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VBPM Connection, Issue #026 -- News from your doctor's office.
October 14, 2012
The Virginia Beach Premier Medical Newsletter
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.
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An article appearing in the New England Journal of Medicine this month promises a new way of determining the best medical treatment for specific cancers in individual patients. Tumor cells obtained from a biopsy can be grown in a lab dish and then various drugs can be applied to determine which one works the best in killing the tumor cells. This drug can then be given to the patient to fight the cancer. This is similar to the method used to determine which antibiotic is best for treating a particular bacterial infection. The results can be obtained in as little as 2 weeks.
A similar research study uses a block of a patient's tumor cells implanted into several different mice. A different potential treatment is applied to each mouse to see what works the best in destroying the tumor. Then that treatment can be applied to the human patient from which the tumor cells were obtained.
This promises to be an important breakthrough in customizing cancer treatment and hopefully would reduce some of the trial-and-error treatments that have had to be used thus far.
Further cancer research is showing that in any given cancer, only a small collection of the cancer cells within the tumor are the ones that cause all the growth of the tumor. This is why in many cases the chemotherapy destroys a large part of the tumor, but if these so-called cancer stem cells survive, they cause recurrence of the tumor. If these particular cancer cells can be metabolically identified, targeted and destroyed, the cancer could potentially be cured.
Being able to drive as a senior is a major functional indicator of independence. None of us want to lose this ability as we get older. However, it is also a great responsibility, since your vehicle, after all, can be a lethal weapon in the hands of a person who has lost the ability to respond to sudden changes in traffic and pedestrian activities. If your reflexes are getting a little slower, or if your hearing and eyesight are not what they used to be, it would be wise to consider that driving may be a lot more difficult and dangerous than it once was. if you are 90 years old, you may not care that much about your own longevity, but the car in front of you may be carrying 2 or 3 children who have their whole lives in front of them. If you couldn't stop in time, you may end up being responsible for the loss of their lives.
This is really no different than drinking and driving, (or even texting and driving). The presence of an impaired individual behind the wheel is a higher risk than necessary and should always be avoided for the protection of others and the prevention of an early death that would otherwise be avoided.
Excessive bruising in older patients is almost certainly due to thinning of the skin related to age, and capillary fragility caused by loss of elasticity also due to the aging process. If you add Aspirin, Plavix, Coumadin or Pradaxa to the mix, you are sure to have multiple bruises on your arms or legs or elsewhere. This is not a sign of leukemia, but more an indication of age and the presence of blood thinner medications. Cosmetically it looks bad, but it's not dangerous. One way to look at it is that it's better to have a few bruises than a stroke or heart attack.
Chronic cough in an adult is an annoying problem but usually not serious. It can be caused by a number of different problems including gastroesophageal reflux which may be occurring at night without your knowledge. It could be caused by medications like lisinopril or metoprolol. Sometimes it is due to post-nasal drip related to allergies. Smoking, Asthma or COPD could be playing a role. Occasionally, it can be due to stress or anxiety. Rarely, it can be due to a laryngeal abnormality like a polyp or to a bronchial lesion. Talk to your doctor if you have a cough lasting more than 3 months.
Dry mouth is a common complaint, especially among the elderly. If you haven't had any radiation therapy to the mouth or throat area, then It is probably due to medications. Many medications can cause dryness of the mouth and mucous membranes.
Talk to your doctor and see if any of the medications can be changed or reduced. If not, consider using Biotine which can be purchased over the counter and can be used as a saliva substitute. Cough drops or tart candy can be used to stimulate saliva flow.
There are other rare causes of dry mouth, including Sjogren's Syndrome, which also can cause arthritis and other symptoms. HIV can do it. Another cause is excessive mouth breathing, especially during the night.
If you have dry mouth, make sure you take good care of your teeth since dryness of the mouth can result in tooth decay. Meticulous brushing and flossing and regular dentist visits should be helpful.
Ringing, buzzing or any other noise in the ear in the absence of any external sound is called tinnitus. It is very common involving at least 10-15% or more of the population. It is usually benign, but annoying and many people seek out all kinds of treatment for it, most of which doesn't work. The cause is often not clear.
Occasionally, it can be associated with hearing loss, vertigo (dizziness), wax buildup, infections, allergies, certain drugs, vascular anomalies, trauma, pressure changes, and rarely tumors or other neurologic disorders. The presence of one-sided tinnitus in the setting of other neurologic symptoms should raise a red flag.
Treatment is often directed toward masking the tinnitus using hearing aids that emits more pleasant sounds. Over-the-counter lipoflavanoids seem to be helpful for some. Most of the time we just have to learn to live with it.
Acute Neck and Back Pain
This is one of the most common reasons that patients come to doctors. It is most commonly due to muscle strain, ligament strain, spasm or a combination. Only about 15% of the time is it due to structural abnormalities like herniated disk, lumbar stenosis, compression fracture, osteoarthritis, spondylolisthesis. Rarely is it caused by tumors, infection, aneurysms, etc. The vast majority of patients improve on their own within 3-4 weeks.
If the physical exam is normal, the pain is not incapacitating and there are no neurological symptoms, fever or other associated signs to indicate a serious disorder, imaging studies, like MRI, are not helpful. Many people ask for one right away, but insurance companies, aware of the statistics, often won't approve it until at least a month has gone by and the patient has tried a course of physical therapy. Conventional x-rays can be done early on, but are usually not helpful either. If there is concern about tumor, then a bone scan and blood tests may be helpful. If there are multiple painful areas and trigger spots over various areas of the neck, back and shoulders, fibromyalgia would be a strong consideration. Other rheumatologic conditions with inflammatory arthritis (rheumatoid arthritis, lupus, polymyalgia rheumatica, etc.) can usually be ruled out by blood tests.
Initial treatments include NSAIDs, local heat, Lidocaine patches, short courses of steroids or opioids, stretching exercises, electrical stimulation by a TENS unit and physical therapy. Bed rest is usually not required and in some cases can prolong the problem. Studies have shown that patients with back pain who maintain their usual activity get better faster than those who rest. If there is no improvement after 4 weeks, then moving forward with a more extensive evaluation is warranted.
What's New in the Journals
Regular cannabis use by adolescents is associated with neuropsychological decline and a significant decrease in IQ continuing into adulthood. This is not reversible even if use is discontinued.
Peptic ulcer disease is on the rise, especially among older adults. This appears to be due to the increased use of low-dose aspirin as well as other NSAIDs (nonsteroidal anti-inflammatory drugs).
Plavix, Singulair and Actos are now available in generic forms.
Magnesium supplements do not help with leg cramps.
Topical NSAIDs are often just as effective as oral NSAIDs for chronic musculoskeletal disorders and have fewer GI side effects.
In patients with fibromyalgia, duloxetine (Cymbalta) seems to improve overall symptoms and function after 12 weeks.
Perfume, Pets and Policy
This may seem like an unlikely topic for a medical office newsletter, but it is an important one nevertheless. If you've ever known someone who has allergies, you know that sometimes exposure to certain things like pet dander and perfume can be quite distressing and can even precipitate a severe asthma attack.
So, when coming into the office, in order to protect our patients and office staff, please refrain from wearing perfumes and bringing in pets. We will be forever grateful.
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.
Patient Centered Care
At VBPM, we provide patient centered care. This means that the patient's care is our number one concern and we bend over backwards to make sure you are getting the best care available. If that means referring you to a specialist or to a medical center, then that's what we'll do. We coordinate your care among all the other consultants and therapists that you might be seeing. All notes, test results and consultation reports are requested to come through our office and are entered into your chart so that all of your medical information is located in a central hub. We keep all your medication lists and preventive health care up to date so you don't have to be wondering if you've done everything you're supposed to do to optimize your health in the future. Your concerns are our concerns, and we will be there for you when you need us. We thank you for the opportunity to allow us to provide this service for you.
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