The Virginia Beach Premier Medical Newsletter

August, 2013

Twistle: Ask us about Twistle, a secure email application linking you directly to the office or to your doctor. Get answers to your personal medical questions. Change your appointment. Get your lab or x-ray results. Request prescription refills. Keep us informed. Ask the staff or your physician for more information, or click on the link...Twistle.

Pre-Diabetes

Pre-Diabetes is diagnosed these days mostly by testing the HbA1c level in the blood. Depending on the specific lab used, if the level is above 5.6 but below 6.4, then you have Pre-Diabetes. If the number is 6.5 or higher, then you have Diabetes. This requires a little clinical judgement as well, because what if one time the result is 6.7 and the next time, it's 6.4? Does that mean you have Diabetes or not? Well it means that you probably do have it or will have it soon if you don't do something about it.

What can a person do to treat pre-diabetes or prevent it? There are really only 3 things you can do:

1- If you are overweight, you will have to lose 7% of your current weight or get into a normal weight range - whichever is the more reasonable goal for you.

2- Exercise for at least 30 minutes 3 days a week.

3- A drug called metformin (Glucophage) can be used for younger people who are Pre-Diabetic, as long as there is no kidney impairment. Those over 65 sometimes don't tolerate it as well and it's not as effective in that group as it is in younger people. It may actually reduce hunger to some extent and help some people lose weight which is an added benefit if the individual using it is overweight.

Some people who are able to lose weight and exercise regularly are actually able to reverse the trend toward diabetes and prevent it's occurrence altogether, or at least delay its onset.

Diabetes is a severe progressive disease associated with many serious complications. If you found out you had the trend to develop it (Pre-Diabetes), wouldn't you want to do everything you could to prevent it? Ask your doctor what the likelihood is that you are going to develop Diabetes. Some simple blood tests can give you the answer. Then you can do something about it.

Blood Vessel Health

Vascular diseases (abnormalities of the circulatory system) are the cause of a tremendous number of medical problems that could potentially be preventable in many instances. Coronary heart disease (including heart attacks), strokes of the brain, most leg amputations, aortic aneurysms, certain types of colitis, and many other vascular diseases are caused by poor health of blood vessels.

Atherosclerosis caused by cholesterol and fat deposition on the inside of the arteries along with uncontrolled hypertension (high blood pressure) which results in a lot of wear and tear on the arteries over the years are major factors in the development of these diseases.

What causes atherosclerosis and hypertension? Poor diet, too much salt, smoking, being overweight, lack of exercise and genetics. You may want to take note of the fact that five of those six factors are things that we can control. Genetics is the only one we can't really do much about.

How healthy are your blood vessels now? How healthy will they be in 20 years? It's mostly up to you.

Cognitive Impairment

Excessive carbohydrate (sugar) intake can increase the risk of cognitive impairment twice as much as a normal or low carbohydrate diet.

Lack of exercise also appears to be a risk factor for dementia.

We are not sure why, but the associations are clear nevertheless.

Genetics, once again, is another factor, but there is not much we can do about that, although it may provide a clue that we might be at risk. If that is the case, if you feel there may be a genetic predisposition to the future development of cognitive impairment, regular exercise and low carbohydrate diet should be part of your daily routine in order to prevent or at least delay even a mild degree of memory impairment.

Protect Your Skin from Aging

A new study done in Australia shows that wearing SPF-15 sunscreen every day on a regular basis, rather than just when they think they need it, results in a significant reduction in aging of the skin even over a relatively short period of 4.5 years. This seems to be especially true for light-skinned individuals.

The authors of the study recommend wearing a broad spectrum SPF-15 sunscreen on a regular daily basis for young and middle-aged fair-skinned people to protect their skin from aging.

How to Quit Smoking

Most smokers know they should quit and would love to be able to quit, but it's not easy. The addiction is strong. Scaring smokers about the terrible diseases they might get if they continue doesn't seem to help much. Nagging, badgering, arguing or trying to make them feel guilty doesn't work either.

Fortunately, there are some things you can do that may help.

~First, you have to really want to quit, to be committed to it, even if it causes temporary weight gain or anxiety or stress. There will never be a good time to do it. You just have to do it.

~Talk to your doctor about it - not just off-handedly at the end of a visit, but as a real health problem, just as if you were discussing a real disease, like diabetes, heart disease or severe hypertension. It should be a major part of your discussion on every visit with your doctor.

~Consider using one of the several medications that are available to help you - including nicotine patches, gum, bupropion or Chantix. Even if you've tried them before, things are often different now than they were a year ago. You may be more committed to it now than you were then. Use all the help you can get.

~Try going to support groups - just like alcoholics use AA meetings to help them quit. Quitting smoking is just as important to your future health as quitting alcohol.

~Use behavioral modification - any tip or trick you can think of that will make smoking a less desirable activity, or less of a habit. Lock up your cigarettes in a safe in the garage so that it's a major effort to get one. Avoid activities that are often closely associated with smoking, like drinking coffee. Switch to tea or iced drinks, for example. Start exercising whenever you have the urge to smoke.

~Seek emotional support from friends and relatives.

~This is important for you and for your family. Do whatever it takes to get it done.

Palliative Care

Palliative care teams have been developed in most hospitals for the purpose of helping to provide multifaceted care for individuals with these types of problems. They are staffed by physicians, nurse practitioners, physicians assistants, various levels of nursing staff, social workers, psychology specialists, physical therapists, occupational therapists and chaplains.

Currently these teams have been developed mostly for inpatient hospitalized patients. For outpatients, a similar approach is available through Hospice care, which is provided by many home health agencies.

For many patients and families who are dealing with serious illnesses, the mere mention of palliative care or hospice, will often bring tears to the eyes and thoughts of death and perhaps even a sensation that the doctor suggesting it is “giving up”. This couldn't be further from the truth. In fact, the addition of palliative care or hospice to the patient's overall plan of care almost always provides enhancement and marked improvement in the quality of life, especially if these things are undertaken early enough to make a difference.

Timing is important in this discussion, because waiting until the last few hours of someone's life before calling a team like this is really not utilizing their services very well, but that is often the way it happens. It is far better to involve these specialists much earlier in the course of illness than what we usually do. They can provide so many benefits to the care of the patient and assistance for the family, that the patient actually lives longer than they would have otherwise, and besides that, the quality of life is much better.

So, if you find yourself or a family member in this situation, don't wait till the last minute, and don't immediately disregard your physician's suggestion for this care as inappropriate or as a sign of giving up. Consider it as a positive plan for improvement in care and quality of life.

Personal Health Record

Many people who do keep medical records on themselves do so using a simple paper folder at home that contains a hodgepodge of lab tests, x-ray results, etc. This is fine, but it’s better to keep them organized, perhaps chronologically, or by topic. Whenever you see your doctor, ask for copies of important parts of your record that might be helpful to you when you go to see a consultant or if you end up in the Emergency Room in some other city. It would be important for you to have a copy of your current medication list, allergies, last EKG and a list of your diagnoses or primary medical problems.

In the digital age, there are many applications that you can use on your computer, tablet or smartphone that allow you to collect these kinds of records electronically. If your doctor has an electronic medical record, the office may be able to provide you with a complete copy of your record on a CD or flash drive. You may even have access to your own chart through a patient portal, so you can see your test results online. We are working on hopefully providing this capability in the near future for those who are interested.

For more information: www.YourRecordSpeaks.org

What's New in the Journals?

~Mild asthma is common and often underdiagnosed and undertreated. A persisting cough, may be a symptom – even if there’s no wheezing. Treatment usually involves using an inhaled steroid spray.

~Patients who monitor their own blood pressures at home usually have better blood pressure control than those who just have it checked in their doctor’s office intermittently.

~Older diabetics with very tightly controlled blood sugars (80-120) do worse than those with looser control (110 – 160). This is because the risk of low blood sugar is higher in the tightly controlled individuals leading to episodes of confusion, falling, passing out, dizziness, accidents, etc.

~Low dose, alternate day use of aspirin in non-diabetic, healthy individuals with no prior heart or vascular disease doesn't seem to provide any benefit as far as prevention of heart attacks or strokes is concerned, but there is a small benefit in preventing colorectal cancer. Those taking aspirin do have a higher risk of gastrointestinal bleeding, however. So, it’s another one of those risk-benefit decisions. Ask your doctor which is the best option for you.

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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