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

Flu Shot Season is Back!

It’s September; the month that literally falls between two seasons with its mild climate, gradual scenery changes and very special days.  First we had Labor Day which marks the official end of the summer, then Patriot Day which is held in memory of those who died during the terrorist attacks in the US and then, on a much lighter note, we have the High Holidays and the Jewish New Year of 5773 (September 17^th) which is a time for introspection and for planning positive changes for the months to come.



So why not take this time to plan ahead for your health. If you have been away or been lazy and indulgent over the hot summer months now is the time to renew your exercise regime, take long walks, eat wholesome foods and,  most importantly, give your immune system a healthy boost against the flu and cold viruses.  Our doctors and nurses have already started to give the flu vaccine to patients to protect them for the entire season. The flu vaccine is now recommended for everyone from 6 months of age onwards.  The more you protect yourself, the more you protect your family and your community.

The most common questions I am asked are:


Why do I need to get the flu vaccine every year?

Because it protects against the prevailing strains of flu in that particular season and because  everyone’s immune system declines over time and needs a boost.


Why do I get the flu after getting the flu vaccine?

The flu vaccine does not give a person the flu. It is an inactivated vaccine (containing killed virus) and will take some time to take effect. If you get the flu it is because the virus was already germinating in your system. It is recommended that you do not take the vaccine if you are feeling unwell and in our office we take your temperature and ask and answer all your questions before we give the flu shot.

And to know more about the Flu Vaccine,  the Centers For Disease Control and Prevention offer more advice that you can find on their website :

http://www.cdc.gov/features/Flu/index.html?s_cid=fb1780

And you can print out the information from here:

http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-flu.pdf

Have a Happy and Healthy September!

Novos Medicamentos para a Perda de Peso

O FDA (Federal Drug Administration), órgão mais importante dos Estados Unidos para a regulamentação dos remédios, acaba de autorizar dois medicamentos para combater a obesidade que devem ser lançados no mercado em breve. Trata-se do Qsymia e do Belviq.



Qsymia, nome comercial nos EUA, consiste em duas substâncias: o Topiramate, anticonvulsivo muito eficaz contra enxaqueca, e o Phentermine, que controla a fome). Ambas substâncias têm efeito positivo na perda de peso.



O Belviq, tambêm nome comercial nos EUA, uma substância "agonista da serotonina", reduz a ânsia da fome. O certo seria indicar um desses remedios para pacientes com uma massa corporal (BMI - Body Mass Index, em Português, IMC - Índice de Massa Corporal) acima de 27kg/m2, se o paciente tem diabetes, hipertensão ou problema de colesterol; se o paciente não apresentar obesidade, um IMC de 30kg/m2.

BMI é a medida do peso relativo à altura. Uma pessoa abaixo do peso ideal, apresenta IMC menor do que 18,5; uma pessoa saudável tem IMC entre 18,5 e 25; uma pessoa acima do peso tem IMC entre 25 e 30; obesos têm IMC acima de 30.

Há mais de uma década o FDA não liberava remédios para controlar o apetite, e agora que a obesidade e o excesso de peso já estão em níveis alarmantes nos Estados Unidos, resolveu-se por bem que o melhor era lidar, de fato, com este problema fenomenal.



As causas de excesso de peso são variadas e incluem o sedentarismo e o acesso excessivo  ao consumo de alimentos, independentemente da faixa social. Você pode se alimentar no Mc Donald's, por exemplo, a um custo relativamente baixo. Hamburguers, batatas-fritas e refrigerantes grandes estão mais ou menos ao alcance da maioria das pessoas.



As calorias em excesso consumidas em uma refeição como essa faz com que você tenha que praticar um esporte seriamente ou fazer exercícios regularmente para evitar acúmulo de gordura na barriga e em outros lugares, pois não será fácil se livrar desses acúmulos no futuro.



O FDA aprovou esses remédios, mas isso não quer dizer adeus aos exercícios e ao controle do que se come. Ainda que esses medicamentos ajudem a controlar o apetite, aproveite, mesmo assim, para escolher melhor seu cardápio diário. Uma vez que você notar sua perda de peso e de barriga, você ficará animado para seguir com uma dieta e queimar calorias no exercício. Isso pode ser feito entre duas e quatro semanas, depende de você!

Albert Levy, MD

911 Park Avenue

New York NY 10075

Tel 212-288-7193

www.manhattanfamilypractice.com

New Weight-Loss Medications

Many of my patients battling with weight gain or desperately trying to lose weight on various diets have been asking me for medicines to help them reach their goals. Having researched many clinical trials on this subject, I have been presribing with some success two pills, one phentermine (acts in the brain to eat less) and the other topiramate (also used for seizure disorders and migraine headaches). I found that these two drugs combined had little side effects and almost all my patients were able to lose weight safely. How? One drug stimulates the metabolism while the other curbs the appetite.

It was no surprise, therefore, when I read about the launch this week of QSYMIA, the new pill that contains both these substances and is now FDA approved for weight loss.



The other weight loss medication approved is BELVIQ which contains a new substance lorcaserin that is a Serotonin 5-HT_2C Receptor Agonist.
It is indicated for weight management, along with a reduced-calorie diet and increased physical activity, in patients with either an initial body mass index (BMI) of ≥30 kg/m² or an initial BMI of ≥27 kg/m² and at least one weight-related comorbid condition (eg, hypertension, dyslipidemia, type 2 diabetes).



Body Mass Index (BMI) is a measure of weight in relation to height. It is the most practical way to estimate if a person is underweight, at a healthy weight, overweight, or obese.

BMI < 18.5:	Underweight
BMI >= 18.5 and < 25:	Healthy weight
BMI >= 25 and < 30:	Overweight
BMI >= 30:	Obesity

I do find that once a patient is motivated by the initial weight loss and their cravings and appetite have been reduced[ then the lifestyle changes necessary, such as a good, healthy diet and regular exercise, is easier to adopt and maintain.

Preventing a Heart Attack

Cardiovascular disease remains the number one killer in the US for both men and women. Not cancer, fatal gun shots, automobile accidents or Alzheimer's disease as you may think. A heart attack or myocardial infarction will hit about a million people in the US this year and will kill about five hundred thousand men and women. The other five hundred thousand men and women will suffer a heart attack and survive but many are incapacitated either emotionally or physically or both. The good news is that heart attacks may be prevented.

Heart attacks don't spare the younger population either. With the rise in levels of obesity and diabetes in young adults of 20 and 30 years of age, this is a cause of great concern and alarm to doctors and official health authorities.

Genetics certainly play a big role in the cardiovascular risk but you can bypass this risk with preventive measures and even some medicines.

It is very important to know your cholesterol and blood pressure numbers to start with. For most people a LDL cholesterol (low density lipoprotein) or as I call it the "Lousy" cholesterol should be under 100 (for diabetics it should be 70) and the HDL cholesterol or as I call it the "Happy" cholesterol should be higher then 60. A good reading for a blood pressure in most people should be 120/80. Please note that patients with a large arm as compared with a regular size arm circumference, should have their blood pressure measured with a large cuff, just as children are measured with a child's cuff. (Yes, even children can have high blood pressure and for a variety of different causes.)



It is also important to know other parameters that can increase the risks for a heart attack such as your glucose (sugar) level, your level of accumulation of fat in the walls of your arteries such as in the carotid arteries, your heart rhythm and the presence (or not) of a heart murmur and others.

Here are some of the most important things you can do:


1) STOP SMOKING - Within a year, a former smoker reduces his heart attack risk by 50%. This is quite impressive.


2) EXERCISE and EAT HEALTHY - Exercise and diet are also fundamental in reducing heart attack risks. Exercising at least 30 minutes a day is associated with a 70% heart attack risk reduction in a year. This exercise could be a brisk walk for example. A good sweat.  A brisk walk 10 minutes a day will reduce by 50% a heart attack risk. Not bad at all if you think of it.

Sitting for more than 4 hours in front of a computer or a television is an added risk factor for a cardiovascular event. Prolonged sitting is associated with higher levels of inflammatory markers in the blood, higher body weight, lower levels of HDL, the good (happy) cholesterol indicating than sedentary behavior has it's own bad biology. Take a walk many times during the day, take the stairs instead of the escalator. Instead of going for a snack, go for a 10 min walk. Invite a friend or a family member to walk with you. It will encourage you to walk more.


3) EAT HEALTHY FOODS - Diet is fundamental. You are what you eat. You know you feel heavy and sluggish after a huge meal and you usually end up regretting it right after you finished your last bite. So limit the size of your portion. Fresh produce and other unprocessed foods are best. Vegetables, fruits, grains, nuts (limit the salt please), olive oils, low fat yogurt, fat free milk or soy milk, fish and some lean white poultry meat should be the preference. Try to avoid red meats, fried foods such as French fries, bacon, butter, whole milk, heavy cheeses, and certainly try to avoid refined sugar. You don't need to add sugar to your coffee or tea. It is a matter of acquired taste and you will soon get used to drinking or eating with less or no sugar.  Same thing for salt. Try to avoid it.

A good healthy diet that I recommend is a Mediterranean one with the products I mentioned above.


4) SLEEP  - Sleeping is very important for your health. It is known that chronic sleep deprivation leads to high blood pressure, weight gain and increase your risk of diabetes.


5) AVOID DEPRESSION, ANGER and HOSTILITY-  These feelings have a deleterious effect on cardiovascular health. Beware of these emotions and try to manage or control them as much as possible. You can try to do this alone or enlist the help of family members, friends or with a therapist if you feel you need it.


6) BE HAPPY - Think of good moments and good times, stay positive. Good humor, be happy, smile whenever possible, try to worry less than you normally do.

WHAT TO DO IN THE EVENT OF A HEART ATTACK?

If you believe you are having a heart attack, chew an aspirin (81mg) while waiting for an ambulance. In fact many doctors prescribe a daily baby aspirin (81mg) to everyone 50 years of age and over regardless of symptoms or history of a heart attack. That is unless you have a medical contraindication to aspirin (allergy, active peptic ulcer, dengue fever and others to be discussed with your doctor).



It may not be easy to follow but keeping to these measures may not only reduce the risk of a heart attack but will also make you feel better, healthier and happier.


Albert Levy, MD

Through Dr Levy's Stethoscope....

Family Medicine and the Role of the Family Doctor:
In a nutshell, my role is to care for the physical, mental and emotional needs of patients of all ages. I have been fortunate to have trained in all areas of medicine, including pediatrics, adult medicine, geriatrics, gynecology, obstetrics, general surgery, psychiatry, psycho-analysis as well as alternative therapies like acupuncture and Homeopathy. The purpose of my blog is to offer updated medical news and share important tips and advice.

Depression Survey

Over a four week period at the beginning of this year, we conducted a survey in our office with the help of one of our top students, Duncan Cheng, from NY Medical College. A Depression Questionnaire, composed by Duncan, (see below) was given to 70 patients over a period of 4 weeks while they were waiting to see their doctors. The intention of the survey was to evaluate if patients coming in with somatic complaints had underlying psychological concerns that manifested physically.

The results showed that 6 out of the 70 patients surveyed, or more than 8%, met the criteria for positive depressive symptoms

From these results we can conclude that when patients come to the doctor’s office, some of them do have hidden psychosomatic agendas. We encourage incorporating questions about mental health in every patient encounter as it could be life-saving to address psychological issues in patients. It also shows that patients should feel more comfortable expressing their feelings openly with their doctors, in addition to their physical symptoms.

More research still needs to be done to further support these findings.

Manhattan Family Practice
Patient Mental Health Questionnaire

Initials:_____ Age:_____ Race/Ethnicity:____________________

Sex: ___M___F

Were you born in New York? ___Yes___No

If no, what year or age did you come to New York? __________

1. Do you feel happy most of the time?___Yes___No

2. Are you content with your life? ___Yes___No

3. Do you enjoy things the way you used to? ___Yes___No

4. Are you usually calm? ___Yes___No

5. Do you have trouble sleeping? ___Yes___No

6. Do you often feel helpless?___Yes___No

7. Do you often feel tired? ___Yes___No

8. Is your appetite as good as it used to be? ___Yes___No

9. Is your concentration as good as it used to be? ___Yes___No

10. Do you ever have thoughts about killing yourself? ___Yes___No

O que É Homeopatia?

Muita gente fala sobre homeopatia no Brasil e na Europa, que agora está resurgindo como modalidade terapêutica aqui nos EUA. A homeopatia já era conhecida há mais de 2 mil anos, desde os tempos do Pai da Medicina, Hipócrates, e já estava em uso nos Estados Unidos desde dois séculos atrás. Caiu de moda com os avanços científicos, já que a homeopatia não se submete ao rigor científico da pesquisa para criar e administrar remédios homeopáticos.

 

No Brasil, na França, Bélgica e tantos outros paises, a homeopatia é uma das modalidades da medicina, e muitos médicos a praticam, seja em caráter exclusivo ou de forma complementar à madicina tradicional, como eu mesmo exerço. Ou seja, quando o paciente precisa de um medicamento homeopático, não hesito em lhe prescrever, especialmente se trata-se de alergias, asma, medos noturnos, traumas, depressão, anxiedade, prevenção do resfriado ou da gripe e tantos outras enfermidades.

 

 

A familia real Britanica tem o seu médico particular homeopata e se trata no hospital homeopático de Londres. Os remédios homeopaticos sao reembolsados pela saude publica em varios paises e provavelmente sera o caso aqui nos Estados Unidos. O problema é que os remédios homeopaticos sao bem baratos e a industria farmaceutica Americana colide com a homeopatia pois a veem como uma rival mais em conta e menos perigosa que os remédios alopaticos, da medicina tradicional. Entende-se que a industria farmaceutica gasta bilhoes de dolares em pesquisa cientifica obrigatoria antes de lançar qualquer produto medicamentoso no mercado e ela quer se resarcir destes investimentos. E como vimos acima, a industria homeopatica não tem esta obrigação.

A homeopatia como o nome indica, estuda as patologias que se curam com substancias encontradas na natureza e que por similitude podem ocasionar os mesmos sinais e sintomas mas em diluiçoes infinitesimais, causam a cura destes mesmos sintomas

Um exemplo clássico é o arsênico que, se ingerido in natura, pode causar sufocação por constrição dos brônquios; se diluído, esse mesmo arsênico poderá causar dilatação dos brônquios. Portanto, a mesma substância, que pode matar em dose encontrada na natureza, pode salvar uma pessoa, se ingerida em forma super diluída. Nesse caso, usa-se o Arsenicum Album no asmático. Não tente diluir o arsênico em casa –isso deve ser feito em uma fábrica especializada, com máquinas muito especiais.

 

Visitei as fábricas em Lyon na França e fiquei impressionado com a técnica, a higiene e asepsia rigorosa com que eles manuseiam seus produtos, até a transformação em pequenas bolinhas homeopáticas. Também produzem cremes como o Arnicare para traumas, o Calendula para queimaduras e mordidas de mosquitos, colírios para inflamações oculares, comprimidos para o stress e assim por diante.

 

Um dos produtos mais populares é o Oscillococcinum, também chamado Oscillo, que vem num tubinho cheio de bolinhas minúsculas e que deve ser tomado ao primeiro sinal de que você vai ter uma gripe –seus poderes de reduzir a duração e a severidade da gripe estão mais do que provados. Uma das vantagens da homeopatia é que ela pode ser administrar em bebês, crianças, adultos, grávidas, idosos, além de não tem contra-indicação, não interagir com outros remédios e ter custo bem mais acessível do que o de remédios convencionais.

 

Vale lembrar que a homeopatia trata os sintomas. Se o paciente tem pneumonia bacteriana com tosse e febre, ele precisará de um antibiótico e poderá utilizar remédios homeopáticos para a tosse e a febre, mas não poderá se curar sem o antibiótico, remédio da medicina clássica.

 

Se tiver um câncer com sintomas de náusea, provavelmente precisará de cirurgia, quimioterapia e ou radioterapia, mas podera tomar remédios homeopáticos para a náusea. Não se trata a doença com homeopatia; sinais e sintomas, sim.

 

Gosto muito de usar homeopatia quando possível, especialmente para pessoas alérgicas a remédios, problemas psicosomáticos, asma, alergias, ansiedade, depressão e em pacientes que já tomam uma grande quantidade de remédios convencionais e que precisam de alguma coisa para dormir ou para a fadiga e o cansaço.