Time to Limit the Pills

 

TIME TO LIMIT THE PILLS?

Here is something you should all try to do or change in this New Year, if possible, and with the help of your Family Doctor: Count the amount of pills, vitamins, herbs and supplements you take regularly and your resolution should be to REDUCE this amount. 

You can start by avoiding online offers or buying through pharmacies things that are not really necessary for your quality of life. More often than not they can be harmful. Instead, bring all you take (or list) to your doctor and discuss each one. A lot of the supplements and vitamins we take is due to marketing hype geared to the vulnerable. 

Your doctor can tell you if you have any deficiency that can be helped with these, if not you can create an overload in your body. For example:

• Too much calcium can produce kidney stones 
• Prolonged use of Omeprazole and similar over the counter anti-reflux medications, such as Nexium and others, can cause a deficiency in Vitamin B and reduce calcium absorption (risk of hip fracture). It can also cause a serious digestive infection with a bacteria called Clostridium difficile which can be devastating and become chronic. If you must take these medicines, your doctor will check your Vitamin B levels at least on a yearly schedule.
• Inappropriate use of statins such as atorvastatin, (Lipitor) can precipitate pre-diabetic state not to mention liver dysfunction and muscle aches. There are now new parameters to calculate cardiovascular risks, rather than just basing it on the level of LDL cholesterol as before. 
• Many patients ask for antibiotics and most are not necessary. Viral infections do not need to be dealt with by antibiotics and most respiratory infections are caused by viruses. The treatment in these cases are rest and hydration and perhaps antipyretics (acetaminophen) for fever. C.difficile is notoriously present after a course of certain antibiotics. I usually recommend a probiotic if I prescribe an antibiotic to replenish the natural gut flora.

So go and talk to your doctor and bring down your numbers......of pills.

"Let food be thy medicine and medicine be thy food". Hippocrates

Dr Albert Levy, 911 Park Avenue, New York, NY 10075

Why the Personalized Physical is a Must

THROUGH MY STETHOSCOPE - FEBRUARY 2015

As a family medicine doctor, my role is to care for the physical, mental and emotional needs of patients of all ages.

The physical exam, a big part of our practice, is not a template and does not work exactly the same for everyone. Each patient is different and has his or her own needs. It is not a compulsory exam, but when a patient decides to come in for an annual physical it is usually to see what is ailing them or to be reassured that nothing can be ailing them.

It gives them an opportunity to talk to an objective person who can listen to their current issues whether it is trouble at home, with work or with stress of any kind.  This psycho-bio-social interaction has many benefits:

•  It reassures and encourages
• It endorses emotions and reactions
• It helps patients make different choices
• It helps to change harmful habits
• The patient can re-evaluate their mental and physical state

I like to think that I am the compass for those patients who instinctively follow the moon and stars to point them in the right direction of good health. They know their aim but sometimes their vision is foggy and those celestial guides can be out of sight or very blurred.

This applies also to the adolescent or young adult when “diseases of choice” can be discussed, such as smoking, alcohol or drug abuse and even eating disorders. Immunizations can be updated to offer that extra protection of care that we are all privileged to receive.

A physical that is “personalized” can serve to reduce unnecessary laboratory and radiological tests, such as cat scans and the accompanying millions of dollars spent in the majority of cases. Rare diseases are indeed rare but everyone needs to be reassured and encouraged especially living in a busy metropolis like New York City.

When you next book your physical exam think of the many advantages of talking to your doctor about you. 

Dr Albert Levy

A NEW YOU IN THE NEW YEAR

The practice of making New Year's resolutions is said to have begun with the Babylonians as early as 2600 B.C and continues to mark a time to reflect on the past and plan ahead.

The top 5 resolutions that I advocate to my patients this 2015 is to improve on these areas:

Meditation and Mindfulness – As multi-taskers we may not be as efficient as we think. We all need to be in the present, to focus our minds and clear our thoughts from time to time.
Restful and regular sleep – Do you make sure you get a good night’s sleep of at least 6 to 8 hours?  If you need help falling asleep or staying asleep do talk to your doctor as there are many sleep aids available.
Balanced diet – smaller portions of healthy foods certainly make a difference to our waistlines, our energy levels and our risk of obesity-related diseases.
Exercise – it just takes a forty minute walk a day (preferably in nature) or any other aerobic exercise to keep you feeling fitter and better
Yoga and Pilates – both these activities involve stretching out those important muscle groups and keeping your body supple and strong.

All the above can be done with the aid of classes,  the internet, useful Apps as well as your doctor’s recommendations.

Whatever you choose to do to improve your well-being, remember that one of the best ways to feel better both physically and emotionally is knowing you are helping others in whatever way you can.
Happy New Year!
“There is no exercise better for the heart than reaching down and lifting people up”- John Andrew Holmes

Doctor, do I have a tropical disease?

You have just come back from vacation and have posted your Facebook and Instagram photos of idyllic locations.  But now you are also noticing headaches and muscle pains and have started to develop a high fever. Maybe you detect unusual skin eruptions or swelling and are feeling fatigued. Chances are that you may have contracted one of a number of viruses that are most commonly caused by bites from infected ticks or mosquitoes.

When you see your doctor, you should inform him or her of your most recent travels and share a log of your symptoms so that the correct tests and diagnosis can be made. Some patients may even find the offending tick in their body and should bring it to the office for laboratory testing. It is quite simple actually, place the tick dead or alive in a small container and bring the container to the doctor’s office.

More than likely the symptoms above can mean any of the following more common viruses: Lyme disease, West Nile virus, St Louis encephalitis among others. Of course you don’t need to have travelled to a tropical country to have been infected with either Lyme or West Nile diseases.

If your travels included South America, Asia or Africa then your doctor should check for rarer  but equally worrying diseases such as Dengue or Chikungunya or even Ebola if it applies.

The most important thing to remember about all these viruses is that they are rarely fatal (well except maybe Ebola) and are not highly contagious. If left untreated, however, they can lead to serious complications especially in small children and the elderly.

Nowadays,  there is a growing fear about the spread of the Ebola virus in Africa and reports of patients suffering from this disease entering the United States is causing widespread alarm. Again, to allay your fears, remember that, unlike respiratory viruses that can spread in the air, Ebola can only be spread through exchange of bodily fluids or through sharing of infected needles.

 Lyme Disease/ West Nile Virus:

Symptoms: fatigue, muscle pains, headaches, red swellings on the skin

Perhaps the most common here in the north east, Lyme disease is a tick-borne virus that can cause more complications if left untreated. Some people come to the office with the tick that they found in their body which is helpful to test. If the laboratory tests prove positive for Lyme disease a treatment of antibiotics will be prescribed for a short duration but if untreated initially the treatment may be longer.  It is important to follow-up with your doctor as post-treatment Lyme disease syndrome can occur in a few rare cases.

How to avoid Lyme disease? - Use repellents that contain 20 to 30% DEET, and shower after going outdoors in the countryside and do a fully body scan for ticks on you and your children, including under the arms, behind the knees and even in the hair.

Chikungunya:

Like most other diseases, rarely is this fatal. It is more commonly found in Africa and Asia and has spread through the Caribbean and in the New York area in recent months.  The symptoms usually develop three to seven days after being bitten by an infected mosquito and can be more severe in small children and the elderly.

Dengue Fever

Symptoms: Severe headache, body pains, fatigue, rash

Also known as the bone breaking disease, Dengue is commonly found in South America, Africa and Asia.  It is advisable not to take any blood thinning medicines, such as aspirin and ibuprofen (Advil), etc… if you think you may have dengue fever

St Louis Encephalitis

Symptoms: St Louis Encephalitis should be considered in all cases of viral encephalitis occurring in the summertime, but particularly in elderly patients or when two or more similar cases cluster in a community. SLE and West Nile infections must be distinguished by serologic tests the viruses contain cross-reactive antigens

 Ebola:

Ebola and Marburg hemorrhagic fever typically begin with the abrupt onset of fever, chills, and general malaise. Other signs and symptoms include weakness, severe headache, pain in the muscles of the trunk and lower back, nausea, vomiting, diarrhea, and abdominal pain. High fever may be accompanied by relative bradycardia (slow cardiac rate), as seen in typhoid fever. A nonproductive cough and pharyngitis, with the sensation of a lump or "ball" in the throat, are also frequently present

As you see, the differential diagnosis can be challenging even for your doctor.

It is important to remember that rare diseases occur rarely. Try to use common sense and consult your doctor if you are not sure about some new symptoms you have developed recently.

Albert Levy, MD

Why a Life Coach can be good for your Health

A patient once told me that the medicine for her migraines was helping but she was still not feeling one hundred percent. She was not handling the stress at work and at home. After a few more searching questions, I took a prescription pad and wrote “book a flight and go and see your family in India”. She sent me a postcard thanking me for this “perfect medicine”.  I treated another older lady with a prescription to “go visit the Vatican in Rome”.  It gave her a second lease of life. I also like to “prescribe” books or movies to make some of my patients feel better. Not all prescriptions require a pharmacist.



As a Family Doctor I have the privilege to get to know a patient not just by their symptoms. I usually know their families and circumstances very well. It is our role to listen and find the “hidden agenda” and very important to relieve or reduce the suffering of our patients both physically and emotionally.

As many people know, the body manifests the workings of the mind and symptoms can be psychosomatic (from the Greek "psycho" which means mind and "soma" which means body). In order to look after the mental or emotional health of my patients I have many times to make informed decisions together with the patients on the right therapist for them.  These are generally patients who fail to improve physically despite all pharmacologic interventions or those patients who seek anti-depressants for their feelings of anxiety, stress, grief and who feel they are not coping with work or family life.



Mental Health Professionals offer very high quality (evidence-based) and efficient interventions, usually on a long-term basis:



1)      Psychiatrists – Help patients with behavioral difficulties, substance abuse problems and mental health disorders (such as bi-polar, OCD, schizophrenia), who may require medications (psychopharmacological intervention)

2)      Clinical Psychologists – can help patients talk through their difficulties and some are specialized in particular  stressful situations like adjustment or migration issues, or divorce, or illness or grief counseling.

3)      Psychoanalysts –  are trained to uncover the patients’ unconscious motivations through intense, long-term therapy and analysis of the past.



Although this is the safest setting to express feelings and to increase effectiveness in their life and work the downside is the stigma and the cost. Many patients feel they don’t need a mental health professional but are open to alternative therapies, such as homeopathy, meditation and acupuncture. Certainly exercise has a beneficial role and some diets too may affect the patient’s emotional status.



Having had the privilege of meeting an excellent Life Coach who was born in Colombia, studied in Brazil, lived in Paris and is now living in New York City, I found another excellent source of referral. I have noted that her interventions with many of my patients have been constructive and successful. She explained to me that instead of looking and analyzing the past, the Life Coach is more about the present and the future.



I asked Liz Polania to tell you more about her Life Coaching and what it entails as I have seen some of the amazing changes in lifestyles experienced by patients in just a few sessions. We can call these sessions therapeutic because any change for the better is therapeutic in itself.

Albert Levy MD

LIZ POLANIA, Life Coach

"People often face challenges with their careers, their relationships with relatives and family or simply with themselves and the fulfillment they get out of life.

Life Coaching is a practice that helps people address these challenges, considering emotional, intellectual and even physical needs:

It helps patients:

-          Understand what is happening in their present life

-          Be aware of the unique way they operate

-          Consider and engage in positive changes, with quick and sustainable effect. 

As a Life Coach, I provide a safe context for self development through the identification of the underlying – latent – strengths needed to overcome obstacles. I help craft valuable goals and outline and execute a meaningful personal project to reach them. Each of the project action steps then becomes an opportunity for the patient to learn and grow, while experiencing concrete life improvement.

My practice as a Life Coach also includes mindfulness, relaxation and breathing techniques, neuro-linguistic programming and active listening. I have repeatedly observed the benefits of a quiet practice where patients feel comfortable, rejuvenated, lighter and in peace within themselves.

As a result of the Life Coaching process, my patients enjoy significant improvement in their health, professional realization and social or personal well being."

https://www.facebook.com/lifecoachingny

Tuberculosis: New Tests and New Treatments in the 21st Century

On this World Tuberculosis Day, we reflect on the impact of this debilitating disease throughout the ages. It was the dawn of the industrial age in the West that brought about a rise in deaths from TB as the unhealthy conditions of poor sanitation, housing and nutrition allowed this disease to flourish. It was the leading cause of death in Europe and the United States from the eighteenth into the twentieth century. It was called “consumption” by the way it seemed to consume the person from within. It has been a subject of tragic operas (Violetta in “La Traviata” and Mimi in “La Bohème”), classic literature, (Fantine in “Les Misérables”, Andy in “A Tree grows in Brooklyn”) and in art, it is represented by a moving portrayal by Edvard Munch of his sister who died of this disease at the age of fifteen (currently here at the Museum of Modern Art in New York). As prosperity – more than modern medicine – developed, the rate of TB deaths became rarer and by the nineteen fifties very few people in the West were dying of the disease. 

However, TB continues to be a major global health concern and continues to spread especially in countries where poor, unsanitary conditions still exist. Statistics show that nearly 1 billion people will be infected with TB globally in the world by the year 2020. Just in the United States alone a total of 10,521 new cases of TB were reported in 2011 which shows a marked increase on previous years.



What is Tuberculosis?

TB is an infectious disease that is caused by a bacterium called MYCOBACTERIUM TUBERCULOSIS that primarily affects the lungs. The bacteria in the lungs multiply and cause pneumonia along with chest pain, prolonged coughing and hemoptysis or coughing up of blood.

As TB is an airborne bacterial infection it is commonly spread by droplets of mucus secreted by those infected, such as through coughing, sneezing and even talking. These droplets can be particularly contagious in small, confined spaces as they can remain suspended in the air and inhaled by others.  



What are the symptoms?

There are two types of TB, one is latent which means that the patient does not have symptoms and is therefore not contagious, and the other is active. Patients with active TB show symptoms of cough, chest pain, fever, fatigue, night sweats, shortness of breath as well as loss of appetite and weight loss.  The cough typically may start as a dry cough but later becomes productive and may be blood-tinged, as made famous in those tragic operatic tales and classic novels and films of the past.



How to test for TB?

The TST is a commonly used tool to screen for tuberculosis and one that we perform at every immigration exam. This involves an injection of 0.1ml. of tuberculin purified protein derivative (PPD) in the forearm. After 48 to 72 hours the skin’s reaction to the test has to be measured and if positive radiology exams and then antibiotic treatment are carried out. Sometimes false positives are read due to cross-reactivity with the bacillus Calmette-Guerin (BCG) vaccine given in some countries. A chest x-ray is then ordered to rule out the infection.



A modern alternative to the TST is the QuantiFERON –TB Gold in-Tube test (QFT). This is a highly-specific controlled blood test for detection of immune responses to TB infection in whole blood. It provides clinicians with an accurate and efficient tool for the diagnosis of both strains of TB.  It can be done in the doctors’ office and the results are much faster. This will eventually replace the conventional TB.



What are the Treatment Options?

Today there are several drug therapies that may last many months or even years. An antibiotic called Isoniazid (INH) is prescribed for six to twelve months, as well as drugs such as rifampin, ethambutol and pyrazinamide and streptomycin if the disease is extensive. In severe cases, surgery is performed to remove damaged lung tissue.  In December 2012 the FDA approved Sirturo (bedaquiline) as part of a combination therapy for adults with multi-drug resistant TB. This is the first TB drug to be approved in the US in forty years.



How to avoid TB?

The most important thing is to take care of your immune system, eat a healthy diet and if you work or live in a high risk environment or return from an infected region you should get regularly tested for TB.

Dr Albert Levy

Relieving Chronic Pain with Acupuncture

According to the Institute of Medicine, about 115 million Americans are living with chronic pain. When it seems like everyone knows someone with a bad back or shoulder, chronic stiff neck, migraines or an arthritic joint—that’s because 1/3^rd of the country is suffering from these sorts of conditions. People often go for months and even years with unresolved pain, relying on pain-killers which are often better suited for short-term use. It doesn’t have to be this way, however. If you or a loved one is living with chronic pain, there are effective ways to help resolve the condition and restore ease of movement.

Research shows....not only was acupuncture more effective than a placebo, but that it was much more effective than standard treatments.

One medical practice that is both gentle and effective as well as safe for chronic pain is acupuncture. This is no surprise to those of you who’ve had acupuncture here at Manhattan Family Practice, where we’ve offered it since 2006. I’ve even used it myself to relieve a persistent shoulder pain that eased after just two sessions.

Recent research coming out of Memorial Sloan-Kettering Cancer Center provides the best evidence yet of acupuncture’s effectiveness in treating osteoarthritic pain, as well as headaches, shoulder, neck, and back pain. Researchers there carefully analyzed the results from 18,000 people treated by acupuncture in the U.S. and Europe. They found not only was acupuncture more effective than a placebo, but that it was much more effective than standard treatments.

Acupuncture is a holistic medicine....both gentle and effective as well as safe for chronic pain.

Here is what you can expect from an acupuncture session from Christopher Dye, L.Ac., the acupuncturist at Manhattan Family Practice:


 

1: Listening - Acupuncture is a holistic medicine, so Christopher will ask a few questions to better understand you and your unique situation.


 2: Gentle Chinese Massage - The treatment will begin with Chinese massage using aromatic Chinese herbs to relax muscles and tendons as well as improve circulation. This massage is an excellent treatment all on its own.

3. Gentle acupuncture - You may have a feeling of warmth or heaviness as the body brings circulation to the areas treated as part of its own intrinsic healing response. Acupuncture is often very relaxing and people often fall asleep during treatment!


Keep in mind that you might be shown gentle exercises to do at home. These are designed to relieve tension around the parts of the body where you’ve had discomfort. Acupuncture usually takes a few sessions to begin fully working, although you may feel some effects immediately. For longer term conditions, a longer course of treatment may be necessary.



For more information on Christopher Dye call our office on 212 288 7193. His website is http://manhattanclassicalacupuncture.com