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

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.

 

Is It a Cold? Is It the Flu? Is It an Allergy? And do I Stay at Home?

"Season of mists and mellow fruitfulness..." and in my office it is the season for giving FluMist (nasal spray) or Flu Shots to the majority of my patients. It used to be a must-have preventive vaccine for those most at risk, like asthmatics, diabetics, people over 65 and young children. Now most people want to be vaccinated so they can feel more protected when they go about their normal work and travel plans during the fall and winter seasons.



Another good reason to be vaccinated is to stop the spread of the influenza virus to those around you and in the community. This year's vaccine covers three strains of the virus out there, including the H1N1. Some people with low immunity can develop infections from the flu or pneumonia so it is very important that we all responsibly take action to protect them and ourselves.

Suppose you do find yourself with a runny nose, sneezing, nasal itching, watery eyes and you do not know what to do. You may actually be suffering from nasal allergy symptoms and require an allergy medicine, (tablet or inhaler).

Or you may be running a slight temperature and you are sneezing, coughing and feeling generally run down. You need to make decisions:

A) Do I go to work?
B) Do I go to the doctor?

Normally, I would say that if you are unable to perform your duties well because of your health condition and if you are sneezing and coughing, then it is best to stay at home as you can be contagious. Germs circulate rapidly.



If after two to three days of resting, drinking plenty of liquids, eating chicken soup, breathing in fresh air, maybe taking over-the-counter flu medications to relieve the symptoms you are still feeling the same then you should go to your doctor to check if you have an infection that can be treated by antibiotics.



The best way to prevent flu is always to remember to:

1) Wash your hands regularly
2) Exercise and keep active
3) Eat nutritious meals with plenty of fruit and vegetables
4) Drink plenty of fluids (but try to avoid sodas and sugary drinks)
5) Get good sleep and rest
6) Don't forget your flu shot!

If in any doubt, call or email your doctor's office for personal advice.

How a Family Doctor Diagnoses Depression

According to a new survey from the Centers for Disease Control and Prevention, one in 10 Americans over age 12 are now taking antidepressants which is a fourfold increase in the prevalence of antidepressant use since the late 1980s.



When a female patient, a mother of two, came to my office for her regular check up this past Summer, she didn't seem her usual self. At 48 years old, she looked tired and complained of difficulty sleeping. When I questioned her further I learned that she was not enjoying all the things she used to in the past. She couldn't understand why she was feeling overwhelmed, irritable and anxious. She was not surprised when I told her it was depression but she was reluctant to take medication. I explained that it could help her cope more easily and she agreed to try it out and come back for follow-up. Now she comes to see me once every few weeks to check in and manage her symptoms and discuss any issues she may have. She says the medication has helped her tremendously and she has started to notice the difference.

Most patients don't come in saying, 'I'm depressed". They come in with all kinds of different symptoms like headaches, anxiety, trouble sleeping, for instance, but after a deeper consultation they will reveal their depression

Most family doctors are best placed to take on the role of therapist with their patients if they take the time to ask the right questions and notice the signs. Some patients are resistant to seeing mental health professionals as they are either in denial or simply can't afford the time or the money.



Many psychiatrists agree that screening for and treating depression in the doctor's office is a necessary expansion of a family doctors' duties. Dr. Gary Small, a psychiatrist and director of the UCLA Center on Aging says "Part of what we do as psychiatrists is teach doctors how to diagnose and treat depression so that a lot of depression can be handled in primary care".



The report, published Wednesday, draws on a survey of over 12,000 Americans over the age of 12. It showed that women were the largest consumers of antidepressants: 23 percent of all women ages 40 to 59 reported taking antidepressants. This does not necessarily mean that women are more depressed than men but that they are more open to seeking help and therapy from their doctors.



Of course, no patient should be treated with medication alone for depression. Follow-up is key so we can talk about adjusting the dosage or stopping the medication as needed. If I see a deeper need for psychotherapy I have an excellent network of professionals I refer to and work together with.



Although the survey captures how many patients are on antidepressants, it does not necessarily represent the true number of patients being treated for depression. Some antidepressants are prescribed for anxiety, neurological pain, fibromyalgia, sleep problems, and menopausal hot flashes.



There is certainly less stigma today attached to seeking help for depression. Talking to your family doctor about your symptoms, your stresses and anxieties will help them decide if an antidepressant will help you cope more effectively and to prescribe the right treatment for you.