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Why Environmental Health Matters

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Each first full week of April celebrates National Public Health Week. The goals of this week are to identify the issues that impact poor health and disease risks for individuals and communities and to start conversations and develop strategies that help build a healthier nation. Each day of the week focuses on a different aspect of public health, and our focus is Environmental Health.

Why is environmental health important? According to Office of Disease Prevention and Health Promotion (ODPHP) the environment plays a key role to the length and quality of your life. Poor environmental health is not only costly, but very hazardous. Per the ODPHP, 23% of all deaths (26% among children 5 years old or younger) are caused by preventable environmental factors. Therefore, to further understand it’s importance, below are some environmental factors that can affect your health.

  • Outdoor Air Quality
    • Poor air quality can lead to many issues: cancer, respiratory/cardiovascular system damage, and premature death.
  • Surface and Ground Water
    • Minimizing your exposure to contaminated water sources is important to your health as contaminated drinking and recreational waters from chemicals or infectious agents can cause serious illness.
  • Hazardous Substances
    • Substances like nitrogen dioxide from gas cookers or the removal of hazardous waste can filter into your water and air supplies, which when absorbed can be a dangerous health risk (especially for children).
  • Climate
    • Climate can affect air, food, water, disease risk, and mental health. It can increase asthma events and heat-related deaths, but can also impact sea level and cause natural disasters – which may spread diseases and also cause damage to your mental health during recovery periods.
  • Homes and Communities
    • With much time spent either at home, work, or school, your health can be impacted by the space you occupy: Indoor air pollution, inadequate heating or sanitation, or lead-based paint hazards can affect your health.

As you see there are plenty of environmental factors that can impact your health, but the Health Department at the University of Minnesota shared few suggestions on how to live a more sustainable life.

  1. Limit the use of toxic substances and unknown chemicals
  2. Buy organic, fair-trade products
  3. Carpool, bike, or use public transportation to prevent further air pollution
  4. Recycle

While there’s a need for long term sustainability to optimize public health, it’s important to take the initiative to ensure you’re living in a healthy environment. Check your homes, check the products you buy, but most important check in with your doctor to make sure you’re void of any disease risks.

Everyday Tips to Relieve Constipation

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There comes a point where almost everyone goes through it – constipation. A period of infrequent bowel movements or hard stools.   Constipation can be a very uncomfortable state, especially the longer it lasts. Though not severe, if not taken care of, constipation can cause damage to the veins and skin in your anus, in addition to significant damage to intestines.  Chronic constipation is also a risk factor for colorectal cancer.

Per the Mayo Clinic, there are a few risk factors that may increase your risk of constipation:

  • Older age
  • Women
  • Dehydration
  • Low fiber diet
  • Little to no physical activity
  • Blood pressure medications/treatments
  • Mental health conditions

Luckily our R-Health doctor, Julia Snyder, MD, offers tools to prevent and relieve constipation.

  • Eat a whole foods, high-fiber diet
    • Eat foods in their unprocessed forms without additives (i.e. sugar, salt, flavorings or preservatives)
    • Consider a trial of dairy and gluten free (two food groups that are likely to cause constipation for people)
  • Try adding 2 tablespoons of ground flax seeds to your daily diet for extra fiber
    • Grind the flax yourself every 2 days for an extra healthy fat boost
  • Eat more good fats and try coconut oil
    • g. – wild fatty fish like sardines and salmon, avocados, and olive oil (which lubricates the digestive system)
  • Supplement with magnesium, vitamin C and probiotics
    • Use 200 mg to 1,000 mg of magnesium citrate daily. Gradually increase the dose until you go once or twice a day. If you take too much, you will get loose stools. If that happens, back off a bit.
    • Vitamin C – you can take 2,000 to 4,000 mg in divided doses two or three a day, along with magnesium supplementation. The same principle applies here: If you begin to get loose stools, just back off a bit.
    • Many people who struggle with constipation are often deficient in healthy gut bacteria, so adding probiotics can help – try adding them for one month. The increased fiber in your diet will give them food to eat and they will be happy to stay.  Also add fermented foods/drinks to your diet.  (Fermented vegetables are found in the refrigerated section)
  • Drink about half your weight in ounces of water each day (add more for hot weather or exercise)
    • Try starting off your day with water and lemon (room temperature to warm)
    • Cold drinks slow down the bowels.
    • Try coffee or tea with an apple and walnuts/pecans/almonds for breakfast
  • Exercise regularly
    • Get up and move – just 10-15 minutes of walking a few times a day will make a big difference
    • Try Yoga – the combination of relaxation and movement aids in triggering the bowels to release
  • Give yourself time to go and listen to mother nature’s call!
    • Schedule time in to your morning – just like potty training your little ones!
  • Position yourself correctly
    • Put your feet up on a stool to mimic a squatting position. This allows the muscles to relax and the stool to exit more easily.

 

 

Following these suggestions are sure aids in constipation prevention and management. However, if you have questions, or have frequent constipation, notice blood in your stool, and have severe pain in your bowel and/or experiencing weight loss, be sure to reach out to your R-Health doctor for assistance.

Enabling Patient Communication with Our Secure Mobile App

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Last year at this time, I was still working at a traditional fee-for-service practice. I was seeing countless patients, trying to squeeze as much as I could into my day, and would sit down at the end of the day to begin returning patient calls. By the time I called my patients, I would usually get their voicemail and thus would trigger a seemingly never-ending game of phone tag.

When I joined R-Health, I was excited about the opportunities provided by Direct Care. One of the most intriguing features of R-Health practices was the enhanced doctor-patient communication through a HIPPA compliant mobile app that is downloaded to both the physician’s phone as well as the patient’s.   Patients can use the app to communicate non-urgent medical questions at any time.  As part of my initial visit with new patients, I explain the app and how they can use it to communicate with me and my Health Guide. I have had patients reach out to me through the app, not only with medical questions, but have received follow up information after an appointment, photos of rashes, and pictures of medication bottles to verify names and dosage strengths.

And the best part – it eliminates the countless rounds of phone tag. Patients send me a message using the app, I return their message, and if needed, we can schedule a time that is convenient for us both for a call or an appointment.

After-hours, I can triage their care and often schedule them to come into the office that same day or next day. My Health Guide, our medical assistant, will often come in to the office the next morning and find that I’ve added patients to the schedule from our after-hours app communications.

You may be asking yourself, but how do you have any down time if patients can reach you 24/7?  What I’ve found to work best is that I schedule certain times in the evening to check the app and respond. I am clear with patients that the app is for non-urgent issues, and they should reach me on my cell phone for any urgent medical concerns. With this approach, I can maintain a great work-life balance while still being proactive and accessible to my patients.

I’ve also found that when patients know they can send me a message at any time, make an appointment with me the same-day or next-day, and generally have better access to me – they are more at ease. By building a trusting relationship, one with mutual respect and appreciation, I find I rarely receive inappropriate calls or messages during evening and nighttime hours.

Practicing in Direct Care – and with assistance of the mobile app – has given me back control. I can practice medicine the way that I think is most effective. I can spend the time I need with my patients, whether that’s face-to-face in the office, via text message on our secure app, or over the phone.

Dr. James Bancroft is a family physician at R-Health New Brunswick.

Growth: The Expansion of R-Health and Direct Care

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The growth of Direct Care continues to spread across the country as more and more people begin to realize its positive influence on healthcare delivery. As awareness has grown, so too has R-Health – as one of the leaders of the industry, R-Health continues to expand its footprint in New Jersey by not only offering unprecedented relationship-based access to doctors, but curating a model that challenges the episodic, transactional, and volume-maximizing traits that presently exist.

Last year, Hint, a software organization that helps streamline administrative tasks for Direct Care practices, released a study on the practice trends of Direct Care, or Direct Primary Care. Hint reported that the average yearly patient panel growth for Direct Care practices is growing at over 8% per year. With more time with the patients due to the elimination of many administrative tasks, Direct Care is great for both the doctor and the patient.

R-Health follows right along these lines. Not only does R-Health offer individual memberships, but after signing a groundbreaking contract with the State of New Jersey, it is able to offer Direct Care as a benefit to over half a million New Jersey school and state employees and their families, completely free of charge.

With such an historic agreement, R-Health saw major growth over the past year. R-Health expanded to seven locations across New Jersey, three which came during the final quarter of 2017. Just like our approach to healthcare, our sites are committed to quality, excellence, and convenience. With comfortable assessment areas along with some of the latest technology in medicine, our locations offer the convenience of a one-stop-shop for all primary care needs whether you’re a patient or doctor. To see a list of all of locations, please visit our website.

Recognized as game changers, in 2017 R-Health received Philadelphia Business Journal’s Healthcare Innovator award for our efforts to reinvent the healthcare industry. Other news outlets such as the Wall Street Journal, Politico, and NJBIZ were just a few others who graciously acknowledged the hard work and commitment towards the success of this model.

In closing, this past year has been a great year for Direct Care, and an even greater year for R-Health. Now having laid a strong foundation in New Jersey, R-Health is driven to expand to more markets and develop new relationships with other businesses more than ever. As a tight knit group that puts our doctors and patients first, excitement ensues for what’s to come and we hope that more physicians join our clinical team to enjoy it with us.

Well, What?

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What is a well woman visit and why it is important?

 
It is a designated time for you and your health care provider to discuss your reproductive health. It may also include an exam, screening tests, like a pap smear or blood work, and immunizations. If you have breasts, a uterus, and/or a vulva it is important to have this type of visit to check the physical organs, even if you do not identify as a woman.

 
A well woman visit can be important in different ways for different people, depending on their needs and stage of life.  For young women, it may just be a discussion about periods and immunization for prevention of cervical cancer.  For those who are sexually active, contraception and STD prevention will likely be discussed.  Those thinking about starting a family might have a discussion about optimizing their health for conception and pregnancy.  For those 21-65 the Pap test allows cervical cancer to be detected and treated before it causes problems.

 

For women over 40, getting a mammogram can help detect breast cancer earlier. Those approaching or facing menopause might discuss bone health, changes in their body, symptoms, and strategies to protect them from long term health risks. It may not be necessary to have an internal exam or breast exam every year.  You can discuss with your doctor the risks and benefits.

 

A well woman visit is another important way to be proactive about your whole health. From an evolutionary stand point, one of the most important functions of our body is to reproduce.  So, reproductive health can be an indicator for overall health and well-being.

 
It also is an opportunity to continue to build a good, honest relationship with the doctor. With unlimited access to your R-Health doctor, not only are you not pressured with remembering all your questions for a single visit, but no matter what is discussed, you’ll always get the time you need to fully understand and have your input applied to any course of action.

Wash, Rinse, Repeat!

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The little things. It’s always the little things that are often overlooked, but can carry the most importance. Fresh air. Cold pillows. A good breakfast. Washing your hands. Few have the impact of the latter.

Washing your hands is one of the most important steps to not only protecting your own health, but also prevention of germ spread and other bacteria to others. This week is National Handwashing Awareness Week, and with the flu and many other sicknesses very prevalent during this time, now is as good a time as any to discuss the importance of handwashing, and how it’s relative to prevention.

For a little context on how important this topic is, here are a few facts, courtesy of the CDC, related to handwashing:

  • Washing hands with soap and water can reduce diarrheal disease-associated deaths by up to 50%
  • Handwashing can reduce the risk of respiratory infections by 16%
  • A large percentage of foodborne disease outbreaks are spread by contaminated hands, which could be greatly reduced by handwashing.
  • The use of alcohol gel hand sanitizer in classrooms can result in upwards of 20% reduction in absenteeism due to infection.
  • Reducing the number of infections through handwashing may help prevent the overuse of antibiotics (and eventual antibiotic resistance) often prescribed for these health issues.

Looking for more reasons why handwashing is important? Look no further than the main culprit of sickness: germs.  As the CDC describes, feces is a main source of germs, like Salmonella and E.coli that spread many respiratory infections such as, hand-foot-mouth disease and adenovirus to name a few. These germs get onto your hands a variety of ways, including:

  • After toilet use
  • Changing diapers
  • Blowing your nose
  • Handling raw meat
  • Taking out garbage
  • Petting animals
  • Caring for sick people

These are common, everyday activities that people do, yet if people don’t take the initiative to wash their hands, germs will stay on the surface of your hands for hours. With frequent touching of the body (i.e. touching eyes, nose, and mouth) coupled with germ pile up on your hand surface, it gets you sick, and even worse, it transfers to other objects that will get others sick.

So, what can you do? Wash your hands multiple times throughout the day and follow standard handwashing techniques:

  1. Wet – Wet your hands with clean water, then apply soap
  2. Lather – Rub your hands together with the soap, making sure to get the back of your hands, between fingers, and under the fingernails
  3. Scrub – Scrub your hands for at least 20 seconds
  4. Rinse
  5. Dry – Air dry or use a clean towel
  6. *Tip* For public restrooms, shut the faucet off with a paper towel, and use your shoulder (or another towel on the knob) to open the door

If you’re not near a sink, hand sanitizer is a great substitute. However, if your hands are visible dirty and greasy, this will not be as effective in eliminating the high number of germs. It’s also important to note to avoid the use of antibacterial soap, due to the dangers of triclosan. As the Mayo Clinic describes, although triclosan is an active ingredient in making some soaps antibacterial, excess use can cause small amounts to be absorbed by the skin, which may lead to a damaged immune system and/or antibiotic resistance.

In closing, sometimes it’s the little things that have big impact. Don’t risk getting sick, especially during peak flu season, by not washing your hands. Your R-Health doctor hand-washes every time they see you, so take the lead and follow suit. Or use our R-Health hand sanitizer.

Defeat Diabetes!

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With Thanksgiving approaching, it may seem like a joyous occasion for most, but for a segment of the population, it may be another day of battling your urges, for the sake of long-term health. November is recognized as American Diabetes Month; and with diabetes affecting nearly 30 million people and their families, it’s important to remind them that they are not alone, and to share information to those who are newly diagnosed.

For a quick summary of the condition, we turn to the Mayo Clinic. Diabetes affects how your body uses glucose. Glucose, or blood sugar, is a major source of energy for the cells in your muscles, tissues, and your brain. However, too much glucose in your blood can cause major health risks such as:

  • Cardiovascular Disease
  • Nerve, Kidney, Foot, and/or Eye Damage
  • Hearing Impairment
  • Skin infections
  • Alzheimer’s

Since there are different types of diabetes (Type 1 and Type 2) there are different risk factors associated with each, and we’ll share a few below:

  • Type 1 Diabetes – more prevalent during childhood/adolescence – removes insulin production from the body.
    • Risk Factors
      • Family History
      • Dietary Factors
      • Environment Factors
      • Geography
  • Type 2 Diabetes – more prevalent during adulthood – body becomes insulin resistant.
    • Risk Factors
      • Family History
      • Age/Weight/Race
      • Inactivity
      • High Blood Pressure
      • Abnormal Cholesterol levels

Consequently, knowing these risk factors, what should you do if you’re diagnosed? Binge eating will certainly not be the answer, however, Diabetic Living shared a few tips on how to approach a new diagnosis.

  1. Inspect your health plan – find the best and most affordable health plan that will cover your upcoming medications and supplies.
  2. Consider medications to lower your blood sugar – It’s now recommended to take at least one glucose-lowering medication as soon as you’re diagnosed (e.g. metformin).
  3. Create a diabetes eating plan – Monitor what you eat, but also track it to see its impact on your blood glucose levels. Most times you don’t have to make drastic changes.
  4. Create a physical activity plan – Just like your diet, physical activities are important when diabetic. Food provides the energy, and the activity helps burn some of it. Incorporating this into an everyday routine can have great impact.
  5. Shop for Diabetes supplies – Blood glucose meters, test strips, and a blood glucose journal are just a few things that can help you along the way.
  6. Connect with others – As we mentioned earlier, you’re not alone in this fight. Connecting with others can relieve you of any anxieties and motivate you to take care of yourself.
  7. Choose your primary care provider

Now if you’re not a diabetes rookie, you’d be more focused on how to manage your diabetes. With help from the National Institutes of Health (NIH), they shared 4 major actions you should take to manage your diabetes throughout your lifetime.

  1. Learn More about Diabetes
    • Get a better understanding about the type of diabetes you have and ones you’re not sure of (e.g. Gestational diabetes).
    • Take classes, join support groups, and talk to your doctors (i.e. dentist, dietician, eye doctor) in your health team to see how it can affect other areas
  2. Know your diabetes ABCs
    • A – A1C test. It measures your sugar levels over a 3-month span
    • B – Blood pressure. Have blood pressure goals and know what gets it too high or too low
    • C – Cholesterol. Like blood pressure, have cholesterol goals and ask your doctor what those numbers should be
  3. Learn to live with diabetes
    • Ask for help, discover new hobbies, voice your concerns to your support system
    • Spend time developing a food palette and compare your sugar levels to see what part of your diet needs changing
  4. Get routine care
    • Getting routine care at least twice a year can help catch any future problems, early
    • Get the A1C test twice
    • Ask your primary care doctor and other members in your health team if any other tests are required

If you’re already an R-Health Member, you’ve already got a great primary care doctor. Your R-Health doctor can spend the time with you to create your own health plan, covering what to eat, medication suggestions, and how to balance physical activity. A strong relationship with your primary can help you overcome some of the obstacles associated with diabetes, including a loaded Thanksgiving plate.

The Battle of Flu Prevention

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Although the weather is a bit misleading, we are in the start of flu season. While many people may have misconceptions about the vaccine, think they are immune to the flu, or may even believe the flu is a myth, it is very important to take the preventative measures to thrive during flu season. Moreover, if you were skeptical about the flu and its vaccine, here are some WebMD stats that might change your mind.

  • Between 5% to 20% of the U.S. population will get the flu, each year
  • 200,000 Americans are hospitalized each year from the flu and its complications
  • In the U.S., 3,000 – 49,000 people will die each year from flu-related causes
  • Finally, it can take between 1-4 days before flu symptoms begin to show, and you may still be contagious 5-10 days after the illness starts.

As you see, it’s important to take the preventative steps that aid in virus prevention, not only for yourself, but for those around you. Where can you find these tips? Look no further than your R-Health doctors, who are always available for you.  Remember, staying positive and relaxed helps the immune system.  If you are not yet an R-Health member, here are some tips to get you started.

  1. Get the Flu vaccine
  2. Wash hands frequently
  3. Eat Well (plenty of veggies, fruits, and healthy fats, while avoiding added sugar)
  4. Stay well hydrated.
  5. Get enough sleep.
  6. Wear a coat and other cold weather gear (hat/gloves/scarf) when needed
  7. Vitamin D (take 1000-20000 iu daily) unless otherwise recommended by your doctor

In the unfortunate instance you contract the flu, there are a few treatment options you can explore as well.   Talk to your doctor as soon as you have symptoms to find out if a prescription anti-flu medication is needed.  If you don’t have any special medical circumstances, often natural measures are best.  Subsequently, below are some natural treatment tips for the flu:

  1. Elderberry – Take Sambucol (1 tablespoon, 4x a day, for 5 days at first sight of the flu).
    • If you have contact with the flu you can also use Sambucol as means of prevention (2 tablespoons, 2x a day)
  2. Zinc – Take Zinc Lozenge (avoid intranasal zinc) every 1-3 hours for 3 days at first signs of the flu
  3. Steam inhalation with Eucalyptus oil and Chamomile can ease congestion, cough, and mucous membrane irritation
  4. Bone Broth – Soup helps boost the immune system
    • Beef bone broth, and yes, even chicken noodle soup works well!
  5. Honey – A natural cough suppressant, honey works better than Delsym. Take ½ to 1 tsp every 1-2 hours as needed.
  6. Treat a fever only to feel comfortable – High temperatures boost your immune system, but if needed, use the lowest effect dose of fever reducers like ibuprofen and acetaminophen.
    • Try the wet sock technique: put on a pair of wet socks, then a dry pair overtop

As a note, it’s important to inform your doctor on all herbal medicines you plan to take, and more importantly, if you experience shortness of breath, severe headache, confusion, and/or the inability to keep fluids down.  Remember you have unlimited access to your R-Health doctors who are available to you.

 

Prostate Cancer Awareness

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September is prostate health awareness month. Just in 2017, the American Cancer Society reported over 160,000 new cases. Outside of skin cancer, prostate cancer is the most common cancer in American men, affecting about 1 in every 7 during their lifetime. September is a month for raising awareness of prostate health in hopes of encouraging men to get their necessary screenings.

There are a variety of symptoms related to prostate cancer, chief among them are urinary. Cancer Treatment Centers of America (CTCA) described these symptoms being a result of the proximity between the prostate gland to the bladder and urethra. The following can be urinary symptoms of prostate cancer:

  • Burning or pain during urination
  • Difficulty urinating (trouble starting/stopping while urinating)
  • More frequent urges to urinate at night
  • Loss of bladder control
  • Decreased flow or velocity of urine stream
  • Blood in urine (hematuria)

Outside of urinary symptoms, other signs and symptoms that may be related to Prostate cancer:

  • Swelling in legs or pelvic area
  • Numbness or pain in the hips, legs, or feet
  • Lingering bone pain that leads to fractures
  • Painful ejaculation
  • Blood in semen

While Men’s Health offers a few tips for a healthy prostate, one of the best methods to prevent Prostate Cancer from affecting your life is to get screened. There is no definitive opinion on when or how often men should get screened, but it is important for the screening to occur.

Research has indicated that typically, men who are aged 40 or older, should be screened for risk factors. The Prostate Cancer Foundation urges all men to be proactive in their prostate health plan, but especially men who are at higher risk (i.e. positive family history or African American men).

There are different prostate screenings, including but not limited to a digital rectal exam (DRE) and prostate-specific antigen (PSA) test. If either of these tests detect an abnormality, doctors may recommend some additional test including:

  • Ultrasound
  • Collecting a sample of prostate tissue
  • MRI

These tests typically aid in confirming the presence of Prostate cancer and the extent to how aggressive it is may be.

As you can see, prostate health is important, especially if you’re at higher risk. Although many prostate cancers grow slowly, it’s best to get your screening sooner rather than later to treat any cases early. As always, your R-Health doctor is available for you to help answer any questions you may have, so reach out to your doctor to help you decide what’s best for you.

Back to Healthy Foods

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It’s September and Back to School season. Between the books, school supplies, outfits, and event scheduling, healthy eating is often the last thing people focus on. However, it’s important to stay focused on health, especially as work/school days get longer, activities more vigorous, and time becomes more limited. A healthier diet for children may lead to less stress for parents.

Healthy eating can be very simple if you have the right tips. The Huffington Post published a few Healthy Back to School Tips which we’ll discuss.

  1. Start the day off right – Eating breakfast as a family is not only great bonding experience, but also a time where you can prepare a nutrient-filled breakfast that last children until lunch. I know many adults who skip breakfast. Growing children may do better with a nutritious morning meal.
  2. Nix the added sugar – Avoid soda and other sugary drinks (i.e. iced tea, fruit punch) as well as sugary foods/condiments like cookies, ketchup, and sugar sweetened cereals to improve your children’s overall diet and avoid sugar rushes.
  3. Swap juice for whole fruit – Fruits are rich in fiber with high water content, and can help avoid added calories found in many juice pints.
  4. Pack a healthy snack – Always pack at least one fruit and vegetable. Some great options include apples, pears, bananas, yogurt, hummus, baby carrots, and nuts.
  5. Keep portions healthy – It’s important to serve healthy portion sizes to your children. Proper portion sizing prevents nutrient imbalance, overeating and even mood swings.
  6. Skip the white food – White bread, rice, and pasta are notoriously low in fiber, high in processed carbohydrates and lead to overeating. There are plenty of healthy non-processed alternatives such as white beans, cauliflower, along with most green vegetables that grow above ground such as lettuce, spinach, broccoli, and asparagus
  7. Get moving – Integrating exercise and sports is always a great way to keep your children healthy. Since it’s the beginning of school year, there are always an abundance of activities children can partake in, so make sure they’re active.

These are just a few simple tips to keep your children’s diet in check and healthy especially during frenzied times like the beginning of the school year. We know that a Happy wife means a Happy Life. Well, healthy children make happy parents! If you are searching for more health tips, your R-Health doctors are always available, ready to help answer any questions you may have.