University of Pennsylvania Health System

Penn Health and Wellness

Monday, July 6, 2015

How to Beat the Summer Heat

Lori M. Noble, MD, a primary care physician at Spruce Internal Medicine, located at the new Penn Medicine Washington Square offers tips on how to stay safe in the summer heat.

Beat the Summer Heat
Lori M. Noble, MD
Summer is a time for family fun in the sun, lazy days by the pool or ocean and countless outdoor activities.

As the summer heat beats down, though, it can sometimes seem like it’s impossible to stay cool. Not only can it be uncomfortable, but in some cases, it can actually be serious or even life-threatening. It is important to be able to recognize the signs of both heat exhaustion and heat stroke, and to know how to treat and prevent them.

Heat exhaustion is due to either not having enough water or salt in the body, both of which come from a combination of excess sweating and lack of hydration. Common symptoms that you should be on the lookout for include:
  • Pale skin or cool, moist skin with goose bumps when in the heat
  • Fatigue
  • Confusion
  • Dizziness
  • Fainting
  • Headache
  • Muscle cramps
  • Nausea
  • Heavy sweating
  • Dark-colored urine, (a sign of dehydration)
  • Rapid heartbeat
If you or someone you know is experiencing these symptoms, the most important step is to get out of the heat as quickly as possible. Preferably, get to an air-conditioned space or at least out of the sun. Then, drink water, remove tight clothing and take a cool bath or shower. If the symptoms continue for more than 30 minutes despite these treatments, call your doctor. If untreated, heat exhaustion can progress to a more dangerous heat-related illness, called heat stroke.

The common symptoms of heat stroke are:
  • Body temperature over 105° F
  • Throbbing headache
  • Dizziness and light-headedness
  • Lack of sweating despite the heat
  • Red, hot and dry skin
  • Muscle weakness or cramps
  • Nausea and vomiting
  • Rapid heartbeat (which may be either strong or weak)
  • Rapid, shallow breathing
  • Behavioral changes (such as confusion, disorientation or staggering)
  • Seizures
  • Unconsciousness
If you see someone demonstrating these symptoms, immediately call 911. While waiting for the paramedics to arrive, some simple first aid should be administered, which can be life-saving: fan air over the patient while wetting his or her skin with water from a sponge or hose, apply ice packs to the patient's armpits, groin, neck and back to help reduce body temperature, and if the patient is conscious, help them get into to a shower or tub of cool water, or an ice bath.

Preventing heat-related illness is just as important as being able to recognize and treat the common symptoms. Children under age four and adults over 65 or with chronic medical illnesses (like heart disease, lung disease, kidney disease, and diabetes) are at increased risk for both heat exhaustion and heat stroke, so be sure to check in on your loved ones during these hot summer months.

When the temperatures soar above 90 degrees, encourage people without air conditioning to go to a public place that does have air conditioning, like a shopping mall or senior center.

Finally, keep plenty of water on hand and always wear loose, breathable clothing.

Taking these simple steps can help insure that you and your loved ones have a healthy, happy summer.

Monday, June 22, 2015

What to Expect at Your Annual Physical

Lori M. Noble, MD, a primary care physician at Spruce Internal Medicine, located at the new Penn Medicine Washington Square building, discusses what to expect at your annual physical.

Penn Medicine
Lori M. Noble, MD
Going to the doctor for your annual physical can be nerve-racking. You have questions and concerns, your doctor has a separate agenda full of blood tests, studies and vaccines, and all of this typically needs to be addressed in 30 minutes.

To help you avoid feeling overwhelmed, take a look below at tests your doctor may address at your next physical based on the latest United States Preventative Services Task Force recommendations.

For tips of staying healthy, check out Guidelines for Maintaining Good Health.

Cholesterol blood test:

WHO: Women over the age of 45 and men over the age of 35, every 5 years.
WHY: Cholesterol levels help predict risk of future heart attack and stroke. If, along with other risk factors, cholesterol levels point to an elevated risk, your doctor may suggest changing your diet, exercising more, and/or medication.
NOTE: Depending on conditions, such as diabetes or strong family history of cholesterol or heart disease, your doctor may start checking earlier and more frequently.

What to Expect at Your Annual Physical
Also check out Guidelines for Maintaining Good Health


WHO: All women and men age 50-75, every 10 years.
WHY: To detect and remove colon polyps, which could turn into colon cancer if left untreated.
NOTES: (1) If you have colon polyps, you will likely need to return for a repeat colonoscopy in 3-5 years. 2) The colonoscopy is the best test for colon cancer screening, but there are alternatives. Ask your doctor about this option if you are unable to complete a colonoscopy. 3) If you have a strong family history of colon cancer (i.e. a parent or sibling), your doctor may refer you for a colonoscopy earlier.

Abdominal Ultrasound

WHO: One time in men age 65-75 who smoke or who have previously smoked cigarettes.
WHY: To detect an aneurysm of the aorta (the largest blood vessel in the body), for which male smokers are at increased risk.
NOTE: If an aneurysm is detected, you will likely need periodic repeat ultrasounds. If the aneurism is large, surgery may be recommended.

Pap smear:

WHO: All women from the age of 21-65, every 3-5 years
WHY: To detect HPV (human papilloma virus), the virus that can cause changes to the cervix, which ultimately can turn into cervical cancer if not treated.
NOTE: You may need to be checked more often if the result comes back abnormal.


WHO: All women from the age of 50-74, every 1-2 years; women aged 40-49 should have a discussion with their doctors to determine if they should be screened.
WHY: To detect breast cancer in its early stages.
NOTE: If a strong family history of breast cancer (i.e. your mother or sister) exists, you may be referred for mammography earlier.

Bone density testing (aka - DEXA scan)

WHO: All women over 65, every 2 years.
WHY: To detect low bone density, called osteoporosis, which increases the risk of fractures.
NOTES: 1) Women with risk factors for osteoporosis (such as a smoking history, a family history, low body weight, or history of fracture) are recommended to start screening at age 60. 2) There is no agreed upon age at which to stop screening at this time.

So now when it’s time to schedule your yearly physical, be prepared and armed with the knowledge about what to expect.

To help prepare for your next doctor’s visit, Penn Primary Care has also developed Guidelines for Maintaining Good Health, which can be found in the patient resources tab of

Tuesday, June 16, 2015

What to Know About Testicular Cancer

There are certain tests and precautions men need to take to be proactive about their health. Jeffrey Millstein, MD, a primary care physician at Penn Internal Medicine Woodbury Heights, discusses why it’s important to check for testicular cancer.

Jeffrey Millstein, MD
Are you doing all you can to keep yourself healthy? If you aren’t performing a monthly testicular self-exam, you may not be.

It’s estimated that there are over 8,000 new cases of testicular cancer each year. Though it can occur in older men, it’s most common in men between ages 15 and 35.

Fortunately, testicular cancer is one of the most curable cancers. Men diagnosed and treated when the disease is in an early stage have a 97 to 100 percent chance of being cured. Therefore, early detection is critical – and relatively easy to do at home.

Who Is at Risk?

The risk factors associated with the development of testicular cancer are not well established. We’ve found that the disease is more prevalent in white men than in black, Asian, or other nonwhite ethnic groups.

Some factors that increase the risk of getting testicular cancer include:
  • Having had an undescended testicle (also called cryptorchidism)
  • A family history (having a close relative with testicular cancer)
  • HIV infection
  • Body size: Tall men may have a higher risk of testicular cancer.

What Are the Warning Signs?

Testicular cancer can have many symptoms or there may be no symptoms at all.

The most common sign of testicular cancer is a lump, swelling of a testicle or enlargement of a testicle. This may be accompanied by tenderness, pain or a feeling of heaviness. Other signs may include a dull ache in the lower abdomen, back or groin, or a sudden collection of fluid in the scrotum.

It’s also important to note that not every change or discomfort indicates cancer; however, if you notice any type of change in a testicle, seek a medical evaluation.

Monthly testicular self-examinations can help you become familiar with how your testicles normally feel and help you better recognize any changes.

How to Perform a Self-Exam

It’s best to perform a testicular self-examination once a month, during or soon after a warm shower or bath when the scrotal skin is most relaxed.

While standing, check for any swelling on the scrotum. You may need to do this in front of a mirror.

Examine one testicle at a time using both hands. Put your index and middle fingers under the testicle with thumbs on top. Roll the testicle gently between your fingers. It can be normal for one testicle to be slightly larger than the other.

What if You Find Something Different?

Men's HealthIf you find something unusual or you’re not sure about, see a doctor right away.

The doctor will ask if you’ve been experiencing any pain, and if so, for how long. During a physical exam, he or she will examine your testicles for swelling or tenderness and for the size and location of any lumps.

The doctor may also examine your abdomen, groin area and other parts of your body, looking for any possible signs of cancer spread. If anything abnormal is found, additional tests may be performed.

Don’t put it off. Although it may be nothing, it’s important to check regularly and get any discomfort checked out. Better to catch it early than to ignore something that just doesn’t feel right.

Have additional questions or concerns?
Speak with a Primary Care doctor today.

Friday, June 12, 2015

7 Tips to Eating Healthy on a Budget

Tina McGroarty, CRNP, a nurse practitioner at Penn Family and Internal Medicine Lincoln, offers tips on how you and your family can eat healthy - on a budget. 

Healthy Eating
Tina McGroarty, CRNP
We are all aware that eating healthy is an essential part of maintaining health and wellness, and we see and hear these phrases often:
“Eat more fruits and vegetables.”
“Go organic.”
“Avoid processed foods.”
“Incorporate whole grains, legumes and nuts.”

While most know what is recommended, many find it hard to make these dietary changes without significantly increasing the bottom line at the grocery checkout.

Although processed food is more accessible and less expensive, there are ways to incorporate healthier choices into your diet and stay within your budget. Here are just a few suggestions I have found helpful:

Plan ahead. Check out your supermarket’s weekly ads, or circulars, to be aware of any specials. By preparing your list beforehand, you can plan your meals around sale items.

Eat seasonal produce. Fruits and vegetables are fresher and less expensive when in season, so choose meals that incorporate those items. You can also stock up and freeze or can fruits and vegetables to use later. Berries, green beans, corn and tomatoes all freeze/can well and are sure to be enjoyed in the winter months.

healthy eating
Buy local. Most communities have local farmer’s markets or produce stands that offer seasonal fruits and vegetables at reasonable costs. The prices tend to be much cheaper than supermarkets and provide a wider variety of fresher produce.

Grow your own. There is nothing better than freshly picked vegetables from your backyard. Starting a family garden is a great way to add healthy foods at a low cost.

Eat less meat. Most of us eat more meat than necessary. Substituting beans, legumes and other herbivorous proteins in place of meat is much healthier and less expensive. If you are buying less meat, it may make it affordable to buy grass-fed and free-range options, which can be more nutritious.

Buy organic wisely. In an ideal world, we would all love to consume only organic foods, but that is not realistic for most of us. Knowing the most and least contaminated foods can help you decide where to invest your money when buying produce.
  • 12 most contaminated foods: peaches, apples, bell peppers, celery, nectarines, strawberries, cherries, pears, imported grapes, spinach, lettuce, potatoes
  • 12 least contaminated foods: onions, avocado, sweet corn (frozen), pineapple, mango, asparagus, peas (frozen), kiwi, bananas, cabbage, broccoli, papaya.
Prepare meals at home. Home-cooked meals tend to always be healthier and less expensive. Taking a few hours on the weekend to cook/prep a few meals for the week will go a long way. Soups and stews are a great option as they can be loaded with vegetables and proteins, they freeze well and are delicious! Packaging leftovers and individual salads for lunch is also a great way to ensure a healthy meal during your busy work week.

Eating healthy doesn’t have to be expensive. I hope these ideas help you incorporate some healthier meals into your diet.

Need help developing a plan to eat healthier?
Speak with a primary care physician near you today.

Monday, June 1, 2015

Men: It's Time to Make Health a Priority

Raza Ahmad, MD, discusses the importance of men’s health. Dr. Ahmad practices at Delancey Internal Medicine, now located at Penn Medicine Washington Square.

Raza Ahmad, MD
Raza Ahmad, MD
When it comes to taking care of the house, men will clean the gutters, cut the grass, fix leaky pipes and do many other things to make sure it “stays in good shape”. But, when it comes to their own well-being, they are sometimes less motivated to put the same amount of effort into it. Perhaps this sounds like your dad, brother, son, husband or, even, yourself?

The summer is a great time to remind the men in your life about the importance of getting annual check-ups, proper screenings and taking a look at their overall approach to good health. Make sure that they look as good from the inside as from the outside.

Even if feeling healthy, it’s important to have annual check-ups. This gives your physician the opportunity to obtain a detailed medical history and a thorough physical exam. Additionally, we will collect baseline blood work, including cholesterol, and refer you for proper screening tests, if needed.

With these wellness checkups, potential problems can be identified before they become serious. This also gives you and your physician an opportunity to build a relationship, which will help you and your care team stay ahead of any issues. Should a health situation arise, these previous interactions will help your care team develop a personalized and focused treatment plan.

Your doctor can also provide advice on a proper diet and the best ways to exercise by taking into account your age, weight and family history.

Timetable for Maintaining Good Health

Below is a basic guide providing general medical evaluations for adults. This guide does not take into consideration any existing symptoms, chronic conditions or family history.

Timetable for Men's Health

If you have any specific questions, your regular well checkup would be the time to ask. Playing catch up in the bottom of the ninth inning with two outs is not a position you want to be in when it comes to your health. Preventative medicine is the best medicine!

Take the next step to good health.

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