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VBPM Connection, Issue #028 -- News from your doctor's office.
December 04, 2012
Virginia Beach Premier Medical
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.
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Aspirin: The Best Prevention for Migraine with Aura
Here is yet another thing to add to the growing list of benefits related to aspirin. For those migraine sufferers who have an aura (a preliminary symptom that precedes the onset of the headache), a recent Italian study showed that 86% of those who took 300mg of aspirin a day had 50% fewer migraine attacks than those who didn't take aspirin. The effectiveness of aspirin was found to be six times greater than all other prophylactic medications which have been tried to prevent migraine!
Statins and Diabetes
Despite the recent reports of mild elevations of blood sugar that can occur with statins, they are still recommended for all diabetic patients who either already have cardiovascular disease or for those who have only one other risk factor for heart disease. In other words, if you are a diabetic over 40 years old and have any other risk factors, like a family history of heart disease, you should be on a statin, no matter what your cholesterol level is. The reason is that statins have been proven to have such a strong benefit in reducing risk of heart disease and stroke, particularly in diabetics, that the risks of taking the drug are far outweighed by the benefits.
What Is an Appropriate HgbA1c Level for Patients Over 75?
HgbA1c is the blood test that we do to check for diabetes and to follow it on a regular basis. All diabetics should get a HgbA1c level around every 3-6 months to be sure the disease is under good control.
If the level is 5.5 -6.4, this is considered pre-diabetes and the person who is in this range should be doing everything they can do to prevent the future development of diabetes, like regular exercise, better nutrition and good weight control.
If the number is greater than 6.4, that usually indicates that the person actually has diabetes. In younger diabetic patients, we try to keep the HgbA1c in the lower range of 6.0 to 7.0, because if we do this, it helps prevent future complications of diabetes, like kidney, eye and vascular diseases.
However, in older adults, those over 75, keeping the HgbA1c in the range of 7-7.5 is more appropriate; and for more frail elderly individuals, keeping it around 8 is good. The reason is that the older population does not tolerate low blood sugars as well as the younger people do, such that there is actually a greater risk of heart attacks and other problems if we try to keep the sugar too low in those patient populations.
Qsymia: A New Medicine for Weight Loss
A new medicine is available to help with weight loss. It's called Qsymia (pronounced kyoo-SIM-ee-uh). It consists of a combination of two currently available medications, topiramate and phentermine, both of which have been known to cause weight loss.
Topiramate has been used for prevention of migraines.
Phentermine is a stimulant that has been used for weight loss for years by itself. In fact it was part of the Phen-Fen combination that was removed from the market several years ago because it caused valvular heart disease. The phentermine portion of it was not felt to be the culprit, which is why it's still available.
It can result in a loss of about 20lbs in a year on average.
Side effects include dizziness, insomnia, tingling in the hands and feet and memory difficulties, not to mention that it costs $120-190/month.
It's not really recommended at this point for everyone who wants to lose a few pounds. It should be used only by those who are morbidly obese or those who have significant health risks because of their obesity.
Hepatitis C Testing
The Center for Disease Control (CDC) in Atlanta now recommends Hepatitis C testing for all baby boomers (born between 1945 - 1965). Up to 3% of these people are known to have Hepatitis C, which can ultimately lead to significant liver disease, including cirrhosis and liver failure, if left untreated.
There are no symptoms in the early stages of the disease, so the only way to know if you have it is to get a blood test.
The newer drugs for this have a cure rate of up to 75%, so it's definitely worth finding out if you have it. Ask your doctor for a blood test if it hasn't already been done.
When to Take Your Thyroid Medicine
In the past, most pharmacists have said that people with hypothyroidism should take their thyroid medication early in the morning - at least an hour before breakfast. The reason is that it's absorbed into the blood stream from the intestines better if it is taken on an empty stomach.
So, you don't really have to take it in the early morning hours. You could take it at bedtime as long as it's four hours after eating supper. The most important thing is to take it at the same time every day consistently. That way, when the doctor adjusts the dose according to your blood tests, it won't vary greatly from one time to the next.
If your thyroid blood tests do vary quite a bit from one blood draw to the next, the problem could be that you're not consistent enough with taking it at the same time every day.
Statins May Inhibit Cancer Growth
An observational Danish study reported recently that statin use by cancer patients was associated with a 15% drop in all-cause and cancer-related deaths. A different study showed that statins did not influence the incidence of cancer one way or the other. So, it appears that statins do not reduce the risk of developing cancer, but if a person already has cancer, it can reduce mortality risk by 15%.
Mind Over Matter?
An international study of 104 patients with irritable bowel syndrome, found that there seems to be a genetic predisposition that determines whether patients get better with a placebo (sugar pill) or not. An inherited neurochemical change (increased levels of Dopamine) in the prefrontal cortex of the brain determines the likelihood of responding favorably to a placebo. So, after all, it really is matter over mind rather than the reverse.
Incidentally, we NEVER give placebos for treatment of anything. However, there is always the possibility of a placebo effect occurring with any given drug. The effect could go either way - as a benefit of taking the drug (improvement in symptoms) or as a possible bad effect - often depending on what the patient's expectations are.
Perfume, Pets and Allergies
If you've ever known someone who has allergies, you know that sometimes exposure to certain things like pet dander and perfume can be quite distressing and can even precipitate a severe asthma attack.
So, when coming into the office, in order to protect our patients and office staff, please refrain from wearing perfumes and bringing in pets. We will be forever grateful.
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.
Quality Medical Care
Many health care organizations talk frequently about providing high quality medical care. What is "high quality medical care"? It can mean different things to different people.
To us, high quality care is that which provides knowledgeable, scientific, evidence-based medicine combined with humanitarian compassion, concern and empathy for those individuals under our care. One without the other is not high quality care. Both are necessary components. Combine that with convenience, a high level of attentiveness, easy access, and an ability to go the extra mile to solve problems and you have high quality concierge medicine.
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