Do you have diabetes? Five thing you must do!

The five must do lifestyle changes that will help you stay out of trouble if you have diabetes, or if you are at risk for the development of diabetes, are:

·        Follow a healthy diet

·        Maintain an optimal body weight (Body Mass Index not higher than 25)

·        Engage in recommended amounts of physical activity

·        Don't smoke (don't even think about it)

·        Keep alcohol use to no more than 1 drink a day for women, and 2 drinks a day for men.

According to data released earlier this year by American Diabetes Association, diabetes was the seventh leading cause of death in the US in 2007. Last year it was the sixth. In reality, the number is much, much higher, because diabetes is a major contributor to heart disease and stroke.

The economic burden to individuals and the country as a whole is enormous. Costs attributable to diabetes in 2007 were $116 billion in direct medical costs and $58 billion in disability, work loss and premature mortality. Again, this does not account for the contribution of diabetes to the cost of heart disease and stroke.

Overall, the risk for death among people with diabetes is about twice that of people of similar age but without diabetes.

All of these numbers are undoubtedly underestimates. Many case of diabetes continue to be undiagnosed.

Need help? We're here

Chronic Pain

Pain is now the most common reason why patients seek medical care. Data compiled by the CDC shows that in 2007, analgesics, as a group, was the number one prescribed category of medications in the US, approximately 13% of all prescriptions. The number is most likely higher now.

Pain can be either acute or chronic. Acute pain is the one you get with injury, such as a motor vehicle accident, moving furniture, or playing sports. Chronic pain is sometimes harder to define. Some authorities define chronic pain as pain that persists, despite attempts to cure it, for six months. Others call the pain chronic after 3 months. It appears that the best definition for chronic pain is pain that persists for a period longer than is medically expected for it to resolve.


The economic cost of chronic pain is mind boggling. The American Academy of Pain Medicine reports that in 2011, at least 116 million people in the US have "common chronic pain." Low back pain, migraine (or other form of headache) and neck pain are the leading diagnoses. A significant percentage of chronic pain patients (at least 20%) have had to take medical leave from their jobs and 16% had to modify their jobs. You can only imagine what this does to a person caught with this problem when unemployment is so high.

The cost for direct medical care for chronic pain is estimated to be $261-$300 billion a year. The lost of productivity is $297-$336 billion. This is almost $200 a year for each man woman and child in the US, and it's most likely an underestimate.

Treatment of chronic pain depends on the cause, severity, and the overall health of the person affected. To be effective, treatment is frequently multidisciplinary. Depending on the situation, it may involve medications, physical therapy, surgical intervention, biofeedback, hypnosis, management of stress or depression, exercise and reconditioning, acupuncture, chiropractic, weight management…and the list goes on…

So, it's very important to identify the cause of pain and treat it early in the game, before it becomes chronic. When the pain does become chronic, it is most important to control it, so that the patient can return to the mainstream of life, and become functional despite the pain.

Need help? Don't hesitate to call.

Coupons for medications

We are keeping your out of pocket costs in mind!

Did you know that we have a large collection of money-saving coupons for your brand name prescription medications?

Click here to see the list, and check it periodically. It will be expanded and updated regularly.

If you are already taking coupon-bearing medications, all you have to do is drop by the office and pick up the coupon(s). Otherwise, discuss the possibility of switching to a coupon-bearing medication at your next visit.

In addition, our office has the lists of generic medications that are available at major pharmacies at large discounts (e.g. $10 for a three month supply), and antibiotics dispensed absolutely free of charge. Don't hesitate to ask at your next visit.

Weight and antidepressants – what's the connection?

Depression in the US is widespread, increasing gradually since WWII. More than 30 million Americans are thought to have depression, with two thirds of them women. Not surprising in the age of an economic crisis.

Many Americans with depression are now taking antidepressant medication, such as Celexa, Prozac, Wellbutrin or Elavil, to name a few.

Obesity in the US is even more widespread, with 70% of adults classified as overweight, and half of them classified as medically obese. The harmful consequences of obesity are well known; no need to repeat them here.

Does the use of antidepressants affect your weight? For many, this is a valid health question. For others, especially women (but not limited to women), it's also a social issue, a body-image issue, and many times a reason for refusing to use medically-necessary antidepressant medication.

Many patients on antidepressants gain weight. Is it a direct effect of the antidepressant, or is it that some patients begin to enjoy life more, and "celebrate" it with more eating.

Others lose weight. Is this a direct effect of the medication, or is it that these patients can now better deal with the realities of life and better control their eating habits and exercise?


While the jury is still out on this question, some answers begin to emerge. A meta-analysis (a statistical analysis of related research) that appeared in October of last year in the respected Journal of Clinical Psychiatry indicates that the antidepressants Amitriptyline (Elavil) and Mirtazapine (Remeron) and Paroxetine (Paxil) are associated with weight gain, while the antidepressants Ffluoxetine (Prozac) and Buproprion (Wellbutrin) are probably associated with weight loss.

The pressure to treat overweight in both depressed and non-depressed patients has become so urgent that some antidepressants are now used "off label" for weight loss, either alone or in combination with prescription appetite suppressants.

So, if you're taking or contemplating the use of an antidepressant, and weight loss or weight gain is an issue for you, don't forget to discuss the specific pros and cons related to your situation, with your doctor.

In our office, we have the ability to make a very reliable estimate of your daily caloric requirements (we do this by measuring your actual oxygen consumption while at rest), and use that as a guide in treatment when a combination of depression and obesity exists.

Chronic cough

Cough is common, and can linger, during the allergy season. But does cough equal allergy? Most commonly it doesn't.

A cough can be an annoying, embarrassing symptom, or an important clue leading to rapid diagnosis and effective treatment. It is one of the most common reasons to see a lung specialist, accounting for more than one third of new patient visits in our practice. There is an abundance of confusing medical literature available, most of it on the internet; a recent search found more than 300 articles related to chronic cough published so far this year, and that's only the tip of the iceberg.


Coughing itself is remarkably effective. Acute cough is our primary defense mechanisms to protect the airways and lungs from unwanted invaders, such as aspirated food or secretions laden with bacteria or acid from the stomach. Receptors line the major airways to trigger an acute cough, which can create flow rates approaching the speed of sound! This rapid air flow creates shearing forces that move secretions up and out, but unwanted effects, such as rib fractures, sprained chest muscles and even syncope (brief loss of consciousness) can result.

What makes a cough chronic? The accepted time scale is three weeks without an obvious precipitating cause. There are many clues to the cause of a cough which your physician can review with you. Generally a carefully taken health history and physical exam will identify many major concerns, such as asthma or allergy, exposure to inhaled toxins, or medicines known to cause cough. Smoking is of course an irritant; it inhibits normal mucus clearance mechanisms, and most long term smokers have a chronic cough, though some are not bothered by it. The timing, nature and history of the cough are important to review, along with associated respiratory symptoms and findings on physical exam, such as abnormal breath sounds. Chest x-ray and tests of lung function are helpful in the detection of unexpected or subtle abnormalities, such as airflow obstruction indicating asthma or COPD. “Post infectious” cough can follow respiratory infections, either minor or major, and can last for months. A state of airway hyper-responsiveness develops even though the infection itself has resolved. Frequently anti-inflammatory medicines, such as those used for asthma, are given to bring the airway back to normal. Acid reflux is another occult cause for chronic cough, as is allergic post-nasal drainage. Frequently these conditions produce minimal symptoms except for the cough. Surprisingly the majority of well established coughs have more than one cause as their basis. All must be treated, or resolution does not occur.

In most cases, rare or life threatening causes are easily ruled out and common causes, such as asthma, allergic drainage and acid reflux, are diagnosed and treated effectively. Resolution and patient satisfaction depend heavily on a systematic evaluation and adequate length of therapy, thus a good working relationship with your Physician is key.

Diagnosis and treatment of chronic cough is an important part of our office specialty. If chronic cough affects you, give us a call.

Get what's important from your doctor visit

Part of my article in EzineArticles.

The most important thing you should get out of your appointment with the doctor is an adequate explanation to the problem which prompted your visit.

Write down your questions in the order that you feel is the most important. Write down, or ask your doctor to write down, the answers to your questions, including instructions for the use of prescription and over the counter medications, medical devices, and lifestyle changes. If there isn't enough time to have all of your questions answered, then you will have had the most important ones addressed, and could save the rest for the next visit.


Carry with you, at all times, a legible, up-to-date list of all the medications you take. Include in it all prescribed and non-prescribed medications by all of your physicians. Also include in the list the dose, reason for use, frequency of use, and the date you started taking the medication. Examples might include:

1) Digoxin.25 mg. every evening, for control of heart rhythm, started 6/2009.
2) Buffered aspirin 650 mg. as needed for mild headache, started 2007, Dr. XYZ.

This list will be useful to you during your visit and in case of an emergency. Don't assume that your physician knows all the medications you are taking!

During your visit, try to be as specific about your symptoms as you can. Telling your doctor "I had a fever last night with shaking chills and a temperature of 101" is much more meaningful and leads to a faster diagnosis than saying "I have been feeling sick since last night." Telling the doctor "I have been taking amoxicillin 500 mg. every eight hours since I became sick" is much more meaningful than "I took those yellow horse pills you gave me two years ago for two days."

Remember: In order to derive benefit and satisfaction from your visit to the doctor, both you and your physician must work together. You are the principal source of information about the way you feel. The more detail your doctor has about your condition, the more will he be able to help you, and you will feel better having accomplished what you started out to do. It takes teamwork!

Be an active partner in your own health care. Let's do it together!

Do you have COPD?

If you develop shortness of breath faster than you should, you cough frequently, and are also a smoker, you may indeed have Chronic Obstructive Pulmonary (Lung) Disease, or COPD. The term COPD refers mainly to chronic bronchitis and pulmonary emphysema. More than 80% of COPD is caused by cigarette smoking, with the remainder caused by genetic factors (alpha 1-antitrypsin deficiency), industrial exposure (e.g., coal mining) and questionably air pollution.

COPD is a progressive disease, responsible for an enormous strain on the national healthcare budget, on the work place, and on one's personal well being. More than 12 million Americans are now known to have COPD, and many more have the "hidden" disease. COPD is the fifth leading cause of mortality in the US, and its economic burden is even higher.

The sooner COPD is diagnosed and treated, the better it is. Lives can be saved, jobs can be spared, and extra medical expenses avoided.

So, if you have shortness of breath, smoker or not, make sure COPD is not a factor. Don't delay, see your doctor, you won't regret it!