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Keep Hydrated, Stay Safe

By: George Cavanagh, M.D.

Summer is here. Time for picnics, sports, working in the yard ─ and the risk of dehydration.

Our bodies normally lose fluids in the form of exhaled water vapor, in sweat, and in urine and stool. Along with water, small amounts of salts are also lost. However, we become dehydrated when we lose more water than we take in, and our bodies don’t have enough water to carry out normal functions.

Dehydration often occurs in hot weather during outdoor work or exercise, but it can also be caused by illnesses such as diarrhea, vomiting or fever. Anyone may become dehydrated, but young children, older adults and people with chronic illnesses are most at risk. In severe cases, dehydration can lead to death.

The signs of mild to moderate dehydration include:

  • Increased thirst
  • Dry mouth and swollen tongue
  • Weakness
  • Sluggishness
  • Decreased urine output. (Urine color may indicate dehydration. If it is deeply yellow or amber, you may be dehydrated.)

If you’re a healthy adult, you can usually treat mild to moderate dehydration by drinking more fluids, including water, sports drinks, or oral rehydration solutions.  However, if you develop any of these severe symptoms, you should seek medical attention immediately:

  • Extreme thirst
  • Lack of urination
  • Shriveled skin (that doesn’t bounce back when pinched)
  • Dizziness
  • Confusion
  • Fainting
  • Heart palpitations (the feeling that your heart is pounding or jumping)

The best approach is to prevent dehydration in the first place. If you are caring for people who are sick, make sure they get plenty of fluids if they have diarrhea, vomiting or fever.

If you need to be outside in the heat, follow these steps to keep hydrated:

  • Take plenty of fluids and drink continuously to replace what you lose
  • Avoid exercise and exposure during the hottest part of the day, typically mid-afternoon
  • Wear a hat and light-colored and loose-fitting clothing
  • Carry a personal fan or mister to cool yourself
  • Break up your exposure to hot temperatures and direct sun. Find air-conditioned or shady areas and allow yourself to cool between exposures
  • Avoid alcohol consumption because alcohol increases water loss

Remember, the key to preventing dehydration is to replace the water you lose, so drink up!

George Cavanagh, M.D.
Dr. George Cavanagh is an MPCP partner and practices in our Bowie office. He is certified by the American Board of Family Medicine.

Limiting Sugars in Your Diet

A Q&A with Dr. Pio Poblete of MPCP’s Columbia office

Q: How much sugar do people typically consume?

A: On average, Americans get about 16% of their daily calories from added sugars, according to the Food & Drug Administration.

While many foods naturally contain sugar, a lot more sugar is added to processed foods. For example, a 12-ounce can of cola contains seven teaspoons of sugar, although you might not see that word on the label. Other names for added sugars include high-fructose corn syrup, fruit juice concentrate, molasses, honey, and sucrose.

Even foods that you wouldn’t think of as sweet have added sugar, often in the form of high-fructose corn syrup. High-fructose corn syrup is a preservative, giving packaged foods a longer shelf life, and it plays a role in color and texture.

Q: 16% added sugars sounds like a lot. Are we eating too much?

A: Faced with mounting evidence about sugar’s harms, the 2015 Dietary Guidelines Advisory Committee has recommended that people limit added sugars to a maximum of 10% of their total daily calories.

Q: If I want to reduce my sugar consumption from 16% to 10%, how much sugar is that?

A: On a 2,000-calorie-a-day diet, that equals 12 teaspoons of sugar.

Q: Is added sugar a health concern?

A: Added sugars probably have a greater impact on high blood pressure (hypertension) than does sodium, and fructose in particular may increase cardiovascular (heart and blood vessel) risk. There’s evidence that added sugars, especially sugar-sweetened drinks, raise the risks of excess weight and obesity, as well as type 2 diabetes. And, of course, sugar is a major contributor to tooth decay.

Q: How can I reduce added sugar in my diet?

  1. Use these simple tips to consume less:
  • Drink water or other calorie-free drinks instead of sugary, non-diet sodas or sports drinks. That goes for blended coffee drinks, too.
  • When you drink fruit juice, make sure it’s 100 percent fruit juice — not juice drinks that have added sugar.
  • Choose breakfast cereals carefully. Although healthy breakfast cereals can contain added sugar to make them more appealing to children, skip the non-nutritious, sugary and frosted cereals.
  • Instead of adding sugar to cereal or oatmeal, add fresh fruit (try bananas, cherries or strawberries) or dried fruit (raisins, cranberries or apricots).
  • Opt for reduced-sugar varieties of syrups, jams, jellies and preserves. Use other condiments sparingly. Salad dressings and ketchup have added sugar.
  • Choose fresh fruit for dessert instead of cakes, cookies, pies, ice cream and other sweets.
  • Buy canned fruit packed in water or juice, not syrup.
  • When baking cookies, brownies or cakes, cut the sugar called for in your recipe by one-third to one-half. Often you won’t notice the difference.
  • Instead of adding sugar in recipes, use extracts such as almond, vanilla, orange or lemon.
  • Enhance foods with spices instead of sugar. Try ginger, allspice, cinnamon or nutmeg.
  • Substitute unsweetened applesauce for sugar in recipes (use equal amounts).

For a list of common foods and the amount of sugar they contain, see this article in Medical News Today.

Pio Poblete, M.D.Dr. Pio Poblete is an MPCP partner and practices in our Columbia office. He is certified by the American Board of Internal Medicine.

Hop on a Bike to Get Fit, Lose Weight

By Jose Zarzuela, M.D.

When it comes to exercise, it’s hard to beat bicycle riding. Biking combines cardiovascular fitness with building strength and stamina – and it’s fun.  You can get a good workout while enjoying a ride in the park.  And people of all ages and fitness levels can do it.

There are many benefits to biking:

It’s one of the easiest ways to exercise. You can ride a bicycle almost anywhere, at any time of the year. All you need is a bike and half an hour several times a week.

It tones you all over.  Biking improves general muscle function with little risk of strain or injury. Regular cycling strengthens leg muscles and is great for the mobility of hip and knee joints. Gripping the handlebars also helps tone your upper body.

It’s great for your heart.  You can easily boost your heart rate for a good cardiovascular workout. Pump it up by including hills in your ride. Studies have shown that 30 minutes of moderate riding three times a week can help lower your blood pressure and LDL (bad blood cholesterol), reducing your risk of heart disease.

It boosts energy. Research has shown that bike riding improves energy and decreases fatigue. How? Cycling triggers your brain to release the neurotransmitter dopamine, which is linked to energy.

It’s kind to your joints. Riding a bike puts a lot less stress on your knees, ankles, and spine than running or other high-impact exercises. Most people can easily ride moderate distances without much strain or pain.

It promotes weight loss. Riding can burn hundreds of calories per hour, depending on your size and how fast you go. Since it helps build muscle, cycling will also boost your metabolic rate long after you’ve finished your ride. This chart shows how many calories you can burn on a bike.

It helps reduce stress. Like any regular exercise, riding can reduce stress and depression and improve well-being and self-esteem.  It’s also a good way to be enjoy nature and refresh your mind and soul.

Before you hop and pedal away, keep a few things in mind:

Most people can do bike riding. However, if you’ve been inactive, it’s a good idea to consult a doctor first. Your doctor can advise you regarding your limits and capacities and what you should avoid doing.

Be safe. Biking is fun, but it’s important to get the right equipment for the activity. Always wear a helmet and consider knee pads and elbow pads in case of falls. And if you plan to ride on the streets, make sure you obey all traffic laws, use proper hand signals, and wear bright, visible clothing so cars can easily see you.

Start off easy. For beginners, begin by riding 30 minutes three times a week. Gradually increase the number and length of your rides as you gain strength and experience.

Speed up slowly. Gradual increases in speed are an important aspect of fitness cycling. Cycling can be strenuous, so the key to successful fitness riding is to be patient and not hurry in increasing your limits.

Once you’ve built up your strength and endurance, there are many enjoyable bike rides to take in the Baltimore-Washington area. They vary in length and difficulty. Here are links to some of them:

Maryland:

http://www.traillink.com/stateactivity/md-bike-trails.aspx

https://www.bikemaryland.org/resources/riding/trails/

Washington, D.C.:

http://bikewashington.org/routes/all.htm

Jose Zarzuela, M.D.Jose Zarzuela is an MPCP partner and practices in our Pasadena office. He is certified by the American Board of Internal Medicine.

Bless You!

A Q&A about allergies and testing with Dr. Janice Rutkowski

After the winter season of 2014-2015, we are enjoying the onset of beautiful spring days, but unfortunately not everyone is enjoying the good weather. Maryland is one of the most allergy-prone states, both in air-born allergens and those in food.

In this article, Dr. Janice Rutkowski answers questions about allergies and testing for them.

Q: What are allergies?
A: Allergies happen when your immune system reacts to a foreign substance (allergen), such as plant pollen, dust, certain foods, insect stings or bites, or pet dander. When you come into contact with an allergen, your immune system’s reaction can inflame your skin, sinuses, airways or digestive system.

Q: What are the signs I may have allergies?
A: Allergic symptoms include itchy eyes, nose or throat, nasal congestion, runny nose, watery eyes, chest congestion, cough or wheezing, itchiness or eczema (inflamed or irritated skin). The severity of allergies can range from minor irritation to anaphylaxis — a potentially life-threatening emergency.

Q: Can allergies be cured?
A: Most allergies can’t be cured, but treatment can help relieve your symptoms. In the case of seasonal allergies, many people find relief with over-the-counter medications. But when they don’t respond to the usual treatments, they require testing to determine the cause.

Q: What allergy tests are available?
A: There are two standard tests: skin tests and blood tests.

Skin tests (known as scratch tests) are the most common and are administered by allergists or dermatologists. A very small amount of certain allergens are put into your skin by making a small indentation or “prick” on the surface of your skin. If you have allergies, a small swelling that looks and feels like a mosquito bite will quickly occur where the allergen(s) is introduced.

However, under certain conditions, a blood allergy test is preferable to the skin test.  Allergy blood testing is recommended if you:

  • Might have an extreme reaction during skin testing or have a history of life-threatening allergic reactions.
  • Have severe skin disorders.
  • Are using a medicine known to interfere with test results and cannot stop taking it for a few days. This would include antihistamines, steroids, and certain antidepressants.
  • Cannot tolerate the many needle scratches required for skin testing.
  • Have an unstable heart condition.
  • Have poorly controlled asthma.

MPCP can administer the blood test in our offices for people who have skin disorders or are at risk for an extreme reaction. We can test for many substances in one sitting.

If you are one of many who suffer from cold-like symptoms with the change of seasons or have one of the symptoms listed above, see your MPCP doctor for evaluation and treatment so you can enjoy this wonderful season in good health!

Professional headshot of MPCP partner, Janice Rutkowski, M.D.

Janice Rutkowski, M.D. is an MPCP partner and is certified by the American Board of Internal Medicine. She sees patients at the Arundel Mills office.