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VBPM Connection, #031-- News from your Doctor's Office.
March 06, 2013

The Virginia Beach Premier Medical Newsletter

March, 2013

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 ( 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

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Preventable Deaths

Tobacco is the single-most important contributor to preventable deaths. The link between tobacco use and the development of cancer, emphysema and cardiovascular disease is indisputable. Smoking also results in leathery skin, hoarseness of voice, more rapid aging of every part of your body, strokes, leg amputations and stomach ulcers to mention only a few of its harmful effects. It has absolutely no benefit. It will almost certainly shave a minimum of at least 10 years off your life - on average, not to mention the suffering and misery that it will cause along the way. Is it worth it?

The second most important contributor to preventable death is hypertension, or high blood pressure, which is controllable with appropriate medication in the vast majority of cases. The problem is that many people don't know they have it and even when they do know, they don't get adequate treatment for it for a variety of reasons.

The third major contributor to preventable deaths is obesity. Patients who are overweight and/or obese definitely have an increased risk of diabetes, hypertension, coronary disease and increased death rates from cancers. The Framingham Heart Study found that overweight and obese patients are associated with large decreases in life expectancy. For example, 40-year-old female non-smokers lost 3.3 years and 40-year-old male non-smokers lost 3.1 years of life expectancy just because of being overweight. Those who are obese lost 7.1 years and 5.8 years respectively. Furthermore, patients who are obese and smoke lose a minimum of 13-15 years of life expectancy.

The fourth important contributor to preventable deaths is lack of sufficient physical activity. A sedentary lifestyle is linked to about 20% of deaths from leading chronic diseases. Patients who engage in moderate exercise on a regular basis have a lower risk of heart attack, stroke, hypertension, hyperlipidemia, diabetes mellitus, diverticulosis and osteoporosis. In older non-smoking men, walking 2 miles or more per day is associated with a 50% lower age-related mortality. It helps to prevent colon cancer and prevent breast and reproductive cancer in women. Resistance training reduces osteoporosis in women and increases muscular strength, functional capacity and quality of life in both men and women. Physical activity reduces depression and anxiety, improves sleep quality, enhances mood and overall performance and self-esteem. It reduces both systolic and diastolic blood pressures and reduces pain from osteoarthritis.

Family Support Group

There is a new family support group that meets every Thursday at 5:30 p.m. in the Virginia Beach Psychiatric Center Administrative Conference Room that is hosted by Dr. Palat, psychiatrist and expert in the field of geropsychiatric issues who will be discussing topics like depression in older adults, use of medications for depression and dementia, signs of dementia and Alzheimer’s disease, when to call a professional, etc. If you’re interested, please RSVP at


Rosacea is a rash that begins usually with facial flushing around the nose and cheeks. This is usually progressive and is associated with swelling and thickening of the skin around the cheeks and nose. Sometimes there can be a burning or irritation in the eyes along with this. If you develop the signs of rosacea you need to avoid excessive sunlight exposure, spicy foods, alcohol, hot baths and medications that dilate blood vessels.

Treatment often involves using topical antibiotics like metronidazole or using Retin-A, benzoyl peroxide and sulfacetamide. Ocular rosacea may require steroid eye drops. Sometimes even oral antibiotics such as doxycycline or Erythromycin may be helpful.

Plantar Fasciitis

Plantar fasciitis is an inflammation of the fibrous band of connective tissue on the bottom of your foot, usually in the heel area. It’s usually caused by an injury or tension in that area, such as stepping on a stone which can cause microscopic tears in the fascia which can lead to inflammation and subsequent pain.

Treatment for this includes wearing the right shoes, using cushioned foot wear at all times and avoiding walking in bare feet. A silicone heel cup may be helpful. Limit aggravating activities such as jogging or stair-stepping. Physical therapy to include stretching and strengthening exercises may be helpful. Sometimes using cool water while applying a cloth-covered cool gel pack for 15 minutes twice a day may help.

Taking anti-inflammatory therapy such as ibuprofen might be helpful, as long as it is not contraindicated because of kidney or ulcer disease. Also, losing weight will help ease the strain on your feet. If those methods are not effective, then sometimes podiatrist will recommend custom molded shoe inserts, a cortisone injection, night splint or wearing a cast or walking boot.

How To Treat Pre-Diabetes

If you’ve been told recently that you have pre-diabetes based on a hemoglobin A1C level of greater than 5.6 and less than 6.0 or based on 2 elevated blood sugars greater than 100 on a fasting basis, you may need to consider the following treatment plan: Most people who have pre-diabetes can reduce their risk of developing diabetes later by acting on the following recommendations:

1. Eat healthier – less fat, fewer calories.
2. Exercise for 150 minutes a week or an average of 30 minutes a day for 5 days a week.
3. Lose 7% of your body weight.
4. Eat more minimally-processed foods.
5. Use only moderate portions of low-fat, dairy, fish and other protein sources.
6. Limit your daily intake of meat, poultry and fish to no more than the size of a deck of cards.
7. Reduce saturated fat intake.
8. Minimize sweets, sugary beverages and processed baked goods.
9. Control portions.
10. May still have 1-2 cups of coffee per day, a small square of dark chocolate and no more than one alcoholic beverage.

There is a drug that can be used but it’s not as effective as losing weight and exercising.

Source: Mayo Clinic Health Letter, August 2012

To Test or Not To Test: That Is the Question

As physicians, we are bombarded by the medical literature about recommendations from preventive health organizations, by Medicare and by commercial insurance companies to avoid over-testing when it's not really necessary.

As you probably know, there are several tests that can be done for almost every symptom that a patient mentions. When to do those tests and when not to do them is part of what physicians grapple with during almost every visit with a patient.

There is a certain amount of thought that occurs in a physician's mind related to making a decision about whether to test or not. Part of this decision depends on the benefit/risk ratio, the physician’s experience and judgment, concern about the presence of potentially serious conditions, determining the likelihood ratio of those conditions, the patient’s anxiety over their condition which could be alleviated by a good result, the concern about a potential missed diagnosis and associated medico-legal concerns, along with societal worries of over-utilization of the system and high cost of medical care. For example, should we order a $2000 test that has less than 1% likelihood of finding anything wrong?

There are guidelines that have been written by various organizations of physician specialists regarding these things and we try to go by those guidelines. But our most important concern is alway what's best for our patient.

In our practice, we try to manage this by carefully considering all the options, frankly discussing the pros and cons associated with testing or not testing, discussing the potential risks of not testing, providing our own measured and educated advice on what we think should be done, but ultimately making a decision together with the patient, with the patient’s input after they have been informed of the pros and cons. This is what makes patient-centered care what it is. We provide advice to the best of our knowledge and judgment but always want the patient to know that ultimately the decision to follow through with that advice is entirely up to them.

What's New in the Journals?

Taking probiotics like lactobacillus and others while taking an antibiotic for an infection seems to decrease the risk of developing C. diff intestinal infection afterwards. This should probably be standard for those who have had a C.diff intestinal infection in the past.

All men between the ages of 65 and 75 should be screened by ultrasound for abdominal aortic aneurysm. This is especially true for current and former smokers.

Yet another study, this time done on Swedish women, shows that high calcium intake seems to double the risk of all causes of mortality as well as cardiovascular mortality.

The Mediterranean Diet is the best diet to prevent cardiovascular disease. It may prevent as much as 30% more cardiovascular disease than low-fat diets based on a recent study reported in Loma Linda, CA.

Perfume, Pets and Allergies

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.

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.

Happy St. Patrick's Day!

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