DukeHealth.org: Duke Health Features

What You Need to Know About Your Colon

Mon, 10 Jun 2013 14:35:07 -0400

No one likes to discuss colon health. But it’s serious business, and learning about it—and what you can do to take care of your colon—can help ensure you and your loved ones lead healthier lives.

Here, Benjamin Hopkins, MD, a Duke Medicine colon and rectal surgeon, touches every condition you don’t want to talk about – from hemorrhoids, and fecal incontinence to anal pain and diverticulitis.

Q. What’s the most important thing to do for colorectal health?

A. The best approach to good colorectal health is to maintain a high-fiber diet and drink plenty of water. Eight glasses of water a day helps prevent constipation. A high-fiber diet will help prevent complications of hemorrhoids and anal tears and will help to prevent diverticulitis.

Q. Most people know that surgery is used to treat colorectal cancer, but what other conditions do you treat with surgery?

A. Surgery is necessary to treat recurrent or complicated bouts of diverticulitis and inflammatory bowel diseases that don’t respond to other treatment. It is also used to treat benign problems of the anus and rectum when conservative management fails.

Q. Can surgery really cure these conditions?

A. Yes! That’s why I love my job so much.

Q Does surgery leave an ugly scar?

A. We specialize in minimally invasive surgery, including robotic, laparoscopic, and single-site surgeries, which leave patients with smaller scars, less pain, and a faster recovery. There is no scar from transanal endoscopic microsurgery since all work is done through the anus.

Q. What are hemorrhoids, exactly, and how do you know if you have them?

A. Everyone has hemorrhoids—they are part of our anatomy. It’s just a question of whether they’re bothering you. Hemorrhoids can become aggravated with changes in bowel habits, such as diarrhea and constipation. Over the years, they can pull away from the underlying muscle, prolapse, and bleed. Prolapse means something is hanging out “down there.” Typically, hemorrhoids cause people to experience itching, bleeding, and prolapse. Pregnancy can also cause hemorrhoids to become engorged because of the increased pelvic pressure.

Q. How are hemorrhoids treated when they become aggravated?

A. Initial management includes increasing the amount of fiber and water in the diet. Most of my patients find that’s all that is needed. Be sure to increase fiber slowly: I tell people to increase daily intake by 5 grams for a week, then another 5 grams for another week, until they reach 20 to 25 grams per day. That way they avoid bloating and gassiness. If adding fiber to your diet doesn’t work, there are simple and painless office procedures to treat hemorrhoids. If these fail, surgery may be the next step. One of the procedures my colleague, Linda Farkas, MD, and I perform is a transanal hemorrhoidal de-arterialization (THD). It is a less-painful way to treat hemorrhoids than a standard hemorrhoidectomy. Not all hemorrhoids can be treated with a THD; treatment depends on the severity of the hemorrhoids.

Ben Hopkins, MD, is part of the team at Duke Colon and Rectal Surgery of Raleigh. To make an appointment, call 888-ASK-DUKE (275-3853).

The Dos and Don'ts of Summer Fun

Mon, 03 Jun 2013 10:46:44 -0400

The school year may be almost over, but that doesn’t mean you should adopt a school’s-out attitude when it comes to your health. Regardless of your plans, heed these simple dos and don’ts to ensure you get a passing grade.

At the Park

DO outsmart the bugs. Wear light-colored, breathable clothing—you’ll be less attractive to bees, which like bright colors. Light colors also make it easier to spot ticks. If you’re planning to be outside for an extended time, spray your clothes, not your skin, with a bug repellent that contains DEET. If you are stung or plagued with insect bites, ice the swollen area, says Meredith Barbour, MD, a family physician at Duke Primary Care Brier Creek. An over-the-counter antihistamine will help reduce the swelling and the itching.

DON’T ignore your body’s warning signs. If a sting or a bite is serious, your body will let you know fairly quickly. Hives, facial swelling, or trouble breathing may signal a severe allergic reaction and require immediate medical care. If you know you’re prone to a severe allergic reaction, carry an epinephrine autoinjector (EpiPen). If you develop a rash or a fever after a tick bite, see your health care practitioner, as it may be a sign of Rocky Mountain spotted fever or lyme disease.

At the Backyard BBQ

DO eat seasonal produce. Visit your local farmers market or grow your own. “Fresh fruits and vegetables add color to meals, taste better, and are loaded with vitamins and nutrients,” says Brinkley Sugg, RN, FNP, a family nurse practitioner at Duke Primary Care Morrisville. Meet the daily-recommended five servings of fruits and vegetables by adding berries to salads, grilling pineapple and summer squash, and snacking on watermelon.

DON’T grill meats over high heat. Studies suggest it breaks down muscle proteins in meat and creates a cancer-causing substance, which can jump-start the cancer development process, Barbour says. Shorten grill time by microwaving food first.

On the Court

DO know the air-quality index. Air pollutants are measured via a color-coded, daily air-quality index. “High levels can cause breathing problems for people with asthma, lung disease, or heart problems,” Sugg says. When the air-quality index causes concern, individuals at risk should spend more time indoors and limit strenuous activity.

DON’T think you can beat the heat. Whether you’re exercising outdoors or enjoying time with family and friends, staying hydrated is important. Heat exhaustion occurs when the body loses excessive amounts of water and salt through sweat. If you feel overheated or experience headache, dizziness, nausea, or cramps, Barbour says stop what you are doing. “Move into the shade or cool off in an air-conditioned building or car,” she recommends. Drink cool nonalcoholic beverages, take a cool shower or spray yourself with cool water. Apply a cold compress to your neck or armpits.

At the Beach

DO protect your eyes from the sun. The sun’s harmful ultraviolet (UV) rays can cause cataracts, macular degeneration, and abnormal growths. “Once the damage starts, there’s no way to stop it,” Sugg says. Never look directly into the sun, and protect your eyes by wearing a hat and sunglasses whenever you are outdoors. Opt for eyewear that blocks 98 to 99 percent of UVA and UVB rays.

DON’T choose the wrong sunscreen. Some contain questionable ingredients that have sparked health concerns. For example, oxybenzone may interfere with hormones. Nanoscale zinc and titanium oxides have been linked to potential reproductive and developmental effects. Pregnant women should avoid sunscreens that contain retinyl palmitate. When choosing a sunscreen, a sun protection factor (SPF) around 30 is sufficient, Sugg says. Apply frequently, according to directions.

Recently, the FDA announced it is investigating potential risks associated with spray sunscreens, including inhalation risks. For this reason, Sugg recommends against spraying sunscreen on children. Instead, spray your hands first, then rub on the sunscreen liberally.

Need to make an appointment? Call 1-888-ASK-DUKE or contact the Duke Primary Care location nearest you.

Exercise Isn’t Optional; It’s Mandatory for Good Health

Fri, 10 May 2013 16:11:39 -0400

Some people speak of a “runner’s high”—an intoxicating feeling derived from going the distance and pushing your limits. And then there are those for whom exercise is a chore, an item to be checked off a to-do list.

Matthew Hayes, DO, of Duke Primary Care Waverly Place believes everyone can—and must—exercise, and that there’s some kind of exercise out there for everybody and every body. He takes exercise so seriously that he gives each of his patients a prescription for it.

“I prescribe specific ways to exercise— running, lifting, tennis, and more— based on what my patients like to do,” he says. “I make recommendations on frequency and duration of exercise based on the patient’s current fitness level. I then discuss intensity using target heart rate or how much exertion you feel. It can get fairly scientific in a high-level someone just starting out.”

Hayes tells his patients that exercise is essential to good health and that making time for exercise has to be among the things you consider non-negotiable. You have to buy groceries. You have to pay bills. You also have to exercise—even if you have to trick yourself into doing it.

Sneaking exercise into the day is something anyone can do, Hayes says. “Take the stairs, park farther away than you need to, walk to lunch. Try 10 minutes of core exercise and pushups to start the day or a 15-minute walk over your lunch break. It adds up.”

If you have kids, get them into the game, too. “Encourage kids to play outside, like we did growing up,” Hayes says. “Limit their screen time to less than two hours a day, and set a good example by being active yourself.”

Hayes recommends you start somewhere. A little exercise is, after all, better than none. But he says the current recommendation from the medical community is to exercise four to five days each week for 30 to 45 minutes at a time.

The obvious exercise for the most committed couch potato is walking. “If you are not disabled, then you can walk for exercise,” Hayes says. Beginners could start with a 20-minute walk three days a week. The goal of each walk should be to break a sweat.

And just to drive the point home a little more, Hayes includes a quote from former U.S. Surgeon General C. Everett Koop on his prescriptions: “Exercise is the most effective medicine known to man.”

Get it any way you can.

You Multitask at Everything Else— Why Not Exercise?

• Do stretching exercises while you’re waiting for lunch to heat in the microwave.

• Lunge a little as you wheel your grocery cart down the aisle.

• Get up from your desk and walk a lap around the office, the building, or the block.

Dr. Matthew Hayes' Sneaky Ways To Put Exercise Into Your Day

Walk to any destination that’s less than a quarter-mile away. It will take longer to drive and park, anyway.
Walk your dog 30 minutes a day or more. All dogs need structured exercise. (Humans do, too.)
Take the stairs if you’re going up one or two floors. Do you really want to be that person who takes the elevator up one floor?
Start your day with 10 minutes of core training or calisthenics, such as pushups or crunches. Or do a few minutes of a yoga DVD. You will have done more exercise before breakfast than most Americans do all day!
Join a gym that has child care. The kids can have fun while you work out.

To schedule time with Dr. Hayes or any Duke Primary Care provider near you, call 888-ASK-DUKE (275-3853)

Spring 2013 Duke Med Magazine

Fri, 10 May 2013 09:19:03 -0400

Click here to download the Spring 2013 DukeMed Magazine or view it online.

Why All The Buzz About Gluten-Free

Fri, 03 May 2013 15:55:01 -0400

Today, gluten-free products and diets are all the rage. In fact, a recent study finds as many as 1.6 million Americans avoid gluten, even though they haven’t been diagnosed with celiac disease or gluten sensitivity.

Although there is no harm in eliminating gluten from your diet, doctors say there is no reason to avoid it—unless you’re one of the two million people who cannot tolerate the proteins.

“Gluten is bad for some people, but certainly not all,” explains Michelle Nacouzi, MD, a primary care physician at Duke Primary Care Brier Creek. “So unless you’ve been diagnosed with celiac disease or gluten sensitivity, gluten-free products aren’t necessarily going to give you a health benefit.”

What Is Celiac Disease?

Once considered a rare childhood disorder, celiac was frequently misdiagnosed and just as frequently overlooked. Today, doctors are more attuned to the seemingly vague symptoms that can signal celiac disease, and diagnose it frequently in children as well as adults.

“Celiac disease is now estimated to be four times more common than it was 50 years ago,” Nacouzi says. “And more advanced diagnostic tests may be the reason it seems to be on the rise.” But researchers also believe that the way wheat is now grown, the proliferation of processed foods, and the use of gluten in medications and vitamins, toothpaste, and lip balms, are all responsible for the increase in cases.

The main culprit in celiac disease is gluten, a protein found in wheat-, rye-, and barley-based products. Gluten triggers an immune response that makes it difficult for the body to absorb essential nutrients. In a healthy body, long, fingerlike protrusions called villi line the small intestine and aid in the absorption of nutrients into the bloodstream, explains Nancy McGreal, MD, a pediatric and adult gastroenterologist at Duke University Hospital. The gluten-triggered immune response damages the villi and inflames the intestinal wall. “Patients end up malnourished no matter how much they eat,” McGreal says. “They experience anemia, as well as deficiencies in vitamin D, vitamin B12, and folate.”

Genes play an important role in the development of celiac disease, but environmental exposures can also contribute. “Research is looking into whether being exposed to gluten as an infant predisposes you to getting celiac later in life,” McGreal says. Childhood intestinal infections may be a factor, too. People who have autoimmune disorders like type 1 diabetes and Down syndrome are at greater risk. Researchers are looking into whether breastfeeding may offer protection against the disease later in life.

Celiac? Gluten Sensitivity? Wheat Allergy?

About 6 percent of the population may have non celiac gluten sensitivity (NCGS), a condition that is less severe than celiac disease, and one for which there is no genetic basis and no tests to confirm its diagnosis. Symptoms include abdominal pain and headaches. There is some evidence to suggest that gluten-free diets may offer relief to sufferers of NCGS.

Wheat allergy—often confused with celiac disease—is something very different in that it is an immune-system response to gluten as opposed to a digestive system response. Wheat allergy is most common in children and can be outgrown (unlike celiac disease). Symptoms mimic those of other common childhood food allergies: itching, swelling, runny nose, watery eyes, upset stomach, and even difficulty breathing. As with all food allergies, the best treatment is to avoid the offensive food altogether.

Why Diagnosis Is Important

Celiac disease can cause a host of physical problems ranging from irritability, vomiting, and delayed puberty in kids to joint pain, depression, and anxiety in adults. In some people, the disease lies dormant until an event such as surgery, pregnancy, childbirth, viral infection, or severe emotional stress triggers a symptomatic attack.

Getting a definitive diagnosis is important, McGreal says, because “this is a lifelong condition. We don’t have a cure.”

Undiagnosed celiac disease can lead to serious health conditions including growth problems in kids, osteoporosis, infertility, seizures, and, in rare cases, various forms of cancer. If symptoms or a patient’s family history lead a physician to suspect celiac disease, blood tests are used to screen for antibodies, which signal its presence. A biopsy of the small intestine confirms the antibody tests.

The Gluten-Free Diet

The only treatment for celiac disease is a gluten-free diet. Learning to adopt it can be challenging for the newly diagnosed. Lesley Stanford, MS, RD, a pediatric nutritionist at Duke Children’s Hospital, helps patients navigate the challenges and educates them about what they can and can no longer eat. “This isn’t the easiest diet to follow,” she says. “You can’t just try it. You have to plan your grocery shopping and eating out. A true gluten-free diet is important for people with celiac disease and requires education. There’s more to it than just looking at labels to see if something contains gluten. Gluten proteins can be found in other additives.”

Fortunately, food manufacturers and even restaurants are answering the call. Gluten-free products by the shelf load can be found everywhere from supermarkets to big-box stores, and restaurants are adding gluten-free selections to their regular lineup and on the kids menu as well.

Classic Symptoms Of Celiac Disease

Abdominal cramping, intestinal gas
Distention and bloating of the stomach
Chronic diarrhea or constipation (or both)
Fatty stools
Anemia—unexplained, or due to folic acid, b12, or iron (or all) deficiency
Unexplained weight loss with large appetite or weight gain infants, toddlers, and young children who have celiac disease may often exhibit growth failure, vomiting, bloated abdomen, behavioral changes, and failure to thrive.

Sources: Celiac Disease Foundation, American Journal of Gastroenterology

Helping Your Children Grow into Healthy Teens

Thu, 25 Apr 2013 09:23:42 -0400

Toddlers become teenagers way too fast, and many parents worry about what their adorable child will become. Most teens do very well, especially when supported by parents who play an important role in helping their children mature. Research shows that teens thrive when they have strong relationships with supportive adults.

Healthy relationships develop over years and their foundation is effective communication. Here, Richard Chung, MD, an expert in adolescent medicine at Duke, explains how you can open the lines of communication, and foster that strong relationship with your child now and as they become teenagers.

• Kids don’t talk to strangers: The more involved you are with your child’s lives, the more impact you conversations with your child will have. Being involved should start early on. Make it a habit to spend one-on-one time with your child on a regular basis. If you’re child is already a teen, find ways to spend time together. Go to the movies, play golf, or go shopping. The latter offer spontaneous ways to start conversations.

• Teens need parents, not referees: Make it a habit early on to actively praise your child whenever it’s appropriate. It’s okay to offer constructive feedback, but balance it with a healthy dose of praise. A single positive comment can go a long way toward building their confidence and self esteem.

• I learned it by watching you: If you aren’t able to share information about your life with your children, they are unlikely to do so with you. Parents are role models who should lead by example. Share stories about your childhood and what’s going on in your world currently. Establish a sense of openness that invites them to respond in kind.

• Open 24/7: As your child grows and strikes up conversation with you less and less frequently, it will become more important to drop what you’re doing when they actually want to talk, even when it’s inconvenient. It inevitably will be late at night or when you’re walking out the door, but it will be well worth it if they are truly ready to engage.

• Sigh…“What do you want now!?!”: Make sure communication doesn’t just happen when something has gone wrong or needs to be done. If it’s always negative or stressful, teens will tune out. Touch base daily in a meaningful way. The value of sincere conversation with no motives other than to engage your teen cannot be overstated.

• Meet them (well beyond) half way: It is undeniably challenging to get teens to converse. However, most parents know of at least a few things that reliably get their teen talking excitedly, whether it’s their new video game, their favorite celebrity, or something silly their friend did at school. If that’s their communication comfort zone is, then that’s where you should be.

To make an appointment with Dr. Chung, or another adolescent medicine specialist at Duke, call 1-888-ASK-DUKE.

Let’s Get Stronger Together

Wed, 17 Apr 2013 12:57:42 -0400

Art, Jazz, Food and Health Screenings at Health Fair May 3 and 4

My name is Kathy Kastan. I survived a bypass when I was 42. I know the unique challenges faced by women living with heart disease, and I’ve made advocating for women’s health my passion. As the director of the Duke Women's Health Initiative, I share my passion with women across the region and beyond.

Women have unique health concerns, and need to work together to demand accurate diagnosis, proper treatment and exceptional care. That is why I encourage you to join me May 3 and 4 for an unprecedented series of events.

Stronger Together: Fighting Disparities and the Leading Causes of Death in Women will redefine what a health fair should be. It harnesses the power of creative energy to reach all your senses. We believe the combination of music, food, art, education and health screenings will be a powerful motivator for change. You won’t just leave with the results of your screening. You’ll leave with a plan. Healthcare professionals will let you know what next steps you should take.

On Friday, May 3, the Stronger Together: A Community Benefit Concert will feature:

Prominent leaders discussing healthcare reform and its potential impact on women's health.
Sandra Dubose-Gibson, the first bald beauty queen, who will share her story of empowerment
Nnenna Freelon, a six-time GRAMMY-nominated international jazz artist performing with the Duke Medicine Orchestra and Choir.

The concert will take place at the Durham Convention Center from 6 to 10 p.m. Individual tickets are $125. Dinner and drinks are included.

On Saturday, May 4, Stronger Together: A Women’s Health Education Community Outreach Event will include:

Joe and Terry Graedon of NPR’s The People's Pharmacy, who will discuss Making Positive Lifestyle Changes.
Duke’s Edna Ballard, MSW on Caregiving: Challenges and Opportunities for Women
Alice Cooper, RNC/OGNP on Caring for Women's Health: A Holistic Approach and Being Your Own Best Healthcare Advocate.
Wellness screenings, performed by Duke providers, including blood pressure, Body Mass Index (BMI), HIV testing, depression, thyroid abnormalities and lipid profiles – a test that normally costs $100. (A lipid profile tells you your “good” and “bad” cholesterol levels.)
30 vendors will conduct demonstrations ranging from healthy cooking to yoga and Pilates.
Artwork from 12 regional artists will be for sale
Nnenna Freelon will sing a cappella during lunch, and Sandra Dubose-Gibson (Mrs. Black North Carolina) will be our keynote speaker. Anita Woodley, AKA “Mama Juggs,” will share how her family has coped with breast cancer, and transform how all of us view survivorship. An exciting raffle will end the day.

The event takes place at the Durham Convention Center from 8 a.m. to 2 p.m. The $25 registration fee includes breakfast, lunch and an art show. Ten percent of proceeds will benefit Duke Medicine Women’s Health Initiative Community Outreach

To learn more or to purchase tickets, visit http://docme.mc.duke.edu/womenhealth/home.html

Kathy Kastan, LCSW/MA Ed, is director of Duke Medicine's Women's Health & Advocacy Initiative and is past president, emeritus of the board of directors of WomenHeart: The National Coalition for Women with Heart Disease. She is past chairman of the board of the Greater Southeast Affiliate of the American Heart Association. She recently accepted a board membership on the Mid-Atlantic Affiliate of the American Heart Association. She has been a national spokesperson for the National Heart, Lung and Blood Institute’s The Heart Truth®/Red Dress campaign since 2003. Kastan is the author of From the Heart: A Woman’s Guide to Living Well with Heart Disease and is frequently invited to blog at http://www.huffingtonpost.com/kathy-kastan.

Why Does My Nose Run - And Other Common Allergy Questions

Thu, 11 Apr 2013 12:20:13 -0400

Allergies got you down? Wondering how to get relief? Namrata Shidhaye, MD, a family physician at Duke Primary Care Waverly Place, helps sort out the causes and cures for your annoying runny nose.

The older I get, the more my nose runs. Can you develop seasonal allergies as an adult that you didn’t have as a child? 
Yes, adults can develop environmental allergies at any age. Asthma can develop during adulthood as well. A runny nose isn’t always a sign of allergies, though. Older individuals may experience runny nose due to age-related physical changes—some people, as they age, develop overactive tear ducts and nasal secretions (it’s called cholinergic hyperactivity). Also, some medications taken for other conditions such as high blood pressure, prostate enlargement, or erectile dysfunction can cause a runny nose as a side effect.

How do I know when it’s just a cold?
When should I consider seeing an allergy specialist? A common cold is usually associated with a variety of symptoms in addition to a runny nose: cough, body aches, fatigue, and occasional yellow nasal discharge. All of these symptoms usually resolve in one to two weeks. Allergies occur immediately after contact with the allergens that provoke them. They’re associated with clear discharge from the nose, nasal congestion, and itchy eyes, and the symptoms persist as long as contact with the allergens continues. Body aches are unlikely, but fatigue may occasionally occur with allergies. Your primary care physician can usually help treat your allergies, but if specific testing is required to identify the cause for your allergies—or if symptoms are not adequately controlled with medicines prescribed by your doctor—then a consultation with an allergist is probably needed.

Is it safe to take an over-the-counter allergy medication every day? 
I strongly recommend consulting with your physician. There are several types of over-the-counter allergy medications. Some of them, such as Benadryl (diphenhydramine) and Zyrtec (cetirizine), can cause sedation and performance impairment, so I don’t recommend them for everyday use. Claritin (loratadine) and Allegra (fexofenadine) usually don’t have that side effect. Over-the-counter decongestants such as pseudoephedrine (found in Sudafed) and phenylephrine should be used very carefully—they can cause elevated blood pressure, heart palpitations, difficulty falling asleep, and irritability. I don’t recommend them for patients who have heart conditions, high blood pressure, or hyperthyroidism.

Can certain foods give me a runny nose? 
Food allergies are not likely to cause a runny nose. They usually cause scratchy, itchy mouth and throat; or you may develop hives, a skin rash, nausea, vomiting, diarrhea, or stomach cramps, or have difficulty breathing. Some older individuals experience a runny nose when they eat spicy, hot foods. That’s called gustatory rhinitis, and the quickest cure is to finish eating—or order something else.

Sometimes I wheeze a little. How much wheezing is OK? 
Always consult your doctor when you experience wheezing. Wheezing can be due to allergies or asthma, but sometimes it’s a sign of a heart problem. It’s better to be safe and check in with your physician.

What about natural remedies, like eating local honey or pollen? 
There is no scientific evidence to support the theory that eating local honey or pollen will cure allergies. Practically speaking, most people’s seasonal allergies are caused by airborne pollen from grass and ragweed, and those aren’t the plants that honeybees are visiting. So it’s unlikely that the pollen you’re allergic to is the pollen you’ll find in honey. What’s more, some people can have allergic reactions to impurities in some honey. It’s fine to eat honey if that’s part of your diet, but adding honey as an allergy treatment doesn’t have any scientific rationale behind it.

I’m afraid that I’m allergic to my beloved dog. I love him too much to give him up. Is there anything I can do besides investing in Visine and Kleenex stock? 
Avoidance is the best defense against allergies. But if you can’t get away from your allergen—or, more specifically, if you can’t bear to give up your dog, or cat, or gerbil—and your symptoms can’t be helped by over-the-counter medications, see an allergist. For some patients (ask your doctor) a custom-made allergy shot can be designed to desensitize you to your four-legged allergen friends.

To make an appointment with Dr. Shidhaye or another Duke Primary Care provider at an office near you, call 1-888-ASK-DUKE.

Spring into Physical Activity as a Family

Fri, 29 Mar 2013 10:38:11 -0400

If your kids are bored and you don't know what to do, it's the perfect time to get the whole family moving! Exercising as a family is a great way to spend quality time together, enjoy the warm weather, and show your children that staying fit is an important priority at every age.

“We, as parents, need to be good role models, if we want our children to view physical activity as important,” said Azra Shaikh, MD, a physician in Apex at Duke Primary Care Peak Family Medicine. “Being active benefits the entire family, and creates a special bond you simply can’t achieve by watching TV together.”

The Centers for Disease Control recommends kids engage in at least an hour of physical activity each day. The CDC recommends adults engage in at least five hours of exercise each week. Yet, longer workdays and daily commutes, plus a trend toward more sedentary lifestyles means less adults are meeting those daily recommendations. It’s equally hard for kids as more schools cut physical education programs and daily recess.

“Get your kids to participate in physical activity by focusing on play, not exercise,” said Shaikh. “If there isn’t an element of fun to it, your kids won’t be interested.”

Here’s how all of you can have fun and stay active during your Spring Break, and how you can make physical activities a priority for your family on the weekends too:

Remember the classics: kids love when parents join in on Hide and Seek, Simon Says, Red Light/Green Light, or run fun races in the backyard.
Take family walks and hikes. Bring a picnic to build in some rest time.
Be a tourist. Visit a museum, the zoo or check out the offerings at the local farmer’s market.
Don’t let bad weather stop you in your tracks. Play physically demanding interactive video games. Or, move the old fashioned way by turning up your kids’ favorite songs and showing them your dance moves.
Start a family bowling tournament or try a game of mini-golf.
Play kickball, softball, or shoot some hoops.
Start a vegetable garden. Maintaining a garden can be a great activity, and children will be more likely to eat their vegetables if they took part in growing them.

Call 888-ASK-DUKE to make and appointment with Dr. Shaikh or another Duke Primary Care provider near you.

Podcast: Terry Kim, MD, on Eye Health Screenings

Fri, 22 Mar 2013 14:09:45 -0400

In this podcast, Terry Kim, MD, the Duke Men's Basketball team physician, discusses the vision and eye health screenings he performs for the team and how it helps their performance on the court.

Listen to the Podcast

(Download audio)

Podcast Transcript:

Radio Announcer: We’ve got a lot to cover on today’s show. We’re going to begin with a special guest who’s joining us up here in our “Crow’s Nest” position overlooking Coach K Court. He’s Dr. Terry Kim who’s a professor of ophthalmology at the Duke Eye Center here on campus.

Dr. Kim, I know you’re the team eye doctor for the Duke Men’s Basketball program so we thought we’d get you tell us a little about some of the things you do for the team as far as how you screen them and how it helps their performance in basketball.

Dr. Kim: Well, thanks for having me today, Jon. Well, with the full support and endorsement from Coach K, I started the annual eye screenings for the basketball team back in 1999. We’ve been doing it every year since then.

You know, my staff and I actually bring our eye testing equipment over here to Cameron where we check the player’s vision, the eye pressure; we examine the front and back parts of the eye, and even do visual fields. You know, over the years we’ve been surprised to find some players that have some near sightedness, farsightedness, and astigmatism. We’ve also caught some important eye diseases early like glaucoma before they advanced. But by correcting the player’s vision with contacts or procedures like LASIK, we’ve been basically able to provide these players better vision and also just as importantly help them maintain healthy eyes.

Announcer: Obviously over at the Duke Eye Center, you also deal with a lot of other patients that aren’t on the Duke Basketball team, in fact, most of your patients aren’t. And for the average person who wants to avoid wearing contacts or glasses when they play sports, what are some of their options?

Dr. Kim: Well, you know, we’ve spoken about this before; here at Duke we do strongly advocate the importance of protective eyewear for sports, especially the sports that have a higher risk for eye injury, like lacrosse or field hockey. But for the leisurely athlete that plays golf or tennis, we have a very active and well-respected refractive surgery program here at Duke where we perform a very comprehensive eye exam and determine if that patient is a good candidate for LASIK, PRK, or even procedures like ICL, or the implantable contact lens. And patients can get these evaluations at any one of our multiple locations. We have Durham, Raleigh, Cary, Research Triangle Park, and Winston-Salem.

Announcer: Dr. Terry Kim from the Duke Eye Center is our guest here on the Duke Basketball Tipoff Show. You know, I’ve heard cataracts are being diagnosed a lot earlier now than in previous generations. What are some of the advancements you’ve made for cataract patients over at the Duke Eye Center?

Dr. Kim: Well, you know at Duke we do use the latest techniques and technologies to provide the best options for our cataract patients. This translates to small incision, no-stitch, topical anesthesia cataract surgery. We also offer our patients what are called advanced technology, or premium lenses, that help address astigmatism and even reduce the need for distance and reading glasses after cataract surgery. On top of that, we have a very knowledgeable, experienced, and award-winning faculty that offer these cataract evaluations at all of our multiple locations.

Announcer: Well, Dr. Kim, before we let you go I know we’d like to ask you just one thing about the new facility you’re opening in 2015. I know you’ve broken ground on a new clinical area, tell us what that’ll mean for your patients.

Dr. Kim: Well, we’re really excited about this. You know in the twenty-five years I’ve been here at Duke as an undergraduate, medical student, and of course, on faculty, I’ve seen the Eye Center grow tremendously into an entity that now sees close to 150,000 patients a year and performs over 10,000 surgical procedures annually. Of course, it also produces groundbreaking eye research and it’s a premier center for training our next generation of eye specialists and researchers. You know, so with all this growth, there’s no question that our patients will benefit from the new facility in terms of better customer service, improved technology, and state-of-the-art equipment, but also our providers, our researchers, our trainees and staff will also benefit by taking advantage of the increased space and resources we have to improve not only the eye care, but also the eye health of our patients.

Announcer: Well that sounds exciting and we certainly appreciate you coming up here and sharing the story of the Duke Eye Center with us and hope you enjoy watching the game today.

Dr. Kim: I will! Go Duke! Thanks for having me.

Announcer: That’s Dr. Terry Kim a professor of ophthalmology over at the Duke Eye Center, our special guest, today. And when we come back we’ll talk more about the Duke-Miami contest, that’ll be next right here on the Duke Basketball Tipoff Show.

How Doctors Stay Healthy Year-Round and How You Can Too

Fri, 15 Mar 2013 13:21:17 -0400

Nobody likes being around people coughing and sneezing from colds and flu yet that’s what doctors do. Every day they are on the front lines, listening compassionately to complaints ranging from aches and pain to fever and persistent coughs. Yet they rarely get sick. How do they do it?

Here, Matt Hayes, DO, at Duke Primary Care Waverly Place, reviews the top 10 ways he and his colleagues stay healthy throughout the year, and how you can too:

Wash hands frequently. “It’s the most effective preventive measure,” says Hayes. Use hand sanitizer or soap and water frequently during the day.
Don’t touch your eyes, nose or mouth. They are gateways that allow bacteria and viruses access to your body.
Sanitize surfaces. Disinfectant is used continually at Duke Primary Care Waverly Place to wipe down everything from exam surfaces to computer keyboards. He suggests patients do the same with high traffic areas in their homes or offices. “Wipe down your desk, your phone, any common areas, and where you eat at least once a day.”
Exercise regularly. Hayes, a triathlete, works out six days per week. Brisk walking will also do the trick if you can’t get to the gym. Research shows regular exercise – 30-45 minutes per day, 4–5 days per week, boosts the immune system and helps maintain good health.
Drink water. Clear liquids are best, says Hayes, who drinks water regularly. Aim for 64 ounces, or 8, 8oz. glasses per day. “It keeps your energy level up and ensures your body stays hydrated,” he says.
Get enough sleep. Seven to eight hours per night is key to maintaining a healthy body. “If you do get sick, resting helps your body heal faster,” Hayes says.
Eat seasonal fresh fruits and vegetables. They’re packed with vitamins and nutrients that are essential for overall good health.
Beware of party food. That double dipper may be leaving his germs in the party dip. Stay away.
Laugh a lot. It minimizes stress, which can weaken immune systems.
Don’t smoke. Need another reason to quit? Research shows smokers have poorer health than non-smokers and take more sick days.

Lose Weight While You Sleep? Yes, Sleep is That Powerful

Fri, 22 Feb 2013 10:26:18 -0500

Late-night munchies can wreck havoc on your diet plans so the next time they strike, hit the sack instead. The more sleep you get, the less likely you are to succumb to delicious temptation, and the faster you’ll lose weight.

More studies are showing a link between sleep deprivation and weight gain, says Meredith Barbour, MD, a family medicine physician at Duke Primary Care Brier Creek. “Lack of sleep triggers the release of hormones that stimulate hunger and appetite, especially for those high-calorie, carbohydrate-dense foods like cookies, chips and ice cream,” she says. Going to sleep is the best way to satisfy that craving.

Sleep deprivation occurs more regularly in people who routinely get less than seven hours of shut-eye at night. “Generally speaking, adults should aim for seven to eight hours of sleep per night,” Barbour recommends.

Weight gain isn’t the only health problem associated with lack of sleep. Sleep deprivation can impair your daytime performance and decrease your levels of alertness. That can put you at increased risk for all kinds of accidents. Sleep deprivation can also put you in a bad mood, make you irritable; cause you to suffer from low energy and increased tension.

There are serious ramifications too. Lack of sleep can lead to high blood pressure and heart disease. “It can also have a negative effect on the body’s immune system, which makes it more difficult to fight off infections, such as respiratory viruses and the common cold,” said Barbour.

If you’re having trouble falling or staying asleep, heed this advice:

Maintain a regular sleep schedule
Avoid caffeine after lunch
Avoid alcohol near bedtime
Avoid screen stimuli from televisions, computers, tablets and your smart phone for at least one hour prior to bedtime
Exercise regularly
Relaxation techniques also help. When you are ready to fall asleep, relax every muscle in your body, starting with your facial muscles, and moving down to your toes, one at a time, until you’re fully relaxed.

“If these methods don’t work, talk to your doctor who may be able to suggest alternative treatment options,” said Barbour. It is also important to consult with your doctor before trying any over the counter sleep aids or herbal remedies.

Heart Attack Symptoms Women Need to Know

Mon, 18 Feb 2013 10:09:56 -0500

Chest pain, shortness of breath, dizziness. Those are the well-known signs of heart attack. But what about the not so obvious signs?

Many women experience heart attacks differently then men, and knowing the subtle differences may one day save your life.

According to Radha Kachhy, MD, a cardiologist with Duke Cardiology of Raleigh, women are less likely to experience the crushing chest pain that some men describe as an elephant sitting on their chest. Instead, they may feel a persistent pain in their back, neck, jaw or even in their shoulder blades.

“Where the pain is located is not as important as when it occurs,” explains Dr. Kachhy. “If it happens during times of exertion, it should be taken seriously. One of my patients said her shoulder hurt every time she walked. She thought it was her purse, but her shoulder throbbed when she wasn’t holding her purse.”

Women are also more likely to experience fatigue, sweating and nausea, as well as indigestion they might mistake for heartburn. “What you are doing when you experience these symptoms makes a difference. If you feel what you think is heartburn while walking, chances are good it may not be indigestion.”

Symptoms of heart attack can also occur when you are resting. It’s important to know your body’s signals. “If you feel like you just finished a triathlon but you haven’t moved, take notice,” she advises.

Because more women are likely to brush off their symptoms or delay seeking treatment, they are often their own worst enemy. “I have patients who experienced symptoms of a heart attack and said, ‘well, I decided to do the laundry. When it didn’t get better, I went to the doctor,’” Kacchy said.

“Time is muscle,” she stressed. “If someone is having a heart attack, we want him or her to be evaluated as quickly as possible.”

The best way for women to arm themselves against heart disease and heart attack is to take steps to prevent it. “Know your numbers,” says Kachhy, meaning your blood pressure, your blood glucose, your cholesterol and your body mass index or BMI. If you know you carry some risks for heart disease, if you smoke or are overweight, make lifestyle changes with your diet and exercise to lower that risk.

Also, familiarize yourself with the signs of heart attack – both for yourself and your loved ones.

Women who believe they are having a heart attack, or anyone who experiences severe chest pain should call 911. “If you experience mild discomfort for weeks, make an appointment to see your doctor.

“The longer you wait, the more heart muscle damage that can be done,” Kachhy said.

Good Posture Is Important But It Won’t Prevent Scoliosis

Wed, 13 Feb 2013 10:42:30 -0500

Remember when your parents told you to sit up straight? Slouching among adolescents hasn’t gone out of style and neither has the popular refrain. Sitting and standing tall remains important because it lengthens the spine, and strengthens the back, neck and shoulder muscles.

But can good posture prevent the curving of the spine known as scoliosis? Unfortunately, it won’t, says Robert Lark, MD, a pediatric orthopedic surgeon with Duke Orthopaedics.

“Scoliosis is not preventable,” he says, “but once we diagnose it, there are things we can do to prevent progression of the curve.”

Scoliosis is an abnormal, left-to-right curvature of the spine that often resembles the letter S. In most cases, the cause is unknown, but research suggests genetics play a role.

Parents may suspect scoliosis in their child if one shoulder is higher than the other, or if the trunk of their body appears to shift from left to right. “It’s common to spot scoliosis during the summer time, when a thinly clothed child bends down to pick something off the floor,” says Lark. “You may be able to see the ribs along the spine appear more prominent on one side than the other.” Lark says the muscular imbalance can cause pain in some children.

If you suspect your child may have scoliosis, a visit to a pediatric orthopedist is warranted. The severity of the curve is diagnosed on x ray, and it’s important to make that diagnosis early, when children are young and still growing. Sometimes treatment is as simple as taking a wait-and-see approach. “If the patient is a 14-year-old girl with a small curve, we’ll just keep an eye on it as they keep growing,” Lark says. Core and flexibility exercises are beneficial to strengthen the muscles, but they won’t make the curve go away.

If the curve is more significant, bracing may be recommended to minimize curve progression. It is important to note that bracing will not make the curve go away.

About one-quarter of children with scoliosis may benefit from bracing. The site of the curve dictates the bracing regimen. Children with curves higher in their spine may need to wear a brace when upright for 16-18 hours daily. Lower curves may be corrected with a nighttime brace. Braces are typically worn for one year past skeletal maturity. “For girls, that’s three years past the time of their first menstruation,” Lark explains. For boys, it is one year after the close of their pelvic growth plate.

Surgery may be required if x-rays suggest a severe curve that may progress into adulthood. While the surgery is significant – requiring a three to five-day hospital stay and up to six weeks recovery - “today’s modern instrumentation allows us to correct a lot of the deformity a child may have,” Lark explains.

If scoliosis surgery is recommended for your child, choose a surgeon with a wealth of training and experience, and a medical center with a pediatric intensive care unit, Lark says.

Kids Stash the Darndest Things

Thu, 31 Jan 2013 16:04:26 -0500

On occasion, one of my kids will present me with a particularly challenging problem, and I know exactly what to do. So rare and so perfect are these moments that I remember them with great detail for long after. Like the time nearly two years ago when my son, then three years old, came to me with a popcorn kernel lodged too far up his nose to grab. I didn’t hesitate.

"Let’s do this,” I said to him, as I pinched closed the unaffected nostril, placed my mouth over his, and blew a sharp puff of air. I’m not sure why my son erupted into giggles a second later. It could have been that this medical maneuver tickled, or it could
have been the sight of my face covered with “collateral”—and one popcorn kernel.

I was able to be Mom of the Year at this moment because just a week prior I had seen Ben Linthicum, nurse practitioner at Duke Urgent Care Hillandale (for an unrelated problem). We got on the subject of kids leaving their things where they shouldn’t—such as up noses—and he clued me in to the blowing trick (which actually has both a cutesy name, the “kiss technique,” and a fancy medical one, “positive-pressure expulsion,” I later learned from Jennifer Swanson, MD, medical director for Duke Urgent Care). Swanson told me more tips about dealing with foreign objects in various places, some cautions, and a few eye-openers.

DON’T TRY THIS AT HOME

In truth, the kiss technique is the only trick that’s usually safe for novices to attempt at home. As for other methods and other places in the body, those are best left to the professionals. “Most people don’t know the anatomy well enough—of the ear, for example—to know how to remove foreign objects without doing damage,” Swanson says. “We not only know the anatomy, but also have the proper tools to ensure safe removal.”

Take an impossibly tiny Polly Pocket doll shoe in the ear, for instance. “Unless you can easily work it out with your finger, you really don’t want to make an attempt on your own with any kind of tool because you could rupture the eardrum,” Swanson says.

DETECTIVE WORK

Turns out, I was pretty lucky to have had to deal only with one foreign object in one orifice. Once younger kids discover that things can fit in one place, they’re likely to try other places—just for fun. So if there’s a rock in the nose, check the ears as well.

Some kids are just too young to be able to confess what they’ve done. Recurrent, icky, purulent nasal discharge or nasal infection could be a sign that something is lodged in the nose and has been there for a while.

And children don’t necessarily outgrow the tendency. Swanson and colleagues have seen
tweens and teens with objects in noses and ears, but they won’t admit it. Instead, they might visit the urgent care office complaining of ear pain.

AND MORE DETECTIVE WORK

Then there’s the issue of kids swallowing objects, which can lead parents to a different kind of detective work a day or two later. But it’s important to know that any swallowed object calls for immediate medical care. Any nonfood item that goes in the mouth and doesn’t come back out can potentially be lodged in the airway or esophagus, so it’s best to find out where it landed right away.

Two ingestible items that are deceitfully dangerous are small batteries and strong magnets, says Scott Elston, MD, of Duke Urgent Care Morrisville. “Small batteries, like the ones in hearing aids and small toys, are not only easy to swallow, but can quickly begin to corrode the intestinal wall. Multiple magnets that are ingested can link together and cause an obstruction or even an interruption of circulation to the bowel.”

If the swallowed object does turn out to be harmless and goes into the stomach, once it gets to the small intestine, you’re pretty much home free. Just keep an eye out for a day or two to make sure the “rite of passage” completes.

KEEP IT SIMPLE, SUPERHERO

After my heroic success with the kiss technique, I e-mailed Linthicum to thank him for the advice. He replied, “I’m glad it worked. Not that you want to encourage it, but what kind of distance did you get on the kernel?”

He brings up a good point. Can you discourage kids from sticking stuff in weird places to begin with? The simple rule that parents already know seems to be the best advice: “Just be careful what is left in reach of children and toddlers, not only from this standpoint, but also as a choking standpoint,” Elston says. “Items lodged in the nose can ultimately Become a choking hazard, be aspirated into the lung, and cause other complications.”