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VBPM Connection, Issue #022 -- News from your doctor's office.
June 01, 2012

The Virginia Beach Premier Medical Newsletter

June, 2012

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


We are always looking for better ways to communicate with our patients and colleagues, so when a new, free, secure internet-based messaging system became available, we had to investigate.

Twistle is a new, password-protected, email-based messaging system that was created specifically for doctors' offices that allows patients and doctors to type messages to each other and send documents and even pictures back and forth. This is similar to text messaging or instant messaging, only much more secure. It allows direct communication to your personal physician or to the office staff for things like setting up appointments, refilling prescriptions, asking billing questions or even non-emergent medical questions. Your doctor will be able to easily send you lab or X-ray results and you will be able to respond or ask questions.

Of course, you still have all the other options of communicating with us as before - including calling the office staff, or calling your physician directly, or even using regular email although Twistle could easily take the place of the latter option much more securely than before.

You have to be invited to sign up, so if this is something you would like to try, please let the office staff or your doctor know so that we can send you an email invitation.

You can see how easy it is to get set up with this program on the following instruction page... Twistle Instructions

Sleep Patterns and Obesity

An interesting study by Buxton, et al, has shown that abnormal sleep patterns - either not enough sleep (less than 6 hours per day), or irregular sleep patterns, such as those not following the normal day-night cycle (circadian rhythm) - are associated with metabolic changes in the body that increase risk for obesity and type 2 diabetes mellitus.

So if you're sleeping too much during the day and/or not enough at night, and if you are having trouble losing weight, getting your sleep patterns back to normal may help.

Screening for Hepatitis C

Hepatitis C is a common infection of the liver affecting about 150 million people worldwide. After the initial infection, about 85% of the time the virus remains in the liver causing a slow inflammatory process that does not cause any symptoms, but over many years can lead to the development of cirrhosis and eventually liver failure.

The infection can be spread by transfusion (especially for those transfused before 1992), IV drug use, tattooing, body piercing, healthcare exposure, and probably by sexual activity.

There are treatments available for Hepatitis C, which can result in a 50-80% cure rate, but you have to know you have it first.

About 50% of people have it and don't know it.

Prior recommendations for testing only included certain high risk groups of people. However, a recent study suggests that screening for Hepatitis C should be broadened to include all adults between the ages of 20 and 69. If this is done, liver-related mortality will decrease by 1% for every 15% of the population tested.

If you would like to be tested or have any questions about it, please let us know or talk to your physician about it.


Sciatica is a painful condition involving the low back associated with radiation of the pain and possibly numbness along the posterior and lateral side of the leg, sometimes all the way down to the lateral part of the foot, following the course of the sciatic nerve. It is often caused by pinching of nerve roots originating from the lumbar area of the spine. The compression of these nerve roots is usually caused by arthritic bony overgrowth or by bulging discs.

One of the more common treatments for this has been to inject numbing medicine along with steroids into the area where the pinching is occurring with the hope that decreasing swelling and inflammation in the area will help the pain. These are called epidural steroid injections ESI) and are often given by interventional radiologists or by back specialists.

Studies show that about 50% of people will get better in about 3 months even without this treatment. However, if the pain and disability remain severe after a reasonable period of conservative medical treatment, a steroid injection would certainly be a consideration and worth trying in many instances. Often a series of 3 injections are given one month apart. It may take a week or more after an injection to get relief if it works.

A New Type of Insulin

Insulin degludec is a new insulin that has not yet been approved by the FDA, but is anticipated to markedly reduce the incidence of hypoglycemia (low blood sugar), that is often a problem with other types of Insulin. It is an ultra long acting insulin that lasts about twice as long as Lantus and will likely require a smaller dose. The downside is that if the blood sugar does get too low, it will take longer to get the Insulin out of the system.


Summer's here. Don't forget to use sunscreen!

Skin cancers are increasing in frequency and usually involve people with fairer skin who have had lots of prior sun exposure. However, sometimes it occurs in those who have only had a couple of episodes of severe sunburn.

Actinic keratoses are small scaly precancerous lesions that appear on sun exposed areas and can be easily treated most of the time by cryotherapy (application of liquid nitrogen usually with a spray device).

Basal cell cancers can be locally invasive and if not treated can cause erosive changes to the skin and underlying structures, but they don't spread beyond the area where they start.

Squamous cell cancers are a little more dangerous because they not only spread locally but also can get into the blood stream and spread to other tissues and organs in a small percentage of cases.

Melanomas are the worst form of skin cancer and require a high index of suspicion to find them. There is pneumonic (ABCDE) that helps to determine whether a mole is anything to worry about or not:

~ A - Asymmetrical

~ B - Border is irregular

~ C - Color - Melanomas usually are multi-colored - black, purple, brown, tan - all in one lesion.

~ D - Diameter greater than 6 mm

~ E - Enlarging or evolving - changing

Some people have multiple dark moles all over. A yearly checkup with a dermatologist may be helpful in locating suspicious moles that may require biopsy.

Prostate Cancer Screening

Using the blood test, PSA, as a screening tool for prostate cancer has been in the news again.

The USPSTF (US Preventive Services Task Force) has determined that PSA levels should no longer be used for screening purposes in men of any age group. This was based on 2 studies that showed the risk of harm from "unnecessary" procedures done on the basis of elevated PSA levels is worse than the risk of mortality from prostate cancer by not doing the PSA screening. In others words, doing widespread screening in the general population has not resulted in any reduction in mortality of prostate cancer overall, but it has resulted in problems associated with doing procedures like prostate biopsies, surgeries and radiation treatments. The American Cancer Society seems to go along with this, but other organizations consisting of urologists, oncologists and preventive health experts have found several flaws in this recommendation.

I think the decision should still be an individual one made by discussion with your physician about the pros and cons of doing the PSA test. If the PSA is slightly elevated on one occasion, it probably should just be followed and nothing else done. If it becomes increasingly higher in patients who perhaps have a higher than usual genetic risk of cancer, it seems warranted to investigate it further. For those who would rather not know, it's okay not to do the test. For those who want to know, just to have the option of whether they want to do anything about it or not, it's okay to do it. If it will cause too much psychological stress to know that the PSA is elevated, then perhaps it shouldn't be done.

As in most situations, there are many shades of gray when it comes to making a decision about this. Not everyone is the same and there probably are select groups of men where doing the PSA still makes sense. It's definitely not a clear cut issue.

You can read more about it here... Prevention Panel: No Need for PSA Test


We schedule most of our routine appointments for an hour each so that there is no waiting, no rushing and so that we have plenty of time to take good care of our patients, answer questions and talk with consultants if necessary.

Although we do try to make time for work-ins every day, your doctor only has a limited number of scheduling slots in which to see patients in the office. If someone doesn't show up for an appointment, there is a large void in the schedule where someone else who needs to be seen could have been put in that space.

If you've made an appointment with our office and you won't be able to make it for one reason or another, that's okay. There is no punishment for this like there is in other offices. Just let us know as soon as you know so that we can use the time to see another patient who may need to be seen urgently.

Is Coffee Bad for You?

Believe it or not, a large study involving over 400,000 people found that people who drank 4-5 cups of coffee every day reduced their risk of death significantly over a 13 year period. The risk dropped by 12% in men and 16% for women.

The risk for death from illnesses like heart disease, stroke, respiratory problems, diabetes, infections and even injuries and accidents were reduced. The risk of cancer deaths was not affected however.

It seems dose-related as well. For those who drank only one cup a day, there wasn't much benefit. For 2-3 cups a day, the was a moderate benefit. 4-5 cups a day yielded the best results. For 6 or more cups a day, the benefit was back down to moderate.

Of course there are still situations where caffeine is not a good idea - like those who have heart palpitations, excessive anxiety, hyperthyroidism, excess stomach acid and reflux problems.

Read more here... Coffee Linked to Lower Death Risk

Can Calcium Increase Risk of Heart Disease?

There has been some concern about whether taking calcium supplements may increase risk for heart attacks. Prior studies have not clearly shown whether this is the case one way or the other.

More recent studies and reviews of the data from older studies (called meta-analyses) have demonstrated that there does seem to be a modest increase in risk of heart attacks in patients who take calcium supplements at a dose of over 500mg per day for 5 years or more. Dietary calcium does not cause this, and in fact patients who take high amounts of dietary calcium had lower risk than those who had a low intake. The higher risk only occurs in those who have been taking calcium supplements.

The amount of risk to any individual taking calcium supplements is considered modest at best. Nevertheless, the recent studies suggest we should be careful with calcium as we should be with all supplements. They do help improve bone health and prevent fractures, but there is a small risk of heart attack that shouldn't be ignored.

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.

Health Security

For many patients, the security of knowing they have their personal doctor available to them at a moment's notice, day or night, is a great benefit. Add to that the personal attention, advocacy, thoughtful advice, consideration, patience, listening ability, communication, knowledge, experience, convenience and compassion, not to mention the very friendly and helpful office staff, and you have a recipe for excellent healthcare. That's what you find at Virginia Beach Premier Medical. You can be assured that we're here for you whenever you need us.

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.

Enjoy Your Summer!!!

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