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VBPM Connection, Issue #023 -- News from your doctor's office.
July 06, 2012

The Virginia Beach Premier Medical Newsletter

July, 2012

VBPM Connection is a newsletter published by Virginia Beach Premier Medical, an internal medicine practice dedicated to personalized, highly attentive, high quality care for our patients. The newsletter provides information of a general nature about our office, current health news and various common illnesses and ailments. None of the information provided is meant to be specific for any particular individual. Always seek the advice of your personal physician for any specific information about your health.

If you have a topic that you would like to see appear in the newsletter, please let us know at

Allergic Rhinitis

Allergic rhinitis is a condition of nasal congestion, stuffiness, drippy nose, and post-nasal drip sometimes causing cough. It is caused by an allergic reaction to environmental allergens like dust, mold, mildew, ragweed, pollen, etc. It is usually seasonal but sometimes it bothers people all year round.

Various treatments have been used over the years for this common, annoying condition with variable and sometimes disappointing results.

A new approach using a combination of a steroid nasal spray called fluticasone (Flonase) and an antihistaminic nasal spray called azelastine (Astelin) has been found to be superior to either product alone and far better than placebo. It's a little expensive to have to use both together, but if the problem is bad, and if you've already tried one with limited results, it might be worth it to use both together. If that doesn't work, you may need an allergy workup and possibly allergy desensitization injections.

Should We All Be on Low-Dose Aspirin?

Low dose aspirin is well known to help prevent strokes and heart attacks, but only for those people who have already had an event like that. It doesn't seem to work for primary prevention. In other words, if you haven't already had a stroke or heart attack, or if you have few or no risk factors for these vascular diseases, then aspirin is probably not going to help you and may cause a major bleeding event.

So, while aspirin is still considered one of the best medicines to prevent TIAs (mini-strokes), strokes and heart attacks and even shows some benefit in preventing colon cancer, it's definitely not for everyone - especially not for those who have low risk for those problems.


Pre-Diabetes is the term that is now used to describe "borderline diabetes". It means that sugar metabolism is not quite normal, but it's not bad enough (yet) to meet the criteria required for a diagnosis of diabetes. This is quite common and probably involves about 20% of the population. A large portion of pre-diabetics fall into this category simply because they are overweight. Some people are prediabetic because they've inherited it.

The more we study pre-diabetes, the more we find out that this condition is very close to diabetes itself with regard to cardiovascular risks. A recent study in the British Medical Journal found that pre-diabetics have a 26% higher risk of stroke and other cardiovascular events than nondiabetics. We always knew this was the case for diabetics, but now it's also true for pre-diabetics.

So now we have even more reasons to keep our weight down and exercise regularly - in order to prevent the onset of pre-diabetes as well as diabetes.

Should We All Be on a Statin?

Statins have been getting a lot of bad press recently, mostly because they can cause muscular and joint pain in many individuals, enough so that some people say they'd rather die early than have to live with muscle pain the rest of their lives.

Most of the time we can find a way around this problem by switching to different statins, changing the dose or by adding CoQ10 to the regimen. Nevertheless, many wonder if it's really worth it to take these things. The myth is that maybe they do more harm than good. People worry about whether they will cause liver or kidney problems.

A large meta-analysis (review and compilation of data from many studies) involving 170,000 people showed that taking a statin lowers the 5-year risk of mortality from vascular events (strokes and heart attacks) by 21% for every 40mg/dl that the LDL was lowered. In other words, if your LDL cholesterol is lowered by 40 points by using a statin, you have a 21% less risk of dying from a stroke or heart attack over the next 5 years. This is true even for young healthy people who have low risk of those problems anyway, the study proved. Furthermore there was no increase in mortality from any cause (no liver failure, kidney failure or anything else) while they were on the statin.

So, don't be too quick to give up the statin the next time you get a leg cramp. See if your doctor can find a work-around solution.

Our Website Has Gone Mobile!!

You've heard the recent saying from smartphone owners, "There's an app for that!" There's basically an app for almost anything and everything you can think of.

Well, now there's an app for our office website! Actually it's our same VBPM website ( that now has been reformatted for use on an iPhone, Android, Blackberry or Windows Phone.

If you have one of these smartphones and you want to keep our website with you and all its content, including all the newsletter issues that have been published so far, just go to your browser in the smartphone and type in the address area and hit GO. Our app will appear on the screen with links to all the content. Don't forget to then save the app to your home screen for easy access later.


Don't forget to sign up for a Twistle account right away so you can communicate with us easily and securely over the Internet. The patients who have signed up so far are loving it and have given us great feedback, saying it's a great addition to our practice.

Twistle is a easy, convenient, secure, password-protected way to communicate with our office and/or with your personal physician about prescriptions, lab and x-ray results and any other non-emergent medical problems you would like to have us address.

Check out the following page to find out how to sign up:

Twistle Instructions

Is Dark Chocolate Good for You?!

The amazing answer is YES.

Recent studies are showing that dark chocolate contains polyphenols, including flavinoids, that reduce risk for cardiovascular disease and actually help with treatment of the metabolic syndrome (a combination of being overweight and having hypertension, high cholesterol, and insulin resistance). Indeed, it does seem to lower blood pressure and cholesterol levels. (It lowers blood pressure by about 5 points and lowers LDL levels about 8 points.)

It is estimated that daily dark chocolate consumption would prevent 70 nonfatal and 15 fatal heart attacks per 10,000 people over 10 years.

So, now you have a good excuse to eat something sweet! Just don't eat too much of it that it makes you gain weight. I'm sure the modest beneficial effect could be quickly negated by weight gain.

Dietary Fats and Memory: Is There a Connection?

A new report from the Women's Health Study involving 6183 women around age 66 showed some surprising findings about diet and memory.

Those who consumed higher amounts of saturated fat in their diets were much more likely to have memory problems than those who didn't. Women with the highest saturated fat intake had a 60-70% greater likelihood of having memory problems.

In contrast, those women who took in more monosaturated fats had higher cognitive scores (were smarter and had better memory) than those who didn't). The ones with the highest monosaturated intake were 50% less likely to have a memory disorder.

These are significant numbers.

Interestingly, neither trans or polyunsaturated fats affected cognitive scores either way.

So, if you want to protect your memory, eat more monosaturated fats. Watch those food labels at the grocery store!

Finally, a Guideline for How Long to Take Osteoporosis Medicine!

Drugs like Fosamax, Actonel and Boniva (bisphosphonates) are the drugs of choice for osteoporosis. However, they have recently been discovered to rarely cause atypical spiral type fractures of the femur for those patients who have been on them for more than 5 years. This has resulted in some confusion as to what to do after 5 years. We hate to leave the osteoporosis untreated so that severe fractures of the spine, kyphosis and other problems develop. Do we try to use a substitute that may be less effective?

As reported in the Medical Letter, it appears that the best approach is as follows:

It seems reasonable to stop the bisphosphonate after 3-5 years of treatment in those who have the lowest risk of fractures (i.e., those who have never had an osteoporotic fracture or for those with a T score never lower than -2.5).

For those who have already had osteoporotic fractures, or if the bone density continues to show severe osteoporosis with high risk of fracture, then the benefit of taking the bisphosphonate likely outweighs the risk and should be continued.

Dietary Sources of Calcium and Vit D

Although we continue to use them, newer studies are showing that calcium supplements may be associated with increased risk of kidneys stones and even cardiovascular disease. Dietary calcium however does not carry these risks.

You may be asking, What are the best dietary sources of calcium that we should be eating to keep our bones healthy?

These are the foods that are noted to be high in calcium content:

Yogurt, fortified orange juice, cereal and milk, almonds, Brazil nuts, dried beans, mozzarella and cheddar cheeses, sardines and salmon, cottage cheese, tofu, kale and green leafy vegetables.

Food sources for Vitamin D include: cod liver oil, salmon, yogurt, swordfish, tuna, margarine, liver, beef, egg, swiss cheese, fortified milk, orange juice and cereals.

About Our Office

Virginia Beach Premier Medical is a membership internal medicine practice specializing in comprehensive and compassionate, individualized and personalized patient-centered care. We pride ourselves on full continuity of care – in the office, in the hospital, or even at home.


One of the biggest problems in healthcare these days is poor access and the slowness or lack of communication with healthcare providers. At VBPM, we are constantly aware of the need to improve communication and enhance your ability to get in touch with us quickly when you need to. That's why we provide all of our phone numbers, cell phones and pagers, to all of our patients, and also why we keep open all lines of communication, including the ability to email us or send test messages. The newest method of communication has been a great help to a lot of our patients in the form of Twistle, which is better than regular email and text messaging because it's secure and not able to be phished or spammed or otherwise tampered with.

We will always be on the lookout for better ways to improve communication because we believe this is an important factor in providing the best healthcare possible for our patients.

If you would like more information about our practice please call us at 757-416-6750 or visit our website at Ask to speak with Brittany, our office manager, or Dr. Parks or Dr. Warth. We’d be happy to talk with you anytime.

Enjoy Your Summer!!!

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