The Virginia Beach Premier Medical Newsletter

July 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.

Heat Stroke

Nonexertional heat stroke can occur in patients with heart disease or neurologic disorders and to those who are taking certain medications (like diuretics or anticholinergics) when exposed to heat for extended periods. We often see this happening in urban areas during heat waves.

Exertional heat stroke occurs in people who exercise vigorously in very hot environments without taking adequate amounts of liquids or without taking “cooling-off” breaks. You occasionally hear of sports figures or marathon runners who experience this, but it can happen in anyone exerting themselves without adequate cooling methods. Older folks playing golf or working in the garden in 90-degree weather are particularly vulnerable.

The first sign of heat stroke is sudden lack of perspiration. The skin becomes very warm and dry. People misinterpret this as “getting used to the heat” and don’t regard it as a problem. As the body temperature increases to over 105 F, you begin to see confusion, disorientation and eventually loss of consciousness. Seizures, muscle rigidity, kidney failure and excessive blood clotting may develop after that, and ultimately death at temperatures above 113.

The usual anti-fever medications, like Tylenol and ibuprofen don’t work in these situations. You have to use things like cooling blankets, ice packs, fans, cold intravenous fluids or irrigation of the stomach with ice water, or even immersion of the whole body in cold water. You have to get the temperature down however you can do it.

The best thing of course is to be wary of this possibility and not expose yourself to prolonged heat, especially while exercising.

PSA- Screening for Prostate Cancer

Using the PSA, a blood test, as a screen for prostate cancer is becoming even more controversial. For one thing, no one really knows the best treatment for prostate cancer even if you find it. Sometimes the treatment ends up being worse than the disease.

It probably makes sense for 50-75 year-old males to get tested. However, finding and treating low risk prostate cancer after the age of 80-85 probably causes more harm than good.

Alcohol - How Much Is Safe?

Alcoholic beverages can actually be healthful when taken in small amounts every day. By small amounts, I’m talking about 4-6 ounces of wine, or its equivalent. This amount of alcohol on a daily basis helps to prevent heart attacks, strokes and other vascular diseases. People have actually been shown to live longer when they drink one glass of wine daily. 2 glasses (8-12 ounces) a day kind of evens things out. You won’t live any longer, but you won’t be greatly harmed by it either usually.

3 or more glasses a day are definitely detrimental to your health. At that rate of alcohol consumption, the risk of liver disease, heart disease, brain and nervous system problems and many types of cancer begin increasing exponentially, not to mention the increased risk of accidental deaths caused by falling episodes, automobile and boating accidents, etc.

Report on Zocor (Simvastatin)

A recent FDA report on Zocor indicated that there is higher risk than previously thought from taking very high doses of Zocor. Until now, the maximum dose of Zocor was thought to be 80 mg daily. However this dose has been shown to cause severe muscle inflammation in certain individuals. Lower doses seem to have less risk. This may be true for other statins as well.

This does not mean statins are bad drugs. Like everything else, they have to be used for the right reasons and in a safe dosage range.

Statins have many benefits in addition to their cholesterol-lowering effect, including the reduction of inflammation in the arteries, which contributes to cholesterol buildup in the arteries. They also have an antiplatelet effect, which helps to decrease formation of small clots that can cause stroke or heart attack.

So don’t stop your statin, just lower the dose a little if your doctor agrees.

Report on Niacin

A recent study, comparing the effects of Niacin in combination with a statin vs. a statin alone, was halted early because the study showed no benefit of Niacin + Statin, and in addition, there was a suggestion that the Niacin arm of the study may actually have been associated with a slight increased risk of stroke.

This study is as yet unpublished and so it has not been subjected to the peer review that studies like this usually get. However, if it turns out to be true, this may cause us to rethink our use of Niacin for treatment of elevated cholesterol.

Many cardiologists are already skeptical of the way the study was done, so there is no need to change anything yet. If you are on a combination of Niacin and a statin, you may want to talk more with your doctor about it and watch for further reports on this in the near future.

Fish Oil

Omega-3 fish oil is a medication/food supplement that helps to prevent the deposition of cholesterol on the inside wall of arteries. It also has some antiplatelet properties that reduce the formation of small clots.

Of course you can get fish oil by eating fish, which is a good thing to do 2-3 times a week, but you can get more if you take a supplement as well. This is one of those supplements that is unusual in that more is actually better at least with regard to heart disease and stroke. So far, we haven’t found any bad effects from it at all.

Lots of companies have jumped on the bandwagon to sell fish oil but you have to look at the label carefully before you buy the ones that are available over the counter. Remember that the only specific type of fish oil that is beneficial to you is the omega-3. All the other components are not helpful. The proper dose is at least 1000 to 2000 mg of omega-3 twice a day. It costs a little more but the benefits are worth it.

CoQ10 Deficiency

Recent research has shown that statins can sometimes cause a deficiency in the enzyme CoQ10, a naturally occurring substance that is necessary for proper metabolism. It can be found in organ meats like heart and liver, and also in beef, soy, mackerel, sardines and peanuts.

Your body makes its own coenzyme Q10, which it uses for cell growth, and it helps to protect the heart and skeletal muscles. People have been taking CoQ10 for years as a supplement to help improve their energy levels. Now, as a result of this recent study, we are finding out that if you are taking a statin to help lower cholesterol and improve your vascular health, you should also be taking CoQ10 to prevent deficiency of this nutrient.

Also, by using CoQ10 in conjunction with your statin in a dose of 100mg daily, you may have less risk of muscle pain and cramping.

Primary Care Physicians - The More, The Better

A recent study published in the Journal of the American Medical Association, by Chang, et al. evaluated health outcomes for 5 million Medicare beneficiaries relative to the accessibility of primary care physicians (PCPs).

Not surprisingly, the researchers found that there was a substantial reduction in both mortality rates and hospitalizations in those patients that had more access to primary care physicians, than in those who had less access.

Furthermore, there was no increase in cost associated with these better outcomes.

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 Summer!!