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VBPM Connection, #032-- News from your Doctor's Office.
April 10, 2013

The Virginia Beach Premier Medical Newsletter

April, 2013

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 would like to receive a copy of this free monthly newsletter electronically by email, go to the Newsletter Signup Page on the office website ( and enter your email address in the signup box.

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

Twistle: Ask us about Twistle, a secure email application linking you directly to the office or to your doctor. Get answers to your personal medical questions. Change your appointment. Get your lab or x-ray results. Request prescription refills. Keep us informed. Ask the staff or your physician for more information, or click on the link...Twistle.

What's Your BMI?

BMI, or Body Mass Index, is a medical calculation that relates to whether a person is classified as underweight, normal weight, overweight, medically obese or morbidly obese. The calculation is made by taking the body weight in kilograms and divide by the square of the body height in meters (kg/m2). If you're BMI is below 25, you're normal. If you're in the range of 25-30, then you are considered overweight. If your number is over 30, then you're obese.

We know from many studies over the years that the higher the BMI, the greater the risk of illness like diabetes, heart disease, hypertension and even death.

Treatment is based on these numbers to some extent. For example, if you are in the overweight range, then the treatment is usually diet and exercise. If you are in the obese range, the treatment is diet and exercise plus the use of certain medications would be warranted. If your BMI is over 40, then you might be considered a candidate for gastric banding or bypass surgery.

Ask your doctor what your BMI is and how to get it into the normal range.

What Causes Blood Sugar To Go Up or Down?

If you are diabetic, there may be times when your blood sugar goes up and you may not realize what you may have done or not done to make that happen. Truly sometimes it seems like a mystery.

Here are some things that may effect your blood sugar that you may or may not be aware of...

The amount of activity you do each day can have a dramatic effect on your sugar level. If you exercise at the gym or even at home 3 times a week, your blood sugar is going to be lower on the days you exercise and higher on the days you don't. When you exercise, your body burns up sugar so the amount of sugar in your blood will go down. This is why some people get symptoms from low blood sugar after they have been to an exercise class.

The presence of an infection can cause blood sugar to go up - colds, flu, urinary infections, etc. can all have an effect.

Various medications like steroids, statins, niacin, certain fluid medications and many others can potentially effect blood sugar.

Major medical illnesses, hospitalizations, surgeries, any emotional or physical stress can raise blood sugar.

If you have developed other illnesses, like low thyroid levels, if your adrenal glands are overproducing hormones, your blood sugar may go up. If you are developing kidney disease, your sugar may go down.

Your sugar could be going up just because your diabetes is getting worse, your pancreas isn't producing as much insulin as it did before. If your weight has gone up by more than 5 pounds, this could certainly have an effect.

Changes in your diet may occur without you even thinking about - like around holidays or when you eat out at a restaurant or when you go to a party or even if you travel out of town. Anything that varies your usual routine away from home.

If you're having trouble figuring out why your blood sugar is going up or down, talk to your doctor.

Preventing Sporting Injuries

One of the best ways to prevent sports injuries is to do stretching exercises before you start. Don't forget this as part of your routine if you play golf, tennis or any other sport.

Front Hip Stretching: Stand in front of a chair, put one foot on the seat of the chair and lean forward keeping your back leg straight. The hip muscles in front of your straight leg should feel stretched. Hold that position for several seconds, then relax. Repeat on the opposite side.

Posterior Hip Stretching: Sit down on chair and with your left hand grasp your right knee and pull it up toward your left shoulder until you feel the stretch in your right posterior hip or buttock. Then hold that position for several seconds, then relax. Do the same on the other side.

Shoulder and Chest Stretch: Stand next to a outer corner of a wall or door-frame. Bend your arm and place your hand against the wall. Then rotate your chest away from that arm until you feel the muscles in your chest stretch. Hold that position for several seconds, then relax. Do the same on the opposite side.

Mediterranean Diet

Mediterranean diets are all the rage now - and for good reason. Studies show that it's the best diet you can be on to prevent heart attacks, strokes and other cardiovascular diseases, as well helping with weight loss. It also helps to delay or prevent the onset of diabetes, metabolic syndrome, hypertension, hyperlipidemia and other serious disorders.

This diet has been found to be much better than low-fat diets and improves morbidity and mortality by 25-50%.

What is a Mediterranean diet? Basically, it is all about eating mostly fruits and vegetables, whole grains, lots of fish, while avoiding sweets and meats except maybe 2-3 times a month. The diet promotes using olive oil instead of butter or other saturated fats and optionally allows one glass of red wine daily.

Non-Alcoholic Fatty Liver Disease

A fatty liver, or hepatic steatosis in medical terminology, was previously thought to be a fairly benign condition. It still is for the most part, except that it usually signifies some abnormality in metabolism, like diabetes, overweight status, elevated cholesterol levels, etc. It tends to occur in about 20% of Americans and is usually associated with obesity.

The buildup of fatty substances in the liver can cause inflammation, and eventually, after many years, some of these people (5%) will develop cirrhosis, liver failure or even liver cancer.

Many times there are no symptoms of this problem early on, and it is only recognized when blood tests show abnormalities in liver enzymes, or an imaging study of the abdomen may reveal its presence. Sometimes, it can be associated with pain in the right upper abdomen as the liver capsule stretches due to liver enlargement. Fatigue can also be a significant symptom.

What can be done to control or reduce a fatty liver?

There are no specific medications for it, although some say Vitamin E 400 units/day or other anti-oxidants may help.

The best thing you can do if you have been diagnosed with fatty liver is to eat a healthy diet (like the Mediterranean diet mentioned above), lose weight, regular exercise (150-300 minutes/week), control your cholesterol as much as possible and avoid any drugs that may be toxic to the liver. This incudes various herbal, or "natural" supplements, alcohol, or high doses of Tylenol.


COPD stands for Chronic Obstructive Pulmonary Disease. It is called "obstructive" because the airways are often narrowed in COPD by inflammation and by the increased pressure inside the chest cavity that occurs when patients with this problem try to exhale. The problem, physiologically is not getting air INTO the lungs. The problem is getting trapped air OUT of the lungs to make room for the next breath.

COPD encompasses two illnesses: emphysema and chronic bronchitis, each of which manifest themselves differently but both end up causing an "obstruction" to the outflow of air from the lungs, which is why they are grouped under the category of COPD.

These illnesses are caused by several things, the most important of which is smoking, but other factors could be involved as well, such as chronic exposure to dust, second-hand smoke, air pollution, fumes, industrial gases and vapors. In rare cases, it can be due to a genetic disorder. Sometimes even having severe problems with asthma over many years can increase the risk of COPD.

COPD is usually diagnosed by physical examination and pulmonary function tests in combination with a chest xray or CT scan. Spirometry can be used intermittently to track the progress of the disease.

COPD is not considered a curable problem, but it is treatable and controllable for many years in most instances. Treatment recommendations usually include regular exercise, avoidance of smoke, dust and fumes, vaccination against pneumonia and flu, various inhaled medications, judicious use of antibiotics when respiratory infections develop, and it sometimes requires corticosteroids to help control wheezing and excessive coughing or shortness of breath.

What's New in the Journals?

Men who take Vitamin C supplements, up to 1000mg/day, are twice as likely to have kidney stones, than those who don't. If you have a history of kidney stones, you probably shouldn't be taking Vitamin C.

If you have had to take blood thinners like Coumadin because of blood clots in the legs or in the lungs, you will likely have to be on the medicine for at least 3-6 months. After the blood thinner is completed, a new study shows that if you take 100mg of aspirin every day afterwards, you can prevent a recurrence of blood clots by about 34% compared to those who don't.

A recent study showed that patients with congestive heart failure (fluid around the heart and in the lungs due to weakness of the heart muscle) actually do better by eating a moderate sodium diet (2.8 grams/day) rather than a really low sodium diet (1.8 grams/day).

There is increasing data that certain antibiotics in the macrolide group are associated with a greater number of cardiac deaths when given to patients with underlying heart disease. These antibiotics include azithromycin (Zithromax) and clarithromycin (Biaxin). The numbers of these instances are small compared to the millions of those who have taken these antibiotics without difficulty. However, in situations where a patient with an infection has known underlying heart disease and if other antibiotic options are available, we will be starting to move away from using this class of drugs.

Lowering LDL levels with statins (like Zocor, Lipitor, Crestor, etc.) prevents major vascular events like strokes and heart attacks even in those patients who were felt to be low risk for these events.

Prostate cancer screening with PSA levels significantly reduced prostate cancer mortality when compared with no screening in a study lasting eleven years.

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.

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.

Happy Spring!

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