The Virginia Beach Premier Medical Newsletter

August, 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 would like to receive a copy of this free monthly newsletter electronically by email, go to the Newsletter Signup Page on the office website (www.vbpm1.com) 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 gjwarth@gmail.com.

Ask questions. Change your appointment. Get your lab or x-ray results. Request prescription refills. Keep us informed. Join Twistle, a secure communication network.

Vitamin D Prevents Fractures

The minimum effective dose is 800 units per day. If you're taking a multivitamin, you're only getting 400 units from that. You will need an additional 400 units of Vitamin D for it to do any good - even more if your vitamin D level is low in your lab work.

This is good news, since there is currently a push away from taking calcium supplements due to their risk of vascular problems and kidney stones. High amounts of dietary calcium is not a problem - only the calcium supplements, or tablets.

So, make sure you're getting enough vitamin D. This goes for both men and women over the age of 65. If you're not sure about how much to take, ask your doctor. Why have an increased risk of fracture if you can prevent it?

How Much Alcohol Is Too Much?

Here's the guide:

For women, the maximum amount of alcohol should be no more than 3 standard alcoholic beverages on one occasion, and no more than 7 drinks per week.

For men younger than 65, the amount should be no more than 4 drinks on any one occasion, and no more than 13 per week.

For men over 65, follow the same recommendations for women.

Any use of alcohol by children, teens, women who are pregnant or breast feeding, by those with a personal history or even a family history of alcohol dependence and by anyone engaging in any situation requiring attention or skill, such as driving, operating power tools, machinery, boats, etc, should all be considered hazardous to the health of that person and those around them.

Drinking alcohol in excess of the above recommendations over time will cause serious liver disease, hypertension, heart disease, dementia, pancreatic disease, diabetes, major bleeding disorders, gastritis, ulcers, and various types of cancer too numerous to mention - any and all of which can lead to a very early death. Mentally, it causes depression, agitation, psychosis, confusion, irritability, guilt feelings, alienation of family and friends and complete disruption of life, career and overall health.

I have known many good, wonderful people who died in their forties because of this devastating disease.

It's a slippery slope, because most people who drink excessively are in denial about it and are often annoyed by people who are concerned about their drinking. They eventually become guilty about it, start hiding it from others, and ultimately find that they can't stop shaking without it.

If you are concerned about your drinking or if your family is concerned, talk about it with your doctor. Treatment is available and often effective for those who are willing to recognize that it's a problem, and who are willing to get help.

HealthCare Reform

How much do you really know about the Patient Protection and Affordable Care Act?

First, take the health reform quiz at the Kaiser Family Foundation site (http://healthreform.kff.org/quizzes/health-reform-quiz.aspx).

Then check out the July 7, 2012 blog entry on the Art of Patient Care website for links to some factual information about it.

Art of Patient Care Blog (http://www.art-of-patient-care.com/patient-care-blog.html)

Or, go to the following websites...

American College of Physicians

www.healthcare.gov

www.insuremekevin.com

Zithromax for Chronic Use

Azithromycin has some anti-inflammatory properties as well as being an antibiotic that seems to improve recovery rates significantly more than some other antibiotics in these situations.

There are some hazards to its use, however, and must be used with caution in patients with severe liver disease or cardiovascular disease, or in those patients who have to take a statin for cholesterol-lowering.

Environmental Estimates

Anti-smoking initiatives in New York City are estimated to have reduced the number of smoke-related deaths by 1500 per year.

Heat Stroke

The syndrome often occurs during summer months, particularly during long heat waves, in older individuals who live in apartments with no air conditioning, and who often don't drink enough water. The situation is even worse when the humidity is greater than 75%, because evaporation of perspiration (one of the best cooling mechanisms the body has) isn't working at that point.

The emergency treatment requires rapid cooling, protection of airway, breathing and circulation. Rapid cooling is usually done by spraying the body with lukewarm water while using fans to enhance evaporation. Special cooling blankets can be used as well. Shivering can be controlled by using intravenous medicines like Ativan or Valium. Other complications like kidney failure, dehydration or respiratory failure have to be treated as well.

Shoulder Pain

~ Rotator cuff tendinitis - Lateral shoulder pain aggravated by reaching, raising your arm overhead or lying on your side.

~ Rotator cuff tear - Weakness of shoulder muscles, loss of function, unable to raise arm above 90 degrees.

~ Bicipital tendinitis - Anterior shoulder pain occurring mostly with lifting, flexing, overhead reaching.

~ Acromioclavicular syndromes (like AC separation) - Anterior shoulder pain and deformity, usually caused by trauma or overuse

~ Glenohumeral arthritis - gradual onset of anterior pain and stiffness, decreased range of motion, crepitation (grinding or cracking sensations when moving the joint).

Treatment is directed toward the specific cause, but often initially requires some period of rest followed by physical therapy for 4 weeks. Sometimes cortisone injections given locally are helpful along with use of local or oral NSAIDs (anti-inflammatory medicines).

Bipolar Disorder

Manic or hypomanic episodes are those in which the individual usually feels really good, has lots of energy, loses sleep but doesn't mind it, and often gets into trouble because of impaired judgment. May go on shopping sprees and spend too much money, may become much more vocal than usual that can get the person into trouble, may become very irritable, much less reserved than usual, lacking normal inhibitions, and in general is acting out of character, not like s/he usually acts. The mood may then swing into a severely depressed mode for a while and then become manic again. Of course, like so many other things in medicine, the presentation is not always that typical or classic and often requires a psychiatrist to make an accurate diagnosis.

Treatment is more complicated than it is for simple depression which is why those with this disorder are often referred to psychiatrists who have good knowledge of pharmacotherapy. Many different medicines have been used to treat this disorder, some of which can have significant side effects and require close monitoring.

ADHD

Before a person is diagnosed with this problem, there must be some functional impairment caused by the above symptoms, such as difficulty in social, academic or occupational functioning. There also needs to be a problem in at least 2 different environments, like at home and at work or school. It does run in families. Sometimes adults suddenly realize they have had this tendency after their children have been diagnosed with it.

Treatment can involve either stimulants or antidepressants or both. Behavioral therapy may also be helpful and can reduce the amount of medication required.

There is a tendency for many people even without ADHD to want to take stimulants because they do provide some energy, so there is a high level of abuse which is why it is an FDA-controlled substance. There is a price to pay for using these substances indiscriminately because they can cause hypertension and cardiac arrhythmias and are potentially dangerous.

Telemedicine

It has been used locally in intensive care settings in which the physician can be advised about the condition of a patient using video equipment in the patient's room that will show images to the doctor in his home or office. The patient can be viewed along with current lab work, x-rays and cardiac monitoring information.

The three main types of telemedicine include (1) storing and then forwarding the information such as labs and x-rays to the physician later, (2) remote monitoring, which can provide a continuous flow of EKG monitoring, for example, to the physician's office, or (3) real-time interactive patient "visits", where there is discussion between the patient and the physician via the communication/conferencing equipment.

It's hard to know exactly where this technology will lead us, and there certainly are pros and cons to its use. It has the danger of further eroding the already straining doctor-patient relationships that were once felt to be essential in the practice of clinical medicine. Hopefully, it will ultimately take its place as a useful tool but will not supplant the personal bedside or office visit as the primary means of providing care.

About Our Office

Compassion

At VBPM, you will never find lack of compassion or concern. Those things are inherent within the fabric of all of those who work here. Your worries are our worries, and we will do everything we can to help you with them.

If you would like more information about our practice please call us at 757-416-6750 or visit our website at www.vbpm1.com. 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!!!