people first see a bed bug, so have a response plan ready in advance.

Basic facts about bed bugs: They start as eggs, glued tightly to a surface near where their moms have been feeding. They hatch as tiny transparent critters and get their characteristic brown color after they've had a meal of blood. They grow by shedding their skins until they reach adult size. They never go through a pupa (cocoon-like) stage the way mosquitoes do, and they never develop wings.

Bed bugs can live for several years, looking for a meal the whole time. They commonly bite three times before getting full for the night, leaving three itchy, red bumps in a group on the skin. But they can also live long periods without feeding - maybe even an entire year - in a cool place.

Don't create a bed bug migration!

Bed bugs may not fly, but those suckers can run like ants. You can't get away from them by moving out of the room where you saw them. They'll follow you, and then you'll have them in two rooms. Exterminators charge by the room, so changing bedrooms or sleeping on the couch is a newbie mistake.

Click to enlarge
But because bed bugs will always try to find a human (or pet) at night, you can contain the infestation by continuing to sleep in the same room. Bed bugs are attracted by the carbon dioxide in your breath. They will find you if you move, but they'll stay where there’s food. Bed bugs also don't like light and will run for cover when lights are on. If the infested room is dark, and the uninfested rooms are lighted all night, it discourages them from wandering. They tend to bite exposed areas of the body, permitting a quick get-away when lights come on. They are also less likely to bite the head – they're good at not waking sleeping people.

There is no bug spray or bug bomb you can buy without a license that will cure a bed bug problem. You're just going to annoy them, drive them into new hiding places, and end up paying the exterminator to treat more rooms. However, it is safe to use diatomaceous earth, a dust composed of dried, microscopic, spiny sea creatures, which is available in home and garden stores. It kills insects without repelling them, and it isn't poisonous. Use it around the legs of the bed and around the edges of rooms to kill bugs that are moving back and forth from their daytime hiding places. You probably won't completely eliminate your bed bug problem, but if your finances don't permit hiring a professional exterminator immediately, it will help keep the problem from exploding.

It’s important to remember that bed bugs will travel from house to house by hiding in objects like clothing, purses, backpacks or luggage. When those objects are left in dimly lit places, the bed bugs will come out to look for a new place to hide. They then ride in that new object to another home. Movie theaters, kids' sleepovers, booths in diners, the space under the seats in buses, or shared storage lockers/drawers for purses and coats are all good places for bed bug transfer to occur. When you or your belongings have been someplace dark, think about the possibility of bed bugs when you return to your home.

Bed bugs are absolutely ecstatic when you drag your mattress out to the street, by the way. Please don't do it! They and their eggs will just drop off in your living room and infest your couch and chairs, and they'll go home with the sanitation workers – except your town's sanitation workers probably no longer pick up mattresses without covers, so the bugs will just walk back into you and your neighbors' homes when it gets dark.

Avoid getting bitten

So you're thinking, “This crazy doctor is telling me to keep sleeping with the bed bugs?” Here's where knowing bed bug habits will help during the time between finding the first bug and getting the exterminator in. By taking advantage of their predictable behavior, you can continue to sleep peacefully.

avoid bed bugs
Bed bugs love rough surfaces and skinny crevices. Cloth, wood, paper and plaster are good surfaces for them to climb. But they don't do well on smooth surfaces like plastic, tile, chrome or glass. You can keep them from climbing into uninfested/disinfected beds by putting the legs of the beds in empty plastic food containers (like Tupperware®) or by rubber-banding plastic bags around the legs. Just make sure the sheets and blankets don't drag on the ground. And pull the bed away from the walls. They'll spend the night walking 'round and round, trying to figure out how to get to you. Look around the next morning and kill any that haven't gone into hiding.

Bed bugs spend their days as close to where you sleep as they can get away with. They love the little folds on the edges of mattresses, between the mattress and box spring, inside the stuffing of the box spring, under the plastic guard at the edge of the box spring, or between the box spring and the metal frame. The bed frame and headboard can be scrubbed and vacuumed, but you'll never get them out of the stuffing of the box spring. Once they're in there, you can only seal them inside with a zippered cover. You'd much rather keep them out in the first place, right? Get bed bug covers for all your mattresses and box springs before you get an infestation, and your life will be much easier once it happens. Be sure to get the kind made of zippered fabric; plastic tears too easily. You're going to want the covers to stay in place for years.

Once you see evidence of bed bugs, nothing should leave any room except in a plastic bag. Run all clothes and bedding through the washer and a long, hot tumble in the dryer (at least 30 minutes at high heat). Then leave the clothes in plastic bags until the exterminator has declared your home bed-bug-free. Clean out all bedroom drawers and closets.

Bed bug elimination involves repeatedly scrubbing and vacuuming every couple days to eliminate the eggs and hatchlings as they appear. Alcohol only works if you really get things wet, so it's really not practical for large areas. Vacuum cleaner bags have to be thrown away outside every day, sealed in a plastic bag or trash container. Even with a professional exterminator coming, you will have to do these types of environmental controls yourself.

Also, be sure to keep all pets out of your bedrooms while in the process of controlling bed bugs.

How do you know a rash is due to bed bugs?

If you're waking up with itchy red bumps, particularly in groups of three, suspect bed bugs. The only sure way to know is to find evidence of the bugs, droppings or eggs. But don't assume that you don't have bed bugs just because you can't find any in your bed. They can crawl into the other furniture, into the cracks at the edges of your walls, into your electrical outlets, or occasionally into appliances like clock radios. Even professional exterminators with bed-bug-sniffing dogs don't find the bugs 100% of the time. And don't assume you can't have bed bugs if only one person is getting bites. The bites themselves are painless, and not everyone is allergic to the chemical they inject to numb you while they are biting. A tiny red dot may be the only sign.

Finally, do your best to avoid scratching the bites, as it can lead to scarring. Try pressing on each one with an ice pack until the itch stops. Hot showers make the itching worse, and alcohol can dry your skin and cause more itching, too. Over-the-counter antihistamine pills, like cetirizine or diphenhydramine, help itching.

Hopefully you can get started on effective control measures the first day you see a bug, so you don't actually have to deal with many bites.

Interested in learning more helpful health tips?

Thursday, October 8, 2015

Win the Battle Against Allergies

Jeffrey Millstein, MD, a primary care physician at Penn Internal Medicine Woodbury Heights, explains what “allergies” are and how you can win the battle against them this season.

It is that wonderful time of year again. The leaves are changing and the air is crisp, but unfortunately for some, the sniffling and sneezing of allergies has blurred the idyllic picture.
Jeffrey Millstein, MD

What are allergies?

Allergies – also known as “hay fever” or seasonal allergic rhinitis – is the fifth most common chronic condition in the United States. Pennsylvania and New Jersey have three allergy “seasons” the spring (when trees pollinate), the summer (when grasses release their pollen) and the fall (ragweed season).

An allergy occurs when your immune system overreacts and mistakes an ordinary substance, such as pollen, as a harmful invader. Inflammatory cells swarm to the area of contact (nose, sinuses, skin and eyes) and release antibodies, histamine and other destructive chemicals in an attempt to combat the “invader”, resulting in an allergic reaction.

How do I know if I have allergies?

Because common symptoms include runny nose, sneezing along with itchy and watery eyes. It can be difficult to distinguish allergies from an upper respiratory infection. There are, however, some clues to help determine what you are suffering from. Allergies can cause fatigue and misery from congestion to irritation of the respiratory tract, but will usually not make one feel truly “ill.” A fever, green or yellow mucous, deep cough or shortness of breath are indicative of infection and should prompt a call or visit to your primary care provider.

Allergies typically begin in childhood or adolescence, but they can develop at any time thereafter. While specific allergies are not directly inherited, your risk of developing allergies is increased if family members are affected.

Are there ways to fight allergies?

Below are some tips to help you get through the sneezing season more comfortably:

Avoid the thing you’re allergic to. Monitor pollen counts in your area and avoid outdoor activity when the count is especially high. The National Allergy Bureau or local weather stations provide accurate, accessible pollen count information. Keeping windows closed, and showering after coming indoors may also help prevent symptoms.

Try over-the-counter medications. Antihistamines are the most common of these remedies. Newer types, like certrizine, fexofenadine and loratadine are effective and are much less sedating than ones of the past. Nasal steroids, mast cell inhibitors and montelukast are other prescription options for refractory symptoms. A number of eye drops are available as well, specifically to treat itchy and watery eyes. Talk to your primary care provider to discuss what options would be best for you.

Natural remedies have shown efficacy for treating allergies. A few natural or homeopathic remedies have been shown to be effective, though some are outside the FDA’s purview: the European herb butterbur has shown some efficacy in clinical studies, similar to antihistamines and migraine relief medicine; salt water nasal spray can help wash out pollen from the nose and sinuses and, some cases, acupuncture can be helpful.

When symptoms do not respond to these interventions, as expected, and symptoms are severe or persistent, it may be time to see an allergist. They can perform skin and serologic testing for specific allergens and offer immunotherapy (allergy shots) when appropriate. Immunotherapy is based on the concept that the immune system can be desensitized to substances that trigger allergies. Injections can potentially lead to a lasting solution to allergy symptoms.

Allergies can be very annoying and sometimes disabling, but many effective options for prevention and treatment are available.

Establishing or maintaining a good rapport with your primary care provider or allergist will most likely lead to a satisfactory solution to this common problem.

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