The Virginia Beach Premier Medical Newsletter

April 1, 2011

VBPM Connection is a newsletter published by Virginia Beach Premier Medical, an internal medicine concierge 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.

Chronic Insomnia

Insomnia is a widespread problem affecting at least 30% of the adult population. Chronic insomnia is defined as difficultly with sleep occurring at least 3 times a week for more than one month. It becomes more common as we get older.

There are multiple causes including pain, illness, anxiety, depression, restless leg syndrome, medications, use of caffeine or alcohol, noise, stress, shift work, napping during the day or going to bed too early are just a few. Some of these problems are easily correctible with changes in habits or lifestyle, but some are not.

Sleep apnea is a condition often associated with being overweight resulting in snoring and episodes of apnea (breath-holding) that wakes the person up frequently throughout the night, thus resulting in daytime somnolence. It can also have a bad effect on the heart, lungs, blood pressure and other systems. A sleep study may be required for accurate diagnosis if this is suspected.

Treatment of insomnia usually involves trying to correct or resolve the underlying cause whenever possible. Before starting sleeping pills, which are potentially addicting and often don’t work when used on a regular basis, it is best to try to improve sleep hygiene. For example, try to maintain stable bedtimes, avoid caffeine, nicotine and alcohol, maintain regular exercise but avoid exercising right before bedtime, avoid watching TV or reading while in bed, avoid daytime naps. Don’t watch the clock. Leave the bedroom if you’re not sleepy, do some other nonstimulating activity for a while and return to bed when sleepy. Keep your bedroom quiet and dark. Of course, if sleeplessness persists, talk to your doctor.

A New Rx for Insomnia

A recent study reported that a night-time supplement of melatonin 5mg, along with zinc 11.25mg, and magnesium 225mg in combination resulted in a significant improvement in sleep when compared to a control group that did not receive the supplement. This would be a relatively safe, non-addicting sleep remedy that may be helpful for many insomnia sufferers. Another recent study showed that the risk of falls during the night is significantly higher when patients take Ambien. This makes the melatonin combination sound even better.

Chronic Pain

This is defined as any pain that has been present for at least 3 months with or without a clear cause. It results in great suffering for millions of those who have it and it is very difficult to treat in many cases.

One of the most important roles of physicians in clinical medicine is that if we are not able to cure an ailment, at least we want to try to alleviate the symptoms. Most people with non-cancerous chronic pain have conditions that are not curable (like fibromyalgia, neuropathy, prior injury).

We like to try to control the pain using non-narcotic remedies first whenever possible – things like steroid injections, neuro-stimulation devices, anti-inflammatory meds, antidepressants and muscle relaxants. When everything else fails, then we are left with opioids, which may be very helpful, but they have their own set of risks and side effects, including the potential for death if not used properly. As a result, they have to be used with great discretion and close attention to certain guidelines.

Shortness of Breath

Most people would regard the symptom of shortness of breath as a primary lung disorder. However, in fact, it can be caused by many different disorders as well.

Anemia from any cause can result in shortness of breath because it reduces the oxygen-carrying capacity of the blood.

Heart disease is a frequent cause of shortness of breath especially in the condition called congestive heart failure.

Deconditioning or lack of exercise (being out of shape), or being overweight is other common cause of this symptom. Anxiety and stress can be contributing factors. Hyperventilation due to anxiety can cause severe shortness of breath associated with dizziness and numbness and even fainting.

Other illnesses that cause this symptom include diabetes out of control, hypertension, kidney disease and certain medicines.

Did You Know...?

Unintentional drug overdose is the second leading cause of accidental deaths in the US? 40% of these are caused by prescription opioids.

Daily low dose aspirin reduces cancer risk by 20% over five years? This was mostly beneficial for colorectal cancer prevention, but there was a benefit for prevention of non-GI cancers as well.

Inhaled steroids can increase risk of osteoporosis, cataracts and diabetes? Ask your doctor if you really need them.

Overtreatment of hypothyroidism can lead to osteoporosis in the long term?

You should have a shingles vaccine once if you are 60 or over, even if you’ve already had shingles?

Low Vitamin D levels are associated with frailty?

Annual Physicals

Annual physicals are a great way to stay healthy for a number of reasons. First, it provides a time when your doctor can look over your whole medical condition. Many routine visits are often just about one specific problem that is addressed and treated, but it doesn’t address other aspects of your health. Second, it assures that everything is up to date as far as your preventive care is concerned. This is very important for your future health and well-being.

Third, sometimes, we find things during your complete exam that we might not have found otherwise. This is a way of discovering small problems before they become big ones.

If it’s been more than 12 months since your last complete physical, call to schedule one with your doctor right away.

If you want to be well-prepared for your visit, download the annual health questionnaire from the website under the heading “Physicals”...Or, click here.

Leg Weakness

Leg weakness can be caused by a number of different problems. The most common one is lack of exercise. If we don’t actively use our leg muscles more than just for routine walking around the house or at work, they tend to get weak and atrophy – especially the quadriceps. This greatly increases our risk of falls as we get older. That’s why it is so important to exercise those muscles regularly. Doing leg lifts and knee lifts while sitting in a chair are one easy way to improve the strength of these muscles and reduce your risk of falling.

Another cause of leg weakness is related to lumbar stenosis, or narrowing of the lower spine, which can cause pinched nerves to the legs.

Leg weakness can also be caused by vitamin B12 deficiency, diabetic myopathy, certain medications, poor circulation, being overweight, or any other condition that causes generalized fatigue. Ask your doctor if you have noticed a significant problem with leg weakness recently.

Irritable Bowel Syndrome

IBS is a very common, but poorly understood disorder that is probably related to a neurophysiologic abnormality in the nerves or muscles that control the intestines.

It is basically a diagnosis of exclusion, which means that this is what we think of when all other serious abnormalities have been ruled out as a cause for abdominal pain, bloating, and alteration of bowel habits.

Sometimes stress is a factor in aggravating these symptoms. Sometimes there may be problems with the bowel flora or bacteria. In this case probiotics may be helpful. Antispasmodic medications and high fiber treatments may also be considered. Dietary changes may provide the most relief.

About Our Office

Virginia Beach Premier Medical is a membership “concierge” 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.

Discount Referral Program

Here’s an incentive! If you are a member of our practice and if you refer someone to us who then signs up, we will give you $200 off your next year’s fee.

Here’s another plus! You can accumulate these referral discounts so that if you refer multiple people who then sign up, you will get $200 off the next year’s fee for each one.

Happy Spring!