University of Pennsylvania Health System

Penn Health and Wellness

Wednesday, May 20, 2015

How Much Water Do You Need Each Day?

Raza Ahmad, MD, discusses the question of how much water to drink on a given day. Dr. Ahmad practices at Delancey Internal Medicine, located at Penn Medicine Washington Square.

Raza Ahmad, MD
Raza Ahmad, MD
We all know the human body is predominantly made up of water. We also know that the body thrives when it is properly hydrated. But what is "proper hydration?" Do we really need to be running to the water cooler every 15 minutes to fill up our water bottle? And, do we really need to drink so much water? Can we drink other liquids instead? The answer is…well, a bit fluid.

Why Water is So Important

Water is a vital part of your body’s overall health — because it affects every cell of your body. It is a huge component of muscle and helps you produce energy. This is why you’ll often get a cramp when you work out without proper hydration.

Water also helps the body to maintain its temperature, remove waste and lubricate joints.

“Hydration has the greatest impact on training, performance and recovery," says Dr. Ahmad. "Dehydration, even at the lowest level, can result in impaired performance.”

How Do I know I am Hydrated Enough?

Dehydration occurs when your body loses more fluids, mostly water, than it is taking in. With dehydration, more water is moving out of our cells and body than what we take in through drinking.

The signs and symptoms of dehydration range from minor to severe. Increased thirst, dry mouth, weakness, dizziness, confusion and fatigue are all signs that an individual may be lacking the proper amount of water.

Many think that dry mouth is one of the first signs of dehydration. If you are experiencing dry mouth, though, your body is likely already craving water. If you are concerned that you may be dehydrated, a good way to check is to check the color of your urine.

If your urine is anything but clear, you are lacking the water your body needs. Yellow and orange are not the colors of healthy urine. If your urine is brown, you need to speak with your physician.

Should I Only Drink Water?

It is rare, but you can actually drink too much water.

As much as you need water, too much in your system can create an imbalance between water and electrolytes. When you sweat or lose water through other ways, you lose electrolytes. Replenishing your body with just water can dilute the electrolytes that are already low in your system. This could lead to your sodium levels becoming very low. When this occurs, you could become very ill. Although this is rare, it does occur.

During intense physical activity where you are sweating quite a bit, you may want to grab a sports drink or coconut water rather than plain water. This will help to better replace sodium lost in sweat.

"For slower athletes, it is recommend to drink according to thirst," said Dr. Ahmad. "Elite level athletes should follow a recovery plan, which includes drinking water and carbohydrate-electrolyte drinks."

How Much Water Do I Need Each Day?

This is last for a reason. Although the question is rather simple, the answer is much more complicated.

Unfortunately, there really is no one-size-fits-all approach to the amount of water you should consume on a daily basis.

how much water to drink each dayAs a general rule of thumb, you should try to drink between half an ounce and an ounce of water for each pound you weigh, every day. For example, if you weigh 200 pounds, it is recommended you drink 100 ounces of water if you are performing non-strenuous activities.

If you are going to be working out or hiking, you definitely should add to those 100 ounces. It is recommended that you drink 12 ounces of water a couple hours before your activity and then another 12 ounces about 30 minutes prior to the start. Be sure to also drink throughout the activity.

Other factors to keep in mind when thinking about your daily water consumption include the environment and any illnesses or health conditions. Hot or humid air makes you sweat more and will require additional intake of fluid. If you are sick and vomiting or have a fever, you will again be losing fluid more quickly and need to replenish.

As you can tell, being properly hydrated is important but not a perfect science. The best approach is to listen to your body and look for the feedback signs.

"I can not emphasize enough the importance of hydration," says Dr. Ahmad. "It has the greatest impact on training performance and recovery. Lack of hydration can lead to severe problems, including muscle breakdown, kidney injury and electrolyte imbalances."

Keep Calm and Hydrate on!

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

Tuesday, May 19, 2015

If The Shoe Fits…Run!

Daniel C. Farber, MD, Foot and Ankle Surgeon, discusses the importance of picking the proper running shoe and offers advice while going through the selection process. 

To avid runners, there is much more to the sport than simply lacing up any type of running shoe. They know that selecting the proper shoe is an incredibly important part of preparing for any type of competition.

Running Shoe Selection
Daniel C. Farber, MD
If you're wearing a shoe that doesn't fit your feet properly, you have a better chance of developing an improper gait or poor biomechanics. This added pressure on the heel or ball of the foot could lead to pain, plantar fasciitis, stress fractures, hallux valgus, (bunions) and lesser toe deformities.

When you're standing in the shoe store, most running shoes feel comfortable. Still, the true test doesn't come until you've pounded the pavement for several miles.

"Not all shoes are the same. Make sure you choose a shoe that fits your foot shape and running style," Dr. Farber recommends. "Remember that the most expensive shoe is not necessarily the best. The midrange shoes often have the more proven technology without the trendy price."

So, how do you sift through the many different brands and styles to ensure your feet stay happy and you stay pain-free?
  • Try on all shoes. Sizes among shoe brands and styles tend to vary. Don’t select shoes by the size marked inside the shoe. Judge the shoe by how it fits on your foot.
  • Select a shoe that conforms as nearly as possible to the shape of your foot.
  • Have your feet measured regularly. The size of your feet changes with age. For women, it may change during pregnancy.
  • Have BOTH feet measured. Most people have one foot larger than the other. Always fit to the larger foot.
  • Get fitted at the end of the day. The best time to measure your feet is at the end of the day when your feet are largest.
  • Stand during the fitting process. Standing allows you to check that there is adequate space (3/8" to 1/2") for your longest toe at the end of each shoe.
  • Comfort is important. Make sure the ball of the foot fits comfortably into the widest part (ball pocket) of the shoe.
  • Don’t expect them to stretch. Avoid purchasing shoes that feel too tight, expecting them to “stretch” to fit.
  • Minimize slippage. Your heel should fit comfortably in the shoe with a minimum amount of slippage.
  • Take a stroll. Walk in the shoes to make sure they fit and feel right.
Finally, remember that knowing when to replace your running shoes is just as important as picking the proper pair. Dr. Farber recommends that running shoes should be replaced every 3-6 months (or 300-500 miles) as they show signs of wear.

"With less activity, once a year is adequate Dr. Farber said. "If a shoe is in good condition, but has lost the cushioning of its insole, you can oftentimes simply rehab it with an over-the-counter insert."

"However, if the shoe looks and feels worn and doesn't support your foot well, replace it no matter what the age."

Have questions about a new exercise program?
Speak with a Primary Care doctor today

Are Women Athletes More Susceptible to Injury?

Erik Thorell, DO, discusses if gender plays a role in individuals being more susceptible to injury. Dr. Thorell practices at Penn Medicine Woodbury Heights.

In a perfect world, every run would be completely pain-free. No soreness, no aches and no lingering effects from the previous workout. Unfortunately, many runners constantly deal with a slight disturbance. There are things that can be done by, both men and women, to reduce the risk of injury.

Injuries to athletes
Regardless of how careful you are, injuries do occur. And, for women, the rate of injury is slightly higher. Runner’s knee, stress fractures, shin splints and plantar fasciitis are all injuries that are more common with female runners.

“One anatomical difference between men and women leading to greater predisposition to lower extremity injuries is the wider female pelvis, which results in a larger Q-angle,” says Erik Thorell, DO. “This results in increased stress across the knee in particular.”

Simply put, men and women are built differently. Women tend to have smaller, weaker muscles supporting their knees, as well as more lax ligaments. They typically have a larger hip width to femoral length ratio, which leads to greater hip adduction (muscles located towards the lateral portion of the thigh contract and pull the thigh away from the midline of the body). Females are also more at risk of certain injuries because there is added motion in their hips and pelvis.

When it comes to bone injuries, females are, again, more susceptible than their male counterparts. Women have smaller bone dimensions and are predisposed to lower bone density. Also, estrogen, a hormone in women that protects bones, decreases sharply as women age. All of these factors increase the risk of broken bones.

“Though gender differences do predispose women more to certain musculoskeletal injuries, attention to bone health, nutrition, core strengthening and a well-structured exercise routine can mitigate some of these problems,” explains Dr. Thorell.

Tips to Reduce the Risk of Injury

Because women suffer sports injuries more often than men, it is important they take extra care prior to playing sports or exercising. Below we offer certain exercises and other helpful tips:
  • Leg lifts, back bridges and standing hip flexors help to improve motion and flexibility in the hip and glutes area.
  • Weight-bearing exercises help to build and maintain bone density.  Attend dance classes, go for hikes, pick up aerobics or simply get into fast walking.
  • Balance exercises, such as Tai-Chi, can help strengthen legs.
  • Wear proper footwear and work out on appropriate (not very hard) surfaces.
  • Don’t suddenly intensify or lengthen your workouts.
Need help coming up with a fitness plan to keep you healthy?
Speak with a a Penn primary care physician today.

Thursday, May 14, 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 black and white of winter has given way to the bright colors and plush landscapes of spring. Our moods have brightened; our clothes lightened 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.

Fight allergies
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.

Wednesday, April 15, 2015

Get Moving: A Sedentary Lifestyle Is Harming Your Health

Growing up, how often were you told to “get off that couch and go outside”?

These words of wisdom don’t just apply to children.

We all know that exercise is important and that most of us should be doing more of it. But how and when are we supposed to? With advances in technology extending 9-to-5 work days and the countless items filling our daily to-do lists, there often doesn’t seem to be enough time in the day.

The research continues to mount up, telling us it’s time to stop leading a sedentary lifestyle and get off the couch. Here’s why and how to make it happen.

What Is a Sedentary Lifestyle?

Dr. Schettino
A sedentary lifestyle means an individual is not receiving regular amounts of physical activity. Regular amounts of physical activity, as defined by the Centers for Disease Control and Prevention (CDC), consists of a minimum of 150 minutes of moderate exercise or 75 minutes of a more vigorous regimen per week.

According to the World Health Organization (WHO), 60 to 85 percent of the population worldwide does not engage in enough activity. This makes physical inactivity the fourth leading risk factor for global mortality.

Many people think that a healthy diet and 30 minutes of aerobic exercise a day is enough to offset the time spent being sedentary. Unfortunately, it may not be enough for most.

“Daily physical activity is paramount in maintaining a healthy lifestyle,” says sports medicine physician Michael C. Schettino, MD. It should be as great a priority as eating, sleeping and working. A simple way to ensure adequate physical activity is to walk 10,000 steps (approximately five miles) each day.”

What Are Some of the Health Risks?

An ever-increasing amount of research has shown that physical inactivity increases a person’s risk level for cardiovascular disease and other conditions. Less active, less fit individuals are more at risk for:
  • High blood pressure and elevated cholesterol levels
  • Certain cancers
  • Anxiety and depression
  • Becoming overweight or obese
  • A decrease in skeletal muscle mass
“There’s no easy way out when it comes to physical fitness,” says Dr. Schettino. "It necessitates sacrifice and commitment. In the end, the fruits of one’s labors will be worthwhile. Trust me. Remember, we ultimately reap what we sow. Start sowing an active physical lifestyle today and you’ll begin reaping the significant health benefits.”

fight the sitting disease How to Fight Back

The battle against a sedentary lifestyle and the various health risks it presents can be one we all win. Here are a few simple steps you can take…some quite literally are more steps.

  • Better utilize your commute. If you take public transportation, stand while riding. If you drive to work, park a bit further from the office so that you can walk for a few minutes before and after work.
  • Workout at work. Having an office job is no excuse. There are many ways to keep active and Get Fit While at Work.
  • Clean up after dinner. Don’t let the dishes sit until tomorrow. After you eat a meal, clean the dishes and countertops. This forces you to stand and be engaged in physical activity, which will help to lower blood sugar levels.
  • Get up and go. Mix in walks throughout your day. If you have a dog, bring him or her along as Your Pup May Be the Best Workout Buddy.
  • Skip the DVR. We all dislike commercials – which makes them an excellent time to get up and get things done. While waiting for your favorite show to come back on, do some push-ups or sit-ups. Even if you fold clothes during the breaks, you’re keeping your body moving.
Simply put: We can all benefit from greater activity and it doesn’t require a gym membership or a change in clothing—often just a change in how you think of exercise.

Ready to get started on a physical activity program that is right for you? Speak with a primary care physician near you.

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