Some Healthy Travel Tips from Dr. Lewin: E.A.T. R.I.G.H.T.

"It is no secret that obesity and a lack of good nutrition plagues many Americans. With more than 66% of Americans obese and more than two-thirds of obese children destined to become obese adults – we must break the cycle, but where do we begin?

I work with Dr. Margaret Lewin who specializes in nutrition and prevention who believes ‘you are what you eat’ and the first step is controlling cravings and what you consume.  Her full bio is below.

Some Healthy Travel Tips from Dr. Lewin: E.A.T. R.I.G.H.T.

·         Eat the rainbow! Not only do foods of varying colors pack a wealth of nutrition, they also look ever so enticing on the plate! 

·         Avoid processed foods. 

·         Take a list with you when you shop – with a mind to whole meals containing those fresh fruits and vegetables of varying colors as well as whole grains.

·         Read package labels carefully. 

·         Inspect fruits and vegetables carefully for signs of spoilage, store them properly, and wash them immediately before using.

·         Get locally grown, seasonal fruits and vegetables when possible, in order to maximize nutrition; decrease the risk of contamination and save money.

·         Have fish at least twice weekly – it’s high in protein, low in calories and fat, and high in omega-3 fatty acids. 

·         Take time to enjoy your meals, eating slowly to decrease portion size and to help digestion.

Dr. Margaret Lewin
Chief Medical Director of Cinergy Health
Board-certified in Internal Medicine, Hematology and Medical Oncology, she is a Fellow of the American College of Physicians and Clinical Assistant Professor of Medicine at Weill Medical College of Cornell University. She is affiliated with New York-Presbyterian Hospital and The Hospital for Special Surgery.
       
Dr. Lewin has worked throughout her career to improve the American healthcare system. She has been on the boards of state and local medical societies and is Immediate Past President of the New York County Medical Society and Immediate Past District President of the American College of Physicians. Her decades-long volunteer work has included service to many local projects and organizations and has been enriched by her medical missions to the Third World .

Dr. Lewin has authored numerous articles in leading medical journals and lay magazines, as well as chapters for medical textbooks. Her areas of special interest and expertise include travel medicine, primary and preventive care, men's health and women's health."

-Courtesy of Cinergy Health & Dr Margaret Lewin

Carrying Your Child Could Cause Them Back Pain for Life

Is your child likely to
have back pain for life? According to Esther Gokhale, pain expert and
author of 8 Steps to a Pain Free Back, it
is very likely because the way we carry our children can lead to bad
posture
habits which can subsequently lead to a lifetime of back pain.

According to Gokhale, modern
societies have lost the knowledge of natural posture and movement that
prevents pain and
enhances health. This natural posture becomes lost at a very early age,
when
posture and movement patterns are etched into the brain. Today's parents
and grandparents have lost the generational wisdom for carrying children
the
right way, and today's children are the worse for it, because they carry
these habits with them into adulthood.

Here are a few tips from Esther on how to correctly hold a child:

*        Lengthen your child's back, don't compress it
*        Help your child's behind remain behind him, not tucked under
him

The picture above is a child in the United States who is being
carried with his tail
tucked under; the picture below is a child in Brazil who is being
carried with
his tail behind him.

Here is a Q & A from Esther with additional information.

How common is chronic back pain for young people?

The incidence of back pain in teenagers is approaching that of adults. 
Depending on which studies you follow, teenagers have between a 37%-60%
incidence of back pain. Less than two decades ago, back pain was
considered a rare condition that warranted an extensive medical work up
- now it is so commonplace that nobody blinks an eye when a kid shows up
with back pain. As with adults, blame is usually placed on external
factors - back packs, sitting at a computer, etc.

How should parents be carrying their children to avoid back pain?

Parents can do a lot to start their children out right and avoid back
pain and other musculoskeletal problems later in life. The most
important principles are:

1. Lengthen your child's back during his growing years.
A. For younger children, carry them in ways where their lower bodies
suspend downwards while they are being gripped around the ribcage.
b. For older children, provide them with monkey bars, swing them around
and around or suspended between parents - "wheee."

2. When carrying your child in a seated position, make sure his "tail" 
is behind him, not tucked under him.

If a child or teen does experience back pain what should a parent do?

Do not instruct the child to "sit up straight" or "stand up straight." 
This does more harm than good, both physically and emotionally. First,
understand the connection between back pain and posture, learn about
healthy posture by reading 8 Steps to a Pain-Free Back or taking the
six-lesson Gokhale Method Foundations course offered around the country,
show your child images of healthy and unhealthy posture (8 Steps to a
Pain-Free Back has over a thousand images you can select from), and
offer your child effective and safe instructions like "stack your
blocks," "put your tail behind you not under you," "ducky butt not tucky
butt," etc. Get to the root of the problem and don't issue ineffective
interjections that are a result of frustration from not knowing how to
solve the problem. Be positive and knowledgeable and provide your child
an example with how to deal with problems.

What are the most common causes of back pain in young people?

Posture is the number one cause of back pain in kids (and adults, for
that matter.) This cause is under-recognized and we often blame things
that would not be problems if our posture was sound. Obesity and
inactivity are also real causes of back pain among young people.

Once a kid has poor posture, a lot of activities become problematic -
carrying heavy backpacks, sitting, sports, height, moderate weight gain,
etc., but the root cause of the pain is really poor posture.

www.egwellness.com

-Courtesy of Esther Gokhale

Winter Health Articles

How To Know When Your Baby is Sick

By Margaret Lewin, MD, FACP – Medical Director, Cinergy Health (www.cinergyhealth.com)

            As new parents, you’ve spent nine months emotionally as well as logistically preparing to welcome that magical newborn into your household.  Nevertheless, you may not be prepared to evaluate your infant when he’s ill and to know when you can handle the illness yourself and when to get help.  For infants under the age of six months, the following are some of the signs of illness and general guidelines for when to call the doctor.

·         Fever itself is not an illness, but rather the baby’s response to an illness – most commonly an infection.  Call the doctor if your infant is less than three months old and has a rectal temperature above 100.3F, or if between three and six months has a temperature above 101F.  Even if the temperature is lower than these general guidelines, call the doctor if the baby appears ill with such signs as a rash, irritability, poor feeding, trouble breathing, a stiff neck, persistent vomiting or diarrhea, signs of dehydration or is lethargic or difficult to arouse.

·         Dehydration can happen if the baby is feeding poorly, has a fever, is in too warm an environment, or has persistent vomiting or diarrhea.  You can recognize it if the baby has a dry mouth and gums, wets the diaper less frequently, sheds no tears when crying or the fontanel (the soft spot on the top of the head) appears to sink slightly.  If you think the baby is dehydrated, call the doctor.

·         Diarrhea is common in infants, but call the doctor if there is blood in the stool, the baby has more than 6 watery stools a day, is not taking fluids or shows signs of dehydration.

·         Vomiting (not just ‘spitting up’) may not be serious if it happens only once or twice.  If it happens more frequently, contains blood or is green in color, or if the baby looks dehydrated, call the doctor.

·         Difficulty breathing can be suspected if the baby is breathing much more rapidly than usual, if the tissue between the ribs, above the collar bones, or in the upper abdomen is sucked in when the baby inhales, if the baby grunts while exhaling, if his head is bobbing or if his lips or skin develop a bluish tinge.  The doctor and 911 should be called immediately.

·         Red, oozing or bleeding navel (or umbilical remnant) or penis – call the doctor.

·         Rashes are common in babies, but call the doctor if the rash covers a large area, especially the face, or is accompanied by a fever, if it oozes, bleeds or the area is swollen, or if it looks infected.

·         Colds (upper respiratory infections or “URI”) are caused by a virus and are very common in infants.  They usually last 1 or 2 weeks with an associated runny nose, fever and poor appetite for a few days, and a cough which can last as long as 2 to 3 weeks.  Do call the doctor if the temperature is higher than the guidelines above, if there is a rash, there’s any difficulty in breathing as described above, he is unusually fussy and cries a lot, the cough is severe and almost non-stop or brings up any blood, if he is vomiting, or if the symptoms last more than 2 weeks.

            Finally, under all circumstances, if you’re very worried that the baby looks really ill, trust your instincts and call the doctor!

Health News Digest- Winter Skin

By Margaret Lewin, MD, FACP, Medical Director, Cinergy Health

           

Even the most perfect skin needs help to remain perfect during the winter months, when cold dry air outside and overly-warm dry air inside leech out natural moisture.

           

Dry skin can feel uncomfortably tight and itchy.  When drier still, skin feels rough and looks dry and flaky and the normal fine lines become more pronounced – looking like the cracks in fine porcelain. 

As always in healthcare, Step #1 is prevention:

·         Stay comfortably warm:

ü  Greet the cold outdoors by wearing loose layers, with a soft cotton or a wicking fabric next to your skin to protect it from scratchy fabric such as wool.

ü  Use soft glove and sock liners to add an extra layer of warmth to hands and feet as well

ü  When you’re back inside, remove wet garments – which can cause chafing.

·         Wear a moisturizing sunscreen (with an SPF of at least 15) on all skin exposed to the sun – even in the winter, when not only sun but also light reflecting from snow can cause damage.

·         Protect your lips with petroleum jelly.

·         Protect your face from the wind,  using either a scarf or - in extreme weather - a balaklava. (Don’t forget to shield your eyes from sun and wind as well, by wearing a good pair of sunglasses.)

·         Keep  humidifiers running in your office and at home in your lounging area and bedroom .

·         Take quick, in-and-out lukewarm showers rather than soaking in a steamy hot bath – which, while relaxing, is especially drying to delicate skin.  Don’t shower more than once daily – in fact your skin would be most grateful if you replace your shower with a gentle sponge bath every other day.

·         If you use soap or liquid skin cleanser, chose  a mild, unscented brand.

·         After exiting the shower, gently pat your skin with a clean towel and immediately apply a generous amount of moisturizer (see below) to form a seal over your still slightly damp skin.

Products to consider:  Moisturizers – to slow the loss of normal skin moisture and to replace what has been stripped by dry air.  These consist of pure oil or oil suspended in water with the use of emulsifiers.  Humectants (such as glycerine and alpha-hydroxy acids) might be added in order to attract moisture to your skin. 

The moisturizer should feel good on your skin; if it itches or burns, change products.  What works best for your particular skin depends on how dry it is to begin with, and you may need to go through a bit of trial and error to achieve optimal results.

·         Bath oil – when used in the traditional manner, bath oil floats in bath water and leaves a thin deposit on your skin as you arise from the tub; unhappily, this deposit has also trapped the grime you tried to remove by taking the bath in the first place!   It’s better applied directly to the skin as soon as you’ve toweled semi-dry.

·         Lotions – provide a slightly heavier lay of oil on the skin and should be applied immediately after you wash; although fine for summer, this layer may not be sufficient to guard against winter’s harsh, dry air.

·         Creams – are heavier yet and may be what you need for winter.  Aqueous cream is non-greasy and very inexpensive.

·         Ointments – are the heaviest and contain petroleum jelly or paraffin; they should be reserved for especially dry areas such as hands, feet and lips so they don’t clog pores and aggravate acne.

Moisturize frequently (at least three times) during the day, applying the product to all exposed areas.

A bit of prevention can work wonders for providing that  “winter glow”  and avoiding  the dry, cracked, inflamed skin left defenseless from winter’s dry air.

-Courtesy of Dr Margaret Lewin & Cinergy Health

Healthy Super Bowl Party Tips

Healthy Super Bowl Party

By Margaret Lewin, MD, FACP – Medical Director, Cinergy Health (www.cinergyhealth.com)

                Watching the Super Bowl is always more fun when you share the game with good friends… and having plenty of good food and beverages makes the experience even more memorable.  Here are some tips for making your party healthy as well as filling.

First, set up a table off to the side of the room, so your friends have to get up to refresh their plates.   Use small plates, rather than large ones.  Have a variety of choices such as

·         Make-it-yourself subs put together from trays of healthy breads and wraps, low-fat, low-salt meats and cheese, roasted red peppers, thinly-sliced canned jalapenos, sliced olives, pickles, tomatoes, lettuce, balsamic vinegar, olive oil, mustard and low-fat dressings and mayo.  Add some crisp crackers for smaller do-it-yourself finger food, and large lettuce leaves to replace the wraps for those who prefer to avoid the bread.

·         Baked pita crisps (cut whole-wheat pitas into triangles, brush with a little olive oil, sprinkle with seasonings such as cumin, then bake or toast till dry),  well-seasoned oven-‘fried’ chicken fingers (dip cut-up, skinless chicken breasts in buttermilk, roll in seasoned ground cornflakes or toasted breadcrumbs, then bake till done at 350 degrees); and cut-up raw veggies - accompanied by bowls of salsa, guacamole, hummus, bean or other low-fat dips.

·         Popcorn – air-popped or microwaved (put ¼ cup plain popcorn in a brown paper bag, fold over the top, seal with 2 staples placed about two inches apart, and cook on high for about two minutes); toss with a bit of margarine high in omega-3’s, low in saturated fat and without trans-fat; go light on the salt.

·         Edamame in the shells

·         Pistachios in their shells

·         Cut-up fruit with plenty of toothpicks

·         Chili made with turkey instead of beef, served with fat-free sour cream and fat-free cheese

·         Baked “fries” (lightly coat small, unpeeled white or sweet potatoes with olive oil, cut in half, and put on a rack sitting on top of a cookie sheet; sprinkle with kosher salt, and let sit 5-10 minutes till they ‘sweat’;  then roast at 450 degrees till puffed and crisp) – served plain or with ketchup on  the side

In addition to the traditional assortment of regular and light beers, set out small glasses and

·         a pitcher of ice water containing thin slices of lemon or lime

·          sugar-free as well as regular colas and soda water (have twists of lime and lemon near-by)

·         juices or a good fruit punch or cider (pour a gallon of apple cider into a pot, add 2 cinnamon sticks and 2 large, unpeeled apples or oranges studded with 12 whole cloves; bring to a boil, then reduce heat, cover, and simmer over very low heat for an hour – to let the flavors blend; can be made a day ahead and re-warmed over low heat; ladle the hot punch into small mugs and sprinkle with nutmeg)

So enjoy the game and leave your friends happy that they’ve enjoyed the spread as well, without the usual over-indulgence.

-Courtesy of Cinergy Health

It's a New Year!

It’s a New Year!

By Margaret Lewin, MD,FACP – Medical Director, Cinergy Health (www.cinergyhealth.com)

                It’s a new year:  time to take stock and start anew for a healthier you!  After a bubbly glass of champagne on New Year’s Eve, maybe you resolved to…

·         Train for a Triathlon!  If you’re not really up to that, think this through more soberly and at least walk a brisk 30 minutes every day – for cardiovascular and bone health, and to clear your mind of daily stresses.

·         Get Your Waistline Back to 18 Inches!   Unless you’re planning to turn ten years old again, consider that just adding 15 minutes of resistance training three times weekly to your daily walking can take that belt size down a notch – even without significant weight loss.  Getting rid of belly fat is a major step toward decreasing your risk of heart disease, diabetes and certain cancers.

·         Go Vegan!   On the other hand, if seitan doesn’t look all that appetizing, find ways to make vegetables more interesting – serving them as a first course to diminish your appetite for less healthy foods.   Eating two servings of fish weekly can soothe your conscience – because fish is low calorie protein, contains omega-3’s for heart health and may even decrease your risk of mental decline as you get older.

·         Learn Ancient Greek!  There might be more practical ways to stretch your mind and improve your memory: join a book club or sign up for classes at the local museum or university.

·         Volunteer Your Services in a Remote Country Where They Really  Need You!   Not all of us can put our lives on hold that way, but volunteering at a local organization can lift your spirits by giving to others, expanding your social network to include other volunteers, and making you more a part of your community.

·         Stop Buying Processed Foods!  You’ll probably draw the line when it comes to making your own mayonnaise and ketchup, but you can cut way back on salt and sugars (and save money as well) just by making your own vegetable and chicken stocks to use in cooking – freezing one cup portions in quart-sized freezer bags and letting them lie flat so you can defrost them quickly.  Most importantly, read package labels more carefully, choosing products with no trans fats, limited amounts of hydrogenated and saturated fats, low salt and no added sugars.

·         Drink 4 Glasses of Milk Daily to Strengthen Your Bones!  But remember that waistline thing, and just start taking 800IU of vitamin D daily and 600mg of calcium twice daily.  The extra vitamin D has also shown promise in reducing your risk of influenza, heart disease, diabetes and some cancers.  Excessive vitamin D can be dangerous, so ask your doctor to check your blood levels during your next preventive exam.

·         Daily Tai Chi Classes!  No way do most of us have time for that, but you can break up stressful days by taking short breaks to stretch or to close your eyes, visualizing yourself in a restful environment such as a hammock deep in the woods – listening to the wind through the poplars, feeling that cool breeze as it gently swings you, and smelling that clean, fresh air.

So don’t give up on those New Year’s resolutions.  They’re all valuable.  Just take a practical little bite out of each one, paving the way for a healthier you.

-Courtesy of Cinergy Health

Dr's Tips: Prevent & Reduce Childhood Obesity

Childhood obesity has been in the forefront of the news and remains a growing concern for many parents.  Since the 1970’s, childhood and adolescent obesity has increased three- to six-fold, such that nearly 20% of 2- to 19-year-old children and adolescents are obese. 

Not only does obesity in this age group significantly affect self-esteem (which usually worsens with age), it is also a serious medical condition that can lead to high blood pressure, high cholesterol and diabetes – all risk factors for early heart disease.  Dr. Margaret Lewin, Medical Director at Cinergy Health, provides tips to reduce and prevent childhood obesity. 

Please find her tips below.

Proactive Steps Children Can Take to Reduce Weight:

First and foremost: get help!  It’s extremely difficult to make long-term, substantial changes in life-style alone without guidance and ongoing support and encouragement.  Steps include:

• Increase physical activity.  Even if not athletically inclined, young people can always find physical activities within their capabilities that are fun.  These activities are best done within a supervised group, where there is constant encouragement, other people to cheer them on, and a sense of obligation to participate on a regular basis. 
• Severely limit the time spent on solitary, sedentary activities other than schoolwork.  For example, set a daily limit on electronic games, watching television, surfing the internet, texting, etc. 
• Increase social time not centered on food.  For example, participate in more after-school activities.
• Learn what a healthy diet is!  Then take steps to replace unhealthy foods with those which offer better nutrition and lower calories.  Eat the healthier, low-calories foods first, dampening the appetite for other foods.  Find socially acceptable substitutes for what your friends are eating: for example, cut-up vegetables (instead of chips) with dips, fruit instead of high-fat, high calorie desserts.  Limit portion size by using smaller plates and sharing off-diet foods with friends.  Replace colas with seltzer flavored with lemon, lime or even some cocoa.
• Educate and encourage families to shop more wisely, learn to prepare tasty, healthy alternatives to fattening foods, and keep healthy, low-calorie snacks readily available.

Tips to Prevent Childhood Obesity:

 The community must get involved in solving this problem.  For example

• Safe neighborhood playgrounds and other facilities for after-school activities

• Organized athletic leagues for children, with role models leading them

• Good (and required) physical education programs in schools

• Nutritious meals and low-calorie, healthy snacks in school cafeterias

• Hands-on, fun lessons (for students and parents) on shopping for and preparing nutritious meals
• Fresh fruits and vegetables (preferably straight from the farm) and healthy carbohydrates at affordable prices must be made available
• Intensive community programs such as the ones below

Available Programs:

School-Based

• CATCH (Coordinated Approach to Child Health) is a school health program designed to promote physical activity and healthy food choices.  The program is implemented in over 7,500 schools and after-school programs across the U.S. and Canada
• Middle-School Physical Activity and Nutrition (M-SPAN) is an intervention designed to increase physical activity, encourage healthy eating, and decrease body mass in boys and girls in middle school. 

Community-Based

• Shaping America 's Youth encourages community programs across the country focused on childhood physical activity or nutrition to become part of the SAY national registry of programs (The SAY Network). To date, more than 1500 organizations, corporations, and communities, representing every sector of the US , have provided information about their efforts to reverse the health crisis of overweight and inactivity in young people.
• Eat for Life: A program that offers a holistic approach to healing from a nutritional point of view.  The program provides a solution through education, motivation and accountability.  A professional nutritionist coaches kids to success 

Dr. Margaret Lewin

Chief Medical Director of Cinergy Health

A graduate of Case Western University School of Medicine in Cleveland , Ohio , Dr. Lewin's undergraduate degree from Purdue University is in Aeronautics, Astronautics, and the Engineering Sciences and she holds an M.S. in applied mathematics from Rensselaer Polytechnic Institute.

Board-certified in Internal Medicine, Hematology and Medical Oncology, she is a Fellow of the American College of Physicians and Clinical Assistant Professor of Medicine at Weill Medical College of Cornell University. She is affiliated with New York-Presbyterian Hospital and The Hospital for Special Surgery.

Dr. Lewin has worked throughout her career to improve the American healthcare system. She has been on the boards of state and local medical societies and is Immediate Past President of the New York County Medical Society and Immediate Past District President of the American College of Physicians. Her decades-long volunteer work has included service to many local projects and organizations and has been enriched by her medical missions to the Third World .

Dr. Lewin has authored numerous articles in leading medical journals and lay magazines, as well as chapters for medical textbooks. Her areas of special interest and expertise include primary and preventive care, travel medicine, men's health and women's health.

-Courtesy of Cinergy Health

Women's Health/Cancer Awareness

 In light of January being cervical cancer awareness month, Dr. Lewin has put an article together on cervical cancer awareness. 

Cervical Cancer

By Margaret Lewin, MD, FACP – Medical Director of Cinergy Health (www.cinergyhealth.com)

Last year, 11,270 new cases of cervical cancer were diagnosed and another 1.2 million women will develop dysplasia, a condition which left untreated will turn into cervical cancer. Cervical cancer is a malignancy that develops in tissues of the cervix: the organ which connects the uterus to the vagina.  It is preventable, slow-growing (so that it can be detected and cured early in its course), and is nearly always caused by infection from the human papilloma virus (HPV). 

Cause:  Most cases of cervical cancer are caused by HPV – a highly contagious virus which can be transmitted easily by skin to skin and sexual contact.  

·         At least half of all sexually active Americans contract HPV during their lifetimes

·         About  20 million Americans between the ages of 15 and 50 carry the virus.  

·         There are more than 100 types of HPV – of which more than a dozen (termed “high risk types”) can cause cervical cancer.

·         Most often, a person’s immune system kills off the virus without intervention

·         Exposure to high risk types of HPV is more likely to lead to cancerous changes of the cervix in women who smoke or whose immune system is impaired.

Prevention:  Cervical cancer can be prevented by

·         Having no intimate contact with either men or other women

·         Obtaining the HPV vaccine – which can immunize against two high risk types of HPV (types 16 and 18), which cause about 70% of cervical cancers.  It is given as a series of three injections over a period of six months.  The vaccine is now FDA-approved for females and males between the ages of 9 and 26, although many physicians recommend the vaccine up to age 50 for sexually active women and men who have sex with men.

·         Screening and treatment for early evidence of pre-malignant changes to the cervix

Screening:  The “pap smear” (Papanicolaou test) is used to screen for cervical cancer as part of the gynecological examination.  It can reveal early, pre-malignant changes to the cervix.  It is done by gently scraping the cervix with a wooden or plastic spatula and then by inserting a very small brush into the opening of the cervix.  The cells thus obtained are then evaluated by a commercial laboratory.  For maximum accuracy, your provider should be submitting a liquid-based preparation (not the old-fashioned smear submitted on glass slides).  The same cells can be evaluated for the presence of HPV.

Lately, when and how often to screen has become controversial.  Consensus among the various guideline commissions is still pending, but it is likely that recommendations will be as follows:

·         The first Pap test should be done at Age 21, then repeated every two years.

·         At Age 30, the Pap test and HPV screen (done using the same cells collected for the Pap) should be done; if both are negative and you’ve had at least three consecutive normal Pap smears, screening can be reduced to every three years. 

If the Pap is normal but high risk HPV is present, Paps should be repeated at least yearly. 

If the Pap is abnormal, further testing is necessary – starting with ‘colposcopy’.  This procedure starts like a regular gynecologic examination, with the speculum inserted into the vagina.  The doctor then brushes a material on the cervix to highlight any abnormal areas.  The ‘colposcope’ – a large microscope positioned about a foot away – shines light into the vagina so the abnormal areas can be seen through the microscope.  These areas are then biopsied and evaluated by a special laboratory.

Note: You should continue to see your doctor at least yearly for general gynecologic check-ups, even though the Pap test might be done less frequently.

Of all cancers, cervical cancer is almost unique in that it is preventable.  Ask your healthcare provider whether you should consider the HPV vaccine.  Cervical cancer can be detected early, treated, and cured.  Ask your provider how frequently you should be screened.

-Courtesy of Cinergy Health & Dr Margaret Lewin