Nearly 10 million Americans suffer from Peripheral Arterial Disease (PAD), which is a potentially serious but treatable circulation problem that usually affects the arteries in the legs.

PAD is a disease in which plaque – deposits of fat, cholesterol, and other substances in the blood – builds up in the arteries and, over time, can severely narrow or completely block the flow of oxygen-rich blood to the limbs. This can lead to extreme pain and tissue loss, and significant problems with walking.

In severe cases of PAD, a total loss of circulation to the legs and feet can lead to gangrene and amputation.

Diagnosing PAD

The most common symptoms of PAD are cramping, pain or tiredness in the leg or hip muscles while walking or climbing stairs. Typically, this pain goes away with rest but returns when the activity is resumed. Many people mistake the symptoms of PAD for something else, and the condition often goes undiagnosed by healthcare professionals.

However, PAD can be easily and painlessly diagnosed by measuring the blood pressure in the arm and comparing it to the pressure at the ankle, called the ankle-brachial index (ABI). If the pressure or ABI is less than 1.0, arterial disease is present.

Managing PAD

As a surgeon specializing in vascular and endovascular surgery, I routinely see patients with PAD. The good news for these patients is that pursuing a healthier lifestyle and following a physician’s advice can often help in managing PAD, significantly reducing the need for surgical intervention.

For most patients, a healthier lifestyle includes smoking cessation, maintaining good control of blood sugars (for diabetics), and eating a diet low in fat and sodium, and rich in fruits and vegetables.

Additionally, all patients with PAD should take aspirin or Plavix, as well as a statin (cholesterol medicine).

Finally, exercising for 20 to 30 minutes a day, four or five days per week, has proven to be beneficial.

Treating PAD

Unfortunately, some patients need more than medical management for their PAD and will require a procedure to improve their blood flow.

For patients with pain while resting, or those with tissue loss, we discuss surgical treatment options to restore blood flow to the legs and feet in order to prevent amputation.

For patients with claudication symptoms, or pain while walking a short distance, we discuss medical management strategies first. Intervention for these patients is reserved for individuals who have a significantly reduced quality of life due to their inability to walk.

Living With PAD

As is the case with many chronic illnesses, the physician-patient relationship is extremely important for achieving success in the management of PAD. Through open communication, and sometimes difficult work on the part of both the patient and the physician, the quality of life for the patient with PAD can significantly improve.

If you have leg pain, numbness or other symptoms, don’t dismiss them as a normal part of aging. PAD diagnosis and treatment can slow or stop disease progression and reduce the risk of complications.

Related Links 

• Department of Vascular and Endovascular Surgery

To request an appointment with a Cooper Vascular Surgeon click HERE

This recipe is Diabetes Friendly and Heart Healthy.

Ingredients

Yield: 8 servings

• 8 – 4 ounce chicken breasts, boneless and skinless
• 1 cup flour, seasoned with pepper
• 1 cup buttermilk
• 1 cup walnut pieces, finely ground

Preheat oven to 350 degrees.

Coat chicken with flour and then dip each breast in buttermilk.

Coat each chicken breast with walnuts.

Heat non-stick pan on medium and spray it with vegetable oil.

Place chicken in pan and cook on each side for 2 to 3 minutes, regulating the heat to avoid burning walnut crust.

Transfer chicken to oven to bake thoroughly, approximately 10 to 12 minutes.

Press index finger onto chicken to test doneness. Chicken is cooked when firm to the touch.

Remove from pan when cooked. Slice each chicken breast diagonally into 4 pieces.

Serve hot.

Nutrition Information

Calories: 341
Fat: 17g
Saturated Fat: 2g
Cholesterol: 67mg
Sodium: 107mg
Carbohydrates: 16g
Fiber: 2g
Protein: 32g

Does your nose start to tickle and run and your eyes begin to itch as soon as the weather gets warm? Does springtime make you feel lethargic and a little heavy-headed?

If you answered “yes” to these questions, then you probably suffer from allergic rhinitis, or nasal allergies.

Allergic rhinitis, or nasal allergies, affects 40 to 100 million people in the United States. While the condition is very common, it is not trivial. For many, allergic rhinitis can cause the constant discomfort of nasal congestion, sneezing, sniffling, runny nose, itchy eyes and throat, and headache. For others, symptoms occur seasonally as a result of certain allergenic substances in the air, like pollens and molds.

What causes all of these symptoms?

The nasal lining of a person suffering from allergies becomes inflamed after exposure to specific allergens, e.g., tree pollen. The inflammation produces swelling or congestion, sneezing, sniffling and at times mucus production. Once this occurs, irritating substances in the air, such as perfumes, smoke or fumes, can often irritate the already inflamed nasal passages and worsen the condition.

Allergies can also hinder a person’s performance in school or on the job. People with allergic rhinitis may be kept awake at night from symptoms or from the effects of medications, resulting in lethargy and difficulty concentrating, sleeping, or exercising.

The effects on a person’s quality of life will often lead one to seek treatment. Use of over-the-counter allergy medications will often prove helpful for the control of symptoms from allergic rhinitis. However, these non-prescription antihistamine preparations may not always be enough and at times produce unwanted side effects.

Evaluation by your primary care physician or by an allergist can prove more helpful in providing the proper care and management of the symptoms of allergic rhinitis. An allergist may suggest performing allergy testing. Education about avoidance and environmental control measures is of vital importance. Treatment with allergy medications is usually prescribed. These prescription medications are very effective and produce fewer side effects than the over-the-counter allergy relief. Those who do not get acceptable relief from medication alone, or feel that they do not want to rely on medications, may be candidates for allergy shots or immunotherapy – vaccination to induce tolerance to the specific allergen. There are risks, however, so patients need to discuss this with the doctor.

Relief of allergic rhinitis not only improves quality of life but also prevents unwanted complications, such as recurrent sinusitis and ear infections. In addition, there is a strong association between allergic rhinitis and asthma. Appropriate medical therapy of allergic rhinitis can sometimes improve asthma symptoms.

Remember: Don’t suffer needlessly; consult with an allergist and get control of your symptoms.

Related Links 

•  Division of Allergy/Immunology

]]> http://ehealth.cooperhealth.org/2012/04/allergy-season-is-in-full-swing/feed/ 0 http://ehealth.cooperhealth.org/wp-content/uploads/2012/04/0418_allergyx600.jpgfalsefalse 0418_allergyx200 requestappt_button http://ehealth.cooperhealth.org/2012/04/health-ecooking-carrot-orange-soup-with-mint-coconut-yogurt-2/ http://ehealth.cooperhealth.org/2012/04/health-ecooking-carrot-orange-soup-with-mint-coconut-yogurt-2/#comments Wed, 18 Apr 2012 12:27:39 +0000 Cooper University Hospital http://ehealth.cooperhealth.org/?p=5623 Carrots are packed with beta-carotene, an antioxidant that turns into vitamin A in the body, improving eyesight and elevating your immune system. Coconut yogurt and mint add a tasty garnish.

Ingredients

Yield: 6 servings

Soup

• 4 oz sliced shallots
• 2 lbs diced carrots
• 9 oz water
• 9 oz fresh-squeezed orange juice
• 1/4 tsp orange zest
• 1 sprig thyme
• Pepper to taste

Yogurt

• 4 oz no-sugar-added plain yogurt
• 1 1/2 oz coconut powder
• 1 Tbsp honey
• 1 Tbsp fresh mint leaves, chopped
• Mint leaves and orange segments (for garnish)

Soup

Spray a large pot with cooking spray and heat over medium heat. Add shallots. Sweat shallots for 5 minutes.

Add diced carrots, lower heat, and cover and cook until tender (for about 10 minutes; do not caramelize). Add water, orange juice, orange zest and thyme, and season with pepper. Bring to a boil and simmer for 20 to 30 minutes.

Puree soup mixture in a high-speed blender until smooth.

Tip:

To achieve desired consistency, you can thin the soup with carrot juice or water.

Yogurt

Whisk yogurt, coconut powder, mint and honey in a small bowl. Dollop on to the soup and garnish with orange slices and mint leaves.

Serve immediately.

Nutrition Information

Calories: 166
Fat: 5g
Saturated Fat: 5g
Cholesterol: 1mg
Sodium: 6mg
Carbohydrates: 28g
Fiber: 5g
Protein: 4g

Pregnancy is an exciting time for expectant moms. There is something special about being pregnant that makes you want to take better care of yourself.  For many women, pregnancy has them paying more attention to potential hazards in their home, work and social environments.  Others may put more thought into what and how much they eat and drink, as well as the types of activities in which they engage.

Figuring out the right balance of food intake and exercise output can be tricky.  The old adage “you’re eating for two” is often taken literally and can be difficult to dispel.  Similarly, some patients equate pregnancy with the need for a more sedentary lifestyle and believe that exercise is off limits.  For most pregnant women, this is unlikely to be true.  In fact, overeating and not exercising during pregnancy can actually be harmful.  Excessive weight gain may increase the risk of gestational diabetes, a condition that could result in significant issues for both mom and baby.

How much weight gain is normal during pregnancy?

Weight gain during pregnancy should generally be limited to 25-30 pounds or less (15-20 pounds if the expectant mom is overweight at the beginning of the pregnancy).  While there is a need for an increased number of calories during pregnancy, women and their developing babies are better served if those calories come in the form of a well-balanced diet.  High-sugar content food and beverages (including fruit juices) should be limited.  Stocking the kitchen with fresh vegetables, lean meats, low-fat dairy products and whole grains will help in making wise meal choices.  Keeping physically active can help curtail excessive weight gain.

Ideally, healthy eating habits and exercise are started prior to conception, but as long as the expectant mother does not have significant pre-existing medical conditions or obstetrical complications, regular exercise can be started during pregnancy.  Generally, 30 minutes of aerobic activity daily is encouraged.  Brisk walking is a great way for even the non-athlete to improve her general health and well-being during pregnancy.  Exercise in the supine position (on your back) should not be continued after the first trimester.  Contact sports, scuba diving, and recreational activities with a high risk of falling are not advised and should be discontinued during pregnancy.

However, some competitive sports, such as running, can be continued provided the expectant mom has appropriate medical supervision. Women should discuss weight gain and exercise limitations with their obstetrician or care provider early in their pregnancy.

If you’re pregnant during the holidays, it can be an especially challenging time.  Pregnant moms can and should enjoy some of their old holiday favorites.  Modest adjustments to exercise regimens are often all that is needed to compensate for those tiny indulgences and ward off the extra poundage.

Exercise Programs for Expectant and New Moms

The Ripa Center for Women’s Health in Voorhees offers the following exercise programs designed for women at various stages of pregnancy, as well as those looking to exercise following childbirth:

• Prenatal Yoga – Women in their second – or third trimester can increase flexibility, focus, strength, and awareness.
• Mommy and Baby Yoga – This class focuses on breathing techniques and asanas (postures) for mom, and a chance for mom to regain strength, flexibility and balance while bonding with her baby. It is very beneficial for babies to stretch and strengthen their body parts to help balance their right and left sides, and increase circulation, digestion, growth and development (With mom’s assistance of course!!).
• Body After Baby – By using a combination of Pilates and yoga, you can strengthen joints, ligaments and muscles; increase flexibility; and develop strong abs and tighten the gluts. By incorporating light hand weights, you can strengthen and tone the upper body as you raise your metabolism.

For more information about these classes, and other fitness programs offered at the Ripa Center for Women, visit cooperhealth.org/ripaclasses.

Related Links

• Ripa Center for Health and Wellness
• Childbirth Education Classes at Cooper
• Obstetrics and Gynecology

Ingredients

Yield: 8 servings

• 10 slices whole wheat bread, cubed
• 4 Tbsp trans fat free margarine
• 1/2 cup chopped onion
• 1/2 cup chopped carrots
• 1/2 cup chopped celery
• 1 Tbsp dried sage
• 1/8 tsp salt
• freshly ground black pepper to taste
• 1/4 cup chopped fresh sage
• 1 clove garlic, minced
• 2 cups low sodium chicken or turkey broth

Preheat oven to 350°.

Place bread cubes on a baking sheet and toast in oven about 10 minutes. Remove from oven and set aside.

In a large saucepan, heat margarine over moderate heat until melted. Add onion, carrots and celery, and sauté for 1 minute. Mix in seasonings and garlic, and cook 3 minutes until vegetables are softened. Add chicken broth and simmer for 2 minutes. Remove from heat.

In a large bowl, toss toasted bread cubes (reserve 1/4 cup for topping later) with vegetable mixture.

Coat a casserole dish with nonstick cooking spray. Transfer stuffing mixture to casserole dish and top with reserved 1/4 cup bread cubes. Bake, uncovered, for 20 minutes or until golden.

Serve immediately.

Nutrition Information

Calories: 179
Fat: 7g
Saturated Fat: 0g
Cholesterol: 1mg
Sodium: 454mg
Carbohydrates: 28g
Fiber: 5g
Protein: 6g

Total knee replacement began in the 1970s and has evolved as a safe and reliable surgical procedure to help patients with debilitating joint pain and deformity.

When I tell my patients that a total knee replacement is a good surgical option to relieve the pain they feel during walking and other daily activities, sometimes they are frightened by the phrase “total replacement.” In reality, when I perform a knee replacement, the muscles, tendons, collateral ligaments, most of the bone stock and even the knee cap (patella) are fully preserved.

The best way to explain knee replacement surgery is by comparing it to a common dental procedure, such as the crowning of a worn-out tooth. Only the degenerative, worn-out bone and cartilage is removed from the knee, followed by the placement of a metal (titanium) and high-impact plastic (polyethylene) prosthesis on the sculpted ends of the distal femur and proximal tibia—the parts of the knee that keep the body’s center of gravity balanced over the leg during the stride cycle.

The undersurface of the knee cap is re-shaped to allow placement of a stable plastic disc. No more than several millimeters of bone is removed from the surface of the arthritic knee in order to perform the “total knee replacement.” Patients retain their soft tissues, important muscles, tendons, collateral ligaments and most of the bone.

Knee replacement offers patients the opportunity to get back to their daily activities with little to no pain by creating a stable and comfortable joint. Patients can walk farther, climb stairs with ease, and engage in low-impact sports activities.

According to recent published studies, more than 90 percent of patients are pleased with their knee replacement surgeries 10 years later. Less than 1 percent of patients will have a complication that requires further medical care.

Remember, when surgery is performed by an experienced orthopaedic surgeon in a hospital that performs a high volume of joint surgeries, the complication rates are low.

Also, when the orthopaedic surgeon is personally involved in the patient’s care before, during and after surgery, as well as in supervising an orthopaedic team of nurses, therapists and assistants, patient satisfaction is exceedingly high.

Patients need not fear the words “total knee replacement;” the surgery can tremendously improve a patient’s quality of life.

Dr. Gordon sees patients in Newtown Square, PA and Cherry Hill, NJ.

To schedule an appointment with Dr. Gordon, call 856.342.3159.

Related Links

• Cooper Bone and Joint Institute 

Ingredients

Yield: 2 servings

• 2 flounder, sole or tilapia fillets (6 oz. each, about 1/4-inch thick)
• pinch unrefined sea salt
• pinch fresh ground black pepper
• 2 tsp chopped fresh parsley
• 4 tsp fresh lemon juice
• 1 Tbsp extra virgin olive oil
• 1/2 cup string beans, trimmed and cut into 2-inch pieces
• 1/2 cup corn kernels
• 1/2 cup cherry tomatoes, halved (red and/or yellow)

Preheat toaster oven to 425°. Lightly spritz toaster oven pan with nonstick cooking spray. Place fish on pan and season each piece evenly with salt, pepper, parsley and lemon juice. Bake fish approximately 5 minutes.

Meanwhile, make vegetables. In a skillet, heat oil over medium heat until hot. Add string beans and sauté, stirring, about 1 minute. Mix in corn and tomatoes, pressing them gently to release their juices, and cook, stirring occasionally, about 2 minutes. Add additional lemon juice, salt and black pepper to taste, if desired, and stir. Remove from heat and distribute evenly between two plates. With a spatula, transfer fish on top of vegetables.

Serve immediately.

Nutrition Information

Calories: 270
Fat: 9g
Saturated Fat: 2g
Cholesterol: 82mg
Sodium: 442mg
Carbohydrates: 14g
Fiber: 3g
Protein: 34g

Head of the Division of Maternal/Fetal Medicine, Cooper University Hospital

Many pregnant women worry about the health of their unborn babies and often ask what they can do to improve the chances of delivering a healthy baby.

Avoiding tobacco and alcohol are well-known first steps, as well as attending regular prenatal visits so that doctors can monitor for any developing problems. Less known, however, are steps that can be taken prior to becoming pregnant.

Meeting with the obstetrician/gynecologist prior to planning a pregnancy is an important step. The physician can review the medical history, outcomes of previous pregnancies, as well as current medications.

Many women reflexively stop all their medications once they discover they are pregnant for fear that the medications will harm their babies. This is often ill-advised, as the medications may be needed to maintain their own health. Most medications can be safely continued during pregnancy, such as medications for asthma, high blood pressure, diabetes and depression.

While most medications cross the placenta and enter the baby’s circulation, few of them are known to increase the risk of birth defects.

The obstetrician/gynecologist may discuss those rare medications that should be stopped or switched prior to conception, or might recommend a consultation with a maternal-fetal medicine specialist if potentially risky medications need to be continued.

Folic acid is another important part of pre-conceptual care. Taking folic acid both before and during early pregnancy can reduce the risk of spina bifida in the baby.

Unfortunately, only one-third of reproductive-age women ingest an adequate amount of folic acid. The U.S. Preventive Services Task Force recommends that women planning to become pregnant should take a daily supplement of .4 to .8 mg of folic acid, which can be easily met by taking a daily prenatal vitamin before conceiving.

Finally, women who are planning to become pregnant should reduce their fish intake to avoid excessive mercury exposure. High mercury levels, which can remain for up to one year, can increase the risk of having a child with cerebral palsy or developmental delay.

Large fish, such as swordfish, shark, tilefish, and king mackerel, should be avoided entirely. Other fish, such as salmon, canned light tuna, fish sticks, and fast-food fish, should be limited to two servings per week. For those who prefer albacore tuna (white tuna), only one serving a week is recommended.

While no one can guarantee a normal pregnancy, taking these few steps prior to conceiving can help minimize the risk to your unborn child.

To visit the Cooper Obstetrics and Gynecology page click here.

To visit the Cooper Maternal/Fetal page click here.

]]> http://ehealth.cooperhealth.org/2012/03/protection-against-birth-defects-prior-to-pregnancy/feed/ 0 http://ehealth.cooperhealth.org/wp-content/uploads/2012/03/0320_preg_2_600.jpgfalsefalse 0320_preg_2_200 requestappt http://ehealth.cooperhealth.org/2012/03/have-you-been-putting-on-the-pounds-try-spending-more-time-in-bed/ http://ehealth.cooperhealth.org/2012/03/have-you-been-putting-on-the-pounds-try-spending-more-time-in-bed/#comments Wed, 21 Mar 2012 12:50:57 +0000 Cooper University Hospital http://ehealth.cooperhealth.org/?p=5392 Anna Headly, MD, MFA
Internal Medicine Specialist at Cooper University Hospital

You already know that we are in an obesity epidemic. Most adults are above a healthy weight. This means more diabetes, heart disease, arthritis, sleep apnea, and a myriad of other health problems. People are desperate to lose weight, and physicians are desperate to help them. So if everyone’s on the same page, why is everyone getting so big?

Calories in minus calories out equals weight gained or lost. No one is immune from this law of physics. What has remained mysterious is why some people stay hungry after eating what they need. But research is starting to reveal hints, one surprising: too little sleep may be making you fat.

This seems counterintuitive. Exercise helps you lose weight. How can spending time in bed shed pounds?

It’s obvious how some differences between now and a generation ago increase obesity. You can do your job by lifting only your fingers at your computer. Almost everyone drives to his or her destination, parking in a spot as close to the door as possible. Food is always available — a vending machine down the hall, a 24-hour store on the way home, and a huge refrigerator.

But, one difference isn’t so obvious: We sleep less. In 1998, the National Sleep Foundation reported only 35 percent of us got 8 hours of sleep per night. By 2005, it was down to 26 percent. We know that lack of sleep causes many health problems, but how could it make us fat? One reason is hormones. Sleep deprivation increases ghrelin, which makes you hungry, and decreases leptin, which makes you full. Worse, sleepy people crave sweets, carbohydrates, and salty snacks.

So how can you improve your sleep? Here are some simple life changes:

• Practice good sleep hygiene. No caffeine after 2 p.m.; a regular bedtime; and a dark, comfortable room with no TV in it.
• Limit TV watching. You may believe it helps you unwind, but research shows just the opposite.
• Stop equating sleep with laziness. It’s a very rare person who needs less than 7.5 hours per night, and you may require much more. You can’t change this any more than you can change the color of your eyes, so stop fighting it.

You may find yourself becoming slimmer in the process.