University of Pennsylvania Health System

Penn Health and Wellness

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.



Friday, February 6, 2015

It’s Time to Get a Better Night’s Sleep

Did you know that how you feel during your waking hours depends greatly on how well you sleep? Increased energy and productivity along with an improved immune system are direct results of enjoying a sound slumber each night.

Sleep Better
John Molitoris, MD
Now, the only problem is how to get that better night’s sleep. Between hectic schedules, pressures at work and family responsibilities, it can be extremely difficult sometimes to drift off to dreamland.

"Historic views of insomnia held that sleep problems were a result of distinct medical pathologies, says John Molitoris, MD, a primary care physician at Penn Family and Internal Medicine Cherry Hill. "Current views are very different and hold that most problems with sleep can be remedied with some simple behavioral changes."

Although each person needs to experiment to figure out what works best for them, here are some tips to hopefully help you improve your sleep so that you can be more productive and full of energy all day long.

Keep a Regular Schedule

One of the most important things you can do to achieve good sleep is to stick to a regular sleep schedule. If you are able to go to bed and wake up at the same time each day, you’ll feel more refreshed and energized.

The best way to begin doing this is to record the time each night that you begin to feel tired. Once you see a pattern, try to go to sleep around that time. Even on weekends and holidays, attempt to stick to that time.

Sleep BetterThis also goes for getting up in the morning. If you sleep in when you can, you likely won’t be tired at your normal time, thus throwing off your sleep schedule. If you are getting enough sleep each night, you should eventually begin to wake up without an alarm. By being consistent, you are reinforcing your body's sleep-wake cycle.

If you are unable to fall asleep within 15 minutes of lying down, get up and do something that will relax you. Oftentimes, if you lay in bed agonizing over not being able to fall asleep, you might find it even harder to nod off. In addition, there are other sleep techniques that can help calm restless minds like counting backwards from 58 while linking your breathing to the numbers.

Be Smart About Napping

How many times have you plopped onto the couch only to doze off for a bit? Sometimes those little power naps can feel amazing. And, if you do need to make up for a few lost hours, a daytime nap is much better than sleeping late as it tends to have less of an impact on your sleeping schedule.

You do need to be careful though. If you sleep for too long or too close to your normal bed time, you are likely going to struggle to fall asleep at your usual time. If you are going to take a nap, it’s always better to do it earlier in the afternoon and to try to keep it to less than an hour, as a general rule of thumb.

Create a Relaxing Routine

Not only is it important to go to bed at a similar time each night, but it’s also recommended that you follow a similar routine before doing so. Find things that will make you feel comfortable and calm, and try to consistently do them. Perhaps it’s taking a warm bath or shower, reading a book or listening to soothing music. These types of activities can help you relax and effectively transition from being fully awake to becoming drowsy.

Also, attempt to make your sleeping situation as comfortable as possible. On top of having a bed that allows you enough room to stretch and turn without discomfort, try to keep noises at a minimum and your room at a cool temperature. If needed, consider trying room-darkening shades, earplugs, a fan or other white noise devices to create an environment that best suits your needs.

Exercise and Eat Right

By exercising as little as 20-30 minutes per day, you can help yourself sleep better at night. Simply being active – taking a walk, riding your bike or going to the gym – is going to help you fall asleep faster and lead to deeper sleep. If you feel that working out too close to bed acts as a stimulant, try scheduling your exercises in the morning or early afternoon. Take the time to figure out what workout schedule is best for you, as it will pay off in dreamland.

How you eat also has a major impact on how well you sleep. Be sure not to go to sleep feeling hungry or overstuffed because any discomfort may keep you up. Also, try to avoid eating or drinking anything too close to when you plan on going to sleep to avoid midnight trips to the bathroom. If you are hungry before bed, try something containing carbohydrates – a small bowl of cereal, a banana or a granola bar for example – as it may help to calm you down.

Know When to See a Doctor

Nearly everyone has the occasional sleepless nights. Sometimes, no matter what you do you can’t seem to clear your mind of falling asleep. If you encounter more than a few sleepless nights, have tried the tips above and are still struggling with sleep problems, it may be time to see a doctor who can help you get the better sleep you deserve.



The Penn Sleep Centers

The Penn Sleep Centers provide state-of-the-art diagnostic services and treatment for the full range of sleep disorders. The Centers are staffed by specially trained sleep physicians based in the departments of medicine, neurology, psychiatry, otorhinolaryngology – head and neck surgery, and oral and maxillofacial surgery. By gathering our physicians together from different departments, we are able to maximize the experience and knowledge of our staff. Depending on what factors are causing your sleep problems, we have experts on-hand to focus on your specific needs. Once the cause of your sleep problem is identified, this same team can develop a specific treatment program.


Wednesday, February 4, 2015

Fight the Winter Workout Woes

Lori M. Noble, MD, a primary care physician at Spruce Internal Medicine, located at the new Penn Medicine Washington Square building, discusses ways to keep active during the colder months.
Lori M. Noble, MD
Lori M. Noble, MD

When it’s cold and blustery outside, your warm and fluffy slippers have a tendency to look much more enticing than your running shoes. Before you know it, one day off turns into two and, eventually, that short exercise break has turned into an outright sabbatical.

This doesn’t have to be the case, though. Some simple tips to help stay active this winter:
  1. Switch it up: Who says you have to exercise the same way throughout the year? If you enjoy jogging or biking, there are great indoor alternatives to these activities.

    Try an exercise DVD series, sign up for an up-tempo Zoomba class, or try honing your swimming skills at the local YMCA. If you want to continue biking, get a stand that allows you to turn your road bike into a stationary one.

  2. Squeeze it in when and where you can: You can burn calories by making small changes to your daily routine. Did you know that an individual weighing 200 pounds can burn up to 12 calories an hour simply by choosing to stand rather than sit? That adds up to about 100 calories in an 8-hour workday, which is about the same as running a mile!

    And we often forget that there is a built-in gym in every office building - the stairs. Take them whenever you need to go between floors. Take it a “step” farther and carve out part of your lunch break to walk or run a few flights.

  3. Dress the part: If you know you won’t be able to get past the distractions at home or work to make exercising indoors possible, make exercising outside easier.

    You’ll need breathable, but fitted attire to keep warm and help reduce sweat. Because the body is mainly focused on warming your core, a hat, gloves, and warm socks are critical to feeling comfortable when the cold really hits.

  4. There’s power in numbers: When motivation is lacking, nothing is more powerful than the support of a friend. Try organizing a neighborhood walking club, or reach out to that person with whom you just never have enough time to catch up. Time flies when you’re having fun, so that 30-minute jog will inevitably feel much shorter in the company of friends.

  5. Track your progress: Setting goals is a great way to keep yourself motivated. Jot down your exercise plan for the month while keeping in mind the progress you hope to make. Keep the goals attainable, like increasing your workout by a few minutes each day. It's also nice to have a little reward planned once you've met your goal, like buying that new pair of sneakers you've had your eye on.
This winter, don’t let workout woes slow you down. Keep it interesting, and you’ll find it easier to keep moving.

Got an exercise tip you want to share? Let us know how you plan to stay active, indoors and out.

Tuesday, February 3, 2015

Keep Your Family Healthy This Winter

Jeffrey Millstein, MD, a primary care physician at Penn Internal Medicine Woodbury Heights, offers suggestions on how to keep your family healthy for the remainder of the winter.

Dr. Millstein
Jeffrey Millstein, MD
During the winter, viruses and colds within your household can be as common as snowflakes outside.

The harsh, cold months present many unique health challenges, but a little preparation can go a long way towards preventing winter illness and injury.

By now, you have surely been inundated with information about colds and flu, so we won’t go into too much detail about those. However, there are a number of other winter health issues which do not receive as much attention, but are still important to discuss. Here are just a few things to remember:

Get Your Daily Dose of Vitamin D

Because sunlight is a bit scarce this time of the year and cooler temperatures tend to limit outdoor activities, your family may be lacking vitamin D, which is vital to bone health. Because of this, a vitamin D supplement or multivitamin may be an option, especially if there are other risk factors for osteoporosis.

Sun exposure has also been shown to improve mood and a sense of well-being. For some, the darker winter months lead to a depressed mood, commonly known as “seasonal affective disorder”, or SAD. If this is something you or a family member may be suffering from, speak with your primary care provider about effective treatment options.

On the contrary, going to the tanning salon may be taking things a bit to the extreme. Cosmetic tanning, just like excessive and unprotected sun exposure, can markedly increase skin cancer risk.

Exercise Regularly

keep healthy this winter
For those who get most of their regular exercise through outdoor sports, that first frost can halt the normal routine and lead to decreased activity and weight gain. Try to find a winter alternative such as an indoor gym, swimming, calisthenics or even mall-walking so you don’t lose momentum.

By simply setting aside 20 minutes five or six times a week to focus on aerobic exercises, you can greatly lower sick days for you and your family members.

Scrub Up

Contrary to popular belief, the cold weather itself is not responsible for the prevalence of respiratory infections during this time of year. Spending more time indoors, in close contact with others, promotes the spread of colds and the flu.

The best protection includes frequent hand washing or use of hand sanitizer and avoiding unnecessary hand-to-face contact. When washing your hands, lather them up with soap for 20 seconds prior to rinsing to help eliminate all germs.

Sleep Well, But Consistent

Many people find it difficult to leave their comfy, warm beds this time of the year. The amount of daylight during the winter is more limited than in the other seasons, as mentioned above, impacting the body's sleep cycles and circadian rhythm. Sleeping more than normal could be harmful, though, as it can impact your appetite, alter your energy levels and lead to depression.

Although the lack of light may make your body feel tired and sluggish, it is important to try to stick to a schedule, regardless of the day.

Finally, it is important to keep up with your vaccinations. If you do become ill, your primary care provider can be your resource for helping decide what can be treated with supportive home remedies, versus symptoms that require office evaluation or medication.

Attentive prevention and health maintenance during the winter will make it much easier to return to warmer weather activities. Spring is only a few months away!

Tuesday, January 13, 2015

Color Your Plate Healthy

Paula S. Barry, MD
Paula S. Barry, MD
“Just because it’s cold outside it doesn’t mean you can’t continue eating fresh, healthy foods packed with nutrients. A variety of options of fresh produce are available at most grocery stores,” says Paula S. Barry, MD, a primary care physician at Penn Family and Internal Medicine Longwood.

It has been said the more shades of vegetables and fruits your meal includes the more nutrients you’re eating. With that in mind, let’s take a look at some of the most colorful and healthy “super foods.”

Citrus: Bright Yellows and Greens

Citrus fruits, which encompass the usual suspects - lemons, limes, oranges and grapefruits - aren’t just bright and cheerful looking; they also come with healthy benefits and are at their juiciest in the winter. Citrus fruits are loaded with vitamin C - one medium orange delivers more than 100 percent of your daily dose. In addition, studies have shown that nobiletin, a flavonoid extracted from tangerines, helps to prevent obesity and offers protection against type 2 diabetes.

Pomegranates: Ruby Reds

Pomegranates, which originated from Persia, have a juice rich in antioxidants - compounds that block the activity of other chemicals known as free radicals, which have the potential to cause cancer. Studies have shown that just a cup of pomegranate juice might help prevent free radicals from developing “bad” LDL cholesterol, in effect, lowering high cholesterol levels. It’s also been said that this red juice can lower high blood pressure and help reduce blockages (atherosclerosis) in the arteries of the heart.

Kale: Rich Greens

Dark leafy greens, such as kale flourish in the cold of winter. In fact, a frost has been known to sweeten the leaves of kale. These greens are particularly rich in vitamins A, C and K and are especially good for women of childbearing age. There’s just a little over 30 calories in one cup of raw kale which contains protein and Alpha-linolenic acid, an omega-3 fatty acid.

Potatoes: Creamy Purples, Reds, Oranges and White

Potatoes sometimes get shortchanged for being a white starch and thought to hold little to no nutritional value, like white rice or white bread. However, potatoes, especially sweet potatoes and russet (skin on) potatoes, are packed with a variety of vitamins, minerals and low sodium. They are a whole food that contain an excellent source of two immunity boosters - vitamins C and B6, delivering 25% and 29% of your daily needs per medium potato, respectively. They are also a good source of fiber and folic acid, which has been known to help in the prevention of heart disease and stroke, as well as memory loss, osteoporosis and sleep problems. Folic acid is especially important for women of childbearing age. Purple potatoes can add an especially nice accent color to your plate and have even more healthy nutrients. These include antioxidants that have been linked to lowering the risk of cancer, as well as reducing inflammation.

Squash – Vibrant Oranges and Yellows

Butternut, acorn, delicata and spaghetti squash are some of the most popular assortments of winter squash and they are all excellent choices in the cold season. Want to feel fuller with lower calories? One cup of cooked winter squash contains only 80 calories and is high in vitamins A and C, as well as being a good source of vitamins B6 and K, potassium and folate. These super foods are also packed with helpful antioxidants and omega-3s, not to mention elements for a strong immune system to help protect against colds and flu.

Dr. Barry adds, “Although many experts differ on what food is the most nutritious or has the most antioxidants and disease fighting capabilities, it is certain that eating a well-balanced diet with a variety of fruits and vegetables is important.” She reminds us, “Regular exercise, portion control, and getting your daily dose of these ‘super foods’ can help keep you in tip-top shape and ready for the warm weather that lies ahead.”

Looking for additional healthy eating tips or to create a long-term health and wellness plan?
Speak with a primary care doctor in your neighborhood.

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