The Virginia Beach Premier Medical Newsletter

June 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.

Tick Bites - What You Need to Know

Tick bites are very common in the summer, especially if you spend any time outdoors. If you suddenly see a black or brown floppy mole-like structure on your skin after coming in from outside, that’s likely what it is.

The best way to remove a tick is to use fine-tipped tweezes, grab the tick as close to the head or mouth as possible and gently pull it until the mouth parts release the skin. You should not twist it or turn it to avoid breaking off the mouth-parts in the skin which could later become infected. Do not squeeze the body of the tick as this may cause infected fluid to enter your skin. Also, do not try to burn the tick or smother it with anything or use gasoline or alcohol. The tick may react by injecting infected fluids. After removing the tick, wash the area thoroughly with soap and water. A small amount of redness around the bite at this time is normal.

There are millions of tick bites every year. We can’t treat every one of those or we would quickly run out of antibiotics. Only rarely will a tick bite cause an infection like Lyme Disease or Rocky Mountain Spotted Fever among others. The best thing to do is to watch for any pain, swelling, redness, red streaks or pus in the area. Also if you develop any chills or fever, swollen lymph nodes or rash, this would be an indication to check with your doctor.

Lyme Disease is frequently associated with an area of expanding redness usually appearing 5-14 days after the bite. Sometimes this will look like a target as the center part of the red area begins to clear. There may be some symptoms of joint or muscle pain and fever. Other signs and symptoms may not occur until much later. Antibiotics are curative in most cases.

Tetanus Vaccine

Believe it or not, Tetanus is still with us. True, we don’t see many cases of it anymore, but when it occurs it is frequently fatal.

Tetanus vaccine is highly protective when given every 10 years, but we often don’t think of it till we get an injury. If the injury is infected with the bacteria, giving the vaccine may be too late, but we give it anyway.

The best protection is to get the vaccine every 10 years without waiting for an injury to occur. We combine the Tetanus vaccine with Diphtheria and Pertussis vaccines (tDAP) routinely since those are required every 10 years also. If you don’t think you’ve had one within that time, let us know.

Acute Low Back Pain

Acute low back pain is a very common problem and frequently is due to muscle strain – often related to poor body mechanics, like lifting with your back instead of your legs, and by not stretching properly before exercise, sports or work that could strain your back muscles.

Most acute back pain resolves quickly with rest and short periods of treatment with NSAIDs, like Advil or Aleve. Most people will be back to their usual activity within a few days. Prolonged bedrest is not recommended and doesn’t really help. Studies show that getting back to normal activity quickly after a day or two of rest resolves the problem more quickly than staying in bed, and with fewer complications.

If the pain is unusually severe, if there is any numbness or weakness, or if it lasts longer than 4-6 weeks, then you should be talking to your doctor and considering the possibility of further evaluation, perhaps some imaging studies, and more aggressive treatments – like physical therapy, or even surgery depending on test results.

Chronic Pain Disorders

Non-cancer chronic pain can occur for a variety of reasons, including prior injuries, back disorders, fibromyalgia, postherpetic neuralgia (caused by shingles), and neuropathies of various kinds (the most common one being diabetes), to name a few.

It is often very difficult to treat, mostly because of concerns about unintentional overdoses of opiate medications, which have led to fatalities in many cases, because of the risk of addiction and because of multiple other adverse effects of various medications used to treat chronic pain – like severe constipation, confusion, hallucinations, frequent falling episodes, etc.

It is usually necessary to work closely with your doctor in the treatment of chronic back pain, at least until an effective regimen can be established. The treatment requires a careful balance of controlling the pain and preventing adverse effects. This is never easy. Safety is the most important goal followed by improved functionality.

What Is Hospice?

Hospice is not a place, as many people believe, although there are hospice houses in some areas (not here). Hospice is more a philosophy and method of taking care of terminally ill patients who usually have a life expectancy of 6 months or less.

The goal of hospice care is to provide comfort and support in situations where there is no cure for the illness and all treatments have been discontinued except the ones required to make the person comfortable.

Another goal of Hospice is provide emotional support for the patient and family, improve communication when necessary, and try to make the last days or months more meaningful for both.

Hospice nurses and volunteers are well-trained in these tasks and provide for a much more peaceful and comfortable passing than what often occurs otherwise.


Most tremors that occur as people get older are mild and benign (i.e., not associated with a serious illness). If they cause any significant problems, like difficult in eating or drinking, there are medications available that can help.

Some tremors can be caused by an overactive thyroid, which usually can be easily treated.

Other tremors can be caused by certain medications, like Albuterol and gabapentin, which are usually controllable by adjusting the doses or by changing to other treatments. Some tremors are caused by anxiety or stress. Treatment often involves removal of the stressful stimulus if possible or by learning to cope with the stress. Again, medications can be useful in helping to alleviate anxiety if it interferes with one’s comfort or functionality.

More rarely, tremors can occur in the presence of a neurologic disorder, like Parkinson’s Disease, seizure disorders, brain lesions or strokes.


There are various types of arthritis that can affect people – young and old.

The most common form of arthritis by far is osteoarthritis. This is the kind that we all get if we live long enough. It is due to the chronic wear and tear on our joints over a period of many years. The cartilage in the joints wears down. Bony spurs develop as a result of the physical stress on the bones. This all leads to pain and stiffness, which is often controllable with NSAIDs, like ibuprofen, but sometimes requires surgery, like knee or hip replacement, for example.

Other kinds of arthritis usually fall in the category of inflammatory arthritis, like rheumatoid disease, collagen and autoimmune diseases. These can occur at younger ages and are more difficult to treat, mostly because of the potential side effects of the medications required.

Acute gout is an inflammatory arthritis also but is usually easier to treat, if it is recognized right away.

Joint pain can sometimes be caused by certain medications or allergic reactions as well.


There are many different types of nerve disorders.

The most common one that we see is the numbness, burning and pins & needles of the feet and hands due to diabetic neuropathy. Sometimes this will occur even before the diagnosis of diabetes can be clearly made.

These same symptoms can also be caused by alcohol, deficiency or B12 or Folate, certain medications – especially certain types of chemotherapy. There is a burning feet syndrome that runs in families.

Numbness in other areas is often benign but can sometimes be caused by diabetes, vitamin deficiencies, multiple sclerosis, cancer, brain abnormalities, circulatory problems, etc. Many times this can be caused by a pinched or injured nerve due to pressure or trauma to certain parts of the body. It’s best to consult your doctor if you have any of these symptoms.

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 Father's Day!