University of Pennsylvania Health System

Penn Health and Wellness

Tuesday, March 17, 2015

Prevent the Dreaded Afternoon Crash

We’ve all been there. You plowed through the morning, checking off all the items on your to-do list, sorting through your emails and, even, tackling that project you’ve been putting off for weeks.

Avoid the Afternoon Crash
Then, out of nowhere, it happens. You hit the proverbial wall. Your energy is zapped, and all you want to do is turn off the lights, hide under your desk and close your eyes for just a few minutes.

Don’t fear. You are perfectly normal. That tired, mid or late-afternoon feeling is your body’s response to its natural circadian rhythm — your internal clock that tells you when it’s time to wake up and go to bed — and the changes in blood-sugar levels that are largely dependent on what you eat.

Luckily, there are ways to fight the urge to curl up in your cubicle:

Eat Healthy

As if there weren’t enough reasons to watch what you eat, a healthy diet will help you stay focused throughout the day.

Many times, people will start to feel drowsy and rush to the vending machine for a candy bar or to the cafeteria to grab a piece of pizza or French fries. Rather than racing to sugary treats or fat-heavy foods that may provide a short high followed by a sugar crash, try eating a balanced lunch that includes protein and carbohydrates. The protein helps keep your blood sugar and energy at a good level, while the carbohydrates will keep you feeling full.

It’s also important you don’t skip the most important meal of the day. Yes, you know which one we’re talking about: breakfast. You’ve heard the old saying, eat breakfast like a king (or queen), lunch like a prince (or princess) and dinner like a pauper. Well, that’s because a nutritionally dense and filling breakfast will help sustain you during the times when your mental skills are in highest demand.

Paula S. Barry, MD
Paula S. Barry, MD
“Even if you don’t have time for a large meal each morning, try to include some protein and complex carbohydrates like fruits, vegetables and  whole grains into your daily routine, says  Paula S. Barry, MD, a primary care physician at Penn Family and Internal Medicine Longwood, in Chester County. “This will help to balance your glucose or sugar levels and keep you more focused throughout the day. By changing the food you eat for lunch you can obtain a more steady glucose level throughout the afternoon. Avoiding the peaks and troughs of fluctuating sugars may help you have a more energetic and productive day.”

Also try to watch  your alcohol or caffeine consumption throughout the week. If you simply can’t miss that office happy hour, limit yourself to a drink or two so that you don’t become fatigued later in the week.

Keep Active

One of the best ways to escape the tiredness is to hit the gym or go for a run on your lunch break. Unfortunately, many of us don’t have the time during work hours. If you’re unable to get away, there are things you can do in the office to boost productivity.

If you’re short on time and have just a few minutes between meetings, try some desk stretches to keep your muscles loose or consider a walking meeting. Not only will this provide a quick jolt of energy and inspire new ideas but it can also increase circulation to the brain and allow you to re-focus.

Pushing through the afternoon slump can be tough, but there are things you can do throughout the day to reach the finish line. Remember, there is no break from a healthy lifestyle.

“Always keep in mind that if you have severe or more prolonged symptoms, you should always check with your doctor to be sure you do not have diabetes or some other underlying medical condition,” suggests Dr. Barry.

Interested in other tips for office workouts? Check out Get Fit While at Work.

Need help developing a plan to fight your drowsiness? Speak with a primary care physician near you today.

Ignoring Nature’s Call: What Are the Health Risks

Lori M. Noble, MD, a primary care physician at Spruce Internal Medicine, located at Penn Medicine Washington Square, discusses the health risks of ignoring nature’s call.

Lori Noble, MD
The long, grueling days of medical school and residency impart many lessons, far beyond those related to patient care. For instance, the mantra of my residency experience was "eat, sleep and pee when you can."

While I always made eating and sleeping a priority, urinating had a tendency to fall off my to-do list during a busy day.

I imagine this is not something unique to a career in medicine; I'm sure any woman who works in a demanding field can recall a time (or several) when she "held it in" a little longer than would have otherwise been comfortable. It's a pretty common sacrifice we make to get that one last thing done, typically without giving much thought to any potential consequence.

I recently came across an interesting article in a popular women's magazine that addressed the potential impact of holding it in and thought I'd share what I read and add my medical opinion.

Bladders are unique like fingerprints.
There is no real agreed upon amount of time that is considered okay to hold in urine. This is because every woman is different in terms of how hydrated she stays, how large her bladder is and how sensitive her bladder is to the stretch that happens as it fills with urine.

Bottom Line: The average woman will feel comfortable holding her urine for between three and six hours, but there's a lot of variability.

So Why Not Hold It In?

The authors downplay any consequence of holding in urine for a prolonged period of time, noting that the "worst case scenario" is a "bit more of a likelihood" of developing a urinary tract infection (UTI). As a physician and a woman, I take issue with this for a couple reasons:

Don't ignore nature's call1. UTIs can be dangerous. In some people, the infection can spread from the bladder up to the kidneys and even into the bloodstream if not treated quickly. Pregnant women and those with certain medical conditions that can affect bladder function (i.e., Multiple Sclerosis, Diabetes, etc.) are already at increased risk for UTIs, so they should be extra vigilant about emptying their bladders regularly to prevent infection.

2. Many women struggle as they get older with urinary incontinence (the loss of bladder control). Stress urinary incontinence is leakage when there is increased pressure applied to the bladder, like with coughing, laughing or jogging. Urge urinary incontinence is leakage because of an intense, involuntary contraction of the bladder, often described as the "I gotta go, I gotta go, I gotta go" feeling. Both can be made worse if the bladder fills up beyond a comfortable capacity.

Bottom Line: There are potential consequences of holding in urine for a prolonged period of time. Listen to your body and take time to go when you feel the urge.

Are There Benefits to Holding It In?

There is some evidence that holding urine can "train" the bladder to be less sensitive to the urge to go, and thus allow a woman to wait a bit longer between bathroom trips. In my opinion, the risks of holding it as outlined above, outweigh this potential benefit.

Bottom Line: When it comes to holding in urine, the risks of infection, leakage and pain outweigh the potential benefit of a modest increase in bladder capacity.

What About Men?

The authors didn't address this, likely because the article was in a woman's magazine. However, as men age, the prostate – an organ through which urine must travel to leave the body – tends to enlarge. This can lead to difficulty starting and stopping urination. As a result, the bladder may empty incompletely, putting these men at increased risk for urinary tract infection. So, in my opinion, older men in particular should also make every effort to get to the bathroom when the urge strikes.

Bottom Line: Men need to listen to their bodies urge to urinate, too, particularly as they get older.

So next time you feel the urge to go, try to fight the instinct to just cross your legs and hold it in for a bit longer – your bladder will thank you for it later!

Monday, March 16, 2015

Your Pup May Be the Best Workout Buddy

Cynthia Otto, DVM, PhD, BS, and Karen Baird, MD, discuss the importance of physical activity for you and your furry friends.

America’s obesity epidemic, tied largely to a sedentary lifestyle and lack of meal portion control, is not limited to humans – it’s also an issue for our dogs and cats.

Unfortunately, because the general public is so used to seeing overweight pets, dogs that are physically fit and at an appropriate weight tend to be seen as “too thin.” A healthy dog should have a defined doggy waistline and should have just slightly padded doggy ribs (the same goes for our feline friends).

Research has shown that dogs who are just 10 to 15 percent overweight shave up to two years off their lives. With an average life expectancy between eight and 18 years (depending on size and other genetic and external factors), a couple of years makes a big difference.

The Benefits of Working Out with Your Pet

Now, add the benefits of exercise to the health benefits of pet ownership.

Work out with your petStudies have shown that people who own pets have increased levels of physical fitness, as well as a decrease in loneliness, anxiety and depression. Spending quality time with your pet through exercise can help keep both you and your furry family member healthier by lowering blood pressure, reducing both the risk of obesity and heart disease, and ultimately, having a positive effect on mental wellbeing and connectedness through the human-animal bond.

Together, these things can impact the relationship with your pet by increasing oxytocin release in your brain and your pet’s. Oxytocin is a nurturing hormone that makes you feel good. Petting and playing with your pet can release the hormone. Plus, the interaction through play and physical activity helps dogs release energy, which helps them be better behaved in general.

Since they don’t have a job and can’t read or do Sudoku puzzles, pets rely heavily on you for physical and mental exercise.

Activities for You and Your Pooch

Struggling to come up with fun ways to keep you and Fido active for the recommended 150 minutes of aerobic exercise each week? Here are a few suggestions:
animals need exercise too
  • Go for a couple long walks or jogs a few times a week
  • Let your dog be your ball retriever during tennis practice
  • Practice your Frisbee throw
  • If your dog enjoys water, go for a swim together
  • Include your pet in biking, hiking and trail running adventures 
Before embarking on any exercise program, it is always good to check in with your -- and your dog’s -- physician to ensure that everyone stays safe.

Our friends at Penn Vet are also a great resource, if you need advice on how to help your pet stay fit.

Friday, March 13, 2015

Get Fit While at Work

These days, it seems as though more and more people are working longer hours and using the old "no-time-to-exercise" excuse.

Unfortunately, this lack of physical activity can be harmful to your health, as it increases the risk of obesity, back pain, poor posture, leg cramps and tense muscles, among other things.

"The most profitable investment you can make in life is in your physical fitness," says sports medicine Michael C. Schettino, MD. "Any type of physical activity can improve an individual's health."

Wouldn't it be great if you could find a way to fit in some type of workout during those 8+ work hours?

Well, the good news is…you can. It just requires a slight change in how you work or get to work, to make a meaningful improvement.


Schedule walk-and-talk meetings. Who says a meeting needs to be held around a table? Take a brainstorming stroll with a colleague. If you need to take notes, schedule the meeting at a park where you can sit on a bench.

Avoid the elevator. The Centers for Disease Control and Prevention recommends adults get two hours and 30 minutes a week of moderate-intensity exercise to stay fit. Stair climbing for just 10 minutes, three times a day, for example, will total 30 minutes of heart-strengthening exercise, putting you well on your way to reaching that mark.

Take a stand. Set a timer to remind yourself to get out of your chair every 30 minutes. Use this time to walk to the water cooler or check in on a project.


Workout at WorkReach for the sky. Sitting at a desk all day can lead to neck pain between the shoulder blades. You can reduce the pain by reaching both arms up to the ceiling and arching your back. Then bring your arms down and stretch forward, opening the upper back. Do this every 20 minutes.

Stretch out your shoulders. Sit straight in your chair and reach one hand behind your back with your palm out. Then reach your other hand up and bend it down, trying to touch both hands. Hold for 10 seconds.

Point your fingers. Typing for eight straight hours can be harmful to your hands, wrist and forearms. Stretch one hand in front of you, pointing your fingers toward the ground. Use your other hand to gently push your fingers down and toward your body. Repeat on the other side. Then, stretch your hands upward doing the same.


Tone your arms wherever you can. A great way to sneak fitness into your day is to do a few push-ups here and there. Remember, all you need is a flat surface – and it doesn’t need to be horizontal. Simply lean against a wall, desk or other sturdy surface and get a few reps in.

Rise up out of your chair. Even if you are stuck in your chair all day, you can still get some core work in. Throughout the day, simply lift yourself off your chair with your arms.  If your chair is on wheels, it'll be even harder to hold your body still.

Get your legs up. While sitting in your chair, extend one leg out straight in front of you and hold for a few seconds. Then raise it up as high as you can and hold it again for a few seconds. Repeat with each leg multiple times.

These simple actions can significantly increase your physical health. Squeezing in a little exercise also improves concentration and could actually improve your productivity. Also, don't forget…

"The steps taken to improve physical fitness today will increase the likelihood of climbing the future steps of tomorrow," said Dr. Schettino.

Interested in more helpful tips for staying healthy? Check out our Patient Resources section.

Monday, February 16, 2015

Experiencing the Winter Blues? How to Fight Seasonal Affective Disorder

Karen K. Baird, MD, an internal medicine physician at Penn Family Medicine Southern Chester County, explains what seasonal affective disorder is and how it can be treated.

Seasonal Affective DisorderWe are now a couple months into winter, and for some, that means the “winter blues” are in
full effect.

The “winter blues”, known as seasonal affective disorder (SAD), is defined by major depression that recurs with a seasonal onset as well as a seasonal remission. Often the seasonal onset occurs in the fall and remission follows in the spring.

SAD is quite common, with studies showing that up to 7% of the population is affected with another 10-20% affected with a milder form of SAD, called subsyndromal SAD. More women than men report being affected; this is thought to reflect the higher proportion of women who are affected with depression in general.

The fall onset of SAD is thought to be due to decreased daylight which then triggers depression in those that are susceptible. A genetic link likely plays a role, just as in major depression and other mood disorders.

Primary features of fall onset SAD include: irritability (this often contributes to an increase in personal relationship stress), increased need for sleep, increased appetite (especially for carbohydrates which often results in weight gain), and a subjective “heavy feeling” and fatigue. These symptoms must occur daily for at least two consecutive weeks and have the typical seasonal pattern to meet official diagnosis.

The treatment of SAD differs slightly from the treatment of major depression in that light therapy, use of a specialized light box that provides 2,500-10,000 lux of light for 15-30 minutes daily, is often successful in decreasing symptoms. Many individuals report a change in symptoms after just a few days of daily light box use.

Fight the winter bluesOther treatments that have been found to work well against SAD include the use of anti-depressants, such as the selective serotonin reuptake inhibitors (SSRIs) and cognitive behavior therapy, known as CBT, which is a form of psychotherapy. There does seem to be an overall improvement of symptoms as well as prevention of recurrence when CBT is combined with light therapy and/or antidepressants.

If you believe that you, or someone you know has SAD, please discuss your concerns with your physician. Other medical problems can cause similar symptoms and it is important to be fully evaluated. If you do suffer with SAD, know that the therapies mentioned above are very helpful in improving symptoms – there is no need to wait until spring to obtain help.

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