Feeling Like Fall

The weather has been tricky, alternating between tropical forest humidity and heat, to chilly fall nights and mornings. Unfortunately, this leads to worse asthma and allergy symptoms for anyone who suffers from Fall allergies. Please remember “an ounce of prevention is better than a pound of treatment” and come in for your allergy injections and renewal of medication. 

Speaking of coming in to the office, we are giving the flu shot to everyone who takes it on a yearly basis. While the vaccine is widely available at any pharmacy, it is best to get it from your doctor. There are many types of flu vaccines, with different potencies, modes of administration, and effectiveness. This is why I recommend getting the vaccine from your medical provider who knows your medical history and needs, not the “one size fits all” from the pharmacy. In our office, we have high-grade (specifically designed for people over 60 which covers the widest variety of flu strains) and flu-zone. As always, no appointment, copay or even wait is needed, just show up when we are open.

The fall is when I finally begin to contemplate the end of yet another year. This one seems to be passing by so very fast!  For me as my professional and personal life blend together so much, it means taking stock on what we have achieved, and how we should improve before the year truly ends. Although I am still reminiscing about the Summer sun (see picture below), now I am personally grateful for the blessings of a busy, and mostly fun everyday: soccer games (even for Nathan, my six year old!), music classes, reading together or even playing board games. Professionally, I am looking for ways to make our patient/provider interaction more meaningful. In an age of corporate mergers where hospitals, pharmacy chains, and insurance agencies gobble each other to create huge conglomerates, the patients become “widgets”, and medical care loses its human aspect. In response, I strive to keep my practice rather small, know my patients as individuals, and stay away from conveyor belt type medicine. This approach is difficult to maintain and implement but results simply in a healthier patient. But more about that in our next installment. For now, start digging up your favorite fall receipts, and share the best ones!

Wishing I could go back to enjoying Summer on the beach with my sons Nathan(5) and Benjamin(9).

Summer Vacation Travel TIps

I start looking forward the summer months in mid-January, but once here, the summer seems to fly by.  The long days are still not quite long enough, “relaxed atmosphere” means I have responsibility for more after-camp games, swim sessions, and far more running either with (literally) or after my kids. 

Of course there is also the summer family vacation, which we all look forward to. Every year we try to do something a bit different and cater to our family’s diverse age groups and interests. A very rigorous hike for one of my daughters, kayaking for another, a beautiful beach for another, Shakespeare outdoors for the adults, some classical music for me and one of the boys, anything involving ships, planes, rockets for the other…The trick is to find somewhere where you can have at least 80% of the above, and go there at a time when camp/work and internships all ended, but of course, before the new school year starts. If this does not sound challenging enough add the demands of my practice, and the fact that “time off” for me is still being on call 24/7 as long as I am in the USA. 

They say that “necessity is the mother of invention” and this is how I got to be a good and flexible traveler. If you are contemplating a vacation this summer I have a couple of items of medical advice.

I am frequently asked what to bring along for travel (especially international), even if it at a resort destination. Medical care, and medication differ widely in both name and composition from country to country, and access to a doctor and pharmacy is many times difficult even from a luxury resort. Therefore, being prepared is well worth it. First pack a sufficient supply of your regular medications (such as for blood pressure, thyroid or migraines), as it is more difficult than you think to find an equivalent in Europe, South America or the islands. Second, I will share with you the contents of my traveling medicine bag.

1. NSIDS such as Advil/Motrin or Tylenol which work for both fever and minor aches and pains. I have these in both pill and liquid forms.
2. Benadryl tabs (25mg), as well as Claritin (10mg) because they work in different ways to counteract allergic reactions and can be taken together for a better response.  These too I stock in both pill and liquid forms.
3. Imodium AD, and Pedialyte powder packets. These items are invaluable for the routine diarrhea that accompanies summer travel and the need for re-hydration and electrolyte replenishment that follows. I also take some over-the-counter(OTC) mild laxatives as the first, little known consequence of dehydration is constipation.
4. Prescription pink eye drops as well as drops for ear infections. Pool and ocean swimming increases the frequency of eye and ear infections, and they are very annoying!! I also recommend over-the-counter swimmers’ ears drops that actually dry the water in the ears after a day at the beach and in so doing prevent the infections to a large extent. 
5. Hydrocortizone and antibiotic (Bacitracin) OTC ointments, and many different sizes and shapes of band aids, non-adherent dressing pads, and surgical tape. You have no idea how useful, for many purposes these can be…and how much of a time saver it is to have them with you.
6.  A sharp pair of nail scissors, a needle nosed tweezers and a medium size ACE bandage. Together with my traveling wine opener (for me, not the “patient”)  these tools have performed miracles in many of my travels.

If I travel abroad I may also take along a Z-pack (and am happy to provide one for you) as it works well for a nasty cold, as well as for a stomach bug which Imodium alone can not control. It is relatively safe as there are few allergic reactions, and the once per day for five days regimen makes it easy to take, even on vacation.

Happy travels!

Spring? Is that you?

This May turns out to be one of the strangest yet: wet and freezing one day, breezy, luminous and warm the next... Nature (and your own body) are justly confused. If you usually get spring allergies you are likely to get them a bit later than in previous years, but they will be back for sure! Start taking your Singulair and come in for a Solu-Medrol shot which temporarily tunes down your body's response to allergens..

There's a chance you have not yet met Nadisha Hoseini our Physician Assistant, who has been part of the practice for almost a year now. Nadisha has considerable experience in  a primary care setting, an in depth approach to chronic disease treatment, and a friendly, caring bedside manner. She also has a special interest in weight management, and has worked with our new dietician, Caroline, to better marry the theory of weight loss regimens to the frustrating practice. She is combining diet and exercise with some of the newest medication regimens and achieving considerable success. As the options increase in safe weight loss medications, the surgical options become less attractive, and more people are losing weight in a healthier way. Make an appointment to explore this with her if you are worried about the (hopefully) upcoming beach season!!

Medical care delivery in northern Bergen County is changing even faster than the weather. Most internal medicine and multi-specialty practices have sold out to either Valley Medical Group,  Hackensack University Medical Center (HUMC) partners, or even Summit Medical Group. For you,  that means that there is a financial incentive for doctors to send patients from "hand to hand", from specialist to specialist, from radiology to pathology etc. In this system the medical conglomerate keeps revenue flowing, but the patient is at a loss without anyone taking full responsibility for the whole person, and closing the loop between diagnosis and appropriate treatment.

DC Medical Care is one of the last few independent internal medicine groups which remains functional. MY goal remains to provide personalized quality care, and take full responsibility for the health of our patients. That includes preventive medicine, as well as acute (sick) care, and long term management for chronic conditions. We are also unique as we keep a small number of same day appointments open for sick visits DAILY in order to better serve our patients, and avoid unnecessary emergency room visits. 

Today medical practices must partner with patients to keep our services accessible and deliver the highest quality of care at the same time. In this vein we added a section for "Frequently Asked Questions" to our website to help you better understand our policies. Let us know if there are other ways in which we can serve you better.

Powering Through The Winter

February turned out to be an upside down month. First, the temperature varied much more than usual from teeth-chattering cold to balmy, June-like (!!!) sunny days. This is the type of weather which really messes with your upper respiratory tract and your immune system, so many have been experiencing seasonal allergies way before the expected time. If this sounds like you, head in for your "magic shot" (SoluMedrol, a weak steroid)  which dials down your response to the spring allergens. As it takes a few days to kick in and only lasts for 10 weeks or so, now is the prime time to get it. 

We also have seen an increase in the number of flu cases left untreated. As your body is mobilizing to respond to the viral infection it can become more susceptible to bacterial supra infection such as bronchitis, sinusitis, etc. Don't "wait it out", but give us a call as medication is still quite effective against the flu IF taken EARLY after you become symptomatic. To make matters worse, only approximately 25% of the strains of flu virus now colonizing the Northeast were contained in the 2017 vaccine, an unusual situation which nevertheless results in the vaccine offering little protection against the disease. Therefore, be on the look out for early symptoms-we are here too help!

However, while it's still winter, What better way to ward off the boredom of dark, early evenings than experimenting with good food? For the last year we have all been trying to eat meatless meals during the week and only eat meat on Friday night and Saturday, following my daughter, Rebecca's, example. This has many benefits: we cut our family consumption of red meat substantially, and we increased our vegetable/fruit and "healthy food" intake.  You can debate the ethical and environmental impact as is in style these days, but for me it boils down to this: I have to plan, buy and cook creatively every day so my family will embrace this. Daily this proves to be a bigger challenge than even keeping my patients healthy, or filling in the mounds of paper/on-line work I have to do. Here is my latest go-to,  which Benjamin, my 9 year old, calls " bird in the nest":

Ingredients: 

1. 10oz frozen hash browns, defrosted
2. 6 large brown eggs
3. 4oz. shredded cheese, and 1oz. finely shaved aged Parmesan cheese

Carefully butter (or spray) a 6 muffin deep tin, and line it with shredded potatoes, pressing them firmly up the sides. making sure it is lined well all around so the eggs don't sip out. Place in heated 375F oven for 8-10mins or until lightly browned,

Remove pan and sprinkle the shredded cheese in each muffin then break an egg on top. Season with salt and pepper and dust evenly with the parmesan cheese.Place back in the oven, lower the temperature to 350,  until the eggs are set and the tops are brown. Enjoy!

Final thoughts of 2017!

Happy Holidays to everyone from D.C.Medical Care! I hope that all of you will enjoy the privilege of celebrating with family and friends, the sparkle of the holidays, and some well deserved rest and relaxation. The New Year is just around the corner, so it is really time to take stock.

I always ask myself: What was the most fun time I had this year? Hands down our family summer vacation in the Hamptons. What made this year special, what event in our family was momentous? My middle daughter Rebecca graduated from Princeton University and my youngest son Nathan, on his fifth birthday, had his violin debut featuring “Twinkle, twinkle, little star”. What was the best food I ate? (Always something with chocolate!!!)  Best wine? Best book I read? and a panoply of other questions meant to help me think of the important and discard the trivial aspects of my daily life. I also think of the many things I would have liked to do and did not, and mostly resolve to squeeze them in immediately or early next year. On that note, our office is open this last week of the year and, if you did not yet come in for your physical, please do so immediately! It is the only FREEBIE you get from your medical insurance, complete with routine blood work, and you lose this give away for the 2017 calendar year as the ball drops…Come on in!

My son Nathan on his tiny violin!

Of course we use the results of your physical to support your "New Year Resolutions” (lose 20 lbs, eat healthy, exercise more, be an example of a healthy lifestyle for your children). Here is my advice on that: make it realistic AND get help. There is a reason we did not do all those things in 2017, and found an excuse for it…Your weight loss goal should begin in increments of 5 lbs, which makes it accomplishable not daunting, your eating healthy should always leave room for some desert etc. We are here to help you on that, as our practice has a consulting dietitian twice a week, offers various medication options, etc.

But for now, our most important advice is: indulge, indulge, indulge! An extra glass of wine and slice of cake will not have disastrous consequences, and a new year will not roll in again for 12 more months! Cheers!

Holiday Season Reminders!

What would the holidays be if they were all picture perfect? If all the stress of juggling year end reports and parent-teacher conferences were not enough, you now have to clean, cook a feast, and think of putting up with your in-laws! No, we are not offering you medication for that, but here are a few helpful tips:

1. All home baked good freeze beautifully and keep for minimum of three months. Make your desserts now, and enlist the kids help, they will be very proud to take full credit.

2. Stock up now on essential items both non perishable foods and toiletries that guests may need, so you don’t have to run out at odd hours to replace a toothbrush.

3. Start your holiday shopping early and set a goal to finish before Black Friday because those savings are minimal when you compare to the stress of battling long lines and traffic.

Most importantly, to make this holiday season great you need to look and feel your best. Everyone wants to fit into their sexy black dress for the Holiday parties. It’s time to lose a few extra pounds that have been hanging around since the last set of parties. How should you do it? Exercise is a good thought and a must no matter what. Unfortunately, decreasing the number of calories you take in is the primary step and it is the real, unpleasant but necessary step. You can come in and see our dietitian, and can even consider weight loss medication. We have a strong integrated approach that is quite successful with almost everyone. It’s well worth passing up a few boring high calorie take out meals now and dream of those delicious upcoming holiday treats like Christmas cookies, eggnogs, and potato latkes instead. You can also think of rehabbing (lightening up) some of your family favorites by using less fat and sugar or coming up with new traditional treats you can have while wearing your skinny jeans.

Give yourself the gift of health by scheduling your Physical ASAP, because they are free for each calendar year. If you don’t use it, you lose it. Physicals are important because they can discover issues you didn’t know you had such as high blood pressure, thyroid problems, etc., and fixing those will allow you to start 2018 healthy!

Healthy Choices for October

Your health is important to us at DC Medical Care and we thought we would check in with a couple of tips to ensure you are healthy and happy this month.

With the Fall officially here, it is time to be aware of the inherent health risks of this time of year.  Therefore, October is the month to get your Flu Shot so you can be covered the entire Influenza season. You can come in with no appointment or copay, and most importantly, no waiting time because flu shots are administered by by the Nurse and billed through the insurance directly. This is an easy step to safeguard your health and the health of your loved ones.

October is also very close to the end of the year, so if you have not had a Physical this year you have wasted a lot of money on your monthly insurance premiums. A physical is meant to check up on your overall health, and setup your goals for next year. The yearly Physical is a must because anything we find we can correct before symptoms appear. That is the power of prevention and it is in your hands to make it happen.  Money should not be an excuse as IT IS ALWAYS FREE! (i.e. it’s covered by insurance 100% in almost all cases)

This year we have been blessed with warm weather late into the Fall season. That means sunny Sundays with your family, but also that Fall allergies may start later than usual. If you have symptoms not resolved with OTC Claritin or Zyrtec, please come in soon. Allergy medication takes approximately 2 weeks to relieve the symptoms so the earlier you start, the less discomfort you will endure.

July in NJ: Tick Alert!

July is the month to be outdoors, it's not as hot and humid as August, but more consistently sunny than June. We want everyone to be outside enjoying the sun (with sunscreen SPF 30 and above) and hiking, biking, or just gardening.

In New Jersey though, we have to be aware of ticks because Lyme Disease is a real possibility. Don’t get too worried though, not all ticks carry it and not all bites result in infection.

Here is an easy way to look at it:

At the end of the day, especially a day spent being active outdoors, check your whole body for a tick. I mean the WHOLE body. This summer, we found one hidden behind my 7 year old son’s ear just by the hairline! If you find one, you can extract it yourself by grasping it with a pair of tweezers and pulling up and out. Inspect that the mouthpiece is not left in the skin. Disinfect the wound with alcohol. Do not worry about saving the insect.  A Lyme carrying tick, as opposed to other ones, are very, very small.

You will need a blood test for a baseline to verify that you do not have antibodies to Lyme disease, and a second one about 6-7 weeks later. If the second test is negative it means that you have not been infected from that particular tick bite. If positive you will receive treatment before any actual disease develops. This approach works well and decreases the anxiety associated with a tick bite.

Enjoy the outdoors!!!