University of Pennsylvania Health System

Penn Health and Wellness

Monday, July 27, 2015

Why You Shouldn’t Ignore Sleep Apnea

Karen K. Baird, MD, an internal medicine physician at Penn Family Medicine Southern Chester County, explains why you shouldn’t ignore your sleep troubles.

Do you wake up abruptly throughout the night? Is it from snoring (or from your significant other nudging you because you were snoring)?

Most know that heavy snoring and sleep apnea is not good for your health, but many tend to ignore these signs.

Occasional snoring is usually not very serious. However, if it happens frequently, you are impairing your own sleep quality and could be setting yourself up for several health problems. It doesn’t matter if you wake up every few minutes or once an hour. If your sleeping pattern is making you feel tired the next morning, it’s time to see your doctor.

An individual that wakes up throughout the night could be suffering from sleep apnea. People with untreated sleep apnea stop breathing repeatedly during their sleep. This means the brain -- and the rest of the body -- may not get enough oxygen. Often times, an individual may wake up suddenly, which allows the muscles in their airways to readjust, and then fall back asleep without even knowing what happened.

sleeping problemsSleep apnea can lead to high blood pressure, stroke, diabetes, weight gain, heart problems and other health conditions. If you, or your partner, notice any of these symptoms, call your physician for evaluation.

Nightmares Wake You Up

There’s nothing wrong if you experience the occasional nightmare. The problem arises if you have chronic nightmares that cause you to wake in terror at least once a week. Since you are not sleeping through the entire night, nightmares can lead to fatigue, anxiety and depression.

Chronic nightmares tend to be triggered by psychological stress -- such as that stemming from posttraumatic stress disorder or a severe anxiety disorder. However, other factors such as alcohol abuse, sleep apnea, some dementias and the use of certain medications can lead to nightmares.

You Do Things You Can’t Remember

When you wake up in the morning, does your significant other tell you about the odd things you did the previous night? This isn’t something you should simply laugh off. If this happens frequently, you could have a REM (explain REM) sleep behavior disorder. This occurs when your brain is in REM sleep, but your muscles are acting out your dreams. Frequently, many of the common sleep medications that people take, such as Ambien, are the cause of this issue. You should see a doctor if you are experiencing this, as it could escalate to sleep walking or sleep driving depending. Also, speak to your physician if you are having difficulty falling or staying asleep – there are many things you can do without relying on medications that can have potentially dangerous side effects.

You Wake Up With Tooth and Facial Pain

Many people that experience this type of discomfort when they wake up are grinding or clenching their teeth throughout the night. This action can be caused by a number of things, including stress, depression and dreams. Interestingly, this action occurs during short awakenings throughout the night.

If you do these actions for an extended period of time, call your dentist or your physician. There may be ways you can relieve stress prior to bed or wear some type of night guard that will help to protect your teeth, thus relieving pain.

You Experience Stomach Aches in the AM

There can be several causes of morning abdominal pain including constipation, indigestion and irritable bowel syndrome. If this is the case, simple changes to your diet or workout regimen, or medications, could help to reduce the discomfort. However, one of most common, and potentially most serious, reasons to experience stomach pain is gastric reflux, or even peptic ulcer disease. Individuals with gastric reflux and ulcers often feel nauseated in the morning. This may be accompanied by loss of appetite, nausea and fever. It is important to see a doctor if you experience these symptoms, consistently.

If you are experiencing any of the problems listed above, schedule an appoint with a primary care doctor today.

Monday, July 13, 2015

Ticked About Lyme Disease?

Awareness and Prevention are Key.

The weather is warmer, the days are longer and all you and your family want to do is spend time outside. It really doesn’t matter if it’s hiking, camping, or playing sports -- as long as you are outdoors-- you are happy. It is important to remember that higher temperatures and the more time you spend outside increases the risks of being bitten by a tick and contracting Lyme disease.

Lyme disease is caused by the bacterium Borrelia burgdorferi, which is transmitted to humans from the bite of the deer tick. Most Lyme disease in the northeastern United States occurs during summer or fall, when the small nymphal ticks are most prevalent.

Lyme disease in the summer
The early stage of Lyme disease is usually marked by one or more of these signs and symptoms:
  • Tiredness
  • Chills and fever
  • Headache
  • Muscle and/or joint pain
  • Swollen lymph glands
  • A characteristic skin rash (erythema migrans)
When caught early, Lyme disease is highly treatable and curable with a single course of oral antibiotics. If the disease is left untreated, it can cause neurologic complications, including facial palsy, numbness, tingling and headaches, abnormal heart rhythm and large-joint arthritis.

Tips to avoid ticks

  • Wear light-colored clothing. You’ll have a better chance of spotting a dark tick crawling around.
  • Wear high socks, sneakers and long pants. Tuck your pant legs into your socks, your shirt into your pants and avoid wearing open-toed shoes to minimize areas where ticks can find its way to your skin.
  • Use insect repellents. Apply repellent to any skin that is unprotected. You may need to apply every few hours. Make sure to avoid contact with your eyes!
  • Shower or bathe within two hours. If possible, always wash off within a couple hours after being outdoors to wash away loose ticks. Do a daily tick check. Search all the places ticks love to hide: your hair, under your arms, between your legs, behind your knees and in your belly button.
  • Don’t forget about the kids and pets. Be sure to check any children and pets before they enter the house. Ticks can easily drop off on carpets and furniture.
  • Check all gear. Thoroughly examine all items you brought with you on your trek.
  • Wash and dry your clothes. It is possible for ticks to survive the washing machine, even if hot water is used. Always dry your clothes in a dryer on high heat for an hour as well.
  • Create a tick-free zone at home. Mow your lawn frequently, stack wood neatly and in a dry area and discourage animals by putting up fences. It is also good to keep playground equipment, decks, lawn chairs, etc. away from yard edges and trees.
Tick prevention tips
“While Lyme disease can seem frightening, it is preventable! If you are vigilant about looking for ticks, and can pull the tick off the skin within 48 hours of the exposure, you can't get Lyme disease from that tick. If you're not sure how long the tick was on your body before you were able to remove it, contact your doctor to discuss a one-time dose of an antibiotic to help prevent the symptoms of Lyme disease from developing,” says Lori M. Noble, MD, a primary care physician at Spruce Internal Medicine.

Wednesday, July 8, 2015

7 Common Pains You Shouldn’t Ignore

Regardless of age, everyone experiences body aches at one time or another. These discomforts could be the direct result of a workout or sports injury, or from simply sleeping awkwardly one night.

Rahul Kapur, MD
Obviously, not all aches and pains require a visit to the doctor’s office. But, some do.

Rahul Kapur, MD, Penn Sports Medicine physician and lead medical physician for Penn Athletics, discusses certain pains that need your attention.

Wrist Pain

Oftentimes, minor wrist ailments occur from repetitive movement, such as writing or typing on a keyboard. Relieving this type of pain may be as simple as making a change to eliminate repetitive strain, performing stretches to relieve tension, or wearing a splint or brace to stabilize and put pressure on the joint.

More serious pains – for instance, discomfort on the thumb-side of your wrist – should be examined by a physician, as it could be a scaphoid fracture.

Groin Pain

Especially in athletes, this type of pain is typically caused by a muscle, tendon or ligament strain. It may occur immediately after an injury, or develop gradually over a period of weeks or months. In many cases, simply reducing the use of the injured area can help to alleviate the discomfort.

If you experience a sudden onset of sharp, intense pain in the groin, buttocks or thigh at the time of an injury, this could indicate a high-risk stress fracture of the femoral neck (a break in the neck of the femur or thigh bone). If this occurs, it is recommended you seek medical attention.

Shoulder Pain
shoulder pain

Getting dressed or lifting an item over your head shouldn’t cause pain. The shoulder has a wide and versatile range of motion and when something is wrong, it can hinder your ability to move freely.

If you experience pain that radiates down your arm during one of those activities (or at all), this could indicate a disc issue in your neck - especially if you have numbness, tingling or weakness.

Heel Pain

Heel pain is most often caused by plantar fasciitis, which is inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. This condition can be treated by performing stretching exercises, avoiding going barefoot and icing the heel several times a day.

If pain is present in the back of the heel or Achilles region and is accompanied by swelling or bruising, this could indicate a partial tear and should be examined by a physician.

Foot Pain

Don’t ignore or try to suffer through foot-related conditions simply because it’s “only your feet”. If you have trouble walking, you are more likely to stop being physically active, which can lead to further health issues down the road.

Nagging pain at the top of your foot, especially over the outside (pinky side), could be from a stress fracture. You may be told to keep pressure off the foot for a while or need a cast for a few weeks.

Shin Pain

If you train too hard over a short period of time, you may experience shin splints. They often plague runners who do not build their mileage gradually enough or who abruptly change their workout regimen. Treatment for shin splints can be as simple as decreasing, or completely stopping, your training until the pain subsides.

If there is pain in the lower leg, this could be the result of a stress fracture (an incomplete crack in the bone), which is much more serious. If it’s accompanied by numbness or tingling, you could have what is called exertional compartment syndrome (an exercise-induced muscle and nerve condition). It is important to see a physician so that they can perform the necessary tests to correctly diagnose the injury.

Big Toe Pain

Because we are constantly on our feet, there are many causes of toe pain. Cuts or scrapes and blisters can easily be treated at home. Your toe, though, supports the majority of your weight when you push off your foot and pain there could also be an indication of something more serious, such as gout or arthritis, or in some cases a tear or stress fracture.

While there are aches and pains that don’t warrant a visit to the doctor’s office, it is always better to err on the side of caution. If you have been experiencing pain for some time or are concerned about a recent development, it is best to get checked out by a physician.

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

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