The Virginia Beach Premier Medical Newsletter

March, 2013

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Preventable Deaths

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

Rosacea

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

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

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 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?

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

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.

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