Author: Erin Pearson

Diabetes diagnosis? Take time to learn

An estimated 1.4 million new cases of diabetes are diagnosed in the United States annually, according to Healthline. With such staggering statistics, the importance of spreading awareness can help individuals with diabetes live full and productive lives, and in some cases, can help to prevent the onset of diabetes altogether. Here to provide a wealth of information on the topic is Pacific Medical Centers’ Internist and Diabetes Champion Lisa Oswald, MD, whose insight provides perspective on diabetic symptoms, care techniques, and the differences of Type I and Type II diabetes.

Please explain the primary differences between Type I and Type II diabetes for our readers. What are the main causes of each?

Type 1 diabetes (five percent of patients) has onset in childhood or sometime in early-mid adulthood. It is caused by a loss of the insulin-producing part of the pancreas. It may be caused by the body attacking itself or may have other causes.

Type 2 diabetes (90-95 percent of patients with diabetes have this type) is caused by the body not being able to use the insulin that our body produces very well (this is called “insulin resistance”). Eventually, there may be a lack of insulin, but normally there is plenty of naturally produced insulin that the body just can’t use properly. The causes are complicated, but genetics, being overweight, poor diet, and sometimes medications or medical conditions can all be factors of developing Type 2 diabetes.

What are some early signs and symptoms that may be indicators of diabetes?

Signs and symptoms of diabetes may include excessive thirst or urination; blurry vision; tingling in toes and/or fingers, usually of both sides; unexplained weight loss (especially in Type 1); and unexplained abdominal pain.

What advice can you offer individuals with diabetes to live the healthiest and happiest life possible?

My advice to those who are living with diabetes is to try and educate yourself as much as possible. Diabetes is a complicated and lifelong disease and you must be aware of many aspects of it. This can include talking to family/friends, taking classes (PacMed offers a series of three classes every month), reading about the topic, talking to your primary care doctor and nurse and certified diabetes educators. Additionally, you should have support to get you through this. This can include supportive people in your life, online group, medical team, etc. Lastly, it helps to know about your insurance. Sometimes diabetes medications are expensive, but you should know your options. Be sure to ask your pharmacist or primary care provider about the cost of different medications and if there are cheaper alternatives.

Military personnel are constantly on the go. What are the best practices for diabetics who are very busy?

My advice to military personnel would be to explain your average day to your primary care team and diabetes educator — be realistic about schedules for eating and taking medications. I also encourage making plans with your primary care team for days that you cannot eat for long periods or take medications at the proper time, as this will happen on occasion.

Is there anything else you would like readers to know about diabetic health and wellness?

Additional health and wellness tips I have for those who have diabetes are centered around routine lifestyle changes. Schedule a routine hour or two per week to prepare food and snacks for the upcoming week that you can grab and take with you — it doesn’t have to be perfect! Exercise is also important, so try to make time in your day to be active. This can include short bursts of activity, such as walking, taking the stairs, dancing, playing with children, etc.

Lisa Oswald, MD works on the Internal Medicine team at Pacific Medical Centers. She is an internist and focuses on diabetes with her patients at the Beacon Hill clinic. Her medical interest is within geriatrics, end-of-life care and cross-cultural medicine. In her spare time, you can find her rowing, traveling and spending time with her family. She has been named one of Seattle’s best doctors by her peers for the last five years.

Read the article as published in NorwestMiliatry.com.

Winter blues got you down—again?

Winter BluesIf you always experience depression that begins in fall and continues to spring, don’t brush it off as simply a case of the “winter blues.” You may suffer from Seasonal Affective Disorder (SAD). You don’t need to tough it out on your own! We have supportive help and steps you can take to keep your mood and motivation steady all year long.

Depression and SAD

Depression is a common and treatable condition that can affect anyone. Like other types of depression, SAD is a condition of the brain that leaves a person feeling down. It can sap your energy, erase your motivation and make you moody.

Symptoms specific to wintertime SAD include oversleeping, craving foods high in carbohydrates, weight gain and low energy. Other general signs of depression can include:

  • No longer enjoying the things you usually like to do
  • Feeling sad, down, hopeless or cranky most of the day, almost every day
  • Experiencing changes in your appetite, weight and sleep patterns
  • Feeling tired or having no energy
  • Having trouble concentrating
  • Feeling agitated
  • Thinking about death or suicide

Coping and treatments

Ongoing depression is never a normal part of life. We have safe and effective treatments to help you cope. These include seeing a psychotherapist, taking medications or a combination. With SAD, light therapy can also be a powerful treatment protocol. Read on for light therapy and other ideas you can discuss with your doctors.

Light therapy. With light therapy (also called phototherapy), you expose yourself to a special light box right after you wake up each day. Doing this appears to trigger a change in your brain chemistry and boost your mood. It’s a bit like getting some summer sunshine to start the day. Light therapy often offers relief from SAD in just a few days.

Vitamin D. Our bodies naturally synthesize vitamin D when exposed to sunlight. All you need for a week’s worth of this vitamin is 15 to 20 minutes in the sun—but that can be hard to come by during winter in the Northwest. Because vitamin D helps the body absorb calcium, it supports healthy bones. But recent research has also shown it may help alleviate symptoms of SAD.

Exercise. Physical activity is helpful for all types of depression because it increases the production of endorphins in the body. Endorphins are neurotransmitters that make you feel good.

Sleep. Sleep is a very important way to lessen symptoms. Good sleep hygiene includes getting up at the same time every day, following a bedtime routine to program your body to sleep and keeping your room dark at night. Also avoid all screen use for at least 30 minutes before bedtime.

When to get help

It’s normal to have some days when you feel down. But if you feel down for days at a time and you can’t get motivated to do activities you normally enjoy, see your doctor. This is especially important if you notice some of the symptoms listed above, you turn to alcohol for comfort or relaxation, or you feel hopeless or think about suicide.

With all types of depression, your primary care provider can help guide you to the support you need. Looking for a doctor? See our primary care team at one of our 9 PacMed clinics

ARE YOU OR SOMEONE YOU KNOW IN CRISIS?

If you are thinking about suicide or hurting yourself, help is available:

  • In an emergency, call 9-1-1 or go to the nearest ER
  • Call a 24-hour crisis line:
    King: 1.866.427.4747
    Snohomish: 1.800.584.3578
    Pierce: 1.800.576.7764
  • Call the National Suicide Prevention Lifeline: 1 (800) 273-8255

Stay Energized This Winter!

Stay EnergizedBetween short days, cool weather, holidays and visiting family, it is easy to feel dragged down. Make yourself a top priority! Explore these ideas on how to keep your energy up and fuel your best health.

Work it out. Physical activity boosts your brain chemistry, helps you sleep and primes your appetite for healthy eating! This winter, find ways to keep your exercise goals alive. Get up a little earlier to slip in a run. Walk to work, or climb stairs or hills at lunchtime. Meet a friend at the gym. Maybe you can help an elderly neighbor by raking their yard! Choose a weekly goal—say, 75 minutes of vigorous exercise or 150 minutes of moderate exercise—and then track your time and reward your success.

Lap it up! If you are not well hydrated, one of the first signs is fatigue. Water makes up about 60% of your body weight and is the main component of blood. It’s essential for carrying nutrients to your cells and removing waste products. So, how much should you drink? Watch the color of your urine. It should be a light lemonade color. Dark yellow? Drink a little more. And to keep up energy when you work out, drink 8 ounces of water before you begin, and another glass when you finish.

Don’t run on empty! Did you know that a smaller lunch can help you keep your energy up? A heavy lunch is often followed by a pronounced afternoon slump. Another energizing trick is to eat small meals and snacks every few hours. This can reduce feelings of fatigue because your brain needs a steady supply of nutrients. So what to snack on? Try protein- and magnesium-packed nuts like cashews, almonds and hazelnuts. Eggs and edamame have protein plus vitamin B, which helps convert food into the energy you feel. Finally, eat fresh fruit for a healthy source of fiber, vitamins, sugar and fluids!

Recharge at night. When you get enough sleep, you should feel refreshed in the morning and energized throughout the day. Sleep pretty much affects everything in your life: your heart health, metabolism, ability to ward off sickness and more. Not getting enough good-quality sleep can affect short-term memory, decision making, attention levels, logical reasoning, judgement, mood, and energy levels. Three good tips for healthy sleep hygiene? Go to bed and get up at the same time each day. Avoid all screens 90 minutes before you head to sleep. And slow your pace before bedtime: read a calm book, listen to quiet music or meditate.

Got a cold or the flu? Symptoms for both cold and flu include coughing, headaches and chest discomfort. When you have a cold, your nose and throat become inflamed, so you may experience a runny nose, sore throat, coughing and sneezing. Flu symptoms come on much more suddenly than with a cold, including a high fever, body aches, weakness and fatigue. Sleep, frequent hydration, daytime rest and good nutrition are important. Most over-the-counter medications can help temporarily relieve symptoms such as sore throat, congestion, cough and fever. If your symptoms persist or you have questions about which medications to take, consult your primary care provider.

PacMed Primary Care is a diverse team of providers! If you’re looking for a doctor to support your health goals, we invite you to learn more about our doctors.

A spoonful of sugar

PacMed MD gives informational insight on diabetes

An estimated 1.4 million new cases of diabetes are diagnosed in the United States annually, according to Healthline. With such staggering statistics, the importance of spreading awareness can help individuals with diabetes live full and productive lives, and in some cases, can help to prevent the onset of diabetes altogether. Here to provide a wealth of information on the topic is Pacific Medical Centers’ Internist and Diabetes Champion Lisa Oswald, MD, whose insight provides perspective on diabetic symptoms, care techniques, and the differences of Type I and Type II diabetes.

Please explain the primary differences between Type I and Type II diabetes for our readers. What are the main causes of each?

Type 1 diabetes (five percent of patients) has onset in childhood or sometime in early-mid adulthood. It is caused by a loss of the insulin-producing part of the pancreas. It may be caused by the body attacking itself or may have other causes.

Type 2 diabetes (90-95 percent of patients with diabetes have this type) is caused by the body not being able to use the insulin that our body produces very well (this is called “insulin resistance”). Eventually, there may be a lack of insulin, but normally there is plenty of naturally produced insulin that the body just can’t use properly. The causes are complicated, but genetics, being overweight, poor diet, and sometimes medications or medical conditions can all be factors of developing Type 2 diabetes.

What are some early signs and symptoms that may be indicators of diabetes?

Signs and symptoms of diabetes may include excessive thirst or urination; blurry vision; tingling in toes and/or fingers, usually of both sides; unexplained weight loss (especially in Type 1); and unexplained abdominal pain.

What advice can you offer individuals with diabetes to live the healthiest and happiest life possible?

My advice to those who are living with diabetes is to try and educate yourself as much as possible. Diabetes is a complicated and lifelong disease and you must be aware of many aspects of it. This can include talking to family/friends, taking classes (PacMed offers a series of three classes every month), reading about the topic, talking to your primary care doctor and nurse and certified diabetes educators. Additionally, you should have support to get you through this. This can include supportive people in your life, online group, medical team, etc. Lastly, it helps to know about your insurance. Sometimes diabetes medications are expensive, but you should know your options. Be sure to ask your pharmacist or primary care provider about the cost of different medications and if there are cheaper alternatives.

Military personnel are constantly on the go. What are the best practices for diabetics who are very busy?

My advice to military personnel would be to explain your average day to your primary care team and diabetes educator — be realistic about schedules for eating and taking medications. I also encourage making plans with your primary care team for days that you cannot eat for long periods or take medications at the proper time, as this will happen on occasion.

Is there anything else you would like readers to know about diabetic health and wellness?

Additional health and wellness tips I have for those who have diabetes are centered around routine lifestyle changes. Schedule a routine hour or two per week to prepare food and snacks for the upcoming week that you can grab and take with you — it doesn’t have to be perfect! Exercise is also important, so try to make time in your day to be active. This can include short bursts of activity, such as walking, taking the stairs, dancing, playing with children, etc.

What you should know about breast cancer

To close out Breast Cancer Awareness month, we reached out to a few Pacific Medical Center care providers with some important questions we could all benefit from.

According to the National Breast Cancer Foundation, on average, every two minutes a woman is diagnosed with breast cancer in the United States. Awareness matters. By being aware, we can better support each other and do what we can to maintain our own health.

Answers provided by: Dr. David M. WhiteDr. Christopher Smith and Dr. Sharmila Ahmed.

When talking about breast cancer, we often put the focus on women, but it also affects men. What should people know when it comes to the ways breast cancer impacts both men and women?

Dr. White: Women with a family history, particularly with a genetic component should see their primary care physician at least 10 years before their family member’s (was diagnosed with) cancer to discuss and evaluate. Breast cancer in younger women is on the rise. Men can get breast cancer as well, and approximately 1 percent of breast cancer patients are male. Symptoms for men include breast pain; a mass; nipple changes, including discharge/blood; and breast enlargement. Men who have a family member with a genetic form of breast cancer are at an increased risk.

What advancements are happening in breast cancer treatment?

Dr. Ahmed: Treatment for breast cancer is advancing quickly. The ability to target treatment to a specific genetic mutation has now become increasingly common. Over the past few years, there have been a variety of new advancements for treatments. For advanced breast cancer with a genetic mutation — known as BRCA mutation — another new drug, Talazoparib that targets a particular pathway, was approved in October 2018.

When it comes to prevention, what do you recommend patients do to lower their risk?

Dr. Ahmed: I often get questions about how to prevent breast cancer. My response continues to be that it is important to focus on screening with mammograms and exercise. Diet may also play a role and should be rich in fruits, vegetables, fish, and olive oil. And alcohol consumption should be reduced.

How should people talk to their primary care doctors about their risk for breast cancer? What questions should they be asking?

Dr. Smith: Talk to your doctor about the best screening program for you. Women with an average risk of breast cancer — most women fall under this category — should begin yearly mammograms at age 45. Women should be able to start the screening as early as age 40, if they choose. At age 55, women should have mammograms every other year, though women who want to keep having yearly mammograms should be able to do so. Regular mammograms should continue for as long as a woman is in good health.

In your opinion, what are some of the most common misconceptions about breast cancer that people need to be aware of?

Dr. Ahmed: It is commonly thought that wearing a bra, using underarm antiperspirant, or carrying a cell phone in your bra can cause breast cancer, which is a misconception. (Another misconception is that) breast cancer always gives a sign, such as a lump, and that a mammogram is not needed.

What questions do you hear most often from your patients? And how do you answer those questions?

Dr. Ahmed: We often hear questions about treatment and the side effects. I tell my patients that side effects during treatment are variable. There are four different types of treatments, which include surgery, radiation, hormonal therapy, and chemotherapy. Surgery can cause swelling and discomfort; radiation can cause skin peeling and fatigue; hormonal therapy can cause hot flashes; and chemotherapy has the most side effects, but there are new ways to prevent side effects, including hair loss with the availability of cooling caps. Supportive medications also are given to prevent other side effects. Nowadays, most side effects are tolerated well, and many women continue to work during treatment.

Eight tips for breast cancer prevention

As you may know, 1 in 8 women are impacted by breast cancer in their lifetime, as it’s the most common cancer in American women. Knowing that this is the second leading cause of cancer death in women, treatment is most successful when breast cancer is detected early.

As part of Breast Cancer Awareness Month in OctoberDr. David White, MD, FACS from Pacific Medical Centers (PacMed) offers his insight into common misconceptions, for men and women, regarding breast cancer risks, facts and signs. Additionally, he shared that PacMed follows the American Cancer Society guidelines for breast cancer.

Dr. White is a surgeon at PacMed’s Canyon Park, First Hill and Northgate clinics and shares 8 tips regarding breast cancer prevention:

  1. Women with a family history, particularly with a genetic component should see their primary care physician at least 10 years before the onset of the family member’s cancer to discuss and evaluate.
  2. Breast cancer in younger women is on the rise.
  3. Men can get breast cancer as well and approximately 1 percent of breast cancer patients are male. Symptoms for men include breast pain or mass, nipple changes, including discharge/blood and breast enlargement. Men who have a family member with a genetic form of breast cancer are at increased risk.
  4. Current treatments are focused on breast conservation when appropriate, which greatly reduces the physical and psychological challenges of surgery.
  5. See your physician if you have the following: breast masses or bloody/black nipple discharge. Changes in your own breasts should be taken seriously.
  6. Breast cancer screening guidelines are variable, so patients must discuss a breast screening plan individualized for them.
  7. Currently, there are many genetic associated breast cancers to scan for.
  8. New mammographic techniques have improved the sensitivity of mammograms.

Every Month is Breast Cancer Awareness Month

It’s smart to think about early detection in October—and all year-round. Early detection is a critical step to good breast care.

Ask your doctor about a screening plan for you.
1 in 8 women will be affected by breast cancer in their lifetime. Breast cancer occurs mainly in women, but men can get it, too.

Treatment is most successful when breast cancer is detected early. A mammogram is the single most effective method of early detection. Talk with your doctor about a screening plan that’s tailored to you.

Schedule your mammogram at PacMed.
PacMed is proud to offer the highest quality care. We have the latest technologies, like stereotactic biopsy and breast ultrasound, all delivered on-site, in a comfortable and respectful setting.

We can see you at our Diagnostic & Wellness Center for Women in Seattle or our Canyon Park clinic in Bothell. At Canyon Park, we offer same-day screening mammography and Saturday mammogram appointments!

PacMed also offers a full range of Women’s Health services, including family planning, well-woman care, DXA bone density screening, da Vinci® robotic-assisted surgery and more.

Breast cancer awareness month – my burning questions to the professionals

As part of Breast Cancer Awareness Month in October, I chatted with Sharmila Ahmed, MD from Pacific Medical Centers, who answered some of my most asked questions regarding prevention, screening and treatment options for breast cancer. My maternal grandmother passed away in 1996 from her second battle with breast cancer, and my sister began her own battle in 2015 and is now a survivor!

How quickly is breast cancer technology and treatment advancing?

  • Treatment for breast cancer is advancing quickly. And screening has improved too! We now have digital breast cancer screening available compared to only routine mammograms.
  • For example, we have digital breast scanning known as three-dimensional mammography. Studies show that using this technology can result in a 41 percent increase in the detection of invasive cancer, a 15 percent decrease in recall rates and a 29 percent increase in the detection of all breast cancers. This is available at Pacific Medical Centers and is particularly helpful for women with dense breasts.
  • The ability to target treatment to a specific genetic mutation has now become increasingly common.
  • Over the past few years there have been a variety of new advancements for treatments. For advanced breast cancer with a genetic mutation known as BRCA mutation, another new drug Talazoparib that targets a particular pathway was approved in October 2018.

What are the survival rates now, and how does that compared to five or ten years ago?

  • Based on data from the American Cancer Society it is shown that women with localized breast cancer now have a 99 percent survival rate based on women diagnosed with breast cancer between 2008 and 2014. This is an improvement from survival rates from the 1990s.
  • While breast cancer mortality has dropped dramatically since the 1980s, it is thought that improvements in breast cancer treatment are more likely responsible for this reduction in mortality than screening.

What are some of the misconceptions that still linger regarding breast cancer for men and women?
Common misconceptions regarding breast cancer include:

  • That only women can develop breast cancer
  • You need a family history of breast cancer to get breast cancer
  • There are no behaviors or preventative methods to reduce the risk of breast cancer
  • Wearing a bra, using underarm antiperspirant, or carrying a cell phone in your bra can cause breast cancer
  • Breast cancer always gives a sign such as a lump and that a mammogram is not needed

Knowing that men can get breast cancer too, what is the screening process like for men?

  • The screening process for a male is a physical exam. If a lump is detected, it should be followed by a mammogram and a biopsy may also need to be performed.

What are some of the most common questions patients ask you?

  • I often get questions about how to prevent breast cancer. My response continues to be that it is important to focus on screening with mammograms and exercise. Diet may also play a role and should be rich in fruits, vegetables, fish and olive oil and alcohol consumption should be reduced.

Knowing that every patient experiences something different while going through treatment, what can someone typically expect (I.E. chemo side effects, etc.)?

  • Side effects during treatment are variable. There are four different types of treatments which include surgery, radiation, hormonal therapy and chemotherapy.
  • Surgery can cause swelling and discomfort
  • Radiation can cause skin peeling and fatigue
  • Hormonal therapy can cause hot flashes
  • Chemotherapy has the most side effects, but there are newer ways to prevent side effects including hair loss with the availability of cooling caps. Supportive medications are given to prevent other side effects.

Nowadays, most side effects are tolerated well, and many women continue to work during treatment.

What are your thoughts on engaging in ancient methods of medicine (acupuncture, etc.) while going through chemotherapy?

  • Acupuncture and massage therapy are helpful for women with breast cancer who are having symptoms of swelling or discomfort. The most recent data shows that acupuncture can reduce the side effects of joint pain caused by aromatase inhibitors drugs.
  • Massage therapy is now frequently used after surgery to help patients recover.

What are the current thoughts behind monthly self-breast exams and yearly mammograms? Is this still the best way for early detection?

  • The best method for screening women is using a mammogram. We no longer suggest self-breast examinations, as this has been proven to be less effective than mammograms.
  • Mammographic scans can be done every one-to-two years depending on each individual’s risk level, group and age. Talk to your doctor to find the right screening program for you.
  • PacMed follows the American Cancer Society’s guidelines for breast cancer screening.

Can mammograms come back negative but then also turn out to be something of concern later?

  • Unfortunately, mammograms are not perfect and are limited, so it is important to follow-up on symptoms and to repeat testing or do additional evaluations.

How should people handle negative results and keep this in mind for future screenings?

  • Having a normal or negative mammogram can be concerning. However, it is important to follow up and continue to participate in screenings to reduce the risk of breast cancer. Approximately 230,480 American women are diagnosed with breast cancer annually, so we all know someone who has breast cancer.
  • The majority of breast cancers in the United States are diagnosed as a result of an abnormal screening study, although a significant number are first brought to attention by a patient.

Dr. Sharmila Ahmed is a Cardiologist at PacMed.

Culture + wellness: Feel-good October

As part of October’s Breast Cancer Awareness Month, Pacific Medical Centers is spreading knowledge about the most common cancer in American women—and the second leading cause of cancer death in women. One in eight women is impacted in her lifetime, and treatment is most successful when breast cancer is detected early. Two healthcare providers offer insight into their recommendations and screening advice. (Pacific Medical Centers offers a full suite of diagnostic imaging services.)

Dr. Christopher Smith, MD, FACP explains that women at high risk – because of family history, a breast condition or another medical reason – may need to begin screening earlier and/or more often. Dr. Smith encourages everyone to “talk to your medical provider to be sure about when to start screening.” He also shared that PacMed follows the American Cancer Society guidelines for breast cancer screening.

Dr. Smith’s (Medical Director of Quality and Primary Care Physician) insights for women at average risk for breast cancer:

  • Women with an average risk of breast cancer – most women fall under this category – should begin yearly mammograms at age 45.
  • Women should be able to start the screening as early as age 40, if they choose.
  • At age 55, women should have mammograms every other year – though women who want to keep having yearly mammograms should be able to do so.
  • Regular mammograms should continue for as long as a woman is in good health.
  • Talk to your doctor about the best screening program for you.

Additionally, Dr. Gurpreet Dhillon, MD shares that the goal of digital mammography is early detection, which reduces deaths, extends life expectancy and improves quality of life. “Screening mammograms have reduced the mortality rate from breast cancer by one third while also enabling less surgery, fewer mastectomies and less frequent or aggressive chemotherapy,” Dr. Dhillon said.

Dr. Dhillon’s (Radiology Physician) insights on 2D vs 3D mammography:

  • 3D mammography acquires multiple images of the breast at different angles and allows radiologists to see around overlapping structures.
  • When women have mammograms and an abnormal finding is detected, they will be called back for additional imaging. Because 3D imaging eliminates most summation artifacts—or overlapping breast tissue that can resemble cancer—that can often show up on 2D imaging, this results in fewer women being called back.
  • Additionally, fewer patients will experience short-term anxiety waiting for their second test results.
  • 3D mammography lowers recall rate and has higher cancer detection rates over 2D mammography.
  • 3D mammography offers a 41 percent increase in detection of invasive cancer and a 49 percent increase in positive predictive value.

LWA: New cooking demo

LWA Cooking DemoThe Living Well Alliance has a new cooking video! Next time you need a fast, delicious and healthy meal, try our Vegetarian Peanut Bowl. It pairs colorful vegetables with buckwheat noodles and homemade peanut sauce.

Video and recipe for Vegetarian Peanut Bowl

 

The Living Well Alliance is run by Pacific Medical Centers. Call us today at 206.621.4419 for more information or email LivingWellAlliance@pacmed.org.