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How to clean your hearing instrument

ADC Audiologist Janet Davila, Aud, CCC-A takes viewers on a step by step tutorial on how to clean the most common hearing instruments.   She demonstrates how to clean three types:

  • Receiver in the Ear
  • In-the-Ear
  • Behind the Ear

Receiver-in-the-ear hearing aid

  1. First, you pull the dome off of the hearing aid speaker. You put it in a tissue and you roll the dome or squeeze the dome in the tissue to remove the wax that’s in the dome.
  2. Next, you’re going to pull out the wax guard that’s in the speaker and it’s that little white light saber-looking object. You take a black tab off of the wax guard wheel and then, you pick up your speaker. You’re going to take the empty post or the pulling post, push it into the dirty wax guard until it snaps. Then, you pull it out. Now, you’re going to put the new wax guard into the speaker. Just push it in, press it kind of firmly and it will stay in. Lastly, you put your dome back on your speaker and your hearing aid is clean and ready to go.
  3. This is an older version of receiver-in-the-ear instrument. They can have wax guards with blue tabs or gray tabs, depending on the model. When you buy new wax guards, bring your packaging so you know what you need for your instrument.

In-the-ear hearing aid

  1. If you have an in-the-ear model hearing aid, it works the same way. Pull it out with a pulling post and put a fresh, clean wax guard in after you’ve pulled out the dirty one.

Behind-the-ear hearing aid, with custom ear mold

Notice the ear mold is a custom ear piece. The hearing instrument ear piece needs to be cleaned where that tube comes out or comes through the ear piece. That’s where your sound is coming through. You can pick up from us a small brush with a wire-loop at the end. That wire-loop can be used to clean wax and other debris out of that top hole. It also has a bottom hole called the vent, that lets air in and out of your ear. So keep that one clean in exactly the same way.

Additional information:

Different hearing aids require specific types of wax guards (filters) and domes. Below is a general list. Try to keep your packaging and bring it with you when you need to purchase new supplies, in order to ensure that we provide you with the appropriate type.

  • Oticon hearing aids
    • Wax guard: ProWax, NoWax, or ProWax miniFit, depending on hearing aid
    • Dome (hat): RITE or miniFit, depending on hearing aid (various sizes/styles)
  • Phonak
    • Wax guard: Cerustop
    • Dome (hat): Smokey dome (various sizes/styles)
  • Widex
    • Wax guard: Nanocare
    • Dome (hat): Instant or RIC domes, depending on hearing aid (various sizes/styles)

For more information about the ADC Audiology department and the services we provide patients of all ages,  visit our page or call our office at 512-901-4808.

A sudden sneeze or laughter can cause it to happen.   25 million people in the U.S., 25% of men and 75% of women have it.  What can it be?  Urinary incontinence or loss of bladder control. Too often, people will wait years before seeing a health care provider for incontinence.  But with diagnosis and treatment, urinary incontinence can be controlled and you can get back to doing what you love.

What is Urinary Incontinence?

Essentially, urinary incontinence is loss of bladder control.  Although it is most common in adults over 50, sometimes younger people, like women who have just given birth, may experience leakage. Each individual’s experience is different; some may experience occasional leakage, while others have uncontrolled wetting. The problem can be embarrassing causing people to avoid social situations, family and friends.

Symptoms

Symptoms may vary for each individual, but in general if you experience one of more of the following symptoms, talk to your doctor.

  • Leaking urine on a daily basis.
  • Feeling the need to go urgently or suddenly.
  • You leak urine occasionally when you laugh, sneeze or try to lift an object.
  • You are treating the issue with Kegel or bladder training.

Types of Incontinence

If you think you may have urinary incontinence a visit to your doctor is the first step.   Your provider will diagnose the type of incontinence you may have and offer treatment options. According to the American Academy of Family Practice1, there are five types of urinary incontinence:

  • Stress incontinence
    • Occurs most often in women
    • When pressure on the lower stomach (laughing, coughing or lifting) causes urine to leak.
    • May be caused by a weakened pelvic muscle due to pregnancy and childbirth.
  • Urge incontinence
    • The need to “go” urgently comes on suddenly
    • Often you have only a few seconds or minutes to get to a restroom
    • Common in elderly individuals who may suffer from overactive bladder or an infection
  • Overflow incontinence
    • Often occurs in men
    • Leakage occurs in small amounts
    • Can be caused by a blockage in urine flow due to enlarged prostate or tumor.
    • Diabetes and certain medications may also cause this type of incontinence
  • Functional incontinence
    • Normal urinary function but the individual has other medical or mobility issues which cause a delay in reaching a restroom in time.
  • Mixed incontinence
    • More than one type of incontinence present in an individual

Treatment

There are several treatments for urinary incontinence.  You and your physician will work together to find the best option for your type of incontinence and lifestyle.  Your options may include one or more of the following:

  • Bladder training and/or exercises
  • Medication
  • Surgery

Download ADC’s Urinary Incontinence flyer (PDF) and share with friends or family.  You don’t have to endure loss of bladder control, talk to your internist, family practitioner, ob/gyn or urologist for more information.  

Urinary Incontinence flyer

 

Resources:

How does gestational diabetes affect you and your baby?

Dr. Kiran Mechineni, an Ob/Gyn specialist with The Austin Diagnostic Clinic in North Austin discusses risk factors, its affect on mom and baby and what you can do if you are diagnosed with gestational diabetes.

What is it?

It’s diabetes that occurs in pregnancy. This causes high blood-glucose levels, which can negatively affect the pregnancy and the well-being of the baby.

Risk Factors 

If women eat a lot of carbs, about 50-60% of their diet is carbohydrates, they are at an increased risk. If they are obese and also they have a sedentary life. Those are the risk factors that increase gestational diabetes.

According to the American College of Gynecology, gestational diabetes is more likely in women who

  • are older than 25 years
  • are overweight
  • have had gestational diabetes before
  • have had a very large baby
  • have a close relative with diabetes
  • have had a stillbirth in a previous pregnancy
  • are African American, American Indian, Asian American, Hispanic, Latina, or Pacific Islander

How can it affect my baby and me?

Gestational diabetes can increase the risk of gestational hypertension, preeclampsia and also the babies are big so increased risk of cesarean deliveries or operative deliveries in the women. And, in the baby, they can cause, because there is high sugar levels, the babies grow bigger and they are called macrosomic babies. Also, the fluid around the baby increases, called polyhydramnios, and at the time of delivery, there is increased risk of operative delivery like vacuum, forceps or cesarean deliveries. Also, there is increased risk of unexplained fetal deaths. And after delivery, there is increased risk of the babies having hypoglycemia, jaundice and later on, they may become obese and diabetic too.

What can I do?

Women with gestational diabetes have to change how they eat and they mainly should eat less carbs. Carbohydrates should be around 30-40% of their diet and 20% of protein and 40% of fat. And in the carbs too, they have to eat low glycemic index foods and switch from simple carbs to complex carbs like from white rice to brown rice, quinoa, all those things, oats. From white bread to brown bread, things like that and also increase their fiber intake so that way, the diet is controlled. And also, do moderate exercise.

Resources:

American College of Gynecology (ACOG) Gestational Diabetes Overview

Prevent falls and stay independent

As we age, fall prevention becomes an important part of staying healthy.  According to the National Osteoporosis Foundation, one -third of people over age 65 will experience a fall.  The Centers for Disease Control and Prevention (CDC) reports that each year, 2.8 million people 65 or older are treated in emergency departments for fall injuries 1  In older adults, a fall can limit your independence and mobility; sometimes leading to additional health concerns stemming from inactivity.  In addition, to bruises and pulled muscles, falls may also result in broken bones, making it hard to do things like take a bath or go for a walk.

Fall prevention can help prevent future chronic pain

Research also shows that if you avoid broken bones and injury, especially near a joint like your ankle or wrist, you’re likely to have less chronic arthritis pain as you get older 2, 3. You’ll also be able to get around more easily by yourself.  Individuals at risk for osteoporosis should take fall prevention very seriously and do what they can to strengthen bones through diet, supplements and exercise.  Discussing falls and fall prevention with your primary care doctor or provider is a good first step.  They can help you understand your risks and give you advice on safeguarding against falls.  Ask your doctor about preventing falls at your next visit.

ADC has pulled together some quick tips to help you prevent falls:

Download ADC’s Fall Prevention Flyer (PDF) here or share this post with friends and family.  ADC primary care doctors in internal medicine and family practice will be happy to discuss preventing falls with you.  Call us 24/7 at 512-901-1111 to make an appointment or get established with a primary care provider.

Resources:

 

Here is a list of high fiber foods recommended for good colon health.

Strawberries in

 

High Fiber Grains

  • Bran (wheat or rice)
  • Buckwheat
  • Wheatberries
  • Rye
  • Oats
  • Bulgur
  • Farro
  • Amaranth
  • Whole cornmeal
  • Barley

High Fiber Cereal Products

  • Unprocessed or raw milled bran
  • Wheat bran cereals (All Bran, Bran
  • Buds, Bran, Bran Chex)
  • Mixed grain (Familia)
  • Bran Flakes (Bran, Raisin Bran)
  • Whole wheat flakes (Pep, Wheaties)
  • Grapenuts, Shredded Wheat
  • Long-cooking hot cereals (oatmeal,
  • Ralston, Wheatena, Pettijohn)
  • Crackers (rye, sesame, Triscuits)

Raw Vegetables

  • Cabbage
  • Carrots
  • Cauliflower
  • Celery
  • Cucumbers
  • Lettuce and other salad greens
  • Mushrooms
  • Pickles
  • Okra
  • Olives
  • Onions
  • Pepper, red or green
  • Radishes
  • Spinach
  • Summer Squash
  • Tomatoes

High Fiber Breads

  • Bran bread or muffins
  • Pumpernickel (dark rye)
  • Whole wheat bread

Unrefined Starches

  • Beans and peas, dried, cooked (black-eyed, chick peas, kidney lentil, lima, navy, pinto, red)
  • Brown rice
  • Green peas
  • Parsnips
  • Whole kernel corn
  • Winter squash (acorn, butternut)
  • White potato with skin
  • Yam (sweet potato) with skin

Cooked Vegetables (do not overcook)

  • Artichoke
  • Asparagus
  • Beets
  • Broccoli
  • Brussel sprouts
  • Cabbage
  • Carrots
  • Cauliflower
  • Celery
  • Cucumbers
  • Eggplant
  • Green beans
  • Greens (beet, chard, collard, mustard, spinach, turnip)
  • Pepper, red or green
  • Pumpkin
  • Rutabaga
  • Sauerkraut
  • Squash, summer or zucchini
  • Mushrooms
  • Okra
  • Onions
  • Tomatoes
  • Turnips
  • Wax Beans

Fruits (fresh or frozen)

  • Apple*
  • Apricot*
  • Avocado
  • Banana
  • Berries (blueberries, blackberries, strawberries, raspberries, boysenberries)
  • Cranberries
  • Dried fruits (apples, apricots, currants, dates, figs, prunes, plums, peaches, raisins)
  • Figs*
  • Grapes*
  • Mango
  • Melons (cantaloupe, honeydew, watermelon)
  • Oranges or tangerines (with membranes)
  • Peach*
  • Rhubarb

*Includes the skin which is an excellent source of fiber

Austin Allergies by the Season

Prepare for the next allergy season, by knowing what’s is in the air.  Whether it’s mold, oak or the dreaded cedar allergens in the air, this handy allergy calendar can help you anticipate and get ready for seasonal allergies.

Should you need relief, The Austin Diagnostic Clinic allergy experts can help.  Call 1 (512) 901-1111 or visit ADClinic.com/allergy for more information.

ADC Austin Allergy Calendar

This calendar may be reproduced for educational purposes only. For all other purposes please contact info@adclinic.com for permission to use this image.

eye doctor examines patient

Reduced vision can be a natural part of the aging process, but regular eye exams can prevent many age-related eye problems. In many cases, checkups detect serious eye conditions like glaucoma and macular degeneration that can lead to blindness if they are not treated.

“As we age, we are more likely to develop a wide range of conditions that can damage our eyesight,” says ADC ophthalmologist Thomas Chandler, M.D. “One of the most common is glaucoma. Many people with glaucoma don’t realize they have the disease until they’ve already lost some vision,” adds Dr. Chandler. “Damage to the optic nerve occurs slowly and painlessly, so the first sign may be blind spots that appear in the peripheral vision and move into the central field of vision. By that time, vision is permanently impaired.”

Who should be screened?

Healthy adults over 60 should be screened for glaucoma every one to two years. More frequent screenings may be recommended for people with risk factors such as African ancestry, family history of glaucoma (especially siblings), or increased pressure within the eye. Screenings include a complete evaluation of all risk factors and an examination of the visual field to determine whether damage has occurred to the optic nerve.

While most forms of glaucoma are painless, angle-closure glaucoma causes noticeable symptoms such as blurred vision, severe eye pain, headache, haloes around lights, and nausea and/or vomiting. These symptoms should be reported to your physician at once.

Treatment options

Several treatments are available when glaucoma is detected early. Medication, laser therapy, and surgery may be used to lower pressure in the eye and limit damage to the optic nerve. However, there is no treatment to restore vision lost because of optic nerve damage.

Complications for patients with diabetes

Another common eye problem for seniors is diabetic retinopathy, a complication of diabetes. Diabetic retinopathy, the most common cause of new blindness in adults, is most common in people with untreated diabetes. It also becomes more likely the longer a person has diabetes.

“Many people with diabetes don’t realize the importance of seeing an ophthalmologist in addition to their regular physician,” says Dr. Chandler. “All diabetics should have a yearly dilated retinal exam to screen for diabetic eye complications. The importance of early detection and treatment in preventing blindness caused by diabetes can not be overemphasized.”

Additional age-related eye problems

Cataracts and macular degeneration are also age-related eye problems. Cataracts, the clouding of the eye’s lens, can be removed with a simple outpatient surgical procedure. Macular degeneration is an incurable disease that causes loss of vision from the center out, with peripheral vision usually remaining intact. With proper treatment and low-vision devices, patients can continue most activities.

“Regular eye exams are the key to saving vision,” says Dr. Chandler. “If you haven’t had a checkup in two years, take advantage of this opportunity to schedule an appointment now.”

Do you have a question about what our Travel Clinic can do for you?

Travel Clinic information and questions

Take a look and see if it’s one of the questions we answer frequently.

1. When should I get my vaccines?

The simple answer? As soon as possible.

You should try to schedule your appointment four to six weeks before to traveling if possible. If that’s is not possible, most vaccines need only two weeks to become maximally effective.

2. Is it too late to get vaccinated?

While not optimal, there are still benefits in receiving vaccines before traveling in this situation. At your appointment, the travel nurse will also educate you on avoidance tactics to keep you healthy while traveling.

3. What vaccines do I need?

During your appointment the travel nurse will do a risk assessment for your itinerary. This includes vaccine recommendations and requirements as well as education on non-vaccine preventable diseases.

You can also check out this list from the Centers for Disease Control and Prevention to research risks before your appointment.

4. Do you take my insurance?

There are many different types of insurance plans available, so it’s hard to generalize. The best way to verify vaccine coverage is to call the number listed on your insurance card and ask them if travel vaccines and routine vaccines are covered under you plan. All of our vaccines are coded as preventative care.

Our Travel Clinic contracts with several major insurance carriers, and we can submit your claim for routine vaccines, if we contract with your carrier. You will be responsible for payment of travel vaccines and consultation fees at your appointment time but we can provide you with a claim form and receipt you will need to file for reimbursement directly.  You will be responsible for any charges declined by insurance.

If we are not contracted with your carrier, you will receive an itemized receipt and claim form when you check out that contains the codes you will need to file for reimbursement directly.

Check out our insurance information for the plans we can submit to.

5. How long are appointments?

  • Travel appointments that include education as well as immunizations generally last 45 to 60 minutes.
  • Routine, school or immigration vaccine appointments generally last 15 minutes.
  • Follow-up vaccine appointments usually are no longer than 10 minutes.

6. My whole family is traveling. Can we all come in at the same time?

We try to accommodate families and groups. Give us a call to schedule.

7. If I grew up in the country that I am visiting, will I need immunizations?

Possibly. Immunity to some infectious diseases will decrease the longer you are away from your country of origin. Call us to speak with a nurse about whether you need an appointment.

8. Should I be worried about vaccines if I am not traveling?

Yes! Often times adults do not think about keeping their vaccines current. Call us to see if there are any routine vaccines you might be missing.

Routine vaccines include:

  • Td/Tdap
  • MMR
  • Varicella
  • Hepatitis B
  • Zostavax
  • Pneumovax
  • Influenza

9. What else can I expect?

Our nurses will customize your care based on your individual travel needs.   They will also give advice on food and drink choices to make, medications you should take and how much,  insect repellents that are most effective for protection and much more.

Adjusting your hearing aids for daily use and volume

In this video, ADC Audiologist Janet Davila, AuD, CCC-A explains how to put on your hearing aids and adjust volume.

How to put on your hearing aid

  1. Set the hearing aid or instrument on top of the ear
  2. Insert the dome in your ear
  3. Using your index finger, push (gently) the dome into your ear canal
  4. Flip the anchor or spring upwards to stay flush with your outer ear

When you  look in the mirror the wire should be flush with your skin.

Adjusting Volume Control

Dr. Davila offers this helpful tip to adjust the volume on your hearing aids.  She says to remember that your right instrument raises the volume and your left instrument lowers the volume:

  • Right=Raises volume
  • Left=Lowers volume
  1. Find your volume control button on the back of your hearing aid.  With your index finger give the button a quick tap or push.

Switching to a Saved Program

To switch your hearing instruments to a set program, for example a crowded room setting, follow these directions.

  1. To change from one program to another, hold your volume button down for 1.5 to 2 seconds.
  2. You will hear a beep in each ear when the program has changed.
  3. To return to your previous program, hold the volume button down again for 1.5 to 2 seconds.  You will once again hear the two beeps to indicate the program has been changed.

Does it matter which hearing aid you use to switch to adjust volume or switch to another program?

According to Dr. Davila, it depends on how the buttons on the back are programmed and how big the hearing aids are.  The smaller, mini receiver in the ear aids are ear specific. That is, the button on the right aid turns the volume up for both aids. The left aid button turns the volume down for both aids.

If you have a larger standard sized receiver in the ear, there is a “rocker” switch on the back. Tap the top of the switch and both aids go up, no matter which aid you use. Tap the bottom of the switch and both get softer no matter which aid you use.  Press and hold the top (or bottom) of the switch for two seconds and release it, and the program will change.  It is best to change the program with the right aid though, because it cycles through the programs  as follows; 1 -2 -3 -4, while the left will cycle 4 – 3 – 2 – 1.  Using the right to change programs is more intuitive.

For more information about hearing aids and instruments contact the ADC Audiology department at 512-901-4808.

Did you know ADC’s Audiology department offers free hearing aid cleaning?

If you’re not comfortable cleaning your hearing aids, come by the ADC Audiology department at 12221 MoPac Expwy, 2nd Floor, North Entrance, and we can help you out.  It’s easy, just follow the steps below:

  1. Drop off your hearing aids at the front desk.
  2. Our staff will ask you to complete a form.  Remember to check the box marked, “Please clean my hearing aids.”
  3. Receive a call from our team when your hearing aids are clean or, you may call our office to check.

Please allow 1-2 business days for the cleaning to be completed. For more information about ADC Audiology or any of the services we provide call us at  512-901-4808.

Chicken in caribbean style with pineapple and rice

Make smart food choices to avoid one of the most common travel hazards  – traveler’s diarrhea.

As many as 60 percent of travelers staying several weeks in developing countries will develop what’s sometimes called “Montezuma’s Revenge” or just diarrhea.

How long does it last?

Traveler’s diarrhea is an acute illness that usually lasts three to seven days. There is usually a brief incubation period of 24-48 hours.

If you get sick on the plane home, or as you walk through your front door, you probably let down your food and drink precautions on the last day of your trip.

How can I treat it?

Traveler’s diarrhea is rarely life-threatening. Most diarrheas are self-limiting and require replacement fluids and electrolytes (body salts).  The key is to stay hydrated, especially in tropical climates.

You should begin treatment by drinking:

  • Bottled or canned fruit juices
  • Caffeine-free soft drinks
  • Gatorade
  • Bottled water

You can eat foods that are easily digested, such as:

  • Rice
  • Bananas
  • Gelatin
  • Dry toast
  • Salty broth
  • Saltine crackers

For severe cases, an antibiotic such as Ciprofloxacin may be prescribed. The recommended dosage duration is three days. Travelers should talk to a doctor instead of attempting self-medication if:

  • Diarrhea doesn’t improve within three days
  • Blood and/or mucus is present in the stool
  • Fever occurs with shaking chills

More information

The Austin Diagnostic Travel Clinic also offers vaccines, medicine and information for diseases such as:

  • Yellow Fever
    Occurs in tropical and subtropical regions of Africa and South America
  • Typhoid Fever
    Occurs in many countries including Mexico, Africa, Asia, India, Central and South America
  • Meningoccal Meningitis
    Occurs in Sub-Saharan Africa and Saudi Arabia
  • Hepatitis A and Hepatitis B
    Occurs worldwide
  • Malaria
    Malaria remains the world’s number one infectious disease and the risk to those traveling to countries in the tropics and subtropics is increasing.
  • Dengue Fever
    Worldwide viral disease transmitted by urban mosquitoes

Resources:

CDC Traveler’s Diarrhea

How can you protect your hearing at concerts and events?

We go to outdoor and indoor concerts, attend motor events and sometimes take our kids. And with MP3 players and phones as the most popular option for listening to music, how do you protect hearing for adults and children? ADC Audiologists Janet Davila, AuD, CCC-A and Natalie Rooker, AuD, CCC-A have some great options for you and your child.

Adults

Ear plugs: these simple, yet very effective, foam ear plugs are readily available at grocery stores and pharmacies.
The second type of ear plug has a small stick on the outside for easy insertion and removal. They are typically available at stores, pharmacies and online.

Custom ear plugs: for serious music fans or musicians, ADC audiology can customize filtered ear plugs. You would have molds made for a customized fit, which are then sent to the manufacturer and returned to ADC. These are available in custom colors as well.

Children

Headphones: There are a variety of headphones available online for children.

  • Volume limiting headphones allow parents to set the limit so no matter how high your child turns the volume setting, it won’t go past the set parameter. For older children, volume limiting earbuds are available in a variety of colors as well.
  • Noise-cancelling headphones are a great choice for the parent who wants to bring their child to a concert or event where they may be exposed to loud noises over an extended period of time. The noise-cancelling headphones block out sound and are available in many sizes from infant to child to adult.

How do you know when loud is too loud?

Dr. Davila recommends that parents educate themselves and their children about how loud is too loud. The website, DangerousDecibles.org,  is a virutal exhibit that teaches children of all ages (and adults) the levels of loudness that are most dangerous and how to avoid them.

The ADC Audiology department sees patients of all ages and provides services from infant and child hearing screenings to adult ear cleanings, testing and fitting for hearing devices. If your concerned about your or your child’s hearing, please contact the ADC Audiology department at 512-901-1111 or complete the appointment request below.

Request Appointment

Use this form to request an appointment with one of our doctors or providers.
  • Please note effective Dec 31, 2017, ADC will terminate plan participation with Ambetter & Sendero IdealCare. At this time we are no longer scheduling new patients with these plans.
  • This field is for validation purposes and should be left unchanged.

There is an osteoporosis crisis in the US with up to 50 million people at risk for fractures. ADC osteoporosis specialist Michele McDermott, MD visited the KXAN studios to speak to Gigi Barnett about this disease.  As Gigi states, “we talk about heart disease and cancer, but no one talks about what happens when your bones cannot keep you upright”.   Dr. McDermott agrees by saying many people are unaware of fractures or fracture risk until they begin to lose height.

Know your risk factors

Dr. McDermott lists the following as risk factors for osteoporois:

  • Being a woman
  • Age
  • Smoker
  • Not getting enough calcium and vitamin D in your diet
  • Family history of hip or vertebral fracture

Bone density is key to bone strength.   When the bone density is weakened, bone strength and structure is lost. For women, since estrogen regulates the remodeling of bones, it makes sense that after menopause, the body loses that ability to remodel bone.

Medications

There are two types of treatments for osteoporosis:

  • Antiresorptive drugs
  • Bone building drugs

Dr. McDermott says she comes across many patients who are fearful of taking these drugs due to side effects.  She states the side effects are rare, but fractures are not.   She encourages patients to speak to their doctors and get the facts about these medications and treatments.

Recommendations for good bone health

  • Exercise – weight bearing exercises are great for building & maintaining bone strength
  • Get your daily dose of Calcium (1200mg) and Vitamin D (800-1000 IUs)
  • Limit alcohol intake
  • No smoking
  • If you have a family history visit your doctor to get a bone density screening

Resources:

woman sleeping

  • Go to bed and awaken at the same time every night. It is especially important to always get up at the same time no matter what time you go to sleep. Also, don’t sleep for an extended period of time trying to catch up on your sleep on weekends. Get adequate amounts of sleep every night.
  • Don’t nap.
  • Avoid caffeine completely for at least six hours before bed. Caffeine disturbs sleep even in those who think it does not.
  • Avoid alcohol before sleep. Alcohol may decrease the time it takes to fall asleep, but it will cause frequent awakenings and increase the risk of sleep apnea.
  • Avoid cigarettes before sleep. Nicotine acts as a stimulant.
  • Get moderate exercise regularly. Do not exercise within a few hours of bedtime. This will cause you to have trouble sleeping.
  • Sleep in an atmosphere conducive to sleep: dark, quiet, not too cold or too hot, good mattress, etc. This includes avoiding watching TV and listening to music to fall asleep. If your partner snores or moves frequently in their sleep have them see a doctor to determine if they have a sleep disorder that needs treatment.
  • Do not read, study, eat, watch TV or do other unrelated activities in bed. If you can’t sleep, go into another room and do something relaxing. Try again to sleep a little later. Laying in bed and getting upset and frustrated will not help you fall asleep.
  • Don’t engage in exciting or emotionally upsetting activities too close to bedtime.
  • If you are a bedtime worrier and use your time in bed to worry about tomorrow, plan, reminisce or think, you should try to set aside a time to do these activities. About 15 minutes to an hour before bed write down all your problems and solutions. This helps clear your mind for sleep.
  • Don’t engage in activities that require high levels of concentration before bed.

Expect the unexpected

When traveling internationally, it’s best to prepare yourself for every possible situation.

Before you leave, contact your own insurance company regarding your coverage.

If you need medical care, the American Embassy or Consulate can usually provide names of hospitals, physicians, or emergency medical service agencies.

Be pro-active

Take steps to minimize the risk of injury and establish a plan for dealing with medical emergencies.

If you have chronic medical conditions or you take prescription medications, you should always carry enough to carry you through your trip.

It’s also a good idea to carry a signed and dated statement from your physician indicating any major health problem in case of emergency. You’ll also need your International Certificate of Vaccination.

Because of the variable quality of health care services abroad, hospitalization and treatment may be associated with an increased risk of disease or infection.

What can you expect at your first Travel Clinic appointment?

Your initial visit will take about an hour. Our nursing staff will review your

  • Travel itinerary
  • Accommodations
  • Length of stay
  • Departure date
  • Previous immunizations

They will also review your general health history and recommend appropriate precautions and vaccinations.

On your first visit you will also be given an International Certificate of Vaccination. This document is approved by the World Health Organization as verification that proper procedures were followed in administering vaccines for foreign travel.

An International Certificate of Vaccination records:

  • Date and dose of all vaccinations received for foreign travel
  • Medical exemption from receipt of required vaccinations
  • Personal health history
  • Drug allergies
  • Current medications
  • Prescriptions for eyeglasses and contact lenses

The document will be updated by our Travel Clinic staff at all following visits.

We also provide a weekly updated computerized report, compiled by the World Health Organization, the Center for Disease Control and Prevention, and the US Department of State. This report provides you with the latest news on health related issues, environmental hazards, assessment of terrorism threat, and Embassy and consulate information.

Close up of washed baby spinach

Dietary fiber (or roughage) is the undigestible portion of plants. Fiber is usually found in the seeds, fruits, roots, stems, flowers and leaves of plants. There are two kinds of fiber: soluble and insoluble fiber. Soluble fiber lowers cholesterol and fiber, in general, provides satiety.

Fiber totally lacks nutrients and contains no calories for energy, but it does have an important function. Increasing fiber and fluids in the diet creates larger, softer stools resulting in greater distention of the bowel. This causes the colon to contract more and propel its contents more quickly. The larger stool volume reduces pain and cramping.

The High Fiber Eating Plan

Eat adequate amounts of foods which are high in fiber.

Include at least:

  • 3 to 4 servings of high fiber breads, cereals, and starches
  • 2 to 3 servings of high fiber vegetables
  • 2 to 3 servings of high fiber fruits

Whole grain breads and cereals and wheat bran are the major sources of dietary fiber and appear to have a greater laxative effect than fruits and vegetables. To achieve frequent bowel movements without straining, it may be necessary to increase the amount of fiber by adding milled or unprocessed bran to the diet. The amount of bran required must be determined by trial and error.

Unprocessed bran can be added to the diet by mixing in soup or milk or by sprinkling on cereal and other foods. It can be added to products such as meat loaf, meat patties, muffins, pancakes, breads and rolls. Unprocessed bran may cause distention and increased gas formation, but this generally disappears as the patient adjusts to the diet.

Drink at least 2.5 quarts (10 cups) of fluid each day.

Too little fluid in the high fiber diet may cause dehydration and lead to constipation. It is essential to drink large quantities of water when consuming large amounts of unprocessed bran.

Select additional foods to complete a balanced diet.

  • 4 to 5 ounces of meat, poultry, fish, cheese or eggs
  • 2 cups of milk or servings of dairy products (yogurt, cheese)

Eat three meals each day.

Pre-Visit Laboratory and/or Imaging Testing:

  • To improve patient care, we will require that all ordered laboratory or imaging tests be completed before upcoming appointments with Endocrinology. If you are unable to complete the required lab or imaging tests prior to your visit, you may be asked to reschedule your appointment.
  • The reason we ask these to be completed is to provide more meaningful and seamless care by giving you and your provider the opportunity to review all relevant information and to adjust therapies at a face-to-face visit.

Medication Refill Requests:

  • To ensure that prescriptions are filled accurately and efficiently, we have implemented the following prescription policy:
  • Prescription refill requests are not accepted over the phone, with limited exceptions as in the case of a change in dosage or change in pharmacy. If you need a refill between office visits, please have your pharmacy contact us directly.
  • Prior to your scheduled office visit, please look over all your medications, to determine if you need to request refills during your visit.
  • All medications will require regular follow-up visits at intervals to be determined by your provider. You should receive refills of your medications at each visit that will last until you are due to return. If you are overdue for your visit, your provider will provide enough medication to last until your scheduled appointment (maximum 30-day supply). This courtesy refill is at the discretion of the provider and does not apply to all medications.

Pediatric flu shots

Flu shots are recommended for children 6 months and older.   Flu shots will be given beginning in September.  All ADC influenza vaccine is preservative free (no thimerosal). Please note, The American Academy of Pediatrics (AAP) and Advisory Committee of Immunization Practices (ACIP) have recommended to NOT use Flumist this year due to its ineffectiveness and failure to provide adequate protection for influenza. Parents should call their pediatrician’s office for specific flu immunization availability for private insurance and Self-Pay/Seton CHIPs/ Superior.

Pediatric flu shots are available during clinic hours by appointment at these locations.   Call 512-901-1111 to schedule shots.

  • ADC Cedar Bend  (see graphic below for after-hours flu shot clinic)
  • ADC Cedar Park (established ADC pediatric patients may walk-in at Cedar Park)
  • ADC Circle C (established ADC pediatric patients may walk-in at Circle C Tuesday – Friday from 8:oo am to 4:30 pm)
  • ADC Steiner Ranch

 

Resources:

Guide to Patient Satisfaction Surveys and Ratings

The Austin Diagnostic Clinic values the relationships we have with our patients and their loved ones. As part of our commitment to you, we now post our physicians’ patient satisfaction ratings online.

To assist you, we’ve developed this guide to help patients, family members and those considering appointments with The Austin Diagnostic Clinic physicians understand how we capture and report our patient experience ratings.

About The National Research Corporation (NRC) Survey

The Austin Diagnostic Clinic is focused on providing an exceptional experience in every care interaction. We measure all aspects of patient satisfaction. In order to ensure that we are holding ourselves to the highest standards, we partnered with National Research Corporation(NRC), an independent, third party patient satisfaction company. NRC provides the technology to display ratings and comments on our physician profile pages. All ratings are submitted by actual patients and verified by NRC.

Who Receives the Survey?

The survey is mailed to randomly selected Austin Diagnostic Clinic patients within a few days following their appointments. Patients are asked to complete the survey and provide comments regarding specific aspects of care. We use this feedback to improve and enhance the care we offer.

Do You Post All Comments?

The Austin Diagnostic Clinic is committed to transparency. That means posting all relevant feedback – whether it’s positive or negative. However, we do not post comments that are libelous, profane, or those that risk the privacy of our patients. Every provider rating  published regardless of comment status.

What Questions Do We Ask?

The Austin Diagnostic Clinic utilizes the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group Practice survey, which was developed by the Agency for Healthcare Research and Quality for use in hospitals and medical practices across the country. The surveys ask patients to evaluate how well their physician communicated, listened, and showed courtesy and respect toward them. Results are used to evaluate patients’ overall perception of care and to identify areas for improvement.

We calculate our star ratings based on responses to the below questions from the CG-CAHPS survey.

Physician Communication Questions

  • Did this provider explain things in a way that was easy to understand?
  • Did this provider listen carefully to you?
  • Did this provider give you easy to understand instructions about taking care of these health problems or concerns?
  • Did this provider seem to know the important information about your medical history?
  • Did this provider show respect for what you had to say?
  • Did this provider spend enough time with you?

Overall Rating Question

  • Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate this provider?

Why Don’t We See Patient Ratings and Comments for Every Doctor or Provider?

Industry best practice is clear that more data provides a more accurate picture. That’s why we require a minimum of 30 completed patient surveys per doctor before we post a physician’s rating. Over time, with more surveys received on an ongoing basis, the number of rated physicians will increase.

Why Don’t We See Patient Ratings For Every Speciality?

Some of ADC’s services are not included in the National Research Corporation survey, however, if you wish to share feedback about your visit, we’d love to hear from you. Visit our Feedback page and let us know how we are doing: https://www.adclinic.com/contact/how-are-we-doing/#.WOJO1jsrI_U.

A physician’s rating will only be posted on the site when he/she has a minimum of 30 completed surveys.

Can anyone complete a survey or post a comment about a physician?

No. Only patients having an outpatient visit by an ADC physician may be selected to receive a survey. The results are based entirely from patients who have actually been treated by the physician.

 How is patient information protected?

Patient names are not displayed through the online ratings and commentary reviews. All personally identifiable information is removed prior to display.

What is Psoriasis? 

Psoriasis on elbow

Source: Thinkstock

Psoriasis is a chronic skin condition which affects approximately 7.5 million people in the United States alone.  It is a chronic, inflammatory condition affecting the skin, nails, and joints, but the cause of it is due to specific changes in the immune system.  In a nutshell, faulty genetic signals (and sometimes other triggers) program the immune system to send white blood cells into the skin and joints.  These cells produce substances which cause inflammation (often resulting in redness, thickening, itching or burning in the skin); these substances also tell the skin cells to grow too quickly and to pile up on the surface of the skin, rather than being shed (causing red, thickened, and scaly spots on the skin).  Likewise, these cells may also cause pain, swelling, and sometimes destruction of joints, termed psoriatic arthritis.  Despite its characteristic appearance, psoriasis is not contagious.

Psoriasis occurs in all age groups, but predominantly in adults. It most commonly develops between 15 to 30 years of age; it may also begin between 50-60 years.  Caucasians are more affected than other ethnicities, but it may still occur in the other races as well.  Many people with psoriasis have family members who also have psoriasis, but scientists have shown that not everyone who inherits the genes for psoriasis will actually get the disease.  A person may have to inherit the “right” combination of genes.  After inheriting , the affected person needs exposure to a trigger for the skin and joint lesions to develop.   Eighty percent of those affected have mild to moderate skin involvement, while 20% have moderate to severe disease, involving 5% or more of the skin’s surface area.  Additionally, psoriatic arthritis may affect up to 40% of patients with psoriasis.  The psoriasis skin disease precedes the arthritis in 60-80% of those affected, while in 15-20%, the arthritis may manifest first.  The onset of both may be simultaneous as well.

Several conditions may trigger psoriasis lesions to develop.  These include trauma to the skin, such as a cut, scratch, or even a severe sunburn; cold, dry weather; strep throat or viral infection; a stressful event (physical or emotional); and finally, taking certain medications such as those that prevent malaria, or lithium.  Psoriasis may itch or burn, causing the urge to scratch.  Scratching or picking may worsen the psoriasis, make it thicker, and may even cause hair loss.

There are several types of psoriasis:

  • Plaque – large, red, thick/raised, scaly lesions on the skin (called plaques) occur. These are most common on the elbows, knees, lower back, and scalp, but can occur anywhere on the body.  This is the type that most often involves the nails, but not in all patients.
  • Guttate – small, red, sometimes scaly spots usually occur on the trunk, arms, and legs, but again, may occur anywhere on the body. This type often erupts after an illness, such as strep throat, and may resolve in weeks to months.
  • Inverse – red, moist, raw patches of skin develop in fold, where skin touches skin, such as armpits, groin, buttocks, under the breasts, or on the genitals. The skin is irritated and sometimes painful in these areas.
  • Pustular – red, swollen, painful skin with pus-filled bumps (called pustules) develop, most often on the palms and soles. These pustules will burst and dry, leaving brown dots or scale afterwards.  Patients with an eruption of pustular psoriasis may also feel sick and exhausted, may have fever, chills, severe itching, skin pain, rapid pulse, and sometimes even weakness.
  • Erythrodermic – bright red, itchy, or tender skin on most or all of the body surface. This is the most serious type of psoriasis.  The skin has a burned appearance, and the body is unable to maintain normal body temperature.  They may also lose fluids through the skin.  This form may be life-threatening, and if extensive, should prompt referral of the patient to the hospital immediately.

How is it diagnosed? 

A dermatologist will first do a physical examination of the skin, nails, and scalp.  He or she will ask about family members having psoriasis, about recent stressors or illnesses, about medications (both oral and topical), and about joint pains.  Sometimes the doctor will take a bit of skin to confirm the diagnosis, although this is not always necessary.

Is psoriasis life-threatening?

In most cases, psoriasis is not life-threatening.  However, there are some other diseases or conditions associated with psoriasis that patients should be aware of.  Persons with psoriasis may be at an increased risk for heart and blood vessel disease, stroke, Type II diabetes, high blood pressure, obesity and metabolic syndrome , inflammatory bowel disease (such as Crohn’s disease or ulcerative colitis), and lymphoma (a blood cancer that can affect the skin).  Psoriasis is also associated with smoking, alcohol use, depression, and suicide.  Studies show that psoriasis patients may experience emotional and physical distress on a level similar to those with diabetes, cancer, arthritis, and heart disease.

How is it treated?

There are many treatment options available.  Research over the past 10-15 years has resulted in many newer treatment options, providing better relief and quality of life for those affected.

  • Topical treatments – these treatments are helpful for localized or mild to moderate psoriasis, but are not likely to be helpful for more severe or widespread cases. These include topical corticosteroids, Vitamin D derivatives, coal tar, anthralin, salicylic acid, tazarotene, and moisturizers.  These are applied directly to the psoriasis lesions as directed by the physician.  There are various strengths and formulations available in addition to the traditional creams and ointments: solutions, oils, foams, tapes, and sprays are now available.
  • Phototherapy/laser – such therapies use ultraviolet light (UVA or UVB) to improve psoriasis, especially when widespread or in difficult to treat areas, such as scalp or hands and feet. These methods are monitored and strictly dosed to minimize burning and maximize response.  It is not recommended to attempt using tanning booths to achieve the same effect; without proper training and experience, the risks of burning and blistering are higher, which can actually worsen the psoriasis, and can drastically increase one’s risk for skin cancers, especially melanoma, which may be deadly.  Natural sunlight, on the other hand, may be helpful, when done according to doctor’s orders.
  • Traditional systemic therapies – these are medications that are generally taken orally, such as acitretin, cyclosporine, methotrexate, and apremilast. It is important to note that all medications have side effects, and that most of these in particular will require frequent visits and blood testing to monitor for these adverse events.  Though most patients tolerate them quite well, some of the side effects can be serious, and it is critical that patients adhere to physician’s instructions so as to identify them early if they occur.  But if handled correctly, these medications can work quite well for some patients, without needing to apply topical medications to a large surface area.
  • Biologics – this is a newer class of medications that has emerged over the last 15-20 years. These therapies target specific points in the immune system that are involved in the mechanism of psoriasis.  These are generally given by self-injection or intravenously (IV).  Although most patients tolerate these well, monitoring for potential serious adverse effects is critical with these medications as well.
  • Non-drug treatments – these may help in combination with other therapies listed above to manage the lesions of psoriasis and minimize the symptoms. UV treatments from natural sunlight are mentioned above.  Others include stress reduction, biofeedback, seabathing, moisturizers and anti-itch treatments, and wet-wraps, to name a few.

Where do I start? 

Studies have shown that psoriasis may significantly impact a person’s abilities physically, emotionally, and socially, thereby affecting their overall quality of life.  The disability may be equivalent to or exceed that of patients with cancer, arthritis, depression, heart disease, or diabetes.  Depression and suicide, smoking, and alcohol consumption are all more common in psoriasis patients.  Treatments should be aimed not only at reducing the visual aspect of the disease, but also at improving one’s quality of life.  A couple of good resources for more information include the American Academy of Dermatology website (www.aad.org) and the National Psoriasis Foundation website (www.psoriasis.org).  These websites contain a wealth of medical information, links to other resources, information on support groups, and updates on new therapies and clinical trials.   You should also visit your dermatologist, who will discuss with you your treatment options and assist you in navigating your management course.   With the myriad of exciting options available today, it is possible to improve not only the visual aspects of your condition, but also lend a sunnier outlook as well.


Dr. Melody Vander Straten is a board certified dermatologist practicing at ADC Steiner Ranch.  She welcomes teen and adult patients to her practice.  Call 512-681-5900 for more information or to make an appointment.

ADC’s Menopause and Osteoporosis Center have assembled information about menopause and perimenopause resources for you.   Please take some time to explore and share these resources.

Perimenopause

Menopause

North American Menopause Society websitehttp://www.menopause.org/for-women

MenoNotes

The Menopause and Osteoporosis center have compiled some helpful resources for you.  From infographics, to articles, to good food sources for calcium.  It’s all here:

Infographics

25 . . . .

Guides

Articles

Exercises

Resources:

National Osteoporosis Foundation

Perimenopause– Questions & Answers

What is perimenopause?

Perimenopause is the time “around” menopause.  It begins in the late reproductive years when women begin having irregular menses and lasts until 1 year after the final menstrual period.  Since the average age of menopause is 51, it can start as early as the late 30’s.

How long does it last? 

All women are different.  Some women hardly notice it, while other women may have symptoms off and on for 8-10 years.

What sort of symptoms does it cause? 

All women are different.  The menstrual changes are the hallmark symptom (90% of women have irregular menses for 4-8 yrs.).  In general, menses tend to get a little closer together before women start skipping them.  Menses can be heavier or longer & can vary from month to month.  Also, any of the menopausal symptoms can occur (such as hot flashes, mood swings, migraines, etc.).  In general, in the early stages of perimenopause, the signs of not enough estrogen (hot flashes, migraines, vaginal dryness, and sleep problems) tend to occur from the day prior to the menses to the end of bleeding and the signs of progesterone “imbalance” (mood swings, depression) tend to be worst during the 10-14 days prior to the menses.

Can I still get pregnant?

Yes, although the chances decline, it is still possible.  Women who want to conceive may need to see a fertility specialist.  Women who do not desire a pregnancy should continue to use some form of birth control until 1 year after the final menses.

woman checking Calender on phone

Source: Thinkstock

How do I know if I am in perimenopause?

The most reliable thing is a menstrual chart, with start & stop dates.  Blood tests can be done on menstrual Cycle Day 2 or 3, but since every month is different, this is rarely helpful.  They can be helpful for women who have had a hysterectomy or a uterine ablation or for women who are considering pregnancy.

Should I get my hormones balanced?

It is impossible to “balance” female hormones prior to menopause.  Since the female menstrual cycle is due to the egg growing and releasing and the uterus preparing to receive a baby, the levels of hormones change daily throughout the month.  Some months, the egg may be hard to stimulate or there may not be any ovulation at all.  There is also no “ideal” hormone range to achieve.

What treatment options do I have?

Since this is a natural process, it is not necessary to treat it, unless the symptoms are interfering with your life.  Heavy bleeding can be treated with progesterone, birth control pills, ring, or progesterone only IUD.  If those options don’t work, a uterine ablation (burning or freezing the lining of the uterus) or hysterectomy (removal of the uterus) can be performed.  Birth control pills, ring, or IUD can provide birth control and regulate periods.  The symptoms of low estrogen can be treated with a very low dose of estrogen, either daily or during the menses.  The mood swings and depression can be treated with an antidepressant, either daily or during the premenstrual time.  When the menses become very irregular, this is harder to predict, so we frequently use daily medications.  For mild symptoms, some women are helped by over the counter medications like black cohosh or phytoestrogens (plant based estrogens like soy products).

How do I know if my bleeding is normal or not?

Contact a doctor if you have very heavy menses (soaking a super pad every hour), heavy bleeding lasting more than 7 days or entire menses (including spotting) lasting 14 days, frequent bleeding (closer than 21 days from the start date to the next start date), spotting between menses, or bleeding after sexual intercourse.

What about weight gain and lack of interest in sex?

Weight gain is not directly related to female hormones and this is not changed by taking hormones.  It is related to changes in metabolism that are age related and to the disrupted sleep.  Lack of interest in sex is rarely related to female hormones (unless pain is involved).  It is related more to fatigue and lifestyle issues that can occur at this time of life.

About the author: Patricia Gunter, MD is a menopause specialist at The Austin Diagnostic Clinic certified by the North American Menopause Society.   She practices at ADC North and is accepting new patients.  To make an appointment call 512-901-1111.

Pregnant woman making a heart with hands

Source: Thinkstock

Prenatal Care

When you’re expecting, regular prenatal visits can ensure your pregnancy is progressing as it should and that your growing little one is developing as appropriate so you can welcome him or her in nine months.

One of the most exciting prenatal visits is the first one. This usually doesn’t happen quite as fast as you may think. When you have taken a positive pregnancy test, call your obstetrician to let him or her know that you are expecting. Your doctor will typically recommend making an appointment when you are about eight weeks’ pregnant or eight weeks after the first day of your last menstrual period. If you’re unsure when that time would be or if you have had pregnancy complications in the past, your doctor may have you come in earlier.

The Eight-Week Visit

While the average first trimester visit can vary, there are a few typical events that can occur during the first visit. These include:

Taking your health history.

Your doctor will use the first day of your last period to estimate your baby’s due date. You’ll also need to disclose any chronic health conditions you may have, medications you currently take, and any past surgeries or hospital stays you may have had.

Educating on healthy steps to take.

The first trimester is often the most pivotal time in a baby’s development. For this reason, your doctor will discuss with you important healthy practices to follow. These include avoiding smoking and drinking alcohol as well as refraining from taking many medications known to harm developing babies.

Your doctor will also talk about pregnancy symptoms and what to expect during the remainder of your first trimester. He or she will review symptoms you should call your doctor if you experience. This is a good time to ask your doctor any questions about pregnancy issues, such as morning sickness.

Taking blood tests.

A number of blood tests are available to test for genetic disorders in your baby. Some of these can happen as early as 10 to 12 weeks. While they aren’t always done as a rule, your doctor may recommend them if you have a history of genetic disorders in your family.

Your doctor will draw your blood to test for the following:

  • Your blood type
  • Your hemoglobin level
  • Testing for the presence of certain medical conditions, such as hepatitis B and syphilis.

Conducting Imaging Studies

Your doctor may use imaging technologies to help you hear and/or visualize your baby. An example is an ultrasound. An ultrasound provides a two-dimensional (flat) image of your baby. While your baby is developing arm and leg buds at this time, later ultrasounds will likely reveal images that look more like a baby. Your doctor may also use a Doppler device to allow you to listen to your baby’s heartbeat. This is a special moment that can start to make your pregnancy feel even more “real.”

After this visit, you’ll return in about a month to see more of your growing baby.

The Austin Diagnostic Clinic is proud to provide obstetric care to expectant moms. For more information about our services or Dr. Matthew Romberg, please visit ADC Obstetrics and Gynecology or call (512) 901-1111.