Women's Health: 10 Ways to Avoid a Urinary Tract Infection

By Ns1ghter Provider: Komal Hanif; MD; Family Medicine

Ladies, you can take these steps to reduce your risk of urinary tract infections:

1. Drink plenty of water. Drinking water helps dilute your urine and ensures that you'll urinate more frequently. This allows the bacteria to be expelled from your urinary tract before an infection can begin.

2. Wipe from front to back. Doing this will help prevent bacteria in the anal region from spreading to the vagina and urethra.

3. Empty your bladder soon after intercourse, even if you don’t have to go. Urinating after sex flushes out any bacteria that could have migrated to the bladder during intercourse.

4. Avoid potentially irritating feminine products. Deodorant sprays, douches and/or powders can irritate the urethra. Also, douching washes away the good bacteria, disrupting the natural balance in your vagina and allowing more bad bacteria to grow along the neighboring urethra.

5. Consider your choice of birth control. Diaphragms, or unlubricated or spermicide-treated condoms, can all contribute to bacterial growth.

6. Adjust clothing by wearing cotton underwear, avoid tight-fitting pants and switch out of sweaty clothing soon after a workout.

7. Take showers and avoid prolonged baths. Bacteria can easily contaminate bath water. Sitting in a tub allows these bacteria to reach the urethra.

8. Don't hold it in!  When you feel the need to empty your bladder, do so immediately rather than waiting for later. Holding in urine for prolonged periods of time perpetuates bacteria to infect the bladder.

9. Consider using tampons instead of sanitary napkins or pads during your menstrual cycle. Using tampons keep the bladder opening area clear, thereby limiting bacterial overgrowth.

10. Take cranberry supplements, more so if you are prone to UTIs. Cranberries contain proanthocyanidins, which are thought to prevent bacteria from sticking to the bladder. However, be aware that cranberry supplement products are unregulated and don't all contain the same amount of proanthocyanidins.

How to Get Medical Information in 2017

By Ns1ghter Provider: William Jantsch, MD; Emergency Medicine, Internal Medicine

The human body is a remarkably constructed mechanism which, if properly nurtured, will serve its owner well for many decades. Things do go wrong, on occasion, and the medical profession has developed over centuries to try to help sick and injured people with their illnesses and debilities. Even with incredible scientific advancements, however, there are still major gaps in medical knowledge, associated with multiple controversies.

Modern healthcare in the United States is a gargantuan, intimidating process that unfortunately has lost sight of its primary objective- that is, to relieve suffering and to improve the quality of life for individuals. Primary doctors, such as Family Practice, Pediatric, and Internal Medicine specialists try to help their patients through the maze of confusing and often conflicting information that is available to almost anyone with a web browser.

But whom do you believe?

I certainly do not profess omniscience, but here is what I can recommend:

a. If you have a primary doctor whom you trust, and who is available to answer your questions, you are lucky. You will know in your gut when your concerns are taken seriously, and recommendations will make logical sense. If something doesn’t seem to make sense, ask about it. A good doctor is open to questions, and will even revise advice based upon your preferences and circumstances.

b. If you don’t have a primary doctor, you have some options:

a. On-line web searches

b. Telehealth chat (such as Ns1ghter)

c. Urgent Care centers

d. Hospital Emergency departments

e. Asking your (best friend, mother…)

Here are the advantages and disadvantages of the above options (briefly)

a. On-line searches are free, and easy, readily available. There is so much information at times, however, that it is difficult to apply it to your personal problem. You also run the risk of over-diagnosing serious conditions, that just adds to your worry. You will not be able to order tests or prescribe treatments in most cases.

b. A telehealth chat is another low-cost, easily available option. With a service like Ns1ghter you can ask a question and get a doctor’s opinion very quickly.  Ns1ghter can also provide face-to-face contact with a doctor who can suggest and prescribe medication for some straightforward medical conditions. For instance, if you know you have a bladder infection based upon symptoms that are familiar to you, and all you need is an oral antibiotic, then Telehealth is a good option. I would be cautious of any service that says it can confidently diagnose and treat a wide variety of medical disorders, such as ankle injuries, earaches, abdominal pain or trouble breathing.

d. An Urgent Care Center is basically the doctor’s office, but without the ability to provide on-going care. This is a really good option for earaches, asthma attacks, sudden fevers, and minor injuries. Most Urgent Care Centers have some degree of medical testing, and possibly even x-ray capability.  The expense to visit an Urgent Care is often just a fraction of what an Emergency Department visit would be at the hospital. However, Urgent Care is not a good option for potentially serious problems, such as severe abdominal pain, chest pain, or possible stroke.

e. The hospital Emergency Department is designed to handle all emergencies. This is the place you want to be if you are having a stroke or a heart attack. This is where you will go if you call 911 and get transported. However, if you go to the ED without an obvious acute medical emergency, you may have to wait a long time to complete your assessment, and the charges to you or your medical insurer will be very high.

There are no easy rules to help you to sort out which option to choose! So here is what I hope would be some common-sense advice:

- If you feel a sudden, severe change in your medical condition that you can tell is “very wrong”, call 911 and/or get to an Emergency Department immediately.

- If you can sense something does not feel right, but is progressing gradually and slowly, make use of your “free” options first: look to the Internet for information, and contact a Telehealth chat service for help with the best way to proceed with your evaluation.

- If you start a Telehealth video chat or go to an Urgent Care Center, and the practitioner does not feel that he or she can diagnose and treat you appropriately in that setting, you may be directed to the Emergency Department. That’s OK, it’s difficult even for doctors to know where to go initially for medical assistance.

The most important thing is that you get the best medical care available to you. Don’t be afraid to ask questions, and research on-line to the extent you feel comfortable. Contact the Telehealth chat service. That should get you started in the right direction.

Measuring Your Blood Pressure at Home

By Ns1ghter Provider: William Jantsch, MD; Emergency Medicine, Internal

Having uncontrolled high blood pressure is not good for anyone. Over time, elevated blood pressure increases a person’s chances of having a stroke, heart attack, heart failure, or kidney failure. Many medications are available now for safe and effective blood pressure management, and the proper use of these medicines will help a person stay healthy longer.

But how do you know if you have high blood pressure? How do you know if your blood pressure medications are working effectively?

This is where measuring your own blood pressure at home can help. Pressure readings in a doctor’s office or automated machine can be misleading: your blood pressure rises if you are even a bit anxious or in pain. The most reliable pressure readings are obtained when you are resting comfortably and feeling well.

If you take the time to monitor your blood pressure at home, and document multiple readings over time, you can take this information to your primary doctor and make important decisions regarding the need to initiate or adjust medical treatment for high blood pressure (also known as hypertension).

You will need a blood pressure monitoring device, and these come in 2 varieties. “Manual” and “automatic”. With a manual cuff (also known as a sphygmomanometer), you will also need a stethoscope to listen for the beating sounds in the artery while the measurement is being taken. This is difficult for a person to do by him or herself, and takes a bit of practice and training. So, even though manual cuffs are inexpensive ($10-20), they may not be good for you. The automated devices can be purchased for $40-60, and even less when used. Such a device works simply by turning the monitor on, applying the cuff to the upper arm, and the pushing a button. The reading is automatic. Easy!

A word of caution: make sure you get a blood pressure cuff that fits your arm properly (extra-large cuffs are made for people with large arms). Also, some people have had good results with monitors that take the pressure at the wrist, but I have found these to produce inaccurate readings on occasion.

Understanding the numbers:

Blood pressure is recorded with two numbers, divided by a slash mark:

Systolic blood pressure/diastolic blood pressure

“Systolic” pressure is the maximum pressure (in millimeters of Mercury) when the heart is beating

“Diastolic” pressure is the minimum pressure in the arteries when the heart is in between beats

Good blood pressure levels:

120/80 is generally considered “normal”

Many doctors will not advise starting blood pressure medications until the numbers go over 140/90 or higher, depending on a patient’s age and other medical conditions.

What if the blood pressure reading is really high?

Well, first of all, don’t panic. Elevations as high as 180/100 can be seen in otherwise healthy people if they are under acute stress or in severe pain. People with known hypertension will occasionally generate blood pressures of 220/120 under certain circumstances.  It is important to keep a log of these pressures.  You do not want to stay at these levels for long periods of time.  Always discuss your findings with your doctor.

The New Perspective on Healthcare

By Ns1ghter Provider: Joseph Accursio, NP

As technology advances at breakneck speed, so the world of healthcare evolves along with it. The traditional hospital-based systems that dealt with illness and death have been replaced with a new concept of medicine. The current trends are customer-centricity, convenience store access, the ability to shop for healthcare like it’s a grocery store, and being able to visit with a provider visit through a laptop or a smartphone. Style and delivery now play a major role in medicine.

From a professional perspective, healthcare is concerned with treating customers based upon the most up-to-date scientific guidelines. Gone are the old-wives’ tales and the guesswork. Also electronic medical record permit providers to have a more complete picture of the patient, so that medical care can be comprehensive and patient-centered, giving people the best improved outcomes for their dollar.

Even the definition of health has changed many times over many years, bringing us to the current understand of “health” as not just the absence of illness; instead we speak of “wellness” as the optimal functioning of a person’s life across all spheres. The shift from health to wellness is significant, because it moves the needle closer to reality. But despite the good intentions and aim of all these changes, the best system in the world is still going to fall short without one single and necessary key ingredient – patient responsibility. No amount of technology, science or networking comes close to what can be achieved with a little preventative care.

Where’s the catch? Prevention takes time and energy. It’s about discipline and responsibility for the choices you make. And it can be tough to get started. Granted, it’s a big chore to wade through the sheer volume of misinformation and nonsense that is available to us through the internet. But the fact is, there will never be any match for internal motivation – no one will take care of you or your family better than you will.

That’s where Ns1ghter comes in. With the free consultations, video visits and site content, reliable health information can be tailored to your specific needs and questions. And this puts the profession of healthcare into its proper place – not as a schoolteacher, but as a partner. Instead of dealing with illness and injury after it’s taken a toll on your quality of life, having a healthcare provider who partners with you in crafting smart lifestyle choices not only extends your years, but makes them more fulfilling.

So where do you start in this transformation toward wellness? The first step is honesty. You must take a good hard look at your life – what you value, where you want to be, how far away you are from there, and all the while constantly looking to clear up any health misconceptions that you may have. You have to know what you don’t know, and know where to look for reliable answers. After you gain a perspective on your own health and wellness, you need to have a plan to integrate the changes that need to be made into your life on a permanent basis. This is where it becomes difficult, because sacrifices will be made. These sacrifices and changes will affect not only you, but your close friends, family and daily routine. Change usually comes quickly at first, but after the novelty wears off and the reality sets in, your old ways will rise up against you, and you’ll be in for a fight. Nevertheless, just like eating an elephant, its one bite at a time toward better choices and better quality of life. There will be setbacks, but there can also be great success.

It comes back around to those two ugly words - discipline and responsibility. Because no matter what else may be involved, your health is ultimately in your hands. Anyone who tells you otherwise is selling something.

What is High Blood Pressure

By Ns1ghter Provider: Joseph Accursio, NP

High blood pressure (or Hypertension) is something that’s discussed often in the medical community. That’s because untreated high blood pressure can lead to life-changing health problems in the long run, and many blood pressure-related problems are permanent – once you have them, you’re stuck with them. On top of this, you may have high blood pressure and never have a single symptom or problem until it’s too late.

How does blood pressure work?

A simple and effective way to discuss hypertension is the analogy of a typical garden hose. If you attach a hose to the spigot outside and turn it on, water flows out the other end. This represents blood pressure under control. Now, if you place a spray device onto the end of the hose, you’ll notice that the tension on the hose becomes much greater. Finally, if you kink the hose off by bending it, the pressure inside of the hose becomes enormous, as the water seeks to find someplace to go. That’s essentially a simple explanation of your blood vessel (or vascular) system.

Why high blood pressure is problem

Now If you’ve ever had an old garden hose or broken spigot, then you know that it only takes a little back pressure to cause water leaks from several places. Those leaks are the problems with high blood pressure, and can occur anywhere in your body, most often inside small and fragile blood vessels that can’t take too much pressure – your eyes, kidneys, brain and heart.  Over the years, this can lead a heart attack, stroke, kidney problems, or vision impairment.

How did this happen to me?

There are many reasons why people might have high blood pressure, and some of them can be quite complex. The ones you can’t directly control without help are age, ethnicity, family history, kidney or thyroid problems. Some people have high blood pressure without a known cause – this is called primary hypertension.

Thankfully, there are many causes for hypertension that can be controlled, such as body weight, tobacco and alcohol use, diet, medication use, stress and activity. As you can see, though these are simple ways to fight hypertension, they’re all about discipline and moderation.

If there was one starting place and take-away from blood pressure control, it would be staying at a healthy weight, or within your BMI (body mass index). Research shows that getting into a healthy weight range can lower blood pressure by as much as 20 points. Of course, staying at a healthy weight involves – you guessed it – your diet and activity levels!

Regarding eating habits, the most important thing to remember is that you can NEVER exercise off a bad diet, so healthy choices are pivotal to your success. Regarding exercise, start small – any activity is good activity to start. But keep in mind, the idea is to increase your level of activity over time. Talk to a trusted health care provider about permanent lifestyle changes that will lower your blood pressure and most importantly, help you do whatever you do better everyday.

An excellent and easy starting place for blood pressure management is to look up the U.S. Department of Health and Human Services “Guide to lowering blood pressure.” This booklet discusses body weight, activity, eating right, alcohol intake and common blood pressure medications.

Monitoring your blood pressure

If you want to start watching your blood pressure, the best way is to develop a trend of measurements over time – one to two weeks should do.

Purchase a reliable arm or wrist cuff from the store. Take your BP once or twice daily, no more than that. Take it at breakfast and dinner…something easy to remember.

Before you take it, sit down and relax for 5-10 minutes. Then follow the instructions for your device.

Record this number. Do the exact same thing every day for the next 1-2 weeks. Then take this to a health care professional for discussion and next steps.