Our Mission
Nova promotes optimal health. We offer a personalized approach, collaborating with our patients to enhance health, lifestyle, and well-being. A multi-specialty, integrative practice, we minimize the need to seek multiple doctors and disciplines to attain comprehensive, cost effective, and sensitive care.
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Having Trouble Sleeping?

The inability to fall asleep and wake up feeling refreshed is an exceedingly common problem.  The reasons behind it are multiple, and often it is a combination of things that interfere with our ability to get good sleep.  

Just like everyone else, I have to balance the demands of work and my family.  I get home late, so I eat dinner right before bed.  I drink caffeine throughout the day.  And, there is a TV going in the bedroom and books/journals on the nightstand.   Then I wonder why I have trouble getting to sleep at night?!  

There are many ways to try and improve our sleep habits and get more restful sleep besides starting medication for a sleep aid:

    Set up a Pattern– Try to stick to a schedule as best you can.  Get into a rhythm so that after a couple of weeks your body knows that at the same time each day it is time to start winding down.  The same routine of trying to relax and perform the same tasks like brushing/flossing right before you climb into bed help train your body for the arrival of sleep.   Just as important as the nighttime routine is the idea of getting up at the same time.  A little bit of sleeping in on the weekend is fine, but grabbing 4 extra hours of sleep is disruptive to establishing and keeping your body trained for sleep and in a rhythm.  

      Tone Down the House & Your Activity - Try to turn the TV off for a while before bed and let the house get quiet.  Read something that while interesting, doesn’t get your heart racing.  Tune the radio onto a station playing something relaxing and keep the volume low.  Do regular exercise a few days a week, but early in the day or afternoon so your body can calm down and relax after the exertion.  Eat at a reasonable hour so your body isn’t working to digest the food while you are trying to get comfortable and off to sleep.  Be mindful to avoid caffeine late in the evening whether it comes from coffee, tea, chocolate, or soda. 

        No Daytime Naps – Sleeping during the day may be necessary for infants and young children, but not adults.  Excessive daytime sleepiness can be a symptom of something more significant like sleep apnea and should be discussed with your doctor. 

          Keep the Bed for its Intended Purpose – Too many of us use the bedroom as a multipurpose room.  We keep the TV on watching late night television, read books or magazines in bed, do homework, fold the laundry and so on.  This teaches the brain that the bed is for more than just rest.  The standard teaching is the bed is only for sleep and sex.   If you want to watch TV, get out of the bed.  If you want to read a few pages from a book or magazine, get out of bed.   Keep your mind on the idea that once you get into bed, it is time to sleep.   

             Still not Sleepy? – Don’t lie in the bed and keep checking the clock.  Peeking at the clock and calculating “how much sleep you can get if you fall asleep right now” only increases your anxiety and keeps you from falling asleep.  Get up out of bed, leave the room and go back in after 15 minutes to try again.  If you still aren’t asleep in 15 minutes, get up and out of bed again and again until you fall asleep.   If you wake up early in the morning the same rules apply, don’t lie in bed if you are not sleepy.  

              When Discussing it with your Provider - Before you see your provider for trouble sleeping, try to keep a diary of your sleep habits for about 2 weeks.  The diary should note the time you last had anything to eat, the time you laid down, approximately when you fell asleep, any naps you took throughout the day, any alcohol intake, cigarette smoking, any pain you may have, and all medications, vitamins or supplements that you are taking. 
                In summary, these simple things are the first things your provider will tell you to try when the evaluation for insomnia is being done.  Be patient and give it an honest effort for a few weeks.  Sleep habits form over your lifetime and will take some time to be adjusted.  Sweet Dreams!

                  Posted on 24 June 2013 | 9:43 am

                  Watching Tragic Events Can Create Stress

                  Over the past few weeks, it seemed that any time you turned on the radio, booted up a computer, checked the news on an iPhone or looked at the TV, there was a consistent bombardment of tragic pictures and personal testimonials of horrific scenes in world news – some of which included wind-torn, devastated towns in Oklahoma.

                  While we want to remain informed and are drawn to this news, our own empathic values allow us to absorb the heartache of traumatic stories, which can then become entangled with the real stresses of our daily life.  Visual pictures make an impression in our brains that inform our bodies how to regulate the impacts of traumatic events, regardless of them being in real time, past or remote.

                  In real time, we react to current traumatic situations by becoming more attentive; our pulse rate increases allowing more blood to the brain, our frontal lobe activity is elevated (required for decision making), and our bodies are ready for action.  This mode is a “flight or fight” mode and is a reaction that allows for our survival.

                  Sometimes, an event is portrayed in the news which looks and feels real because of the emotional connection our brains make to the event.  We can be triggered by sensory stimulation; a similar place, feeling, or reaction of others.  Under this triggered stress, the brain can get confused and react as if the event was happening in real time.  The news and images evoke stress triggers which resonate as real fears, real depression, and real hopelessness.

                  If you are watching the news and you feel your heart begin to race, your temperature rise and/or your pulse increase, you are experiencing a response to what you see or hear.  Your resourceful brain is responding and getting ready to react.

                  So, what do you do?  Take a break.  Don’t let this physical response continue.  Remind yourself that you are safe, this is not happening now.  If your thoughts are telling you that you are not safe, this could be the first sign of acute stress.  Share your feelings with someone else, a relative and/or a friend.

                  If these feelings continue and create problems in your everyday life, such as disrupt your work day, wake you up in the middle of the night, and/or cause issues within your family, then you should consider calling a professional counselor to help you learn ways to cope. 

                  -Posted by Dawn Perez, LPC, NCC 

                  *Dawn Perez, LPC, NCC is now accepting new patients in the Gainesville office*

                  Sources: http://udini.proquest.com/preview/media-coverage-of-terrorism-a-meta-goid:216938409/

                  Posted on 28 May 2013 | 12:33 pm

                  The Importance of Cooking & Eating Out Less

                  I grew up in a time when eating out was considered a special treat. I bet if you’re over 30, you did too. My family went out for Mexican food, our favorite, about once a month. My sister and I were even allowed to order a soda! Woo hoo!

                  Nowadays, Americans eat out a whopping average of 4-5 times per week! The proliferation of fast food restaurants and mid-priced chain restaurants, along with more two-income families, made that number possible.

                  The decline in cooking at home and the rise in eating out correspond to the rise in overweight and obesity in the U.S. Research has shown that eating at restaurants is associated with higher BMI and weight gain. A restaurant meal is more likely to be higher in unhealthy fats, sugar, sodium, and calories than a home-cooked meal, plus restaurant portions are likely to be significantly larger than home-cooked meals.

                  I tell my patients that cooking at home is probably the most important thing you can do to improve your diet. It doesn’t even matter what you cook - it’s the act of cooking itself. People who cook eat a healthier diet and smaller portions without giving it a thought. Think about it – are you really going to eat French fries that often if you cook at home? No! Are you going to eat four cups of pasta on a giant restaurant-size plate? Probably not.

                  For those that claim “I don’t have time to cook,” I urge you to rephrase that to “Cooking is not a priority.” We find the time for activities we value, like surfing the internet or watching TV. The problem is we don’t value cooking enough.

                  For those that claim “I can’t cook,” I say “Yes you can.” Don’t be turned off by watching fancy chefs on Food TV. Cooking can be easy and like anything else, you get better with practice. Tag recipes that catch your eye in cookbooks and websites and follow the instructions!  My current favorite sources are RealSimple.com and EatingWell.com.  I pick quick recipes so I’m not in the kitchen for more than 30 minutes.  I use ZipList.com to help me organize my recipes, plan my meals, and create grocery lists. I plan 4-5 meals a week to leave wiggle room for a meal out or leftovers. Sometimes, I also use Sundays to prep for the week.

                  Make cooking at home a priority and I bet you’ll see your health improve. Schedule a consult with one of Nova’s dietitians to help you make cooking and healthy eating a part of your life.

                  -Posted by Nicole Holovach, RD

                  Posted on 8 May 2013 | 2:03 pm

                  Healthy Weight as a Lifestyle

                  Not too long ago, it occurred to me that the only difference between me and someone who doesn’t feel that he/she will ever “master” this wellness thing (a healthy weight, regular fitness, etc.) is that I just keep getting back in the saddle.  (Remember, I used to be 50 pounds overweight, so I’ve had lots of practice over the years...and still do!)

                  Think about it: How did you ever succeed at your first job, or the next job, or the one you’re in now? What about being a good parent or spouse?  So-called failures are inherent in life; in fact, they are so necessary for us to grow that I don’t believe in failures, only lessons.  For some reason, though, patients look at weight loss as not only a task to complete, but one that must be done “right.”  When that’s the viewpoint, as soon as you lose your footing, you’re likely to think it’s time to hang up the reins.  

                  What if you started looking at your weight and life as a journey?  Not just a "to-do" to check off. (After all, your weight is never “done” because there’s this "next-level" game called “maintenance” - for which you’re immediately qualified!)  And, not something that has to look a certain way.  But rather another wonderful path by which you get to prove your perseverance and refine your character.  

                  For example, there’s never any going “off” your plan if you see healthy eating as a long-term lifestyle.  This would mean that you realize that it's vital to treat yourself regularly, rather than a short-term diet that causes deprivation.  It’s still important to have structure, but it needs to be a flexible, freeing, innately natural structure.  Not regimented or forced structure that has you going from an “all” to “nothing” mentality in .5 seconds. 

                  No matter what happened yesterday–whether I overdid the Extreme Cookies ‘n Cream and ended up feeling sluggish OR I had 7 servings of veggies and a kickin’ run–either way, I know I’m gonna be back on the trail today. That’s how I think now that I know health is a lifestyle.  

                  To help youthink about your weight and wellness as a lifestyle, it’s important to examine your beliefs and patterns, and customize a plan of action.  The following coaching questions will help:

                  1. What’s your biggest challenge? (i.e. Mindless snacking, not planning or preparing meals, feeling overwhelmed at work, unmotivated to exercise)
                  2. Why is it a challenge? (What mindset or life circumstances make it difficult for you?)
                  3. What’s one thing you will do today and this week to shift your perspective and practice something new? (i.e. Pausing to rate your hunger on a hunger scale and eliminating distractions in order to combat mindless snacking, or expanding your definition of exercise to include your past love of dance and researching some DVD or class options) 
                  --Posted by Sarah Sutton, MS, CHWC, CPT, Wellness Coach

                  Posted on 2 May 2013 | 12:07 pm

                  D3 - The Supreme Vitamin: What's Your Level?

                  For the past few decades, Vitamin D has continually been featured in the news.  And, recently, has been considered one of the most supreme nutrients for its ability to promote optimal health and prevent today's chronic degenerative diseases.  

                  Vitamin D is freely available to everyone through sun exposure.  Specifically, its production is the result of an interaction of the ultraviolet B (UV-B) ray and cholesterol in our skin.  But, for the past half century, Vitamin D deficiency has become a worldwide problem.  Why?  Well, many people are increasingly working indoors and overall, getting less exposure to sunlight.  Especially those who live further away from the equator.  Additionally, getting Vitamin D from food sources like fish and eggs is very difficult since there's usually such a minimal amount present.  In order to get an optimal level of Vitamin D level in our bodies on a daily basis, nutritional supplementation of Vitamin D is often necessary.

                  So, what's all of the hype - why is Vitamin D so important?  One of the most common functions associated with Vitamin D is its ability to optimize bone health.  This is because it promotes calcium absorption in the gut and a normal bone formation in our bodies.

                  According to the newest research published in an April 2013 issue of the journal JAMA Neurology, babies born in the month of May have significantly lower levels of Vitamin D and are at greater risk for developing multiple sclerosis (a chronic degenerative autoimmune disease that attacks the brain and the nervous system) than babies born in November.  This is not the only study that shows the association; previous studies have also found the same outcomes.

                  In addition to multiple sclerosis, several studies have shown a strong association of low Vitamin D with other autoimmune diseases including rheumatoid arthritis, type 1 diabetes, psoriasis, and scleroderma.  Besides autoimmune diseases, Vitamin D deficiency also increases the risk of developing other chronic degenerative diseases, including bone loss (osteopenia and osteoporosis), diabetes (type 1 and 2 diabetes), high blood pressure, heart disease, fatigue, muscle and bone pain, depression, memory loss (dementia and Alzheimer), chronic respiratory infections, and various cancers.

                  So, how do we test the Vitamin D level and what is an optimal level?   A simple blood test called “25-Hydroxy Vitamin D” will tell you both your vitamin D2 (synthetic form) and vitamin D3 (natural form) levels.  The optimal level of Vitamin D should be around 60 to 80 ng/mL, preferably in the natural form of 25-Hydroxy Vitamin D3.

                  In order to achieve and maintain the optimal level of vitamin D, you may need 2,000 to 10,000 IU/day of Vitamin D3, best taken with food.   Ask your doctor to check your Vitamin D status and discuss the right dosage of Vitamin D3 supplementation for you.

                  -Posted by Teerawong Kasiolarn, ND, MSAc, LAc.

                  Posted on 30 April 2013 | 4:14 pm

                  I Love Spring, But…Aaachoo!

                  If you are like me and millions of other seasonal allergy sufferers, then you would understand the love and hate relationship I share with the spring season.

                  I am from a southern part of India where we do not have these distinctive seasonal variations.   I inherited my father’s love for gardening (he is a retired horticulturist), so when I first came here, the beauty of the spring season had me enthralled!   Now, it still does, but I find myself struggling to enjoy the beauty of the outdoors during the springtime due to sneezing, itchy watery eyes, headaches and last but not least fatigue.

                  Avoidance options like keeping the house and car windows closed, taking a bath every night, and avoiding going out on days with high pollen counts are helpful, but of course we cannot live in a bubble and totally eliminate all exposure!

                  Here are some of the available preventative methods and treatments which can help you to find relief from seasonal allergies: 

                  Allopathic medications can help with blocking the release of antihistamine in your body.

                  ·         OTC Antihistamines (i.e. Claritin, Zyrtec, etc.) are useful for mild-moderate symptoms, but do have side effects of drowsiness and nasal dryness.
                  ·         Prescription corticosteroid nasal spray, which decreases nasal inflammation, can be used alone or in conjunction with antihistamines.  Please note that this can take 1-2 weeks to be effective and can also cause local irritation and nose bleeds.
                  ·         OTC/Prescription Antihistamine eye drops can be used to combat eye symptoms.  But, note that they can sting and cause a nasty taste in the mouth (yuck - from personal experience!)
                  For those who would like to avoid medications and try a more natural route, try these natural remedies:
                  ·         1 – 2 teaspoons of local, wild honey daily can help to build up immune response.  It works gradually and would need to be started 2-3 weeks ahead of allergy season.   A word of caution for people with severe allergies/asthma: start in smaller amounts (i.e. ¼ - ½ teaspoon) and gradually increase.  It is not recommended for children younger than 12 months.
                  ·         Vitamins and supplements such as Quercetin (contained in garlic and onions), omega-3 fatty acid (i.e. flaxseed oil), probiotics, Vitamin C, and Zinc are recommended for allergy relief.
                  ·         Neti Pots – a nasal saline rinse – can be used daily to flush out allergens from the nose.  
                  ·         Herbal medications like Butterbur, Nettle leaf (can be used as a tea or tincture), and Bromelain have been shown to be beneficial.  But, before using an herbal supplement, I strongly advise you to consult with one of our naturopathic doctors.  Some of the herbs can have adverse effects and interact with medications.
                  ·         Studies have shown acupuncture to be helpful in lessening allergy symptoms.  We offer acupuncture in Ashburn, Leesburg and the Gainesville offices.  You can also try Community Acupuncture at The Medical Spa at Nova and in Leesburg.
                  ·         Immunotherapy is available in our allergy clinic in Ashburn.  This helps especially for moderate to severe cases and works great for someone who is looking for a long-term solution.
                  Last but not least, do not forget to exercise regularly and drink plenty of water every day.  Believe it or not, both of these play a great role in avoiding/maintaining seasonal allergies.

                  Enjoy Spring!

                  -Posted by Dr. Afzal Rasheed

                  Posted on 26 April 2013 | 12:50 pm

                  Living a Balanced Life

                  Since having my second daughter in December, life has got a little crazier (OK...a lot crazier!).  As I'm getting back in the swing of things at work, I have been thinking a lot about balance and

                  how to juggle practicing family medicine with the needs of my own newly expanded family.

                  I know a lot of you are also struggling with finding balance in your lives because I hear how stressed you are caring for children and elderly parents, working a demanding job and somehow also trying to find time to eat healthfully, exercise, and spend time with your significant other.  It sometimes feels like there are not enough hours in the day!

                  Two books I have been reading lately have given me hope that finding balance is actually possible. Bria Simpson's “The Balanced Mom” and Joan Borysenko's “Inner Peace for the Busy Woman” have shown me that one of the most important things I can do is attend to my own needs... without guilt.

                  If I am rested, eating well and taking time to relax and exercise, I will be a better mother and physician.  In addition, they have taught me not to be too hard on myself.  A lot of the stress we feel comes as a result of unrealistic demands that we place on ourselves.  Sometimes it’s okay not to be perfect, just good enough.  Sure it would have been nice to bake cupcakes from scratch for my daughter’s Valentine’s Day party, but I was busy and I don’t think the kids noticed that they came from a mix! 

                  I am also learning how to ask for help more and I am building up a support system of friends and family.  This one is tough because we all like to think that we can handle things on our own!
                  I am learning to take what I can get, when I can and to adjust my expectations.  Too busy to go to a yoga class?  Maybe I can take 5 minutes and do a few yoga poses.  Can’t get a sitter for date night with the hubby?  Let’s order in and watch a movie instead.

                  Simple things like placing a pot of daffodils on my kitchen table or putting up my kid’s pictures at work have proven to be great stress busters.  I still have those crazy, tiring days when nothing seems to go right, but I am hopeful that those days will become fewer and that I can learn to live my life to the fullest without wanting to pull my hair out!

                  If you are struggling with finding balance in your own life and are feeling the effects of negative stress, consider seeing one of our mind body specialists, Camille Grosso or Dawn Perez and our Certified Wellness Coach Sarah Sutton for help. 

                  Make it a priority this Spring to learn to live joyfully and to the fullest.  My family and I will be right there with you!

                  -Posted by Hannah Phillips, MD

                  Posted on 17 April 2013 | 6:12 pm

                  Nova Medical & Urgent Care Center Gainesville Now Open!

                  We are pleased to announce that our new Gainesville office is now open!

                  Nova Medical & Urgent Care Center Gainesville
                  6950 Piedmont Center Plaza
                  Gainesville, VA 20155

                  The new office includes 8 treatment rooms, on-site digital x-ray, and the following services:

                  To book an appointment with one of our Gainesville providers, please call 540.347.7611.

                  Posted on 9 April 2013 | 4:27 pm

                  Make Peace with Your Body

                  I have coached clients and been in enough conversations with my own friends to know that if we actually spoke to a passerby on the street in the same constantly disparaging ways we talk internally to ourselves (particularly about our bodies), we’d end up in some serious hair-pulling, tear-inducing fight 

                  Those kinds of thoughts and mistaken beliefs are simply not in line with the gift you are in this world. But, since you’ve likely carried this subconscious attitude for a good long time now, what do you do about it, and how can coaching help?

                  I describe coaching as four overlapping and ongoing phases:

                  1. Discovery—Uncovering your blind spots or judgments about life that are unknowingly causing you to get in your own way.
                  2. Perspective Shift—Choosing a new way of looking at your particular challenges that opens up possibilities for action.
                  3. Commitment, and
                  4. Action 
                    When you apply coaching (or, at least my brand of coaching) to the weighty body image conversation, all sorts of transformative shifts happen.  I’ll give you an example of a pivotal “A-ha” moment that helped a client of mine – Emily – completely change course. 

                    Emily’s initial revelation (Discovery) came during a simple 5-minute visualization exercise that I led in one of my group coaching classes.  When I asked participants to envision their ideal experiences of body health, the overwhelming feeling that Emily got was that she was having FUN.  Now, if you know Emily, she is fun.  She’s funny and always upbeat.  But, when it came to her wellness, she was seeing that piece of her life through the lens of what the industry tells people they “should be” doing—going to the gym 5 days a week and swearing off desserts.  Ugh, so not fun!

                    Emily decided to suspend this previous belief and choose a way of being that was more intrinsic to the woman she already was (Perspective Shift.)  I challenged Emily onlyto commit (Commitment) to actions that felt FUN for her (since that’s what losing weight represented for her).  If it wasn’t fun, she was not to do it.  So, she started playing more with her kids and even getting in the pool with them!  She tried new zesty foods and instituted a healthy homemade pizza night on Fridays (Action).

                    When I coached with Emily a month later, she exclaimed, “This is the easiest weight loss program I’ve ever done.”  And, the cool thing is that when she started relating to her body in a new way – in addition to trimming down to a more natural weight (by a difference of 100 pounds!) – Emily made all sorts of new ground in her career and relationships, as well. 

                    So, now it’s your turn.  What’s one way you can start to make peace with your body this week?  Please comment below.

                    --Posted by Sarah Sutton, MS, CHWC, CPT

                    Posted on 2 April 2013 | 4:36 pm

                    Diet Soda - Friend or Foe?

                    It’s hard for me to believe that 10 years have passed since I started my career as a certified diabetes educator, and that I have been a registered dietitian for – cough, cough – 20 years!

                    I have seen many, many food trends come and go.  Remember the fat-free craze?  As long as foods were “fat-free,” they were considered by many to be healthy.  I remember my roommate Emme sitting on the couch, munching on boxes of Snackwell cookies, only to complain to me that she had gained 10 pounds.  Hmm, I wonder why that happened!?  In the kindest tone I could muster, I would tell her it was probably because the fat-free cookies were not calorie free!  Now, we know that not all fats are considered bad and that some are indeed very healthy for us.

                    Diet soda has been around for as long as I can remember – it started with Tab, which was sweetened with saccharin, and has continued to include every feasible type and flavor of soda and artificial sweetener.

                    Over the years, I would encourage my patients to drink diet soda in place of regular soda because it didn’t contain any calories and that would help them achieve their weight loss or blood sugar goals…or, so I assumed…

                    Fast forward to today.  Recent epidemiological studies have been conducted on thousands of diet soda drinkers.  These studies show a strong association between drinking diet soda and having an increased risk of disease.

                    So what does that mean?  Well, one study suggests that if you drink diet soda daily, you have a 67% greater relative risk of getting type 2 diabetes than non-diet soda drinkers.  You also may have a 36% greater relative risk of being diagnosed with metabolic syndrome, which can lead to other serious diseases.  While the studies do not prove that diet soda directly causes these conditions, it sure does make one pause when making drink selections.  Obviously, more research will need to be conducted.

                    The study of nutrition is always changing.  And, as a professional, I am constantly working to keep updated.  My approach is now one in which I encourage my patients to learn about the importance of eating whole foods and not chemically altered “Franken foods.”  If your great- grandmother wouldn’t recognize the food that you are eating or drinking, it is probably not something that should be consumed.  It seems nutrition, like all things in life, has come full-circle! 

                    -Posted by Amy Johnson, RD, CDE

                    Posted on 22 March 2013 | 3:03 pm

                    Do We Really Know What We Are Eating Anymore?

                    An email from our Marketing Director Melanie with the quote below and an image of these new chips, got me thinking about what goes into a certain product and asking the question: "Do we really know what we are eating anymore?"

                    "I saw these last night and thought you would get a kick out of it.  How disgusting!  If there are 49 chemicals in Strawberry flavoring… I can only imagine how many are in this “Chicken and Waffle” flavored bag of chips!"

                    Well, here's the answer.  Ingredients in Lays Chicken & Waffles:

                    Most likely chicken flavor is from a chemical called methyl furanthiol, which is a food additive from yeast. Not the worst ingredients I've ever seen, but still I wouldn't eat this stuff!  

                    What is interesting to me is that I couldn't find any human safety studies in PubMed on the food flavor, methyl furanthiol.  Not one.  There was one study showing that it is secreted in breast milk.  I did find one in vitro study showing that there is some weak mutagenic potential (depletes glutathione, an important antioxidant) of this ingredient.  This study does mention another food additive not in this product, that has much greater cytotoxicity and mutagenicity (strongly depletes glutathione) at much lower doses.  That food additive is (E)-2-hexenal (HEX- this has a fruity flavor and is added to frozen dairy, baked goods, non-alcoholic beverages, gelatin puddings, candy, jellies, frozen vegetables, soups, reconstituted vegetables and is added also to perfumes...scary!)  

                    Additionally, there were several studies in food science journals on the ways to make methyl furanthiol flavor more appealing to the human palate.  It is interesting to me that conventional medicine and research often gets very uptight about the safety of herbal medicines that have been used for thousands of years when we have no idea about the effects of these chemicals that are being consumed by some on a daily basis... 

                    I am not anti-science by any means - I think research is important, and it can be useful to expand traditional knowledge with modern methods.  However, I also think that there should be more research dollars and emphasis placed on substances that are being consumed by the majority of the population and that we have very little understanding of as it relates to the effects on human health. 

                    Food chemistry and science is a rapidly expanding field and it is absolutely fascinating, I learned a lot by exploring the links listed below.  Our food is changing faster than we realize and we don't really know if these changes are safe.  
                    One thing is for sure: that flavors and aromas are very tantalizing to humans, we may not realize it, but we like them and the demand for them is increasing.  A "natural flavor" company had to ramp up its production of "natural chicken flavor" in 2010 to keep up with demand.  The memories for food is very much near to our pleasure centers in our brain.  Certain foods can lead to secretion of pleasure hormones more so than other foods.  Interestingly, in some people, this can occur even more so for foods that they are allergic or sensitive to (i.e. gluten).  We can become addicted to food and I do wonder if food additives are playing a role in this.  Is processed food becoming the new nicotine?
                    Do you ever feel like you just need more fast food fries, like you just really need to have them!?  MSG is a perfect example of an artificial flavor that was rampant in processed food, but eventually led to labeling laws because of its deleterious effects on human health. 

                    One of my teachers, Steven Sandberg Lewis, commonly says: “You are what you eat, digest, metabolize, eliminate, think and feel.” 

                    Do we really know what we are eating anymore?

                    "Food for Thought" - Interesting Articles to Reference:
                    • http://nyti.ms/WKegOV
                    • http://bit.ly/Wgn8dT
                    • http://bit.ly/152aLBw
                    • http://1.usa.gov/152aVJj
                    • http://1.usa.gov/Zr8PB4
                    • http://bit.ly/Yuq3ev
                    • http://bit.ly/16v5q9A
                    • http://bit.ly/12TA11k
                    • http://bit.ly/YdOzBo
                    • http://bit.ly/WKe95T
                    • http://bit.ly/YdOFJf
                    • http://bit.ly/10Mw1uy 
                    • http://1.usa.gov/Z79AQA

                    Posted on 14 March 2013 | 2:56 pm

                    What a Pain in the Neck!

                    Like many of you out there, I spend the majority of my day staring at a computer.  All of that time has resulted in a pain in my neck, literally...   

                    At first, I thought nothing of this pain, but as it persisted, I became more concerned with it.  Perhaps I had slept funny or something.  The more I thought about it, the more I realized it was not from one isolated incident but from the bad habits I had developed in my everyday activity.    

                    Bad habits can be hard to break, especially when it comes to poor posture.  But, here are some tips that I have started to incorporate into my day to improve my pain in the neck:  

                    1. Stretch.  Start by gently tilting your head from left to right, hold for 20 seconds on each side.  Next, place your hand on top of your head and stretch your neck towards your shoulder on each side.  Be sure to perform these stretches with slow, smooth movements. Make sure that you are doing it gradually, as any quick stretch is more likely to tear a muscle or ligament.  If you feel increased pain or numbness, stop that motion.  These simple stretching exercises can be done a few times per day while sitting at your desk. 
                    2. Shoulder rolls.  In the sitting or standing position, hold the arms at the side with the elbows bent. Try to pinch the shoulder blades together.  Roll the shoulders backwards 10 to 15 times, moving in a rhythmic, rowing motion.  Rest.  Roll the shoulders forwards 10 to 15 times. 
                    3. Sit up straight.Your shoulders should be in a straight line over your hips and your ears. 
                    4. Practice proper ergonomics.  Position your desk chair and computer monitor to be at eye level.  Avoid sitting in the same position for prolonged periods of time and take periodic breaks.    
                    5. Apply heat.  A heating pad can provide welcomed relief after a long day of work.  Apply a heating pad or hot pack for 20 minutes at a time.  Avoid direct contact with the skin by using a towel between your skin and the heating pad.  
                    6. Try a massage or acupuncture.  Both are great options and can provide considerable relief.  I know I am looking forward to scheduling a massage through The Medical Spa at Nova!  
                      I hope you find these tips as helpful as they have been for me!

                      -Posted by Kimberly Zawistoski, DO


                      Posted on 22 February 2013 | 3:11 pm

                      A Neat Weekend!

                      I had a most unusual weekend.  On Saturday, I saw the movie Silver Lining Playbook with my daughter and on Sunday saw Quartet with my friend.   You may wonder how these two movies connect.   The connection may be tenuous, but to me, they are both part of what’s important to me today. 

                      Silver Lining Playbook is a wonderful movie about a person with bi-polar illness.  The movie displays superbly the nature of bi-polar illness and its effect on patient, family, and community.  The stress of the illness can be overwhelming to say the least.  The movie was funny, sad, and finally showed that treatment in many different forms can be effective and that there can be a happy ending!

                      There is a lot of focus on mental health/illness these days with the tragedy in Newtown, CT and the subsequent issue of guns and the mentally ill.  I am called upon by my practice to note that the stigma towards mental illness – while lessened to some degree – is still active and pervasive.   What many may not realize is that if there is violence from a mentally ill person, it is much more likely for it to be an act of violence towards the self; in self-harm and suicide.  I’d like to emphasize that with treatment, people can and do get well!

                      Now, how does Quartet connect?   This is just a delightfully sweet movie!  It is about musicians who join a retirement community for professional musicians.  Music remains a central part of their lives and movie goers get to escape into the pleasures of music.  

                      Much of my practice time is spent teaching patients how to relax and manage stress, thereby enhancing their health.  Music can transport a person out of themselves, allowing a short vacation from their stresses and strains.  I know that music and movies work for me...  they can work for you too!

                      -Posted by Camille Grosso, PhD, APRN, BC                                                                    

                      Posted on 13 February 2013 | 3:16 pm

                      What's Holding You Back?

                      Recently, Sarah Sutton joined our team here at Nova.  Sarah is a Wellness Coach.  It made sense to me that we should have such expertise here at Nova – and, for that matter, at all practices – to help us to motivate patients to make the changes in their lives that are important.  With that being said, I really did not have a frame of reference to understand how Sarah might make some changes in my life, but I was willing to find out.

                      Sarah presents herself in a confident and cheery, non-threatening manner.   She has a “Can-Do” manner which really helps when we must face things in ourselves that we would like to improve.  Sarah asked me what I would like for her to help with.   I braced and responded, “Sarah, I need to lose weight.”

                      Sarah responded that “need” was the wrong verb to use and that it implied some degree of desperation.  I agreed that it did, but perhaps it was accurate, since I did feel desperate to get the weight off.  

                      Not only do I need to get the weight off, but I need to get in shape too – and I know that it’s not going to be easy!   After all, I had a left total hip replacement 3 months ago and was tired of not completely having my life back.   I gained 10 pounds since surgery and that is not a good direction to continue…  

                      Around  the same time that I met with Sarah, I decided to also cough up $20 and join “The Biggest Loser Contest” at Nova  (How lame would it be if I came last place!?).   To start the competition, I got a BIA done…Karen, the nurse team lead in Ashburn, got me through it.  It really was not that bad, but I learned that my BMI is 26% and it needs to be below 25%.

                      Sarah asked me “How would you like to approach this goal?”  I responded that I eat quite well, but I need to cut out drinking all alcohol and I need to work out.   She asked me what was blocking me from doing this.   I responded,  ”Getting it on my calendar.” 

                      I was really embarrassed that I was not capable of getting this on my calendar, I mean really...!!!!!   I was worried that Sarah might pass some judgment about this, but she did not.  She said, “Well, let’s do that right now.”  So, we did.   I booked a time on Monday and Friday to work out and then planned to get up every morning, to have some time for myself before the children got up.   I would go through some gentle workouts at home, as instructed by my Physical Therapist.

                      She suggested, rather than cutting wine all together, how about limiting to just one or two glasses per week, versus my 5-6 routine?   That sounded good to me.   Sarah reminded me that she would be checking up on me and that if I was not adhering to these simple changes, to write down the issues that were blocking me from achieving my goals.

                      So, since then, (1 week), I have worked out three times, performed my PT workout daily, met with a personal trainer twice and am now scheduled to do so every Monday and Friday at 8 AM.   That time works and is not as difficult as my prior routine of getting up at 5:30 AM and working out in my home.  Once I get back in the routine, I think that I can rely on myself to do this more at home, but for now, I need the accountability to Sarah and my Personal Trainer.  I also signed up for a weekly Pilates Class, but am required to have 4 private sessions before starting.   I will learn to use the Reformer for the first time.  Yes, it is true… you can teach an old dog new tricks!

                      And… I met my girlfriends for dinner for Friday evening, had a seafood salad and one glass of wine.  I was satisfied with an unsweetened ice tea thereafter.

                      So, I have my weekly weigh in tomorrow for the “Biggest Loser” competition.   I intend on winning that pot of cash that is now at $700 (Now that Cyndi S. has joined up…)!   Yes, the competition is fierce, but I am intent on making a good showing…if not winning that cash!   If I’m not the overall winner, maybe I will just enjoy losing a few pounds and feeling a bit better about how I look and feel.

                      So, I now understand how a Wellness Coach can help me.  She has motivated me to tackle something that I do not like about myself and must change, and…..I am having some fun doing it! 

                      I am currently chowing down some Kale Salad for lunch, because my loyal colleague Megan is competing against me and this will definitely give me an edge today.  She ran 2 miles yesterday though, so, the pressure is on!   Just about three months to go to reach my goal of losing 23 pounds.

                      I will keep you posted….

                      -Posted by Grace Keenan, MD

                      Posted on 6 February 2013 | 3:44 pm

                      The Power of Asking for Help

                      I just finished a wellness coaching session, which testifies again to the power of resource, and specifically, to resourcing others.  My client Megan* had such a busy work week running the retail store that she owns that she neglected exercise and ate mindlessly.

                      She was so frustrated with herself that her diaphragm felt constricted and her hands were jittery, as if she had too much caffeine.  The metaphor we came up with was that of a frayed live wire, dangerously close to sparking its shock to others.

                      Megan was trying to do it all herself, and therefore had let her naturally extroverted energy turn in on itself.  What was needed was not to squelch the energy, but rather to neutralize its frenzy while better utilizing its natural flow.

                      Megan realized that her store manager Alana* was the perfect person to not only help manage the responsibilities Megan was taking on as all her own, Alana also had a calm and relaxed nature that Megan absorbed whenever she sat for meetings with her.  What a perfect resource!  She committed to meeting with her right away.

                      Seeking out and accessing resource in the form of others in your life is one of the most powerful transformational wellness coaching distinctions I can share with you.  Whenever you are stuck, blowing off your commitments, or confused by your own actions, stop and consider what resource—what provision—in the universe you could take advantage of. 

                      Examples of resources:

                        • Talking with a friend to shift your perspective (mental energy)
                        • Music or a piece of inspiring art to shift your mood (emotional energy)
                        • Exercise or deep breathing to shift your bodily sensations (physical energy)
                        • Prayer, meditation, or a gratitude list to shift your focus on what’s important (spiritual energy)

                        You can access any of these resources virtually anytime you need to.  But there’s something special about reaching out to others, especially your own inner circle.  It requires your posturing yourself in humility and vulnerability and making a request for support.  The thing is: We cannot do anything in life—from landing a job to getting in shape to being a loving parent or spouse—withoutthe help of others. 

                        Even weight loss, which is often incorrectly assumed to be a solo task, requires: negotiation with your family as to what you’ll have for dinner, using the babysitting service at the gym while you work out, requesting accountability from a friend, etc.

                        Resourcing others by making specific requests is a way of reorienting your present circumstances in order to have the future (your vision) that you desire.  It is seeing the abundant opportunities before you, rather than the lack.  In fact, it is a brand-new—a transformational—way of standing in the world and acting on your life.  

                        ‘No man is an island.’  The sooner we recognize this, the sooner we’ll be able to get out of our own ways. 

                        How will YOU resource others this week? 

                        -Posted by Certified Health & Wellness Coach Sarah Sutton 

                        *Names have been changed to protect privacy.

                        Posted on 22 January 2013 | 12:06 pm

                        Feeling a Little Blue... or SAD?

                        Does this sound familiar to you?

                        It is January, the holidays are over, it is cold and dark outside, the trees are bare and you are feeling a bit “blue…”  Or, are you feeling more than a bit blue?  It is understandable that a gloomy day outside can make you feel gloomy inside, but what if it is something more?  Do you feel down every time winter rolls around?

                        If you answered yes, you could be suffering from Seasonal Affective Disorder or SAD.

                        SAD is a form of depression that most commonly strikes people during the fall and winter months in northerly climates.  It is a recognized medical condition and it is not something that should be ignored.   

                        Some possible symptoms of SAD include:

                        • Increased fatigue or lethargy
                        • Increased irritability 
                        • An overall feeling of sadness or hopelessness 
                        • An increased appetite  
                        • A lack of desire to socialize with friends or loved ones 
                        •  Inability to concentrate

                        The good news is that there is help for people with SAD.  Treatment can involve:
                        • Light Therapy which can be done at home and involves regular exposure to a special lamp that mimics sunlight 
                        • Antidepressant Medications prescribed by a Physician 
                        • Cognitive Behavioral Therapy which involves changing your thoughts or behavior during the winter months.  This could mean exercising more, finding an enjoyable hobby or maybe doing volunteer work.  
                            As with any medical condition, self-diagnosis and self-medication/therapy is not the best option.  While there is no test for SAD, your Nova Medical Group health care provider can make a diagnosis by asking about your history of symptoms.  He or she may also perform a physical exam and blood tests to rule out other disorders that are similar to SAD.

                            Remember, SAD is not something to ignore, so schedule an appointment with your provider today.

                            Posted on 7 January 2013 | 11:05 am

                            Weight, What's in the Number?

                            As we ring in the new year, many of us find ourselves more mindful of the scale.

                            One downfall of most common scales is that we aren’t given a breakdown of body composition, meaning that they do not distinguish for us how much of the weight is from fat mass or non-fat mass.

                            Research demonstrates that body composition is directly related to health.  A normal balance of body fat to lean muscle is associated with good health and longevity, whereas altered body composition increases your risks for chronic disease, including cardiovascular disease and diabetes.  So, identifying an improper balance in body composition can allow for earlier intervention and prevention.  

                            You may wonder then, how do I determine my body composition?  There are a number of different ways to assess body composition.  The measure that I find works best clinically for determining body composition is bioelectrical impedance analysis (BIA).  A BIA machine uses the resistance of electrical flow through the body to determine the body composition. The electrical flow passes easily through non-fatty tissues which contain 70-75% water, and slower through fatty tissues which contain just 10-20% of water.  BIA analyzers are able to calculate a person’s body fat and fat-free mass using this impedance information, height and weight.

                            A BIA machine can also indicate hydration status and offer segmental readings of the body composition.  So, for example, you can see the ratio of body fat and fat-free mass in each of your arms, your legs and your trunk.  This is extremely helpful when monitoring weight loss as it illustrates if you are losing in the desired areas of the body.   

                            Other methods of determining body composition include skin fold testing, Air Displacement  Plethysomography/Bod Pod, underwater weighing, and DEXA.   

                            One of the most common methods used is by skin fold testing, however, it is a bit invasive as it requires areas of fat throughout the body to be pinched with calipers and is not very accurate.  Air Displacement Plethysmography, also known as the Bod Pod, is where body volume is measured through the displacement of air and body composition is determined through known equations.  Underwater weighing is based on similar principles, but is not readily accessible to most people or clinicians and has obvious dangers.  Dual energy x-ray absorptiometry (DEXA), determining body composition through radiography is the most accurate measure of body composition, however, this is reserved for clinical and research purposes and has the drawback of radiation exposure.

                            BIA readings are offered in our Ashburn office with the help of a fancy, computerized machine: the InBody 520.  This machine is used in research and offers highly precise (has a 98% correlation to the gold standard DEXA) and reproducible readings.

                            Readings are quick, easy and cost effective – they can be done in a 15 minute appointment and simply involve standing on the scale for 45 seconds while an imperceptible electrical current passes though the hands and feet.  After this process, we provide you with a report of the detailed measurements.  These reports offer useful indicators of health and hydration status, serve as a tracking tool for weight loss programs, and also help our integrative providers to create personalized dietary and exercise plans for patients.

                            Since BIA analyzers assume proper hydration, factors affecting hydration status can affect readings, it is best to get measured when you are well hydrated and at a similar time of day.  Other requirements for the most accurate reading can be found on our Web site.

                            If you’d like to learn more about our BIA machine and other fitness and nutrition services that we have to offer, save the date for Saturday, January 12thfrom 10 a.m. – 12 p.m. for a Free Wellness & Weight Loss Seminar.  This event is open to the public, but registration is required.  To register, call 703.554.1100 x 333 or email mschmidt@novamedgroup.com.

                            Whatever your personal wellness goals are for this new year, our team is here to support you and help you to succeed!  

                            -Posted by Sarah Giardenelli, ND, MSOM, LAc.

                            Posted on 2 January 2013 | 2:42 pm

                            Have a Healthy Holiday!

                            "I can't believe I am getting sick, I have many guests coming over this weekend..."

                            "I just traveled back from business trip.  I don't feel well..."

                            "I have so much on my mind and so much to do... I can't be sick, I have to feel better!"

                            "I have a trip coming up during the holidays, and I am feeling sick..."

                            Working at an Urgent Care, I see patients who come in with acute illnesses on a daily basis.  I have noticed people are more susceptible to illness when they are stressed.

                            According to research from American Psychological Association, stress weakens the immune system.  The holidays are here, and I would like to share a few tips with you to keep your stress level low and immune system strong:

                            1. Don't forget to get plenty of sleep. Your sleep suffers when you have too much to do and too much to think about. But, sleep is an essential time when your brain and body recharge. The quality and amount of sleep you get affects your mood, energy level, concentration and overall function.

                            2. Stay active and keep hydrated. Try to stay with your routine physical activities.  Most adults need at least 20-30 minutes of moderate physical activity, five days a week. The key is finding the type of exercise that fits your age, schedule and interests.  Don't forget to drink 8-10 cups of water a day to stay healthy.

                             3. Eat healthy.  People tend to overeat because food is everywhere during the holidays.  However, there are a few things you can try to keep your weight in check and stay healthy.  For one, serve yourself smaller portions and eat slowly so that you can tell more easily when you are satisfied.  Eat a healthy snack before holiday parties so that you don't go overboard on sweets, cheese or drinks.

                            4. Protect yourself from contracting the flu.  Flu season is here.  Washing your hands and getting vaccinated are good ways to stay healthy during the holiday season.

                            5. Listen to your body.  This time of year is filled with shopping, cooking, parties, sending cards and wrapping gifts.  Don't go overboard and exceed your ability.  Spend some time with yourself.

                            6. Stay connected with friends. Good friends are good for your health. Friendship can boost your happiness and reduce stress.  Friends can help you celebrate good times and provide support during bad times.

                            This holiday season, nourish your mind, body and spirit.  Wishing you and your family a happy and healthy holiday season!


                            Posted on 21 December 2012 | 4:26 pm

                            Allergy Testing Now Available

                            Do you suffer from allergies? Rather than taking over-the-counter and prescription allergy relief aids which may be yielding uncomfortable side effects, address the underlying cause of your symptoms with precision allergy testing.

                            We are excited to announce that beginning in December 3rd, Nova Medical Group will offer United Allergy Testing Services in the Ashburn and Warrenton offices.

                            Call today to schedule your appointment!

                            Posted on 3 December 2012 | 9:20 am

                            Beware of Fake Fiber

                            I just saw that Pepsi is releasing a new version of their soft drink in Japan with fiber.  I nearly gagged.  What is with the food industry adding fiber to all these random foods?!  

                            In the U.S., you can find fiber added to yogurt, ice cream, juice, cookies, and other foods that never had fiber in the first place!  Don’t be fooled by your box of sugar cereal proclaiming “Good Source of Fiber!” on the front.  These foods contain what I like to call “fake fiber.”

                            Fiber is in general good, but not all fibers are created equal.  Real, naturally-occurring fiber in fruits, vegetables, legumes, and whole grains can help you lose weight, control blood sugar levels, lower cholesterol, and maintain bowel health.  But the food industry likes to cash in on trends, so it removed fiber from grains and isolated them, turning them into powders to add to packaged foods.

                            These isolated fibers have no proven health benefits.  What’s worse is they can cause digestive discomfort in many people.  When you consume fiber in its natural state, there are other components of the food to help you digest it.  Isolated fibers by themselves can cause stomach cramping, gas, and bloating.  I can’t tell you how many patients, friends, and family members I’ve counseled to remove these products from their diet, only to have them report back, “My stomach feels so much better!”

                            To spot fake fiber, look for these ingredients on the food label:

                            • Chicory
                            •  Inulin
                            • Maltodextrin
                            • Polydextrose 

                            Also, be skeptical about packaging hype.  Ignore fiber claims like “Double Fiber,” “High Fiber,” or “Extra Fiber.” 

                            Aim for 25-35 grams of fiber a day from real, whole foods.  A bowl of oatmeal, a sandwich on whole grain bread, some nuts, and a few servings of fruits and vegetables will easily get you on your way – no fake fiber needed!

                            -Posted by Nicole Holovach, RD

                            Posted on 27 November 2012 | 11:00 am

                            Mom, I'm Hungry!!

                            Computers, Xbox, I-touch, Nintendo, cell phones, and Kindles are the electronic devices that describe the day-to-day passions of my children, which I think is typical of most middle class families living in Northern Virginia.

                            Electronic devices have become the top choice of entertainment for kids these days, and unfortunately, this indoor play has contributed to the childhood obesity epidemic in America.

                            When I was little, we played outside.  Nearly every waking hour was spent playing in the woods, building forts, riding bikes, and playing hide and seek.  We were forced outdoors by my mother and disappeared for hours at a time.  We used our imaginations in a more physically active way, and for the most part, we were thin and eating limited processed foods.

                            Childhood obesity rates were last collected in Virginia in 2007 and showed that approximately 30% of children – ages 10-17 – were found to be overweight or obese. This figure ranked the state 23rd highest in the country for percentage of overweight or obese children!

                            We all know that obesity has a tremendous impact on our healthcare system, but now our children face diseases that were once limited to adults, including high cholesterol, high blood pressure, and Type 2  Diabetes.  As adolescence approaches, we become more concerned about depression, cancer risks, and the impact on these children's fertility in the future.

                            Let's face it, this is a complicated issue – it's hard to talk to kids about being overweight. Nobody wants to damage their kid's self-esteem by mentioning they have a weight problem.  But, kids don't necessarily process the discussion about overeating as a criticism of their size.  Avoidance of discussing weight gain may communicate a lack of parental concern and cause a child to feel more hopeless about their weight.  Children often give us clues that they might actually want help.  Parents who are obese and overweight may also dismiss their children's weight struggles due to their own embarrassment or uneasiness about their issues with weight or food. 

                            So, how do we talk to kids about food and help keep them at a healthy weight?

                                  Keep healthy food in the house, don't bring the junk home. Don't reward children with sweets for eating healthy foods.  Explain that treats have a proper place in our diets, but that they don't provide the nutrients we need to stay strong and healthy.
                                  Keep your attitude towards food relaxed. Remember to continue to encourage your child to try healthy foods and that it may take several tries for a child to accept a new food.  Motivate them to be adventurous with food and praise them for trying new things.
                                  It's helpful to talk about nutrient-rich food as fuel for our bodies, which helps us to grow and be strong.  Discuss that foods that are nutrient-poor weaken our bodies and may cause us to crave more junk food – putting us at risk for disease.
                                  Find ways to encourage your child to exercise. Children should be getting about 60 minutes of playtime every day. Ride bikes together, kick a ball around, take a trip to the playground, or just take a walk together – these activities will help your child to stay active.   And, not to mention, it will also help to strengthen your emotional ties as well!  Share your favorite ways to stay active with your child. 
                                  Kids benefit from discussing how problems in the world may promote obesity. Talk to kids about huge portion sizes and food advertising's role in promoting obesity. Explain the concept of whole foods and avoiding additives and refined sugars. 
                                  Treat your kids like they are smart. Instill in them a sense of responsibility to take care of their bodies, just as they would take care of their pets or possessions.  
                                  Address the problem as a family goal. Tell them that together, the whole family needs to be conscious of what each family member puts in his/her body and that everyone could be healthier. This helps kids to realize that even grown-ups aren't perfect and struggle to eat right and exercise on a daily basis.  Sit down with your kids and pass on healthy eating habits.

                            To you and your children's health,

                            -Posted by Rachel F. Bonner, CFNP
                            Sources: State and Regional Obesity Data: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey (BRFSSS) Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and prevention.

                            Posted on 30 October 2012 | 12:09 pm

                            Winter Sports Safety Can Be Tough Sledding!

                            I hope everyone is enjoying the wonderful weather that we have been having lately.  I am having a great time - I wish we had this type of weather all year long!  But, as we all know, winter is just around the corner.

                            It just so happened that I went out shopping this past weekend with my 7 year old son who wanted to buy some sporting stuff for this winter… you know, the snowboard, and the skiing gear, etc.   

                            I was talking to him about the precautions that he needs to take to avoid injuries this winter. That is when it occurred to me that now would be a great time to also teach my patients and community about Winter Sports Safety as well. 

                            Most of us think that the injuries that frequently result from skiing, skating, and sledding include sprains and muscle strains, dislocations, and fractures.  But, they actually have the potential for severe injuries if proper safety precautions are not practiced. 

                            I suggest that everyone take these tips into consideration – both children and adults alike – before partaking in winter sports.

                            1. Check the weather for snow and ice conditions before heading outdoors. For warmth and protection, wear several layers of light, loose, and water- and wind-resistant clothing; layering accommodates the body's constantly changing temperature. 
                            2.  Wear appropriate protective gear, including goggles, helmets, gloves, and padding. Check to make sure that all equipment, such as ski and snowboard bindings, is in good working order. Children should wear a helmet for skiing, snowboarding, sledding, and even skating.  
                            3. Avoid participating in a winter sport alone.  If possible, ski with a partner and stay within sight of each other.  Observe all marked hazard and trail signs, and do not venture into closed areas.  
                            4. Warm up thoroughly before playing because cold muscles, tendons, and ligaments are vulnerable to injury!
                            5. Drink plenty of water before, during, and after outdoor activities to stay hydrated.  Avoid the intake of alcohol, which can increase the chances of hypothermia.  
                            6. Keep in shape and condition your muscles before partaking in winter activities.
                            7. Learn how to fall correctly to avoid injury. If skiing, learn how to properly hold the poles with the strap to avoid "skier's thumb."  
                            8. To help alleviate the risk of anterior cruciate ligament injury, avoid high-risk ski behavior, maintain balance and control, and recognize and respond correctly to dangerous situations.  
                            9. Seek shelter and medical attention immediately if you are experiencing hypothermia or frostbite.  Early frostbite symptoms include numbness and tingling in your digits, lack of feeling, and poor motion.
                            10. Avoid participating in sports when you are in pain or exhausted.  
                            11. Follow up with an orthopedic surgeon if you are injured, especially if pain or discomfort persists.

                            Posted on 22 October 2012 | 1:08 pm

                            An Apple a Day...

                            The fall is upon us, which means apple picking season has arrived!   I cannot wait to go apple picking!  

                            Apples are among the top 20 best antioxidant sources.  I’ll bet you didn’t know that two thirds of the antioxidants are actually found in its peel.   So, I recommend buying organic apples.   Not only do they usually taste better and are a whole lot fresher, but they contain a less pesticide residue.  Conventionally grown apples are known to have more pesticide residue on them than any other fruit or vegetable!

                            Let’s take a look at some of the health benefits of an apple:

                            1.       Boost Weight Loss.  Eating an apple will promote weight loss since it is lower in calories and also packed with both insoluble and soluble fiber.   One medium Gala apple is 55kcal, 15g carb, 5g fiber, 113mg K, 0g fat, and 1g protein.
                            2.       Brain Health.  A flavonoid found in apples, Quercetin, may protect against oxidative brain damage that can lead to memory loss.   So, apples can help to prevent age-related memory loss and Alzheimer’s disease.
                            3.       Cancer Prevention.  Quercetin is also known to help prevent different types of cancers including breast, pancreatic, colon, liver, prostate, and bowel.  
                            4.       Metabolic Syndrome.  Eating apples can help you to lower your blood pressure and keep a trimmer waistline.
                            5.       Lung Health. Foods that are high in fiber, like apples, and the flavonoids found within may help to reduce chronic cough and other respiratory symptoms.  
                            6.       Immunity. The soluble fiber, pectin, found within apples may help to reduce the inflammation associated with obesity-related diseases and also help to strengthen the immune system. 
                            7.       Gut Health.  The soluble fiber found in apples helps to strengthen gut health!  
                            So, how about trying a nice, juicy apple today for an afternoon snack?      

                            Posted on 9 October 2012 | 2:17 pm

                            Baby Soft Skin

                            As new parents, many are excited to cuddle and hold their new infants with their baby soft skin.  Fear and concern often arise when the newborn develops rashes – sometimes within the first few days of birth.  Most of these eruptions are short-lived and occur as the infant's skin is renewed.  Here a few common benign eruptions to be aware of:  

                            Erythema Toxicum Neonatorum(ETN) – This common newborn rash often appears primarily on the face, chest and legs on the 2nd or 3rd day of life.  The pustules (i.e. pimples) fade in 5-7 days without treatment.   The cause is unknown.   

                            Neonatorum Acne– A similar appearing eruption to ETN, this eruption is caused by oil gland stimulation by maternal hormones.  The comedones – or blackheads – fade without treatment over 4 months.   

                            Milia – Milia are 1- to 2-mm pearly white or yellow papules (solid elevations of skin with no visible fluid) that are most often found on the baby’s forehead and chin.  They appear and fade during the first month of life.  Milia are caused by keratin protein plugs in the pores, and no treatment is needed.

                            Please remember, your baby does not need a bath every day.   Cleanse the diaper area gently with each change.  Simple Vaseline is sufficient to keep the skin healthy.  During bath time, use tepid water.   Cleansing products should be scent and dye free.  Products such as "Free and Clear" or Aveeno baby care products are recommended.

                            Enjoy your new bundle of joy!

                            Posted on 8 October 2012 | 11:16 am

                            The New Arrival

                            Someone (for the life of me, I cannot remember who it was…) once said “Parenting is the hardest but most rewarding job there is.”  

                            My wife and I are expecting our first child in the next couple of weeks.  Even though I am an internal medicine-pediatrics physician by training, I’m sure I will be as challenged by our new arrival as any parent would be.  I hope all of the current and future parents, grandparents, uncles, aunts, cousins and friends will benefit from these tips on preparing for a new baby.

                            • If this is your first child, I would investigate whether your delivering hospital offers a tour of the labor and delivery facilities.  This will offer useful information on what to expect when you come in for the baby’s birth.  Even mundane things like “Where’s the cafeteria?” and “Where do I park?” are helpful to know because those questions will be two less things to figure out when you have other more important things going on!
                            • When the third trimester starts, it would be a good idea to start getting together a suitcase with all of the supplies you will need for the hospital.  It is rare to deliver on your actual due date, so being prepared early is always advisable.   Among things to consider packing are toiletries, clothes for mom (and for the person staying with her in the hospital, if allowed by the hospital), snack items, a camera, any registration paperwork, and at least two outfits and blankets for the baby.  
                            • After having gone through a delivery, moms will often be exhausted and wanting to bond with baby.  I might suggest getting a text or email list together of everyone you want to inform of the baby’s arrival before the due date and enlist someone (dad, grandparents, aunts/uncles, friends) to send out the happy news to your contact list.
                            • If you’ve received mailers from baby stores, you know that there is no shortage of items one can buy to help care for our little ones.  However, perhaps the most important item is a proper rear-facing car seat because the hospital will not let you go home without one! 
                            •  If your baby is coming home to meet any brothers and/or sisters, they can feel jealous or threatened at times.  It is a good idea to get brothers/sisters involved in some capacity.  If your hospital allows children to visit, having the siblings come in to meet their little brother or sister can help with the eventual transition home.  Additionally, giving a small present from “the baby” to his/her siblings can help them feel like a part of things.  
                            • From a pediatrician’s perspective, it is always helpful to have as much information about the baby’s health and the circumstances surrounding the delivery.   After leaving the hospital, it is usually advisable to get an appointment with your baby’s pediatrician anywhere from two days to two weeks afterwards.  It reallyhelps us to have the discharge paperwork at the time of the first appointment, which the hospital should provide you with when you leave.
                            • It is important to remember that when dealing with your pediatrician, no question should be considered silly or off limits.  We’d rather be asked an easy question and be able to put your mind at ease than have you worrying about your baby.  Keep a notebook and pen near your diaper bag so that, whether home or out, if you think of a question, you can write it down to ask your pediatrician. 

                            Hopefully this list will give you some good tips to get you from the preparation stages to the point where you can bring your little one home!   Following that transition, remember to enjoy your time with the baby and make sure you take care of yourselves as well.

                            Best wishes to all the current and expectant parents we have at Nova Medical Group!
                            -Posted by Jeff Conklin, MD

                            Posted on 25 September 2012 | 10:14 am



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