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Smoothie your way to health?

Whether you’re on a health kick or just looking for a way to cool off this summer, a smoothie seems like a great way to do it, right?! Well, maybe. Primary care physicians often see diabetic patients in their daily practice, and I’ve recently encountered several patients with sudden increases in their blood sugar readings. Part of the fun as a primary care doctor is that we are typically the first ones to see a patient with a new problem. That means a lot of detective work to help uncover the cause of a given problem. So, in the case of my diabetic patient with high sugar levels, I often start by asking the most basic question. What are you eating that’s different lately? To my surprise, I’ve had three different cases where smoothies were the answer! What could be bad about fruit and vegetables blended up into a cool treat? Alas, these delicious beverages can still pack a caloric punch. Does that mean it is to be crossed off of the list? Of course not! I teamed up with registered dietitian Brittany Goldman of Blue Ridge Orthopaedic & Spine Center to give you some guidance. Here are some things to consider the next time you decide to blend up a drink.



Smoothies pack significantly more calories than the average beverage, so they are great as meal replacements. I recently walked into a smoothie shop that also serves food and realized that many people order a sandwich and have a smoothie as their beverage. Given that even the lightest sandwich can often have 300 calories, the addition of a smoothie can add 200-500 calories, making what seems like a light lunch actually count for 1/3 to 1/2 of your caloric need! Logging food intake is often employed when trying to manage weight or sugar as a means of estimating total daily carbohydrates for blood sugar control. I recommend requesting a copy of the nutrition guide to help guide your choices. (Need a food log? My personal favorite is myfitnesspal, which has smartphone applications and is also web-based).



Many commercial smoothie shops actually ADD sugar to the fruit in the smoothie. However, a savvy customer can request no added sugar. Feeling like it’s not sweet enough? Artificial sweeteners can be used, but exercise caution as some studies suggest many artificial sweeteners can be associated with weight gain. Stevia is a natural no calorie sweetener that can be used. Other no calorie “natural sweetener” includes monkfruit. Both of these are available in most grocery stores. Honey, agave nectar, molasses, and coconut sugar are often marketed as “low glycemic index” sweeteners, leading many to believe they are safer to use than sugar. While these options are less processed than white, granulated sugar, they still have calories! I like to add spices such as cinnamon and ginger to help give more sweet flavor without calories. Cinnamon is an excellent choice because it helps with glycemic control.



Whole fruit is recommended as your sugar source since it has fiber to help regulate the way sugar levels spike in the body. Also important to remember is that the peel of many fruits is where many nutrients can be found, so make sure to buy organic when possible and wash fruits well to reduce pesticide intake. For more information on that, visit



Additional fiber in your smoothie can come from vegetables. While kale based smoothies are all the rage, I recommend starting with a less bitter green, such as baby spinach, until your taste buds acclimate to the green taste. One of my colleagues used to blend unsweetened frozen berries and baby spinach each morning. Other options include celery, carrots, and beets. I sometimes also use a little bit of avocado for texture, but remember this is high in fat.



Another way to keep your sugar level stable when having your smoothie is to incorporate a quality protein source. Protein will help your smoothie keep you full longer. Some protein choices include plain Greek yogurt (nonfat or lowfat), 1 tbsp of natural almond or peanut butter (avoid commercial brands that have added sugars and hydrogenated oils), or protein powders. When choosing a protein powder, be sure to check the label to see if there are added sugars. I used an unflavored whey concentrate, which saves 30-40 calories per serving since it’s unflavored! Plus, I can add that to any base and not worry about whether the flavors match. Other protein powders include pea or hemp protein. Use care if choosing soy protein as it contains plant based estrogens, be sure to ask your doctor for guidance.



Seeds – Flax and Chia seeds are popular, but be sure to use ground flax seed in order to harvest the most omega 3 benefit. Chia seeds are also a good source of fiber and omega 3 and do not have to be ground.

Who knew so much could go into a smoothie? Whatever you choose to put into your smoothie, I recommend adding the individual components up to see your net calorie/carb/fat/protein intake. This will help guide you to your perfect smoothie recipe. Remember that using a lot of fruits in the smoothie can often mean more than 1 serving of fruit per smoothie. Making smoothies in batches is often helpful for those of us always on the go. I usually make two smoothies per recipe.

If you are looking at making any major dietary change, consult with your doctor or a nutritionist to make sure you’re on the right path.


Trouble Sleeping?


Sleep is vital to a bodies overall well-being and does not include relaxing or taking a break from everyday routines.  Ample sleep also may play a part in helping our bodies recuperate from sickness and injury.  Continuous lack of sleep is associated with obesity, heart disease, depression and diabetes.

Adequate sleep is very important for emotional and mental well-being.  If you suffer occasionally from sleep problems you may show signs of stress and be less productive in normal routine tasks.  People with ongoing insomnia are more likely to develop psychiatric problems.  In a recent survey, those who had trouble getting enough sleep described the inability to perform the following tasks:

  • Memory
  • Learning
  • Logical reasoning
  • Mathematical calculation


Inadequate sleep is thought to be a factor in strained relationships and unfulfilled potential at work, and overall is quite dangerous as it can lead to serious or possibly fatal accidents.  Think about these facts from the National Sleep Foundation:

  • Sleep problems get worse with aging.
  • Lack of productivity and health care expenses cost approximately 100 billion dollars annually.
  • Sleep deprived drivers are the cause of at least 100,000 police reported accidents a year.
  • 40 million Americans report having difficulty sleeping.

How much sleep do you really need?

Sleep requirements are not the same for everyone; usually most healthy adults need no more than seven to nine hours of sleep a night.  If you experience any of the following symptoms, you may need additional sleep, or a better quality of sleep, than you are receiving:

  • Trouble staying alert during monotonous or boring activities
  • Irritable feelings
  • Trouble concentrating or remembering facts

Types of Sleep Disorders

Disorders of sleeping and waking hamper with quality of life and overall health.  These problems range from staying awake or having a normal sleep/wake cycle to sleepwalking, bed wetting, nightmares, insomnia, restless leg syndrome, snoring and sleep apnea.

If you suffer with a sleep disorder there is help.  Talk with your doctor about which sleep disorder program is right for you.  If you have questions regarding sleep disorders please contact the specialists of Dominion Internal Medicine @ 540-878-5408 or visit us at www.dominioninternalmedicine.comMost insurances accepted

Compassionate Care for a Healthy Heart, Body and Mind

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Most of us consume around 6 to 18 grams (equivalent to 1 to 3 teaspoons) of salt every day.  If you have been diagnosed with diabetes it’s important to limit your sodium intake to help prevent or control high blood pressure.

Recommendations by the U.S. Department of Agriculture suggest limiting your sodium consumption to less than 2,300 mg a day.  The AHA (American Heart Association) takes a more cautious approach and recommends no more than 1,500 mg a day.

How do you measure sodium?

  • 28 grams = one ounce
  • 1 gram = 1,000 milligrams
  • 5.5 grams of sodium = 1 teaspoon

High sodium foods

Although most foods include sodium the majority of sodium is added during the processing of prepared and prepackaged food products.  Here are some examples:

  • Meats – Bacon, breakfast sausage, ham, cold cuts (bologna), Canadian bacon, corned beef, hot dogs, Polish and Italian sausages
  • Fish –  Canned tuna, salmon, sardines; commercially frozen, prebreaded, or smoked fish; canned shellfish
  • Canned foods – Vegetables, soups, vegetable and tomato juices
  • Prepared or premixed products – Boxed macaroni and cheese, potato mixes, TV dinners, frozen entrees
  • Snacks – Salted crackers, pretzels, potato chips, commercially-prepared baked goods (for example, cookies and doughnuts)
  • Other foods, such as olives, pickles, commercially-prepared salad dressings, soy and steak sauces, cheeses

There are many tasty alternatives now available with lower sodium content.  Try adding fresh spices and herbs for a tasty surprise!  Salt substitutes are also available.  When you purchase food items, don’t forget to look for NA or NACl, or sodium or sodium chloride on the label.  This will indicate sodium is in the food and will give you an accurate measurement.

For more information and tips on how you can manage diabetes and sodium in your diet, please contact the expert physicians of Dominion Internal Medicine at (540) 878-5408 or visit  Most insurances accepted and Dominion Internal Medicine is now accepting new patients!


 Compassionate Care for a Healthy Heart, Body, and Mind

Are you having a Medical Emergency?



How do you know when you have a medical emergency?  According to the American College of Physicians (ACEP), these 12 signs require immediate medical attention.

Emergency symptoms –

  • Unexpected or severe pain (Any)
  • Uncontrolled bleeding
  • Trouble catching breath or breathing difficulty
  • Vomiting or coughing blood
  • Vision changes
  • Chest pain or pressure lasting longer than two minutes
  • Fainting, sudden dizziness, weakness
  • Problems speaking
  • Suicidal or homicidal feelings
  • Unusual pain in the abdominal pain

Other symptoms to be on the lookout for –

  • Blood in the urine – Blood in the urine can be a sign of a bladder infection or something much more serious such as a kidney stone or a malignancy.
  • Rectal bleeding – Blood in the stool is commonly associated with hemorrhoids.  However, blood in the stool can also be caused by an active ulcer or colon cancer.
  • Abnormal sores, lumps or lesions – Keep your eyes out for sores that are irritated or moles that change size, have unusual shapes, or change color.

If you experience emergent symptoms please seek medical attention immediately.  If you have other symptoms that may not require emergent treatments please don’t ignore them.  Your doctor will perform a variety of health assessments and tests to determine the underlying cause.  Please contact the office of Dominion Internal Medicine today @ 540.878-5408 if you are seeking answers to your medical questions.  We can help!  Most insurances are accepted!

Compassionate Care for a Healthy Heart, Body, and Mind


Lyme Disease



Summer is here.  While we begin to enjoy the beauty of spring, we need to protect ourselves from Lyme disease.  Lyme disease is a bacterial infection that is spread by black legged ticks.  In this article from The Center for Disease Control it shows in 2009 there were almost 30,000 confirmed cases in the United States.

Here are some helpful tips to safeguard you this spring –

  • Use a repellent with Deet
  • Know where to expect ticks.  Ticks live in moist and humid environments, particularly in wooded or grassy areas.
  • Modify your landscaping to create “Tick-Safe Zones.”  Keep patios, play ground areas away from shrubs, bushes and other vegetation.
  • Use a chemical treatment.  There are many safe chemical agents available or if you feel more comfortable, call a professional.
  • Prevent family pets from bringing ticks inside.  There are many tick medicine and collars available.  Work closely with your veterinarian to choose the right one for your pet.
  • Be sure to check for ticks after you have been outside.  Ticks can hide under arms, around the ears, inside belly button, back of knees, in and around all head and body hair, and around the knees.  Check clothing and pets as well.

What should you do if you are bitten by a tick?

Remove the tick using fine tipped tweezers as soon as you realize you have been bitten.  If you are unable to remove the entire tick, it’s very important that you schedule an appointment with your doctor.  If left untreated, Lyme disease may often lead to a stage of Lyme that is disabling and difficult to treat.  In rare instances it can be fatal.   If a tick is attached to your skin for less than 24 hours, your chances of developing Lyme disease is minimal.  To be safe, watch for signs or symptoms of Lyme disease by following these tips as provided by The Center for Disease Control.

  • Red expanding rash
  • Fatigue
  • Chills
  • Fever
  • Headache
  • Muscle and joint aches
  • Swollen lymph nodes

If you experience any of the above symptoms please contact your doctor immediately.   Dr. Jennifer Ackerman, Dr. Michael Ackerman and Dr. Robert Lin of Dominion Internal Medicine are expert internist’s who will collect your medical history and perform a physical exam to determine if you are infected with this often hard to detect disease.  For more information or to schedule an appointment please contact our specialists @ 540.347.5408.  Now accepting CareFirst.


Compassion Care for a Healthy Heart, Body, and Mind

Understanding Asthma



Most of us have heard of asthma but what is it really?  Asthma is a chronic inflammatory lung disease which causes reoccurring breathing difficulty.  The traits of asthma are three airway problems:

  • Blockage
  • Inflammation
  • Hyperresponsiveness

Many people don’t realize they have asthma as symptoms strongly resemble other respiratory problems including bronchitis, emphysema, and lower respiratory infections.  Anyone can get asthma but studies show that asthma is more prominent in females.

Symptoms of Asthma

  • Chronic cough (particularly at night)
  • Tightness in the chest
  • Noisy breathing
  • Wheezing

Causes of Asthma

The underlying cause of lung irregularity is unknown, yet health care professionals have determined that it is a specific type of inflammation of the airway that can cause:

  • Constriction and irritability of airway muscles
  • Production of mucus
  • Swelling and inflammation in the airways

What Occurs During an Asthma Attack?

  • Lungs and airways overreact to certain triggers and become inflamed and clogged.
  • Breathing becomes difficult and may hurt
  • Coughing
  • Wheezing or whistling sound

Asthma Statistics

The latest information from the American Lung Association, the CDC, and the National Institute of Allergy and Infectious Diseases show the following statistics:

  • Approximately 24.6 million people in the United States have been diagnosed with asthma.
  • More than 3 thousand Americans die each year from asthma

If you have signs of asthma or you are unsure, it’s important to see your doctor.    Let the expert physicians of Dominion Internal Medicine help create a treatment plan to manage your asthma and get you back to everyday living.  To schedule an appointment, please contact Dominion Internal Medicine at 540.878.5408.  If you would like to learn more information about our services please visit www.dominioninternalmedicine.comMost insurances accepted!

Compassionate Care for a Healthy Heart, Body, and Mind


Comprehending COPD



COPD (Chronic Obstructive Pulmonary Disease) is a disease of the lung caused by chronic bronchitis and emphysema.  According to the American Lung Association ( ) COPD is the third leading cause of death in the US.  It can cause serious disability and early death.  Unfortunately, there is no cure for COPD but there are many ways to prevent and treat COPD.

COPD sufferers have difficulty breathing which is caused by a barrier in the lungs and the flow of air is less than it should be.  When this occurs it’s difficult to get rid of carbon dioxide which is the waste gas.  As COPD progress’s, it’s extremely hard to continue an active lifestyle due to shortness of breath.

What initiates COPD?

  • Smoking is the number one cause of COPD.  If you are a smoker stop smoking now!  If you are considering smoking – don’t!  If you are in a smoke environment you are at risk for COPD.  Protect yourself and loved ones by making your home “Smoke Free.”
  • Air pollution and aggravating fumes and dusts, especially work-related can also cause COPD.
  • In rare cases, COPD can be related to emphysema which is formed by an inherited absence of a protective protein in the blood.

Symptoms of COPD

  • Chronic coughing
  • Shortness of breath performing everyday tasks
  • Wheezing
  • Difficulty breathing or unable to take a deep breath
  • Producing large amounts of phlegm or mucus


If you or a loved one has symptoms of COPD, is a current smoker or a former smoker you should see your doctor right away.  Don’t ignore the symptoms or wait for them to get worse, valuable treatment time could be lost.  Don’t forget:  Early detection is vital to successful treatment.  Most lung diseases can be treated, allowing you to live a longer and improved quality of life!  For more information on COPD – please contact the specialists of Dominion Internal Medicine @ 540.878.5408 or visit

Compassionate Care for a Healthy Heart, Body and Mind


Is your tetanus vaccine up to date?


Is your tetanus vaccine up to date?

Tetanus disease (also refered to as lock-jaw) is not to be taken lightly as it can develop into a debilitating sickness or even cause death.

The tetanus vaccine is a vaccine made of unactive tetanus toxins and is used to put a stop to an individual from becoming infected with tetanus disease.

Symtoms and prevention from

  • Painful muscle spasms that begin in the jaw
  • Stiff neck, shoulder and back muscles
  • Trouble swallowing
  • Convulsions
  • Breathing difficulty


  • The tetanus vaccine is given at 2, 4, and 6 months of age, with boosting doses at 4 years, between 15 to 17 years, and 50 years of age.
  • If you are an adult and have not had a booster in the last ten years you will need to get one when you turn 50.
  • If you have received a primary course of 3 doses as an adult, you should receive booster doses 10 and 20 years after the primary course.
  • If you have sustained tetanus prone wounds such as an open fracture, deep penetration wound, contaminated wounds or burns you should immediately disinfect the wound and seek medical attention to begin a boosting dose of tetanus vaccine if more than 5 years have elapsed since your last does.

If you have questions or concerns about tetanus disease or the tetanus vaccine please contact the knowledgeable physicians of Dominion Internal Medicine @ 540-878-5408.

Most insurances accepted!  Now accepting CareFirst

Compassionate Care for a Healthy Heart, Body, and Mind

Summer Safety



Summer is here and while we all love spending time outside with our families at the pool, backyard cookouts, sporting events and all types of other outdoor happenings, it’s important to keep you and your family safe.

Here are a few safety tips from

  • Guard you and your loved ones from the sun:  Wear appropriate attire such as wide brimmed hats, light clothing, sunglasses and always use water resistant sunscreen that contains SPF 15 and reapply every two hours.
  • Hydrate! Hydrate!  Hydrate!  Drink adequate amounts of water before, during and after physical activity.  A refreshing low calorie treat – add slices of your favorite fruits (lemon, lime, melons, berries, mint or even a cumber!)
  • The sun is the strongest between noon and 3pm, limit intense activities during this time.
  • Head inside if the heat becomes intolerable, research your local YMCA or rec centers to provide safe and cool indoor activities that your entire family will enjoy.

See your doctor immediately if you think you or a loved one is suffering from heat exhaustion.  Heat exhaustion may lead to heat stroke if not treated right away.  If you have questions about heat exhaustion, please contact Dominion Internal Medicine for more information or visit  Now accepting new patients!  Most insurances accepted.

July is Bladder Cancer Awareness Month!



What is Bladder Cancer?

The most common form of bladder cancer is transitional cell (urothelial) carcinoma.  Many forms of malignancy may occur in the epithelial lining of the urinary bladder which in turn may spread through the lining into the muscular wall of the bladder.  Bladder cancers most often are defined by how far they have traveled into the wall of the bladder.

  • Non-invasive bladder cancers remain in the inner layer of cells and have not grown into deep deposits in the wall of the bladder.  Most non-invasive bladder cancers are detected early and surgery can almost always remove these tumors.
  • Invasive cancers grow into the wall of the bladder making it easier for the cancer to spread to the lymph nodes, other organs of the body such as the kidneys, liver and lungs.  Treatment will be determined by your physician based upon how much the cancer has spread.  Once treated for bladder cancer it is not uncommon for the disease to return and your physician may recommend having chemotherapy or immunotherapy to lower the risk of return.

Symptoms of bladder cancer –

  • Blood or redness in the urine
  • Pain during urination
  • Frequent urination
  • Difficulty urinating

If you are experiencing any of these symptoms it’s important to see your doctor.  Diagnosis of bladder cancer will include a urine culture (searches for bacteria in the urine) and urinalysis (searches for existence of blood) and or check for tumor makers as well as a urine cytology test which will check for abnormal cells.  For more information, please contact Dominion Internal Medicine @ 540.878.5408 or visit  Most insurances accepted.  Now seeing new patients!

Compassionate Care for a Healthy Heart, Body, and Mind