The Virginia Beach Premier Medical Newsletter

February, 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.

Drug Shortages

Drug shortages are quickly becoming a national crisis. Increasingly, medications that we have come to rely on for patient care are in very short supply and are often unobtainable. This applies to many types of medications including antibiotics, certain sedatives and analgesics used in surgical patients and in obstetrical care. Commonly used medicines like intravenous Ativan, various oral pain medications, drugs used for attention deficit disorder, antacids, diuretics, IV Valium, blood pressure medicines, Vitamin K, asthma inhalers, vasopressor agents used for treatment of life-threatening disorders like shock and even certain forms of Insulin are all in short supply and becoming very difficult to obtain. At some point this will ultimately result in rationing, or using less effective medications, or having to use ones with a higher risk profile.

There are three main reasons for this occurring. First, for economic reasons many of the pharmaceutical companies have merged together. If two companies were making a particular drug before, now only one company is making that drug. Thus we have fewer manufacturers.

Some drugs are no longer economically feasible for a company to make. If it costs more to make the drug than what the company can make in a profit, they simply won't make it.

Thirdly, poor manufacturing practices by some companies have resulted in crackdowns by the FDA inspectors. Many of the plants that have been making these drugs have actually been shut down by the FDA until the manufacturing practices come back up to the FDA standards.

In the meantime, some patients will suffer as a result of these problems. Hopefully soon, some of the manufacturers will be back in business again but it may take years before these shortages improve.

Polypharmacy

This is a term used to describe the problem of taking so many different medications that the risk of side effects or drug interactions can become a serious problem. Sometimes prescribing multiple medications is necessary to control certain conditions. For example, for a patient with diabetes, high blood pressure and high cholesterol, it may require as many as 6 or 8 medications to keep these illnesses under proper control. In this case, the benefits of taking the medicine far outweigh the risks of not taking it.

Nevertheless, polypharmacy is something that we should always be mindful of and try to avoid as much as possible. It is entirely appropriate for you to ask your doctor if you still really need to take all these medicines. It forces your doctor to think about it, and then perhaps the med list could be reduced. If you have to start on a new medicine, ask if an old one can be reduced or eliminated. It may not be possible, but it is something that we should look at on every visit.

One caveat: Don't stop any medication abruptly without checking with your doctor first. This could potentially be harmful or even dangerous with some medications.

One thing that helps reduce the amount of medication that you have to take either now or in the future is closely monitoring and improving your lifestyle. Regular exercise, losing weight, stopping smoking and reducing alcohol can greatly reduce the likelihood of having to take medication both now and later.

Edema

Edema is a medical term that refers to swelling in the arms and/or legs as a result of fluid retention. This can have a number of different causes including high blood pressure, congestive heart failure, kidney disease, obesity, excessive salt ingestion, poor venous circulation in legs, severe chronic lung disease, liver disease, lymphatic obstruction, keeping your legs in a dependent (down) position for a long time (such as on an airplane or during a long drive), and the presence of blood clots clogging up veins in the arms or legs. It can even be caused by certain medications including Neurontin, calcium channel blockers (like Norvasc), steroids and certain diabetes medicines.

When presenting with edema for the first time, your doctor will likely want to try to determine the cause with studies like an echocardiogram (ultrasound of the heart), leg vein studies, blood tests, etc.

Diuretics like Lasix, Bumex or hydrochlorothiazide can be used to treat edema effectively. Other medicines may also be required depending on the cause of the problem. If it's just due to poor veins in the legs, compression stockings and elevating the legs may be all that's needed. If it's occurring because of obesity, weight loss will be the best way to get rid of it. If it's because of a medication, your doctor will have to weigh the risk/benefit ration to determine whether to continue the drug.

A common myth is that if you have edema, you should drink a lot of fluid to help your kidneys "flush it out". This is not true. It usually just makes the problem worse. In fact for many conditions, we advocate actually restricting fluid intake, which then reduces the amount of medication you have to take to get rid of the fluid.

Annual Physical Examination

One of the best things you can do to optimize your health is to get an annual physical examination. This allows for and actually forces the opportunity to make sure you are as healthy as you can be and that you have done everything you can do to prevent illness later. You owe this to yourself and your family.

First, the annual health assessment provides the chance for you to sit down with your doctor and discuss everything that's happened to you over the past year or more relating to your health.

Furthermore, it helps you see where you are a this moment - whether you are healthy, not-so-healthy or maybe even in bad shape. If the later is the case, you need to become aware of it and start focusing on the third benefit.

Third, you will be able to receive recommendations and suggestions from your doctor about what can be done to make your life and your health better. You may already know what some of these things are. But there are many recommendations that you may not know about unless you get this evaluation done.

It is very important to do this even at a young age to be sure you are on the right track for a healthy future. It is also equally important to do this at older ages as well, because we can find things that you didn't even know you had, and correct them before they become incurable.

Many people like to have their physicals done on their birthday months, some will choose a different time of year when their jobs allow them more time to be off. It's always good to do it at the same time every year because you're are less likely to forget about it and you and your doctor come to expect it.

Of course with our practice, there is no extra charge to do your physical and indeed it is part of what you should expect to receive as part of your fee.

If, for one reason or another you have not had a physical for more than a year, call now to set up your appointment. It's important, and you'll be glad you did. Your family will love you for it also.

Z-pak vs. Statins

If you are taking a statin (like Zocor, Lipitor or Crestor), and if you come down with an upper respiratory infection like sinusitis or bronchitis, and if a doctor wants to prescribe Zithromax (Z-pak) to treat the infection, you need to make sure you hold the statin while you are on the Zithromax. The reason is that the Zithromax results in increased blood levels of the statin into a potentially toxic range that could cause severe myositis which could then lead to kidney failure.

Lipitor and Diabetes

A recent study by Dr. David Walters at the University of Southern California in San Francisco showed that there was a slight increase in the risk of diabetes in patients who were taking a high dose of Lipitor, the cholesterol-lowering drug that has been one of the most commonly prescribed drugs in the world and one of the most effective cholesterol-lowering agents on the market.

The study showed that 9% of the Lipitor group developed type 2 diabetes, while this occurred in only 6% of the control group. This, unfortunately made big headlines, and caused some concern among those patients who were taking Lipitor. As it turns out the patients in the Lipitor group who developed diabetes happened to have more risk factors for diabetes than in the other group, and they were probably going to develop it anyway. Nevertheless, the link was made. The slight diabetes "risk" with Lipitor is no greater than it is with any other statin. In a comparison trial with Zocor, the risk of diabetes was no different.

When considering statements like this that are put out in the media, we must consider the background of the huge amount of medical research and literature that has already occurred in this arena. There are literally hundreds of thousands if not millions of heart attacks and strokes that have been prevented by statins, not to mention the number of lives saved over the past 2-3 decades. The benefits of these usually well-tolerated drugs far outweigh any risks. This is not to say that there are no risks, and we will always have to weigh the risks and benefits for each individual patient before prescribing these medications, just as we do with all medications.

However, there really is no need to be alarmed by this "new finding", nor is there any reason to stop the medication if it has been working well for you.

Even Dr. Waters, who did the study, was quoted as saying the risk of developing diabetes from a statin is small... "An important point," Waters said, "is that the risk of developing new-onset diabetes and its complications (is) greatly outweighed by the benefit of statins in reducing cardiac death, heart attack and stroke."

Pharmacy News

Many of our patients who use Express Scripts for their long-term medications have been dismayed by the recent loss of association between Express Scripts and Walgreens.

What we are suggesting for those patients is that they should consider signing up with CVS CareMark. They should go ahead and establish an account now. Then when they need a medication renewed that previously was handled by Express Scripts, let us know, so that we can call it into CVS Caremark. This seems to be the easiest and smoothest way of making the transfer.

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.

Coordination of Care

One of the greatest things about our practice is that we specialize in coordination of care for our patients.

The current medical system is often very fragmented such that people go from one specialist to another with no one in the center of it all to direct, coordinate and manage the whole person. Someone needs to be looking at everything that's happening, reviewing all the medicines, making sure that all the bases are covered, all the preventive tasks are being done. Someone needs to talk with the patients, explain things, and help them make decisions about their health care.

That's what we do. We serve as the hub of medical care for our patients. All the specialists, labs and radiologists report to us about our patients, and we keep track of it all in one place. We communicate directly with our consultants. We explain everything to our patients and help them understand what is going on. We help people organize and manage their medications, and we provide case management and advocacy for our patients so they don't have to feel alone in this complex medical world.

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.

Happy Valentine's Day!!!

SBI!