Nurse Practitioners: Understanding and accepting all that we do

One of the biggest challenges our practice has is overcoming the perception that Nurse Practitioners can’t provide comprehensive primary care.   The health care culture in this country assumes that only MDs are qualified to provide this kind of care.   However, Nurse Practitioners are qualified and have been providing this kind care for years.   Now, as our health care system is struggling to meet the needs of our communities, Nurse Practitioners are finally being recognized and accepted as providers who are providing excellent comprehensive primary care services to people throughout this nation.

Attached is a great article from the NY Times about MD acceptance of the Nurse Practitioner role.


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On-line drug interaction websites: Make sure your medicines/remedies are safe to take together.

Attached is a quick article with links to on-line drug interaction sites.  These sites are designed to help you make sure that your prescription medications, over-the-counter remedies and herbs or supplements are safe to take together.  When you read this remember to contact your prescriber or pharmacist if you have any concerns.  Many medications will say there is a risk for interaction but the interactions are dose dependent.  Additionally, many medications should not be stopped abruptly without the guidance of the prescriber.

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Sitting: Why it is Bad for Us


Many people struggle with getting enough exercise to stay healthy and maintain a healthy weight.   Our days are often consumed with commuting, working behind a desk, doing school work, eating, watching TV or working on a computer.  If anything, our society is moving even more so in this direction as much of our leisure time is taken up with technology and screen activities.    For those of us who do exercise, we hope that our 30-60 minutes of exercise 3-5x per week will be enough to stave off the ravages of sitting too much.   Unfortunately, those faithful exercise sessions, although better than nothing, are probably not enough to do the trick.   

One reason for this may be the need to increase levels of Lipoprotein Lipase in our blood stream.   Lipoprotein Lipase is increased when we use our leg muscles.  This protein is responsible for grabbing onto triglycerides in the blood and transporting them to the cells to be used for energy.  When the levels of Lipoprotein Lipase fall the triglycerides in the blood get stored as fat instead of used as fuel.    It appears that the levels of Lipoprotein Lipase fluctuate throughout the day depending on our level of activity.  Therefore, getting up and moving around every 30 minutes may make a difference in the way triglycerides are utilized in our bodies.  If you move around every 30 minutes in addition to your regular workout, you may stave off some of the ravages of our modern sedentary lifestyle.

Attached is a great article about the research behind this finding and the importance of frequent activity throughout the day.


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Do You Know the Unique Heart Attack Symptoms in Women?

When someone is having a heart attack we often imagine someone clutching their chest and describing the sensation of having an “elephant sitting on their chest”.  While this is often the case, women may experience different symptoms causing a delay in getting appropriate medical care.

Women are more likely to have the following symptoms when having a heart attack:

·         Atypical chest pain that presents in the upper back, shoulders, jaw, neck, arms and upper abdomen.  The pain may not be as severe as one would think.  Often this pain can be confused with heartburn.

·         Shortness of breath that does not necessarily correlate with the activity being done.  Some women describe a feeling of gasping for air like they had run a marathon. 

·         Heavy sweating that is sudden.  It may be difficult to differentiate from a menopausal hot-flash.  Some women describe it as feeling both hot and cold with clammy skin.

·         Unusual fatigue can be described in the days or weeks prior to the heart attack.  The fatigue is often described as profound, limiting even the most simple daily activities, such as making a bed, walking to the bathroom or lifting a laptop.

·         Lightheadedness and nausea can occur during an attack. 

·         Women can also have the classic crushing chest pressure.  However, it is important to remember that heart attack symptoms in women can be much more subtle.

Most of the heart disease risk factors for women are similar to men but there are some differences. 

·         High cholesterol and triglyceride levels.

·         Loss of estrogen after menopause.

·         Weight gain around the belly – usually most prominent during and after menopause.

·         Smoking!!!!   This has been shown to be a bigger risk factor for women than in men.

·         Being overweight.

·         Not exercising.

·         A diet high in saturated fats and refined carbohydrates.

·         High blood pressure and Diabetes.

·         Family history of heart disease.

·         Women in their early fifties can have a heart attack.  So you do not have to be older to have a heart attack.

What can you do to lessen your chances of having a heart attack or suffering a severe heart attack?

·         Know the symptoms.  Call 911 or seek medical care immediately if you experience the above symptoms!

·         Exercise regularly:  That means 30 to 60 minutes a day.

·         Don’t smoke!

·         Maintain a healthy weight.

·         Eat a diet of lots of fruits, vegetables, whole grain, olive oil, monounsaturated fats and complex carbohydrates.

·         Reduce emotional stress.

·         Take prescribed medications properly.

Prevention of heart disease and early recognition of a heart attack symptoms are the keys to preventing serious damage from heart disease.   

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Smart Phone Apps can help you lose weight!

Weight loss apps made for Smartphones and other devices, and on-line food diaries have been shown to improve the chances of successful weight loss.   Why?  These apps and websites make tracking what you eat, ie keeping a food diary, much more convenient and are chocked full of great nutritional information.   Before this technology people often kept a handwritten journal and would have to research the nutritional information if they wanted to count calories and other nutrients.  Now it is so easy.  Some apps even allow you to scan the nutritional bar code right into your phone or device. 

But why are food diaries so important.   A 2008 study of 1,685 people through Kaiser Permanente found that the people who kept a food diary six days a week were twice as likely to lose weight as those who kept a diary one day a week or less.   For years we have known that keeping a food diary is one of the most important things you can do to have effective, long-term weight loss.   Yet, many people have never done it or found it too cumbersome.   Keeping a diary enlightens you on what you eat, when you eat, why you eat and how you eat.    Comments I have heard include; “I had no idea how much I was snacking”, or “No wonder I am starving by dinner, I don’t eat enough early in the day”, or “I never realized how many calories were in that whoopee pie”, or “I didn’t realize how few vegetables I am eating”, or “I didn’t realize my typical lunch was 1000 calories”.   Food diaries also create accountability.  If you know you have to write it down, type or log it in, you will often think twice before going for that whoopee pie.   

Here are five tips to keeping a food diary:

  • Write as you go. Don’t wait until the end of the day to record what you ate and drank.  Have access to you food diary to log your food as you go.
  • Focus on portion size. Practice at home with measuring cups, measuring spoons, or food scales. And be aware that people tend to underestimate how much food they are eating.   Some of the apps have handy measurement tricks, such as… your average size thumb tip (to the joint) is a teaspoon, the palm of your hand is 3oz, or one fist is about one cup.
  • Use whatever type of food diary works for you. It doesn’t matter whether you use scrap paper, notebook, a Smartphone, iPad, or personal computer.  Whatever is easiest and you will use.
  • Don’t skip your indulgent days.  It is tempting to not record those indulgent days.  However, recording them is enlightening and will teach you how to manage the next challenging day that comes along.  Don’t look at it as punishment.  Look at it as a learning curve.
  • Cook at home. You’ll have more control over what you consume, by knowing what is in it and having control over your portions.   Plus it is easier to log homemade food than food from a restaurant. 

Choosing an app or website can be overwhelming.   There are many free ones that are very good so don’t get roped into buying a subscription unless you really like what they offer.  Two websites that I have used are and  There are apps for them too.  Both are free and track exercise as well.   Go online and take a look around at what might work best for you.    

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Why Sit When You Can Walk!

We all know exercise is a key component of overall health. Yet, most struggle to make it a natural part of our day. This three minute talk suggests an easy way to add exercise to our day and get all those things done that always take priority over our physical health. Sometimes it is the little things that can make a big difference in our physical and emotional health.

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Lyme Disease Transmission

To follow up on the deer tick post from the other day.  Many people ask, “why wait for the tick to be on 24 hrs before being concerned about Lyme transmission?”  Well,  there is an enzyme conversion in the tick that has to take place after the tick bites you for Lyme transmission to occur.  This enzyme conversion takes 24 hours to complete.  So, if you think the the tick has been on more than 24 hrs, contact your PCP.

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Deer Ticks…They’re Baaack!!

Hope Health Family Practice offers you some handy tips about how to deal with Deer ticks.

Remember to cover up and apply tick repellent when going for hikes or being in fields and woods.

Remember to check yourself thoroughly when you have come in from the outside.  Strip down and pay particular attention to creases, the waist, underarms, hair line and groin.  Ticks seem to be drawn to those areas.

If you find a tick, do the following:

  1. Remove it with a pair of tweezers by firmly pulling straight back until it releases.  Deer ticks can be very difficult to remove as they hang on tightly.  Dog ticks come off much more easily. 
  2. Notice the color and size.  Dear ticks are brown and tiny (the size of a pin head),when not engorged (filled with blood).  Dog ticks are bigger and darker.
  3. Note if the tick looks engorged.  An engorged tick looks white/gray and puffy
  4. If it is engorged, try to think about when you might have last been exposed to ticks.
  5. If the tick is engorged, removal is difficult and/or you think the tick has been on 24 hours or more, then you should contact your Primary Care Provider for an appointment.

The bite of a Deer tick will leave a nasty looking bite.  The center part of the bite is usually dark brown/black and often there is a surrounding reddened area that can extend up to an inch or two in diameter.  It will appear within a day or two of the bite.  THIS IS NOT A LYME INFECTION RASH.  This is just from the reaction to the bite.

A Lyme infection bulls-eye rash takes 7-10 days to develop post bite, if it develops at all.  It can be very obvious or extremely faint.   The size of redness can vary greatly and it doesn’t always look like a bulls-eye.  Sometimes it can be sore but usually you won’t feel it at all.

The great outdoors is part of why we all live or visit Maine.  Knowing a few tips about how to stay healthy and enjoy nature will make the long awaited spring and summer more pleasant.    Have fun out there!


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Healthy International Travel!!!

Traveling outside of the country this year?  Remember to plan early and find out about the necessary vaccines and medicines you will need for your travels.

Many destinations recommend Hepatitis A and B vaccines.  These vaccines are a series of two or three shots which take a total of six months to complete.   The Hepatitis A vaccine is particularly important as Hepatitis A is spread through the fecal/oral route when hygiene is poor.   Another vaccine that is commonly needed is Typhoid.  The Typhoid vaccine is a series of four capsules that need to be ingested over eight days at least one week prior to possible exposure.   You may need other vaccines and prescription medications depending on your destination and your own personal medical needs.

Give us a call to set up an appointment to go over your travel plans, vaccine and medication needs and to discuss how to have a healthy travel experience.

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As I continue my journey to better health, I am constantly amazed at the importance of eating REAL food.   Here is more proof that we MUST stay away from processed and refined foods.   Buy, grow, make and eat REAL food. It is that simple.

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