THE KeepingWAITING you up to date for the times you have to wait! ROOM MAGAZINE thewaitingroommagazine.com

men’s health Preventing the Top Seven Health Threats to Men

women’s health Breast Cancer Prevention Tips

healthy parenting Promote a Healthy Body Image in Children

healthy lifestyle Is Chronic Sinusitis Ruining Your Life?

aging gracefully New Options for Cataract Surgery

doc spotlight

Dr.Dr. MichaelMichael As Featured on: DansingerDansinger THE DOCTOR BEHIND NBC’S BIGGEST LOSER TELLS US THE SECRETS

THAT WILL TRANSFORM YOUR BODY AND CHANGE YOUR LIFETheWaitingRoomMagazine.com 1 Find a Doctor That’s Right For You. Right Now.

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EXECUTIVE EDITOR Siobhan O’Grady MANAGING EDITOR Dana M. Jarrett A note from the ASSISTANT EDITOR Tina Neagu ART DIRECTOR Nina Laurel Executive Editor

e are honored and delighted to present you with the THANKS TO THE FOLLOWING LEADING PHYSICIANS OF inaugural edition of The Waiting Room, a trademark THE WORLD CONTRIBUTING DOCTORS: publication from the Leading Physicians of the World. W Written exclusively by our member doctors, The Feyrouz Al-Ashkar, MD, FACR, CCD | Dima Ali, MD Waiting Room is designed to be an informative companion for you Keivan Ansarian, DDS | Asad A. Bakir, MD, FACP as you wait for your appointment. Mark Berkowitz, DDS, NMD, IBMD, C.Hom The Leading Physicians of the World has long been a resource for Juergen H. A. Bludau, M.D. | Antal F. Borbely, M.D. selecting and documenting top doctors in all specialties from across Renee Bovelle, MD | Jane M. Brotanek, MD, MPH, FAAP the globe. Through our annual publications and online resources, Glenn A. Brottman, MD | Kevin Chan, D.O., M.S., F.A.S.A. we give you the opportunity to be an active participant in one of the most important healthcare decisions - selecting your providers. Russell S. Chin, DDS | Lynne Carr Columbus, D.O. Now for the first time, we have gathered our physicians together to Alex. R. Constantinescu, MD | Michael Dansinger, M.D. share their much desired expertise. Inside these pages our doctors Chrystal E. de Freitas, M.D., F.A.A.P. | Susan W will provide invaluable information and advice on medical topics, Denfield, MD, FAAP, FACC | Mahir Elder, MD, FACC, healthcare news, wellness tips, fitness motivation and lifestyle FSCAI, FASNC, FAHA, FCCP, RPVI | Jason Faller, M.D. improvement articles for the entire family. The Waiting Room will inspire you to live a happier, healthier life, while arming you with Patrick R. Felice, M.D. | Alan G Finkel, MD FAAN FAHS the knowledge needed to become an informed patient in all of your Annette Fiorillo-Quinn, MD, DO, MS | Margareta health related decisions. M. Gavrila, DDS | Raghav Govindarajan, MD In this edition’s cover story, we sit down with Dr. Michael Dansinger, Nusrath M. Habiba, M.D., Assistant Professor one of the doctors behind NBC’s hit TV show The Biggest Loser. He M. Brinson Hargraves, M.D. | Wes Herman, MD is a renowned expert and lifestyle coach for managing and Herbert A. Insel, MD FACC | Walter E Jacobson, MD preventing diabetes, obesity, and heart related conditions. Beyond the phenomenon of his success on the small screen, Dr. Dansinger Karim N. Jamal, MD | Brian Kahan, D.O., FAAPMR, shares pragmatic, realistic approaches that will keep you in tip-top DABIPP, DABPM, DAOCPMR | Matthew R. Kaufman, shape, from the inside out. MD, FACS | David Kavesteen, MD FACC I truly hope that you enjoy reading The Waiting Room, and the Camille Y. Keene, MD | Carolyn LaFleur, MD collaborative work that our doctors have put in to see this Harvey Levy, DMD, MAGD | Manuel Lois, MD, FCCP, FACP publication come to fruition. As a new magazine, we welcome any questions or suggestions that you may have to help us in our efforts Dr. Stuart C. Marmorstein | David H. McDaniel, MD, FAAD of moving forward. Danielle Marie Mellace, DO | M. Alan Menter, MD I wholeheartedly congratulate you in taking the first step towards Anita Myers, DDS | Ron Noy, MD | Frank Orlando, educating yourself and increasing your awareness on health related DDS, FAGD, FICOI | Carrie Polster, DMD issues. It is my earnest belief that the more information you have Tomi T. Prvulovic, MD | Tamim Qaum, MD CPE about health care, the better you are to make decisions about what is best for you and your family. COE CASC FAWM CPHIT CPEHR CPHIE CSSGB OCS William J. Schlotz, DDS | Marc Howard Shomer, MD Happy Reading and Good Health, David A. Slaughter, DDS | Tina N. Tillis, MD James Uhles, MD, | Rachel B. Wellner, MD MPH FACS Eric M. Wilner, MD | Sonny J.H. Wong, MD, FACC Subhashini Yalamanchi, MD Siobhan O’Grady, Executive Editor

TheWaitingRoomMagazine.com 1 10 18

93 73 69 contents REGULAR FEATURES Women’s Health Doc Spotlight All the health information and tips women These doctors are very special, and tell their own need to succeed! A section specially devoted to personal stories in this section. Highlighted women and their healthcare needs, including throughout the magazine are doctors who have illnesses only seen in women and how they are their own life experiences and health wisdom treated. Common beauty trends as well as very to share...... 13 real health threats to women are also covered....4 Aging Gracefully Healthy Heart With featured illnesses that primarily affect the Everyone has a heart, learn how to protect yours aging population, this section gives the elderly in this special section with articles devoted to and approaching elderly health tips to live a cardiovascular care for patients of all ages...... 10 quality, prolonged life!...... 70

Healthy Lifestyle Healthy Smile Learn how to avoid and manage pain as well People are often judged by their smiles. This as how to maintain a healthy lifestyle in section, which features articles written by some this section, which documents a variety of of our top dentists, teaches others to take good miscellaneous ill-nesses, and anti-aging tips care of their smiles and overall oral health...... 86 to keep you healthy...... 17 Mind Over Matter Healthy Parenting This section features some new trends and This section has all the parenting tips one may emerging problems and patterns in mental health. need, for new parents to old. Children of all ages Written for people of all ages, these articles and their issues are documented in this area, help us to maintain our sanity and improve our to help make any parent feel at ease...... 6 mental state in a very busy world...... 99

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DOCTORS IN THE SPOTLIGHT

OUR COVER STORY Michael Dansinger M.D...... 13 Weight loss and nutrition advisor for NBC’s hit prime time series “The Biggest Loser” shares the secrets to a healthy, fit life.

A Personal Battle...... 35 Lynne Carr Columbus, D.O. shares her battle with a rare disease discovering a new awareness of the downside of health care.

Attending To The Health Of The Mind And Body...... 82 Glenn Brottman, M.D. perfected a life-saving procedure to treat depression without invading the body with Transcranial Magnetic Stimulation.

An Explorer And Healer Of The Eye...... 85 Tamim Qaum, MD describes his pioneering research in discovering a medical solution for diabetic retinopathy has revealed that anti-VEGF therapy can be used to prevent damage to the retina caused by diabetes.

An Outstanding Advocate Of Dental Health...... 96 Margareta M. Gavrila, DDS understands that more and more people sacrifice dental health care because they cannot afford insuranceco-payments, so she hosts a Dental Emergency Day.

The Fulfillment Of Life After A Successful Career...... 97 Carolyn LaFleur, MD develops programs in countries where Americans are less fortunate and shares her talents to raise their quality of life

TheWaitingRoomMagazine.com 3 women’s HEALTH

Promoting a healthy lifestyle and quality of life Through Breast Cancer Prevention

Breast cancer is one of the world’s leading cancers in women. It affects one in eight women over a lifetime, and there are roughly over 230,000 new cases of invasive breast cancer and over 50,000 cases of non-invasive breast cancer per year in the country alone. About 40,000 people die of breast cancer annually in the U.S. It contin- ues to be a major cause of mortality world-wide, particularly in developing coun- tries, where access to prevention, screening, and even appropriate management might be scarce. One percent of all breast cancers actually occur in men.

reast cancer refers to the malignant growth of Risk Factors: cells within the breast gland. The gland consists • Breast cancer incidence is strongly related to age, peaking of structures known as lobes, lobules and ducts in the later decades. B and is surrounded by fat and connective tissue. • Other risk factors implicated in the development of breast Each breast contains around 15-20 lobes, which are, in turn, cancer include genetics (strong family history of breast or composed of smaller lobules, the milk-making factory of the other related malignancies), breast, all clustered together. Connecting lobes and lobules • hormonal and reproductive risk factors such as early are lactiferous ducts, which carry the milk out the nipple. menarche, late menopause, late onset of first pregnancy, Breast development, function, and even tumor genesis are hormone replacement therapy, primarily under hormonal control but are also affected by • environmental risk factors including obesity, excess genetic and environmental factors. alcohol, high-dose radiation, and possibly nutritional factors.

4 TheWaitingRoomMagazine.com women’s HEALTH

• People at high risk for breast cancer include those Preventive strategies include: previously diagnosed with breast cancer, those with 1. Adopting a healthy lifestyle involving a diet rich in atypical cells on a breast biopsy, and patients with vitamins (esp. vitamin D) and anti-oxidants, low in saturated mammographically dense breasts. fats, moderate exercise, and low alcohol consumption. 2. Additional risk reduction involves judicious use of Paralleling our improved understanding of breast combination hormone replacement regimens. carcinogenesis, risk factors, and improved surveillance are a 3. Early detection, or secondary screening, emphasizes the multitude of advances in treatments. Whereas in the past, importance of going for yearly mammograms and other appro- a classic radical mastectomy represented a patient’s only priate screening tests (sonograms, MRIs appropriate in select groups). option for resection, developments in surgical management 4. Furthermore, capturing patients who are at high risk for has allowed us to offer patients less radical surgery, developing breast cancer, such as those with a heavy family ranging from breast conservation (lumpectomy) to skin- and history and/or those with a known genetic mutation, can also nipple-sparing mastectomies, and less radical lymph node lead to earlier diagnosis and allow for the employment of specific resections. Furthermore, advances in breast reconstruction, prevention techniques as guided by a specialist physician. including “oncoplastic” surgery (the restoration of tissue 5. Finally, with early diagnosis and prompt treatment, patients contours while removing all cancer), afford women the are candidates for minimally invasive medical and surgical opportunity to restore their bodies. options with a largely improved prognosis. WR

Rachel B. Wellner, MD MPH FACS, is dedicated to delivering Advances in modern chemotherapy have also influenced compassionate, high quality care. The current Director of Breast Services the landscape of breast cancer treatment. The survival rate at The New York Eye and Ear Infirmary, a subsidiary of Continuum Cancer Care, an acclaimed fully accredited academic breast center and center of for early-stage breast cancer is greater than 90 percent, and excellence, she joined forces with the Center for Microsurgical Breast even many patients with Stage IV breast cancer, the most Reconstruction under the leadership of world renowned reconstructive advanced stage indicating wide-spread disease, can expect surgeons Dr. Robert Allen and Dr. Joshua Levine. Exclusively working with the world’s best in diagnostics, medical oncology, radiation oncology, a longer survival on systemic therapies. Newer techniques in reconstructive surgery, and other ancillary services, she is able to offer radiation therapy have also made lumpectomy exceptionally patients the most modern, state of the art therapeutic options. safe while lowering recurrence rates significantly.

Rachel B. Wellner, MD MPH FACS As our understanding of carcinogenesis is evolving, more Director of Breast Services, NYEE and more targeted treatments are being developed. In lieu of Continuum Cancer Care a definitive cure, our efforts must be focused on prevention, 77 Worth Street, New York, NY 10013 early detection, and prompt management, all proven 212-987-5000 strategies in the prevention of cancer death.

In lieu of a definitive cure, our efforts must be focused on prevention, early detection, and prompt management, all proven strategies in the prevention of cancer death.

TheWaitingRoomMagazine.com 5 women’s HEALTH

Question: What is Latisse? AND DOES IT REALLY WORK TO GROW YOUR LASHES?

he short answer: Latisse is a prescription eye of those people you’d better keep your expectations in solution used to grow eyelashes making them check because it is unlikely to work before that time frame. longer, thicker and darker. Yes, it works. My sister That’s human physiology. If it causes you anxiety to apply T is an eye doctor so I had the inside scoop a long Latisse daily and have to wait to see a visible result, either time ago and tried it myself. It really does work! get false eyelashes or lash extensions. If you are compliant and patient, YOU WILL SEE RESULTS. For maintenance, The long answer: The chemical name for Latisse is bimatoprost, I recommend treatment 2-3 times per week. Please note that and it was discovered in the 1930’s as a new class of drugs if Latisse is discontinued completely, your eyelashes will called prostamides (yes, as in derived from the prostate – shed and return to normal in about 60 days. Latisse has been my goodness what we’ll do for beauty…). By the 1970’s, there reported to cause increased brown pigmentation in the area was widespread use of the drug for the treatment of glaucoma used but this should not be permanent or cause for concern. (hypertension of the eyes). Since December 2008, it has been marketed by Allergan (the makers of Botox and Juvederm) I remember when minoxidil (an anti-hypertensive agent) was as a topical prescription approved by the FDA to “stimulate marketed for hair growth in the 1980s-1990s as Rogaine. eyelashes to grow longer and thicker.” Please note that it is a Homer Simpson heard about “Dimoxinil” on an infomercial prescription and therefore only available through physicians. and just had to have it. He bought it from a doctor in a back alley, applied it and the next day woke up with a full head of Prior to its FDA approval as Latisse, bimatoprost was hair. His boss Mr. Burns mistook him for someone else and marketed as Lumigan eye drops and prescribed by eye promoted Homer to an executive position. I’m sure that it’s doctors for glaucoma. It was noticed that patients being just a matter of time before Marge gets hooked on Latisse… treated for glaucoma were developing thicker, longer eyelashes. Latisse retails anywhere from $120 to $150 per bottle I recommend applying it to the base of the eyelashes in the (about 80 drops). WR morning to clean lids (it comes with a little application brush). Dima Ali, MD, or “Dr. Dima,” as her patients and colleagues affectionately Although it is not recommended for the lower lids or eyebrows call her, founded one of the East Coasts first medical spas, WellMedica (the FDA is picky), it is safe for use in those areas as well. Aesthetic & Anti-Aging Medicine in Reston, VA. Her areas of expertise include aesthetic laser surgery, minimally invasive face lifts, fat grafting, botox, soft tissue fillers, chemical peels, sclerotherapy, mesotherapy/ You should expect to see eyelash growth within 60 to 90 days. injectable lipolysis and bio-identical hormone replacement therapy. This is probably the biggest complaint…”why does it take so A popular and international media figure, Dr. Dima has also been featured on CBS News and on the cover of leading magazines. Dr. Dima was named long??” We all want that instant gratification. If you are one the Cosmetic and Anti-Aging Guru for IamModern Magazine.

Dima Ali, MD WellMedica Aesthetic & Anti-Aging Medicine 1801 Robert Fulton Drive, Reston, VA 20191 703-787-9866 www.wellmedica.com | www.cosminology.com

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You can’t stop getting older, but you don’t have to look old....

All too often we underestimate the value of starting small. Keeping up with the aging process does not start with a facelift. There are a myriad of things we can do to help prevent the rapid signs of aging.

linical skincare is always a good place to start when looking for ways to improve your appearance. This should not be confused with a “facial” delivered C in most spas which can be a relaxing experience, but does little to reverse or prevent further aging of the skin. It is essential to use the proper concentrations of restoring fruit acids in the least irritating formulations. Chemical skin peels should be done in a medical setting and can be enhanced by a properly performed Microdermabrasion procedure. By taking proper care of your skin everyday, you can create a healthy foundation from which to build a plan for subtle improvements.

Many of these procedures can be further enhanced when done in combination with each other. For example, Botox® is very effective for the treatment of frown lines, crow’s feet and Individuals that have structural features that require elevation forehead furrows. These are the lines that are created by the or lifting will need to consider surgical procedures such as contraction of muscles during normal facial expression. eyelid lifts, forehead lifts, face and neck lifts. Obviously there The results from Botox® are impressive. Unfortunately, there is more downtime associated with these procedures, are many misconceptions. Botox® will not poison you. It will but when necessary, the results are very gratifying. WR not leave you with an expressionless face. And no, your eyes will not stay open when you are sleeping. Botox® should be Patrick R. Felice, MD, maintains active privileges at Saint Francis Hospital and Medical Center, Health South Surgery Center, and the University of administered in a medical setting and preferably by a physician Connecticut where he is an Associate Clinical Professor. He holds the who understands the actions of the various muscle groups. office of Secretary/Treasurer for the Connecticut Society of Plastic and Reconstructive Surgeons and has been honored by the Consumer Research Council as one of the Top Surgeons in the United States for the last Wrinkles that are not associated with muscle activity will 10 years. His private practice, Youthful Images, was created in order to not respond to Botox®. These wrinkles require filler provide the highest standard of care possible in cosmetic surgery. materials. There are many choices for different conditions such as Radiesse®, Restylane®, Juvederm®, Perlane®, Dima Ali, MD Patrick R. Felice, M.D. Sculptra®, among others. Photorejuvenation (Intense Pulsed WellMedica Aesthetic & Anti-Aging Medicine Dr. Felice’s Youthful Images Light) further enhances the combination procedures by evening 1801 Robert Fulton Drive, Reston, VA 20191 580 Cottage Grove Blvd., Ste 103 Bloomfield, CT 06002 the skin tones, stimulating the elastic fibers and thickening 703-787-9866 Ph 860.242.0505 existing collagen. A series of treatments are generally www.wellmedica.com | www.cosminology.com www.youthfulimages.com required and has the distinct advantage of no down-time.

TheWaitingRoomMagazine.com 7 women’s HEALTH

Safe Beauty Regimen for Pregnant Women

Most of the women avoid alcoholic drinks and sushi when they are pregnant – all for the best of the baby. But what they often forget is the safety of the routine beauty products they regularly use. According to Andrew Healy, MD, an obstetrician at Baystate Medical Center in Springfield, any substance absorbed by the skin can reach the blood stream and then cross the placenta. Hence whatever the beauty products are, some amount of caution has to be applied to avoid unwanted prob- lems. However, very few substances are known to be harmful for women and the developing fetus during pregnancy.

f you are not sure of the safety of a particular product instead. The most important beauty regimen for a healthy it is better to bring it to the notice of the doctor, says teeth and smile is to brush and floss regularly. John Bailey, PhD, chief scientist for the Personal Care I Products Council. Given below are some information Hair Spray and Nail Polish on what is safe and what should be avoided in the beauty Phthalates is an ingredient in these products which has products when you are pregnant. some health concerns. Opt for mousse or gel, or any other phthalate-free polish. A number of studies have shown a link Teeth Whiteners between this chemical and increased risk of birth defects. Almost all of the teeth whiteners contain a worrisome But according to FDA the amount of evidence available is not ingredient, peroxide. If you are really concerned about its sufficient enough to establish an association between the health issues, try teeth whiteners which are peroxide-free. use of phthalates in cosmetics and health risk. According to Colleen Olitsky, DMD, a cosmetic dentist in Ponte Vedra Beach, the active ingredient peroxide is safe for use in Judith Hellman, MD, associate clinical professor of adults. This remains safe even if you swallow a small amount dermatology at Mount Sinai School of Medicine in New York, during the bleaching process. But the effect of this ingredient says that it all depends on the amount used. Anybody can on the developing fetus is still not known and hence it is use a small amount of the spray without inhaling, according best to avoid them during pregnancy, she cautions. Dayna to her. But if you are exposed to fumes of hairspray regularly Salasche, MD, clinical instructor of obstetrics and gynecology at work, there is increased risk to the developing baby. at Northwestern University’s Feinberg School of Medicine A study published in Environmental Health Perspectives in Chicago, feels that it is better to avoid using peroxide- in 2008 showed that baby boys born to women who had containing teeth whiteners and opt for whitening tooth paste continuous exposure to hair spray at work had increased

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chances having a defect in the penis. But this study could not not been studied much. Hence many doctors recommend prove that hair spray was the culprit in causing birth defect. avoiding its usage. Jeannette Graf, MD, dermatologist in New York, says that dyes contain a number of ingredients that While wearing nail polish one can reduce the exposure by when ingested can be poisonous to the person. So it is better applying it while in a well ventilated area. Once the polish dries to avoid dyeing the hair when pregnant, she adds. One can opt the risk is less as nail polish is not absorbed through the nails. for hair highlighting which is not applied on the scalp.

But according to Healy, phthalates are not associated with There are contradictory views as well. Leddon says that only birth defects in human beings. But since animal studies have a small amount of the substance applied for the treatment shown that these chemicals to be the cause of defects in male of hair are absorbed into women’s skin and hence it may sexual developments, it is better to apply some caution, he adds. not cause much issues for the developing fetus. To be on the safer side, avoid applying the hair dye during the first Sunscreen and Self-Tanners trimester when the fetus is susceptible. According to him, Both sunscreens and self-tanners are known to contain the best option is to use products without ammonia, treat an ingredient oxybenzone, a chemical that can produce the hair in well ventilated room, wear gloves and rinse harmful health effects. The best way to avoid having this is immediately after the treatment. Even though it is not to use products containing zinc oxide or titanium dioxide. tested, one can use it safely throughout pregnancy as it is In a recent study the results showed that absorption of only a topical application, opines Salasche. oxybenzone in sunscreen is associated with low birth weight of girl child. But the study does not prove that the Makeup actual cause of low birth weight is oxybenzone. Lead and fragrance are the two unwanted ingredients in makeup products. Many women have the habit of staying Effects of self-tanners have not been studied in pregnant with the foundation, lipstick and other cosmetics until women. According to Hellman, an occasional self-tanner bedtime. Pregnant women should be careful in choosing may not cause much harm when compared to real tan or the products and the try to avoid anything extra, says Sean tanning beds. But sunscreens cannot be totally avoided as Gray, senior analyst at the Environmental Working Group, pregnancy hormones make the skin more sensitive than a non-profit organization which co-founded the Campaign normal, says Salasche. Sun blocking creams are a better for Safe Cosmetics. Lead added to lipstick makes it long- option as they are absorbed and one can also wear hats lasting. A study conducted in 2007 showed that most of and other accessories to prevent the heat. the leading brands of lipsticks contain lead. FDA does not consider presence of lead in lipstick as a health concern as Acne Medication it is not ingested. But if one is concerned about the chemical, All major acne medications contain ingredient like salicylic opt for lead-free lipsticks available in the market. acid, benzoyl peroxide, retinol and retinoid. Moreover, acne worsens during pregnancy because of the surge of Anti-Wrinkle Cream, Botox Cosmetic hormones in pregnancy. Avoid all medications which contain Many pregnant women have a tendency to go for an anti- the above said ingredients. Prescription retinoid products wrinkle cream as a stretch-mark lotion. Most of the wrinkle also should not be used. Jeanie Leddon, MD, PhD, a derm- creams contain retinol, a compound linked to birth defects. atologist in Lafayetto, suggests that using prescription Some women go for botox cosmetic injections to smooth the topical applications containing azelaic acid, erythromycin furrowed brows. It is better to avoid this during pregnancy as or clindamycin would be a better option. Glycolic acid peels it may be associated with miscarriage and birth defects, also can be used safely during pregnancy to control acne. even though there is no conclusive evidence. As there are no Healy warns that salicylic acid is associated with increased well-controlled studies of Botox cosmetic in pregnant women, risk of miscarriage when taken in the first trimester. it is better not to have it during pregnancy, says Kellie Reagan, a spokeswoman for Allergan, the drug company that Hair Dye makes Botox Cosmetic. If a pregnant woman wants to use an Hair dyes contain worrisome ingredients like ammonia and anti-wrinkle cream, it is always better to have a word with peroxide but the effects of hair dye on pregnant women has the physician before applying it, says Healy. WR

TheWaitingRoomMagazine.com 9 healthy HEART Healthy Heart

MYTHS, RISK FACTORS AND BASICS FOR A HEALTHY CARDIOVASCULAR SYSTEM

Did you know that the leading cause of death worldwide is cardiovascular disease? You need to know that the physical condition of your arteries determines the potential for future adverse cardiovascular events. As Sir William Osler said, “You’re only as old as your arteries.” Hence, the health of your cardiovascular system will greatly rely on how you took good care of it in the past.

ome of the 8 risk factors that you need to watch Common Myth that Needs to Be Corrected out for to have a healthy heart and arteries include We tend to consider the benefit of “diet and exercise “largely S the following: as a “means” to lower cholesterol, blood pressure and blood sugar levels. That should not be the case. “ Diet and • Hypertension • Diet exercise“ should be looked upon as an “end“ in and of itself • Hyperlipidemia • Weight for improving cardiovascular health beyond the effect it has • Diabetes • Activity Level on one’s “numbers“. That is because prudent lifestyle • Cigarette smoking • Mental Well Being modifications have a direct beneficial effect on the health of one’s arteries and serve to reduce the tendencies for Though the first four factors are known to cause plaque growth (atherosclerosis) and consequent rupture cardiovascular problems, you need to understand that (causing heart attacks). While there is an inherent limit as to failure to check the last 4 factors will give you the same how much “diet and exercise“ can alter one’s blood pressure, degree of consequences. For this reason, anybody may lipid and glucose levels, there is no such limit to the acquire certain types of heart and arterial problems if improvement in one’s cardiovascular health by achieving one fails to live a healthy lifestyle. the proper balance of diet and exercise..

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Start With the Basics Points to Remember Protecting your heart doesn’t have to be such a big You need to realize that the health that you have today is the momentous event. It is how you live each day of your result of the decisions that you have made in the past. If you have life. Obviously, you cannot change your genetic set up decided to ignore the idea of eating a healthy diet, exercising but you can do a lot to change your lifestyle. You need regularly, and watching out for the risk factors that can lead to to find ways to exercise and to eat a healthy diet even cardiovascular illness, then you may develop a cardiovascular if you feel like you do not have the time to do so. disorder one of these days. WR Reducing stress and enhancing one’s mental well being is extremely important. You need to know that Herbert Insel, MD, is a board certified internist, cardiologist and a Fellow of the American College of Cardiology (FACC). He maintains a private practice on the chronic stress can contribute to arterial plaque growth upper east side of Manhattan and has admitting privileges at both North Shore and consequently arterial rupture. If you don’t have LIJ Lenox Hill and NYU Langone Medical Center Hospitals. Dr. Insel’s special professional interest is preventive cardiology, a field in which he frequently lectures the time to go to the gym, park your car further from to professional groups, medical facilities and corporations. Dr. Insel is the Senior where you are going or climb stairs instead of using Cardiologist at Executive Health Exams International, where he has been for over the elevator. And if you do rigid trainings, make sure 20 years, and serves on their Medical Advisory Board. that you will not be at a level or intensity that leads to pain either during or subsequent to your Herbert A. Insel, MD FACC workout. Eat variety of fruits, vegetables and whole 1125 Park Avenue, grains and good sources of proteins and fats instead NY 10128 of taking a “low fat diet” or “low carb diet”. 212-360-1800 Furthermore, if you want to lose weight, www.herbertinselmd.com know how to eat less.

TheWaitingRoomMagazine.com 11 healthy HEART

CLOGGED ARTERIES = BLOCKED PIPES

There are three major arteries, which supply blood to the heart. These arteries are very important to maintaining the proper function of the heart. Similar to pipes that carry water in a home, blood does not flow properly when there are blockages in these arteries. These blockages can lead to many problems including chest pain, heart attack, congestive heart failure, and even death. This is called coronary artery disease.

ardiovascular disease is the number one killer Specializing in interventional cardiology, Dr. Mahir D. Elder is experienced in the newest interventional modalities, and has performed many diagnostic in the United States causing more deaths than cardiac catheterizations including peripheral interventions. Dr. Elder has been lung cancer, breast cancer, and AIDS combined. published in a plethora of medical journals, and involved in numerous clinical There are several risk factors for coronary artery trials for pharmaceutical and medical device companies and currently serves C as Associate Clinical Chief of Cardiology and Ambulatory Surgery. Today, he is disease including age, family history, smoking, high blood a Clinical Associate Professor of Medicine at Wayne State University School of pressure (hypertension), diabetes, and high cholesterol. Medicine and practices cardiology in Michigan at Heart and Vascular Physicians.

Although one cannot control all risk factors, prevention Mahir Elder, MD, FACC, FSCAI, FASNC, FAHA, FCCP, RPVI and treatment are important to the improvement of this Heart and Vascular Physicians disease. Maintaining a low fat-low cholesterol diet and 4160 John R. Street, Suite 510, Detroit, MI 48201 exercising 3-4 times a week can make all the difference. 313.993.7777 Talk to your doctor today about what you can do to www.hvimd.com prevent or manage your heart disease. WR

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MD SPOTLIGHTTHE MICHAEL DANSINGER

Michael Dansinger, M.D. is a nationally recognized expert in lifestyle coaching for prevention and treatment of heart disease, diabetes, obesity and related conditions. He is the weight loss and nutrition advisor for NBC’s hit prime time series “The Biggest Loser”, and a contributor to the best-selling book series based on the show. Dr. Dansinger is also the Diabetes Doctor for WebMD, Director of the Diabetes Reversal Program at Tufts Medical Center in Boston, and Director of his own “Biggest Loser Style” Diabetes Reversal Program at CATZ gym in Needham, MA. In addition to all that, Dr. Dansinger is the Medical Director and lead architect of the cutting-edge heartmattersTM wellness program created by Boston Heart Diagnostics, a leader in personalized diagnostics dedicated to preventing heart disease and related events.

he Waiting Room wwas lucky enough to sit down with Dr. Dansinger and ask him to share the secrets to a healthy,

Mahir Elder, MD, FACC, FSCAI, FASNC, FAHA, FCCP, RPVI fit life. With his extensive expertise in nutritional matters, Heart and Vascular Physicians T Dr. Dansinger provided some invaluable insights into 4160 John R. Street, Suite 510, Detroit, MI 48201 tailoring eating plans for individuals. He told us, “It’s much better to 313.993.7777 have a wide variety of options, the whole spectrum, rather than one www.hvimd.com best plan for everyone.” One of the main points he conveyed was that although there is a wide spectrum of eating strategies crosses

TheWaitingRoomMagazine.com 13 cover STORY

If you believe in yourself and you are persistant then it’s never too late to improve your health for the better. You know you will succeed once you decide you will never give up trying.

a broad range of carbohydrate, fat and protein intake, not every diet will achieve the desired or required goals that an individual seeks. This spectrum of diets begins with the Atkins diet, which reduces starch consumption, and ends with the Ornish diet, which emphasizes starch and vegetables and reduces animal fats.

Dr. Dansinger pointed out the two major criteria in choosing an eating plan. The first is to account for the subject’s personal preferences. If a certain food group is a large portion of an individual’s normal dietary intake, then the preferred eating plan for that individual should include a larger portion of that food group. Rather than trying to reconfigure a subject’s eating patterns to the plan, it is often more successful to find and implement a diet plan that is more suited to the subjects dietary habits and lifestyle.

Another criterion is to tailor an eating plan to the individuals pre-existing medical conditions. If someone is in the high risk category for heart disease, then oftentimes the appropriate strategy is one that is low in animal fats and unhealthy cholesterol. On the other hand, if someone is at high risk for diabetes or obesity then a plan that is low in starches and sugars may be important. food processing industry. Our primitive ancestors relied on fruits and vegetables as the main staples of their diet, Dr. Dansinger noted his 2005 study in the Journal of the with abundant, lean protein. Unfortunately, the widespread American Medical Association indicated that adherence level introduction of unhealthy fats, processed starchy foods is much more important than the type of eating plan. Dr. and sugars in readily available “modern foods” has done Dansinger emphasized that participating in a lifestyle coaching considerable damage to America’s health and waistline. program can dramatically increase adherence. For most people Simultaneously, because America’s jobs have moved from it’s most difficult to achieve long-term success without some agrarian and industrial sectors to office jobs, the average external accountability. American tends to be much less active compared to previous generations. The combination of a hectic When asked about the epidemic of obesity in America, Dr. modern lifestyle and the ready availability of unhealthy Dansinger responded that much of this results from lifestyle modern foods has led to an explosion in obesity related changes in American society and unhealthy changes in the health problems.

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Dr. Dansinger advocates substituting healthier alternatives participants with varying degrees of health and mobility. in an individual’s daily routine. For example, instead of high All participants were required to commit to ten hours of fat sausage or bacon for breakfast, low fat turkey sausageTHE or exercise a week. The philosophy of the program was to Canadian bacon could be consumed. He also warned against produce dramatic weight loss and markedly increase fitness eating large quantities of starches, because they can be levels over a longer period of time. In contrast to the dramatic appetite stimulants. This is because the body turns starches weight loss on The Biggest Loser, the Diabetes Reversal into sugars and a rapid rise in blood sugar followed by a rapid Challenge was primarily designed to reverse obesity and fall is a potent appetite signal to the brain. Dr. Dansinger diabetes over a much longer time frame. mentioned that his personal dietary intake consisted of protein, fruits and vegetables with only small amounts of starch. Dr. Dansinger emphasizes a “consistent and persistent” exercise regimen. One participant who maintained a consistent Another important consideration in losing weight is to change exercise regimen and followed the recommended eating plan eating plans if the current plan is no longer working. Dr. with 95% adherence, was able to lose twenty pounds in the Dansinger labeled this innovative strategy as “dating the diet first month and seventy pounds by the end of the sixth month. plans.” Some individuals can remain on a single eating plan Dr. Dansinger stated that similar results could be attained indefinitely while showing consistent results. Others, however, by many others on a similar exercise and eating plan, if the may need to alter their chosen plan or seek an entirely new right environment could be established. Accountability and a one, in order to produce ongoing weight loss or long-term willingness to push oneself were vital elements in any weight health benefits. loss strategy. Dr. Dansinger emphasized that solo dieting and exercising are much less likely to be produce significant The flip side of the weight loss coin is the exercise regimen. results, but with proper encouragement, a healthy weight and Dr. Dansinger’s philosophy on exercise matches his philosophy lifestyle was much more attainable. on eating plans. The exercise regimen should be tailored to the needs and limitations of the individual. Again, a one size The topic of diabetes is one that Dr. Dansinger has studied fits all fitness routine is not going to be effective for all people. extensively. Diabetes and heart disease, he stated, have Choose a routine that is tailored to the capabilities of the genetic precursors that can raise the likelihood of an individual aiming to produce long-term adherence and results. individual acquiring them. However with the proper diet, exercise and medical care these can be avoided, stalled in Dr. Dansinger recently established “The Diabetes Reversal their progression and even reversed. Although he advocates Challenge”. It is a pilot program with a group of 25 to 30 personal responsibility on an individual basis, Dr. Dansinger believes that much more could be done on a population level to stem the rising tide of type II diabetes in America. Dr. Dansinger voiced his support for more government intervention and advocacy for diabetes prevention, treatment and reversal. People in the lowest socio-economic groups are at especially high risk for diabetes and there is much that can be done to reverse this growing population to the benefit of the whole country.

As Dr. Dansinger assumed the role of the lifestyle coach, he emphasized that big life changes can be implemented incrementally as long as the individual maintains his or her resolve. The most important part of acquiring healthy habits is to establish a group of people around you who will continue to encourage you in your journey. It is difficult to exercise or eat properly in a social vacuum, but with proper encouragement, a newer, healthy you can be just around the corner. WR

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Q & A

Q: What are the foundational principles in a healthy lifestyle? A: Both eating and exercise are obviously very important components of a good fitness and wellness program. The main driver of weight loss is reducing caloric intake.

Q: How has dieting changed in recent years? A: We’ve seen over the last couple of decades a popular diet spectrum that has fully blossomed. It remains important today that we have a wide variety of eating strategies available...the whole spectrum all the way from a low carb strategy on the one end which is low in sugar Q: How important is modifying the diet and starch, to the low fat vegetarian strategy higher in plan if it fails to produce results? whole grains but very low in animal fat, and everything in A: Extremely important. I used to talk about dating the between. So I’m an enthusiastic supporter of the popular diet… In the past I have spoken about “dating the diet” diet spectrum concept and that there is no one best eating concept. Many are just looking for the best one and once plan for all and that there is a wide variety of eating a person finds “the one” they get married and stay faithful strategies available for everyone. to it forever. Others just prefer to sort of “date around” and change eating plans every few months. Q: What are your major considerations in suggesting an eating plan to a patient? Q: How have you implemented A: The main things I use to try to match an individual personalized exercise regimens? with an eating plan are their food preferences, their A: We recognize that people who have diabetes or other medical conditions, and their lifestyle habits. I feel I am weight related medical problems are not typically in good much better at this matching process now than I was ten cardiovascular shape or have arthritis or other mobility years ago when I first started this approach. In addition limitations. Nevertheless, in my program we have been to the food preferences it’s important to recognize their able to give a good two hour workout to almost anyone existing medical conditions. because the trainers know how to vary the intensity for a wide group of participants simultaneously. I’ve been Q: Why has American obesity become fortunate enough to partner with some excellent trainers so prevalent? at CATZ for the exercise component of my program. A: We’re genetically designed to thrive on low fat, proteins and high fiber fruits and vegetables. Throughout Q: What is a good approach to a 99% of human existence that’s what people ate but in sustainable exercise regimen? recent generations the food that we eat in modern times A: It’s normal when you are out of shape and haven’t has become so severely different from natural food that exercised for many, many years to feel lousy once you we’ve crossed a nutritional breaking point. Advances in start. However, as you push yourself to work out, that food processing technology are driving the epidemic feeling goes away, especially with persistence and of obesity and type II Diabetes which have become so consistency and is soon replace with feelings of accom- severe in the past twenty to thirty years. The food and plishment. Anything you can do to put yourself in the our environment has crossed a critical threshold of position of being pushed and held accountable seems to be acceptability for the human body. the best approach for maximizing your chances of success.

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Using Ginger As A Holistic Approach To Health

Most people know that ginger relieves morning sickness and motion sickness. Ginger is a very unique and versatile spice. It also helps digestion and prevents bloating with gas, which causes stomachache (colic).

inger is an anti-inflammatory and pain One another note to consider: Before reaching for medication, try relieving spice. It can help relieve drinking ginger tea the next time you have a sore throat. Ginger chronic muscle aches and discomfort has well documented antibacterial qualities. The warm liquid will G associated with back pain. Try using soothe your throat and the ginger will work at killing off the chopped fresh ginger root to your favorite recipes. infection causing bacteria. WR You can also add powdered ginger not only to lunch Subhashini Yalamanchi, MD, is a Pediatrician practicing at the Delray Beach and dinner dishes but also to healthy deserts. Health Center in Delray Beach, Florida. She graduated from Guntur Medical College in 1973 and has been practicing medicine for over 34 years, as well as being a member of the American College of Physicians. Dr. Yalamanchi provides Ginger contains 2 chemical substances called nutrition counseling, immunization, and well and sick child visits to the one “Gingerols” & “Shogoals”. These 2 compounds could million plus residents of the Palm Beach community. This clinic is one of 8 serving help fight “migraines”. When you start having the community, with services for all ages and incomes. migraine symptoms, chew a small piece of fresh ginger every 4 to 5 hours, or take about 500 mg 0o Subhashini Yalamanchi, MD powdered ginger with water. Hopefully, your migraine Ayurvedic physician pain will subside, as the ginger fights off the 225 S. Congress Ave., Delray Beach FL 33445 inflammation. You can also try this method, which 561-274-3100 commonly used in India--grind some fresh ginger www.pbchd.com into a paste & apply to your temples.

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UNDERSTANDING PAIN The Importance of A Proper Diagnosis

At some point in our lives, most of us will suffer from chronic pain. One out of every three Americans live daily with discomfort from an injury, arthritis, or cancer. We know too well that chronic pain changes our life-while relaxing, working, eating and even sleeping. Pain also leaves patients depressed and affects their relationships with family and friends.

nfortunately, while long-term pain is common, providing long-term relief of headache, neck, back, arm, too often it is simply misunderstood. Many people leg, and cancer pain. resign themselves to enduring pain and let it go • Medical management U untreated. But no one should live with pain. • Physical Therapy It can be properly diagnosed and controlled giving you the • Mental health counseling WR relief you need and the opportunity to live a normal and Dr. Lynne Carr Columbus is currently the President of Gulf Coast Pain full life.The first step in pain management is obtaining the Management, a multidisciplinary pain center. She currently serves as proper diagnosis. Only then can a customized treatment a member of the Pinellas County Prescription Drug Advisory Board and serves as an expert witness for the Florida Department of Health plan be developed. As an Interventional Pain Management Prosecution Unit. Specialist, innovative procedures are utilized to manage pain.

Pain Treatment is coordinated with patient’s primary care Lynne Carr Columbus, D.O. specialists and other specialists. A multidisciplinary treatment Gulf Coast Pain Management plan is the most effective approach to treating a patient’s pain. 3890 Tampa Road, Palm Harbor FL 36484 727-789-0891 Effective treatment modalities include: www.gulfcoastpain.com • Nerve blocks which desensitize a painful nerve

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A Whole-Body Approach To Pain Management

BELIEVE THE PATIENT, TREAT THE CAUSE (NOT THE SYMPTOM), RE-EDUCATE THE MUSCLES.

iagnosis is a large part of the practice of Two of these — pain subspecialists and musculoskeletal physiatry, and a good history and physical exam subspecialists — are experts in how the body works with are crucial to the diagnosis. Brian Kahan, D.O., respect to muscles, nerves and joints. “Although we can’t put D a physiatrist and medical director of The Kahan things back together if they’re broken, we understand how Center for Pain Management, relates this example: things work,” Dr. Kahan says. “We use a finely tuned process A gentleman complaining of right-sided pain was found on that includes examination, exercises and spinal injections MRI to have a herniated disc. After surgical intervention to to appropriately diagnose and help treat the impairment. remove the disc, his pain was still there, exactly as it had And we ask a lot of questions.” Orthopedic surgeons often been before surgery. Thinking he needed help with his rely on physiatrists to confirm a diagnosis and to exhaust “post surgery pain,” the surgeon referred him to The Kahan every nonsurgical means of intervention. Center for Pain Management. “At first glance, it was easy to attribute his condition to normal postoperative pain,” “If a patient does not respond to conservative treatment Dr. Kahan says, “but in this case, the pain pattern didn’t fit. within six to 12 weeks, we usually know where the What would produce pain on the right side?” problem is coming from and we begin to consider surgery,” Dr. Kahan says. WR Upon questioning the patient further, Dr. Kahan learned that the gentleman also experienced headaches, numbness and Brian Kahan, MD, owns the Kahan Center for Pain Management in Annapolis, Maryland. He is the former Director of Outpatient Services for tingling along with the right-sided pain. “The only way to rehabilitation at Albert Einstein College of Medicine and continues to give get that kind of pain is to have something wrong in the lectures, while offering a preceptorship for post graduate training in brain,” Dr. Kahan says. “We began to think in terms of a interventional pain medicine residents. disease such as multiple sclerosis and the whole picture changed. There had been, in fact, a herniated disc in this Brian Kahan, D.O., FAAPMR, DABIPP, DABPM, DAOCPMR patient’s back, but it was not the cause of his pain. This is The Kahan Center for Pain Management why we, as physiatrists, take more of a whole-body approach 2002 Medical Parkway Suite 150, Annapolis, MD 21401 to pain. If we focus on a single organ system, we may miss www.theKahancenter.com the diagnosis completely.” Physiatrists work in various 410-571-9000 subspecialties from traumatic brain injury to pediatrics.

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Is Chronic Sinusitis Ruining Your Life? Gain Control Over Your Health Today!

Chronic sinusitis is one of the most prevalent illnesses in the United States, affect- ing as many as 30 million Americans. Chronic sinusitis affects adults and children and can greatly impact quality of life. Acute sinusitis is often due to infections; however chronic sinusitis is often associated with allergic disease, abnormal sinus anatomy or problems with your immune system.

hronic sinusitis presents with facial pain, Chronic sinusitis is painful, results in missed days from headaches, congestion, and can cause worsening work or school and impacts quality of life. Specialists in the asthma or cough. Over time untreated sinusitis field of Allergy/Immunology can help identify the cause C can cause fatigue, difficulty concentrating, for chronic sinus disease resulting in less sinus infections. loss of smell and taste. If the underlying cause for recurrent Proper diagnosis gives patients back control over their sinusitis is not identified, patients are often treated with health and improves quality of life. WR multiple courses of steroids and antibiotics. Unnecessary Annette Fiorillo-Quinn, MD, DO, MS works at Long Island Allergies in treatment can lead to antibiotic resistance and harmful Oceanside, NY. In addition to treating patients with allergic rhinitis, side effects due to recurrent oral steroid use. asthma and sinus disease, she has special interests in treating eczema, food allergies, drug hypersensitivity and evaluating patients with recurrent infections. Identifying the cause for chronic sinus disease is simple and includes a physical exam, allergy testing and evaluation of your Annette Fiorillo-Quinn, MD, DO, MS immune system. If the cause is due to allergies, medications 2940 Lincoln Avenue, Suite 200, Oceanside, can be used to prevent allergic symptoms thereby preventing NY 11572 sinus disease. If your sinus disease is due to minor problems 516-307-9140 in your immune system a vaccine can be used to boost your www.longislandallergies.com immunity and decrease the number of sinus infections.

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Cosmetic Surgery Guide for Non-Caucasians

The demand for cosmetic surgery within non-Caucasian ethnic groups has risen dramatically in the last two decades. The desire to maintain a youthful appearance and preserve beauty through surgery crosses ethnic boundaries. Unfortunately, many of the standard cosmetic surgery procedures were developed for Caucasians and do not necessarily address the aesthetic concerns of darker skinned individuals. Furthermore, there are structural differences between Caucasians and non- Caucasians with regard to skin, facial anatomy and body type.

he most obvious example is the different Darker racial ethnic groups are often classified as Types IV characteristics of skin between Caucasians and through VI. Although the classification system was originally non-Caucasians. Plastic surgeons and designed to assess sensitivity to sun exposure, it is now T dermatologists categorize skin type based upon used to determine the safety of certain cosmetic surgery a scale, called the Fitzpatrick skin type classification, procedures. For example, laser resurfacing of skin is an developed by Dr. Thomas Fitzpatrick in 1975. It is based upon effective method for reducing fine wrinkles, sun-spots, and six categories, which include: dilated blood vessels on the face. The procedure was • Type I (very white or freckled): Always burn developed for Caucasian skin types and is not considered • Type II (white): Usually burn safe in patients with skin types IV or higher. • Type III (white to olive): Sometimes burn • Type IV (brown): Rarely burn There are concerns in darker skinned individuals that often • Type V (dark brown): Very rarely burn deter them from procedures commonly performed in • Type VI (black): Never burn Caucasians. Brown or black skin may be predisposed to

WR

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Before embarking on cosmetic surgery it is of the utmost importance that the patient and the plastic surgeon have the same expectations and goals with regard to the desired result.

unsightly scarring or even keloid formation – the process by popular media portraying beauty as a petite light-skinned whereby a scar enlarges outside the normal margins of woman with delicate facial features. Over time it would be only the wound site. Certain cosmetic surgery procedures, expected for women of color to think they need to try and such as facelifting or breast reduction, rely on optimal achieve this so-called “aesthetic ideal”. scar healing to achieve patient expectations. The locations of the scars in these procedures are not inconspicuous, By exploring the anatomical and psychosocial differences on the side of the face or on the breast, respectively. that exist between Caucasian and non-Caucasian groups The procedures often have to be modified in order to we are able to refine standard cosmetic surgery principles achieve the best result and minimize the chances of and practices to better serve the multi-ethnic groups in an unsightly scar. our society. WR

Dr. Matthew Kaufman works at the Plastic Surgery Center in Somerville, Perhaps even more important are the societal New Jersey. He is board certified in both Plastic Surgery and Otolaryngology- differences in the perception of beauty. Whereas one set Head and Neck Surgery, and he is a Fellow of the American College of Surgeons. He has been consecutively named as a Top Plastic Surgeon for of aesthetic ideals may be used for Caucasian men and 2009, 2010 and 2011 in both the Castle Connelly Guide (New York metro women, there are major differences that exist in non- area) and Inside New Jersey magazine. Caucasian ethnic groups. Before embarking on cosmetic

surgery it is of the utmost importance that the patient Matthew R. Kaufman, MD, FACS and the plastic surgeon have the same expectations and The Plastic Surgery Center & Institute for goals with regard to the desired result. Furthermore, Advanced Reconstruction some patients may have an unconscious desire to 535 Sycamore Avenue, Shrewsbury, NJ 07702 | 732-741-0970 change their ethnic appearance in order to appear more www.looknatural.com | www.advancedreconstruction.com Caucasian. In our society we are constantly bombarded

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Weight Loss: A Challenge For Our Mental And Physical Health

Obesity is a growing epidemic in the United States that affects not only adults but also youth and children. Losing weight is no longer a superficial aspiration but an imperative need given the risk factors we expose our health to by being overweight. In today’s society, weight loss represents a far more difficult challenge than we are ready to accept.

mpatience and laziness in our society often lead to Weight loss does not have to be a solitary endeavor. quests for quick-working weight loss antics through There are many forms of motivation including weight loss the use of dietary supplements, laxatives, cleanses journals to keep track of progress, support from family I and diets that consist of little to no nutritional value. and friends and exercise buddies. Not only does increased Not only do these measures usually result in yo-yo dieting, physical activity burn fat, but it is also the key preventative where one gains weight back as quickly as it was lost, but measure against cardiovascular disease, pains associated the overall care to our bodies and minds diminishes. with arthritis and osteoporosis, and diabetes.

As each of our bodies is unique, any weight loss program In addition to improving physical health, maintenance of should be catered to that person’s life style and metabolism. weight loss can also lead to increased mental health as The healthiest way to lose weight is to do it gradually, well. Exercise will boost your energy throughout the day, consistently and realistically. Thus, the best way to keep and keeping weight off will increase self esteem. Making weight off is by being mindful about the foods that we fuel minor changes to include light physical activity and eating our bodies with coupled with increased physical activity. right can do a long way in developing a positive and healthy lifestyle. Being overweight may increase the risk of developing

Matthew R. Kaufman, MD, FACS Nutritional consultation can reveal the optimal daily caloric hypertension, diabetes, high cholesterol or obesity. The Plastic Surgery Center & Institute for intake for a person and a nutritionist can plan out smaller Advanced Reconstruction meals to be eaten frequently throughout the day with this What Is Hypertension? 535 Sycamore Avenue, Shrewsbury, NJ 07702 | 732-741-0970 information. Those who change their eating habits and Though it is one of the major causes of cardiovascular www.looknatural.com | www.advancedreconstruction.com sedentary lifestyles, who strive to lose about 1-2 pounds disease, hypertension or high blood pressure is often called per week, are more successful at keeping weight off. “the silent killer” because it rarely gives rise to physical

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symptoms. Though the precise cause of high blood pressure refer to high cholesterol and high triglyceride levels. The causes is unknown, there are many factors that contribute to its of dyslipidemia usually come from lifestyle habits, or treat- development including smoking, lack of physical activity, stress, able medical conditions. Obesity, lack of exercise, smoking, alcohol abuse, obesity, and family history, overconsumption of and eating foods high in fat and cholesterol can all salts and fats, diabetes and kidney disease. Although hyper- contribute to high lipids in the blood. Also, conditions such tension is not limited to overweight people, it is imperative as hypertension, diabetes or hypothyroidism, if untreated, to be physically active and exercise on a regular basis. can contribute to Dyslipidemia.

What is Diabetes? What Is Obesity?

Diabetes is a metabolic disorder. Metabolism is the way our The terms obesity and overweight have different implications. bodies use digested food for energy. Diabetes develops when Obesity is defined as having an excess of total body fat. the pancreas does not make enough insulin, or the cells in On the other hand, being overweight means weighing too the muscles, liver, and fat do not use insulin properly, or both. much which could result from muscle, bone, fat and/or body As a result, the amount of glucose in the blood increases water. Both terms essentially mean the person is above his or while the cells are starved of energy. her normal body weight range.

There are also some lifestyle habits that may also raise the Being obese increases your risk for conditions such as risk of diabetes. Here are some tips that will allow you to coronary heart disease, Type 2 diabetes, hypertension, some lower your risk: cancers, stroke and other serious health problems. Weight • Keep your blood sugar level under control loss of as little as 5% of one’s body weight can lower the • Lose weight and keep it off risks of these diseases. Increasing physical activity and • Increase your physical activity decreasing calorie intake through a nutritiously balanced diet can greatly reduce one’s risk of becoming overweight or What Is High Cholesterol (Dyslipidemia)? obese as well as strengthen one’s overall health. WR Dyslipidemia is a condition of abnormally elevated lipids (fat) in our blood. These elevated lipids in our blood primarily David E. Kavesteen, MD, FACC, has a private practice in North Babylon, NY. The practice specializes in multiple cardiovascular tests to indicate various types of cardiovascular disease. Triple board certified by the American Board of Internal Medicine in Nuclear Cardiology, Cardiovascular Disease and Internal Medicine, Dr. Kavesteen has also produced several research articles on diabetes, creatine levels, and other heart and vascular heath topics. He also likes to emphasize the importance of preventive care in his work, to help delay the onset of cardiovascular disease.

David Kavesteen, MD FACC Heart and Health LLC 1350 Deer Park Avenue, North Babylon, NY 11703 631-482-1355 www.heartandhealth.com

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The Relation Between Chronic Alcohol Abuse And Lung Injury

Alcohol abuse alters the proper functioning of the human body in ways which contribute to the development of a number of illnesses on the long term. Alcohol is a substance which is metabolized inside the human body. In large quantities, alcohol has a number of negative effects on the body systems affecting them irreparably in many cases. The respiratory system is vital to life but it is also fragile and hypersensitive. Alcohol abuse interferes with the respiratory functions of the lung attacking them both at a cellular and molecular level. The effects of alcohol abuse can be seen outside and inside the lungs, with and without a microscope.

lcohol is one of the most commonly used drugs their lifetime. The prevalence of alcohol abuse and worldwide. It is estimated that the prevalence of dependence in hospitalized patients worldwide is similar. alcohol use is 66% in the United States. Epidemio- A logical studies show that 13% of Americans will Epidemiological evidence has shown that alcohol abuse meet the diagnostic criteria for alcohol dependence during independently increases the risk of developing the Acute

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However, even otherwise healthy alcoholics show evidence of severe oxidant stress (the effects of excess oxidation due to lack of antioxidants) in the alveolar space that correlates with alveolar epithelial and macrophage dysfunction (correlates with dysfunctions of both the epithelial and the macrophage cells of the lung air sacs).

Respiratory Distress Syndrome or ARDS by as much as three to • Increases activation of metalloproteinases and four times as demonstrated by Dr. Moss’ seminal paper degrades the alveolar matrix during endotoxemia. published in 1996 on the subject. Based on these • Renders the lung intrinsically susceptible to injury observations and under the direction of Dr. Guidot, it has during endotoxin-mediated acute inflammation; been shown in experimental models as well as in clinical • Decreases functional surfactant in the alveoli and studies, for the first time, that chronic alcohol abuse causes increases respiratory failure during sepsis in vivo. changes in the alveolar epithelium that render the lung • In the cecal ligation and perforation model there is susceptible to acute edematous injury in response to sepsis increase in the expression and activation of trauma, and other inflammatory insults. transforming growth factor- within the alveolar space where it can increase epithelial permeability. We have shown that chronic alcohol ingestion decreases the levels of the antioxidant glutathione within the alveolar Mankind is yet to fully discover how the human body works. space by as much as 80 to 90%, and, as a consequence, However, there are medical certainties which are supported impairs alveolar epithelial surfactant production and barrier by both live and in vitro studies. One of these medical integrity, decreases alveolar macrophage function, and certainties is the fact that alcohol abuse is a decisive factor renders the lung susceptible to oxidant-mediated injury. in the develop-ment of lung injury. People are affected to a These changes are often subclinical and may not manifest higher or lower degree depending on numerous added factors as detectable lung impairment until challenged by an acute including the fact that each human body is unique, physically insult such as sepsis or trauma. However, even otherwise and structurally. WR healthy alcoholics show evidence of severe oxidant stress in the alveolar space that correlates with alveolar epithelial and macrophage dysfunction (correlates with dysfunctions of both Manuel Lois, MD, is an Internist practicing in Fort Worth, Texas. Specializing in cardiac care and Pulmonology, Dr. Lois is also the author the epithelial and the macrophage cells of the lung air sacs). of an article on tracheal obstruction in the Journal of Broncology and Interventional Pulmonology. All our data indicate that chronic alcohol intake • Impairs surfactant production and increases oxidant- Manuel Lois, MD, FCCP, FACP mediated necrosis in alveolar epithelial cells 1500 South Main Street, Fort Worth TX 76104 • Increases oxidant- and cytokine-mediated apoptosis 817-702-8929 in alveolar epithelial cells in vitro and in vivo. www.jpshealthnet.org • Increases protein leak across the alveolar barrier and decreases alveolar liquid clearance in vivo.

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AnTi-Aging: inside and outside

The quest for maintaining or restoring health and beauty impacts each of us in different ways. If you are sitting in a doctor’s office as you read this article, then you are likely involved in some aspect of this quest. Much of American (and west- ern) medicine is focused on treating disease and hopefully restoring health, sadly with much less emphasis on maintaining wellness and health. Ideally, each of us would have as one of our life’s goals to pursue not just a long lifespan, but rather the goal of achieving “healthy longevity”. Having a lifetime of good health inside and out requires some planning and education. There are many articles and books devoted to these pursuits so I will simply try to summarize a few key points and highlight some practical tips that are easily adoptable even for people with limited time or limited budgets.

hile a healthy body does not guarantee In particular, environmental damage to your body – whether healthy skin, the old adage that “inner from the inside or the outside – really impacts not only your beauty of spirit shines through” also applies health and longevity, but also how long you maintain a W to a healthy body – our skin tends to reflect youthful appearance. While we all experience chronological our inner health and well-being. Problems such as chronic aging (the clock ticks onward for each of us), lifestyle physical illness, chronic stress, poor nutrition, lack of exercise decisions can significantly impact biological aging. We all and many other factors certainly take a toll on the skin. know people who do not look or feel their age. We also know

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those who seem much older than their birthday. Even identical David H. McDaniel, MD, is Director of the McDaniel Institute of Anti- twins typically die many years apart in age! There are studies Aging Research as well as the Laser & Cosmetic Center in Virginia Beach, Virginia; He also consults for some of the major skin care showing dramatic differences in aging of skin in identical twins companies in the world. An inventor and co-inventor on many who have had different environmental exposures (oxidative patents, he was named as a pioneer of the LED photomodulation science and theory, one of many non-surgical skin rejuvenation stress from free radicals and inflammation are two major causes treatments available today. He is also the President of a non-profit of premature aging that we can impact). charity, the Center for Disfigurement.

Twin studies show us that while some aspects of aging are due David H. McDaniel, MD, FAAD to genetic inheritance, others are clearly due to differences in Director, Institute of Anti-Aging Research lifestyle. While we cannot change our genetics (or genes or DNA) Eastern Virginia Medical School and we cannot completely control our environments, our lifestyle 125 Market Street, Virginia Beach, VA 23462 choices can significantly impact how our bodies (and our skin) 757-437-8900 | www.DrMcDaniel.com/research cope with daily life. So please choose wisely and choose health!

Anti-Aging Tips for Healthier Body & More Youthful Skin

1. Diet 4. Be proactive (and not reactive) a. Eat a “Rainbow” diet with brightly colored fruits and about your health vegetables rich in antioxidants Read, learn and become your own advocate b. Decrease sugar as much as possible (and I prefer to avoid most substitutes as well) 5. Keep your mind active…not just c. Eat cruciferous veggies (yes, this means broccoli, your body. cauliflower and Brussel sprouts!) Stay engaged, pursue something you love, enjoy d. Omega 3 fish oil supplements (or natural if you can fellowship with other people, help someone else, accomplish that) and never, never stop learning and thinking! WR e. Avoid high glycemic index foods and include good natural fiber f. Eat as close to the farm as you can (less processing is generally better) g. Check vital nutritional values such as vitamin D and other critical ones

2. Protect your skin a. SPF with “Broad Spectrum” label per new FDA labeling guidelines b. Consider topical super-potent antioxidants c. Rx topical retinoids are still among the best products for many people

3. Exercise & Sleep Get enough of both and don’t overdo either one

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Top Tips on Wellness

Q: What do you recommend as Top Tips on 19. Follow age specific screening tests with your primary Health and Wellness for your patients? care physician to prevent disease and provide early life saving detection. David H. McDaniel, MD, FAAD 1. Enjoy the benefits of cardiovascular 20. Director, Institute of Anti-Aging Research Move Your Body! Embrace Generosity, Happiness, and Love! Eastern Virginia Medical School and strength training, as well as flexibility, meditation 125 Market Street, Virginia Beach, VA 23462 and relaxation techniques Q: What simple steps can I take as a young 2. Eat a diet rich in Anti-oxidants, such as blueberries, 757-437-8900 | www.DrMcDaniel.com/research healthy female to prevent osteoporosis in blackberries, and strawberries. 3. Drink Green Tea which is rich in the antioxidant my future? epigallocatechin gallate (EGCG) 1. Weight Bearing exercises! 4. Include Omega-3-Fatty Acids to your diet for heart 2. To preserve musculoskeletal health, protect bone density, health such as salmon, trout, herring, walnuts or and decrease risk of osteoporosis I recommend woman flaxseed. ages 20-50 y/o to take 5. Savor the miracle of Olive Oil 1,000-1,500 mg/day of calcium 6. Eat Fiber for colon health. 400-1,000 Units/Day of Vitamin D3 7. Keep Good Sleep Hygiene 400-500mg/day of magnesium. 8. Drink lots of water 3. Eat calcium-rich foods 9. Romance with Red wine which contains Resveratrol 4. Stay up-to-date on age specific screening for Osteoporosis 10. Vitamin Supplements that are age and disease appropriate. 5. Be aware of medications and medical conditions 11. Enjoy your sweet tooth with an occasional piece of that can affect bone health such as anorexia nervosa, Dark Chocolate, which is rich in flavonoids and inflammatory bowel disease, celiac disease, and procyanidins glucocorticoids. WR 12. Cook for yourself, family, and friends, rather than eating out Danielle Mellace, DO, currently works for New York Downtown Hospital 13. Portion control your meals and holds an academic appointment as Clinical Instructor of Medicine for Weill Cornell Medical College. Dr. Mellace will soon be moving to Beverly 14. Learn Effective Stress Control Hills and joining Kaiser Permenente’s West LA Internal Medicine practice. 15. Eat protein with every meal to help balance your blood sugar Danielle Marie Mellace, DO 16. Decrease flour and preserved products in your diet New York Downtown Hospital 17. Eat foods rich in phytonutrients such as all dark colorful 170 William Street, New York, NY 10038 fruits and vegetables 646-588-2500 18. Live Clean and Green – Limit exposure to heavy metals, www.downtownhospital.org pollution, and other environmental toxins

TheWaitingRoomMagazine.com 29 healthy LIFESTYLE

Psoriasis: A highly prevalent yet undertreated disease

Psoriasis is an immune-mediated, genetic skin disease which affects 1-2% of the world’s population, 120 million worldwide and 7 million Americans. It is the result of an overactive immune system, which ultimately attacks the surface layer of the skin and leads to visible red raised, scaly plaques. Nineteen different genes are involved. It is not a contagious disease and has varying levels of severity; mild, moderate, and severe. It can also be associated with other health disorders such as obesity, heart disease, diabetes, Crohn’s disease and depression. There are certain external trigger factors associated with the disease that can cause one’s psoriasis to become active. These include stress, infections (especially strep throat in younger people), injury to the skin, and a few medications.

soriasis expresses itself in different forms and psoriasis typically occur in younger individuals and are occur in particular locations. One person’s usually symmetrically located on the body and frequently psoriasis may look very different from another. associated with prior recent strep throat and respiratory P Plaque psoriasis is the most common form of infections. Inverse psoriasis occurs in body fold areas such psoriasis and present with characteristic red thickened as armpits, groin, under the breast, genitals, and buttocks patches with silvery scale. Guttate (drop like lesions) and have a shiny, bright red appearance. Pustular psoriasis

30 TheWaitingRoomMagazine.com healthy LIFESTYLELIFESTYLE

A patient with mild chronic plaque psoriasis (Left) and severe chronic plaque psoriasis (Right).

are small non-infectious, pus filled blisters usually occuring on Psoriasis is currently a highly prevalent yet undertreated the palms and soles. Erythrodermic psoriasis is a severe, inflamm- disease that has profound effects on a patient’s quality of atory form of psoriasis, affecting the entire body. The scalp is life with depression not uncommon and interpersonal invariably involved in 80-90% of patients and the nails in 60-70%. and work relationships invariably affected. Therefore, it is important for all physicians and patients themselves to There are multiple treatment approaches dermatologists utilize recognize this disease and refer to dermatologists for in treating psoriasis. Topical agents (creams, gels, lotions, sprays, treatment where appropriate. WR and ointments) are the first line of treatment for mild to Alan Menter, MD, works at Texas Dermatology Associates in Dallas, moderate psoriasis. They include corticosteroids (most common), Texas. Dr. Menter is a world-renowned dermatologist, noteworthy for synthetic vitamin D3, and vitamin A. Phototherapy is available for his expertise in the treatment of psoriasis and other complicated patients with more widespread disease. Using specially diseases of the skin, and has authored 252 articles, 4 books, and multiple book chapters in peer reviewed medical publications. constructed ultraviolet light B cubicles, Psoralen + UVA (PUVA) Also serving as a Clinical Professor of Dermatology at UT units, or laser machines targeting individual patches. Systemic Southwestern Medical School in Dallas, he founded the International Psoriasis Council (IPC), an international organization dedicated to agents are therapeutic modalities reserved for moderate to raising international consciousness and understanding of psoriasis severe psoriasis patients unresponsive to topical agents and as a serious immune-mediated disease with major quality of phototherapy. These oral agents include acitretin, cyclosporine, life implications. and methotrexate. Biologic treatments are a relatively new therapeutic modality that utilize a more targeted approach (ie M. Alan Menter, MD specific components of the immune system) and as a result, have Texas Dermatology Associates improved side effect profiles compared to systemic agents. 3900 Junius Street, Suite 45, Dallas, TX 75246 These include Enbrel, Humira, Remicade, and Stelara. They are 214-820-9115 given by injection either by the patient themselves or in the www.txdermassoc.com dermatologist’s office.

Psoriasis is currently a highly prevalent yet undertreated

disease that has profound effects on a patient’s quality of life

with depression not uncommon and interpersonal and work

relationships invariably affected.

TheWaitingRoomMagazine.com 31 healthy LIFESTYLE

NEW HOPE FOR CHRONIC BACK PAIN SUFFERERS

Almost everyone has experienced some form of pain in their lifetime but imagine the worst possible pain that is present 24 hours a day. Chronic pain sufferers often exhaust all modalities of pain treatment such as multiple surgeries and high doses of narcotic medications, which may lead to addiction. Even with these interventions, their pain is unmanageable. Chronic pain often leads to depression, inability to work, inability to perform activities of daily living, interference with sleep and enjoyment of life. It puts strain on personal relationships with family and friends. Chronic pain sufferers often feel guilty for complaining about the pain and feel it is something they will have to live with for the rest of their lifetime. They feel hopeless. Pain management can resolve many of these issues.

nterventional Pain Management consists of various Pain management techniques are constantly evolving and forms of minimally invasive treatments. These include improving with the introduction of minimally invasive injections, spinal cord stimulators, hydrodiscectomy, procedures such as percutaneous disc decompression I endoscopic discectomy, radiofrequency rhizotomy (hydrodiscectomy). (burning the nerves causing the pain) and other modalities. After the procedures, the patient is able to walk to their car Hydrodiscectomy uses high-speed fluid to effectively shave and go home. away the disc bulge that is causing back or leg pain.

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Because there is only a small incision, recovery is quick and patients resume normal activity shortly thereafter.

Endoscopic percutaneous discectomy is performed on patients with protruding as well as herniated discs with and without ruptures. Unlike other “open” surgical procedures for herniated discs, endoscopic discectomy removes Wash Your Lower Back Pain Away the herniation without invading any bone Hydrodiscectomy can relieve your bulging disc pain in just 20 minutes structure. After these procedures, the patient is Have you been suffering from significant back pain for years now? able to walk unassisted to their car and go home. Does this symptom disrupt your normal daily routine, depriving you The advantage of the endoscopic approach versus from getting a good sleep? Well, you may be suffering from a the “open” surgical approach is that the endo- herniated disc pain. Unless you do something about it, such scopic procedure is usually performed as an out- discomfort may even get worse in the days to come. patient procedure. The endoscopic approach uses fewer narcotics post-operatively and has a reduced Consulting a doctor about it is the best thing that you can do. After recovery time compared with “open” surgery. some radiographic findings, you may be diagnosed with a herniated disc or bulging disc problem. The doctor may advise you to undergo Spinal cord stimulation (SCS) is another an invasive surgical procedure. But before you make your final decision, modality used to treat chronic pain, Patients you need to know that there is another treat-ment option that has who experience failed back surgery syndrome, been proven to be effective in 40,000 surgical cases globally. This chronic back/leg pain and CRPS (Complex employs a high speed water stream to correct your herniated disc. Regional Pain Syndrome) are usually ideal Such procedure is called “Hydrodiscectomy”. candidates. SCS is an implantable device similar to a pacemaker delivering electrical Dr. PRVULOVIC has been known to be the expert when it comes to stimulation that interrupt pain signals from Hydrodiscectomy procedure. In fact, a lot of his patients can attest to reaching the brain. his expertise. One of his patients was Tim who developed a bulging disc after falling from a 35 foot high building. He received a lot of As a pain management physician, my goal is to epidural injections without any relief. However, after a 20 minute diagnose, treat and improve the quality of Hydrodiscectomy procedure, he was able to walk and got his life back. patient’s lives. WR The same thing happened to Rima. She resumed her regular job after undergoing the same treatment. Tomi Prvulovic, MD, works at Healthspine and Anesthesia Institute in Goshen, New York and Cedar Knolls, New Jersey. This procedure requires no cut, no hospitalization, nor a long hospital Board certified in anesthesiology and pain medicine, stay. And most important, this procedure is FDA approved, making it Dr. Prvulovic is a Diplomate of the American Board of the safest intervention for herniated disc problems. Anesthesiology and of the American Academy of Pain Medicine. Dr. Prvulovic holds honors/awards including For more information visit: www.washawaybackpain.com the American Medical Association Award (1988), Academic Excellence Scholarship (1987) and the Dubois Competitive Scholarship (1985).

Tomi T. Prvulovic, MD Healthspine & Anesthesia Institute 70 Haffield Lane, Suite 201 Goshen 10924 Figure 1. Large left paracentral L5/S1 Figure 2. Reduction of defect after (845) 294-2006 disc herniation prior to decompression. HydroDiscectomy. Patient Patient had failed multiple epidural steroid experienced complete short-term www.healthspinemd.com injections and Coblation Nucleoplasty. relief of symptoms.

TheWaitingRoomMagazine.com 33 healthy LIFESTYLE

Lifestyle And Heart Disease

Prevent heart disease by following a healthy lifestyle. Here are six steps you can take to help protect your heart.

igarette smoking, high blood pressure, high Exercise should be something that is enjoyable and should cholesterol, diabetes mellitus, along with obesity occur most days of the week. Walking is ideal for half and physical inactivity are all risk factors that every an hour a day. Running, jogging, swimming all can be enjoyed. C one can control. Any movement is better than none at all. Work in the garden and yard work all counts towards your daily exercise. Take the Ideally one should maintain a reasonable body weight and in stairs instead of the elevator. Park a block from work and walk. terms of good health a BMI less than 29 is helpful. I hope these tips will get people motivated to change. High cholesterol can be controlled with a healthy diet that Prevention is the best medicine. WR emphasizes lots of whole foods, fruits and vegetables with Dr. Sonny Wong is in private practice in Kailua, Hawaii with the whole grains. Red meat, chicken and fish, which are all high in Windward Heart Center, LLC. He is board certified in Cardiovascular saturated fat should be kept to a minimum, perhaps a meal a Diseases, Internal Medicine and Echocardiography. He has over 25 years of clinical experience and is on the clinical faculty of the University of week. Sugar in its many forms should be avoided asginger Hawaii, John A Burns Medical School. He has been a Fellow of the is sodas, candy, cakes and cookies. Fried food is off limits. Oils American College of Cardiology for over twenty five years and has been should be kept to a minimum. voted by his peers as one of the Best Doctors of America-Hawaii.

Blood pressure should be well controlled with diet, exercise and Sonny J.H. Wong, MD, FACC medications as needed to maintain a BP= or lower than 130/80. Winward Heart Center, LLC. 25 Maluniu Avenue, Kailua, Hawaii 96734 Diabetes can be controlled with diet and medications. 808-261-2441 www.windwardheart.com Cigarettes need to be stopped.

34 TheWaitingRoomMagazine.com doc SPOTLIGHT

A Personal Battle As told by Lynne Carr Columbus, D.O.

I have always been a very athletic and active person. I have had to endure quite a bit of pain in conjunction with athletic injuries. Having been a nationally ranked equestrian in the past, I have had horses fall on me, step on me, kick me, all of which never felt too great, but I basically sucked it up and jumped right back up on the horse. Last March, I began to experience right hip pain, which I just attributed to a hip bursitis related to my jogging, and back pain, which I attributed to strain from lifting weights.

Spring break approached in April and the kids and I went on and a tumor in my right femoral head, the obvious sources of a well-anticipated trip to Hawaii. But when the kids and I fell my excruciating pain. I stood there stunned. I looked over at exhausted in our beds at night, I couldn’t sleep because of my father and saw his eyes well up with tears. All I could think severe back pain. My pain was so intense; I couldn’t find any of to say was, ‘I guess I’m not crazy, there really is a reason for comfortable position. all of this pain.”

Living On The Other Side Of Medicine I placed a phone call to Andy Hano, DO, a family friend and I contacted my surgeon, thinking that I might be suffering a oncologist. I remember talking to him while he was at a complication from my cholecystectomy. He ordered a CT scan Tampa Bay Lightning game. He was having a great deal of of my chest and abdomen. The films revealed multiple difficulty hearing what I had to say because of the noise pulmonary nodules. I looked over the radiologist’s shoulder from the enthusiastic crowd surrounding him. I told him that and stood there speechless. I didn’t know what to say, and I didn’t know what was going on, but that I had a feeling neither did he. He looked up at me and said, “Sorry, Lynne, I was going to be in need of his services. He graciously this doesn’t look pretty.” I went to my car and sat there agreed to see me right away. That same night, I called my stunned for a minute, not knowing where to go or whom to friend, Frank Vrionis, MD, a very reputable neurosurgeon at call. I scheduled a PET scan first thing the next morning. That was one of the most uncomfortable procedures I have ever had to endure. I was not taking any type of pain medications and lying still on my back for the amount of time required for the scan was nothing short of torture. I laid there and just thought about my kids. I utilized every breathing technique I had ever learned to try to control my pain. When the study was over, I remember having a lot of difficulty bringing my arms down and standing. I felt like I was floating and in a different world. I went to the changing room and put my clothes on. I walked around the corner to the radiologist’s reading room. My parents met me there and we looked at the films with the radiologist, Manny Rose, MD. He spent a lot of time reviewing them with us and was in awe of the unexpected results. I had two tumors in my spine

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around the waiting area playing with the toys, computers, and little animal chairs as if they didn’t have a care in the world. Children are so resilient. They became an immediate source of inspiration. I thought to myself, if these kids can do it, so can I.

I started my chemo on a weekly basis. It’s amazing how you become a part of the oncology family. I feel like Dr. Hano’s chemo suite is like a second home. I go there with enthusiasm for my “magic juice” in anticipation of it destroying these nasty cells that are trying to take over my body with their tumor formation. My hip and T3, T4 tumors have definitely improved with my treatments. In late October, Moffitt Cancer Center, to perform a biopsy of the thoracic I felt excruciating pain in my skull. It felt like I had an ice tumor. I began to round up the troops. I used every contact pick stabbing my left parietal area. The pain was so intense, that I knew to get procedures scheduled in a timely fashion. I wanted to scream. Not wanting to upset my children by I was anxious to find out what was inside of me and move letting them see me in distress, I got in the car and drove to forward with battling this insidious disease. my office and injected the area with local anesthetic and a small dose of steroid, which provided me with moderate I had my biopsy performed and received a phone call from relief. To my dismay, a skull lesion had broken through my Frank two weeks later. I recall him saying, “Lynne, I always current chemo treatment, so, Dr. McClain added some oral knew that you were a kid at heart. Your biopsy is positive for chemo agents to my current drug regimen. I seemed to be eosinophilic granuloma. Are you familiar with that disease?” doing well and hoped to be done with all of my treatment by I thought hard and grabbed a memory from medical school, June. Three weeks ago I began to feel severe pain in my mid recalling that eosinophilic granuloma was a form of back, and unfortunately, I have developed another lesion at T8. histiocytosis, a very rare disease that occurred primarily in I met with Dr. McClain last week and I will be starting a new children. He reassuringly added, “I have spoken to many people chemo regimen. This new regimen will be more physically here at Moffitt and it seems to be a disease that responds to draining and bottom out my immune system, so, chemo with a good prognosis. Unfortunately, it is so rare that I am preparing to go into hibernation for 6 months and we don’t have experience here at Moffitt treating it.” become “bubble girl” (from Seinfeld’s bubble boy episode).

I went into overdrive researching the disease on the Internet. I feel that I am in the home stretch with my treatment. I am All of the research and adult experience seemed to lead to confident that I will be able to force this insidious disease one man, Kenneth McClain, MD, a pediatric oncologist at Texas into remission and go back to what I love most, seeing Children’s Cancer Center in Houston, Texas. I called Dr. McClain, patients and treating them for their painful conditions with a delightful, pleasant Texan whose enthusiasm for finding positive, effective results. I think that becoming a patient another patient to treat and help cure, was obvious. So, and experiencing what it is like to have insurance issues, I hopped on a “Life Guard” flight piloted by a very dear friend long waits in waiting rooms, spending hours in imaging and supporter of Sun Coast Hospital, and began one of many facilities, being stuck multiple times for lab draws, sitting journeys to follow to Houston. I walked into the waiting room next to chemo patients as they struggle to stay awake and of Texas Children’s Cancer Center and was in awe of what lie converse with their companions while battling off their before me. The facility was immaculate. But what really nausea; has definitely increased my awareness of the caught my eye were the hairless, cushingoid children running downside of health care.

Children are so resilient. They became an immediate source of inspiration. I thought to myself, if these kids can do it, so can I.

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But I have also been made aware of the very positive side of I encourage you to utilize these resources that FOMA healthcare by experiencing the support that is available from our makes available to you should you experience a society and the physician community. I have a great support system similar situation. They are the rock of our osteopathic from my family, office staff, patients, and very dear boyfriend, Paul profession in Florida, and will help make it easier for Vitale. I am truly grateful for all of the support and concern that the you should you have to live life on the other side of medical community has given me. the medicine.

“I think that becoming a patient and experiencing what it is like to have insurance issues, long waits in waiting rooms, spending hours in imaging facilities, being stuck multiple times for lab draws, sitting next to chemo patients as they struggle to stay awake and converse with their companions while battling off their nausea; has definitely increased my awareness of the downside of health care.”

Q & A in every way and became my “rock”. My daughter was my little angel and a huge source of support. Her smile is what Q: Could you share with us how the new gets me through my day. My son is a typical teenager, who is regimen is progressing? focused primarily on his teenage lifestyle. I’m sure that any A: When I began my chemotherapeutic regimen, I was parent of a teenager can relate to his behavior. hopeful that I would be able to totally rid myself of this insidious disease. Unfortunately, I have had to live with Q: Did your experience with eosinophilic multiple recurrences, which has just become a part of my life. granuloma change your vision of life? I still receive chemotherapy and treat the recurrences as soon A: There is no doubt that this experience has changed my as I am aware that they are occurring. If a patient suffers a vision of life. I tend to be an optimist and rid myself of any recurrence within 2 years of their initial treatment, there is negativity that is tying me down. Every day is a gift. In the an 80% chance that they will have chronic recurrent disease. past, I used to focus so much on where I would be 5 years I have fallen into that category. down the road. Now, I wake up in the morning and focus on what I can realistically do that day that is positive and fills Q: How would you say this disease has affected me with happiness. I work on what I can control and forget your practice as far as your approach to patients? about what I have no control over, such as other people. A: Suffering from a chronic, recurrent disease has definitely Thus, optimism makes me much more persistent in my pursuit allowed me to empathize with my patients. I know the good of goals and happiness. and the bad of dealing with chronic pain and a disease that requires frequent doctor visits and monitoring. I understand Q: Would you say that your profession has what they are going through physically and emotionally. I think played a significant role in your positive that many of the patients are more at ease with me as their approach to your condition? physician because I can empathize with them. My patients A: I believe that my profession has played a very significant have been a big source of support for me and have definitely role to how I have dealt with this battle. It has given me the provided me with a “purpose” to continue to try to get better. resources necessary to find appropriate treatment for this disease, which is often misdiagnosed. If I had waited any Q: How much does family support count in the longer for a diagnosis and postponed my treatment, I could way that you cope with such a disease? have had a very different outcome, which would have been A: When you go through such a devastating illness, you even more devastating, such as paralysis due to the thoracic definitely find out who your true friends are and who you can tumors or a hip fracture due to the hip tumor. These are the count on for support, even within a family. I couldn’t have cards that I have been dealt, and they have certainly helped made it without my parents. They were always there for me me play the best hand that I can play. WR

TheWaitingRoomMagazine.com 37 Biliary Colic Learn the Symptoms

One of the most common complaints evaluated in a general surgeon’s office is biliary colic. Colic refers to the characteristic pain experienced during a “gallbladder attack”. The pain is usually sharp in nature, can extend to the right upper quadrant or around to the back, and may last from several minutes to several hours. The pain can be accompanied by nausea, vomiting, and fever. Often, the onset of pain is related to the consumption of certain “trigger” foods that are usually spicy or high in fat content.

he most common cause of this type of pain is a decreased number of episodes with diet modification. cholelithiasis or gallstones as they are more Following a low-fat, bland diet may lead to an improvement in commonly known. Gallstones develop over time symptoms. When diet modification fails, patients often obtain T and may initially be asymptomatic. Gallstone relief by having the gallbladder removed. This operation is formation occurs as a result of an increasing concentration known as a cholecystectomy and is one of the most common of certain substances within bile. Cholesterol is the major operations performed by general surgeons. Typically, the oper- component in more than 80% of gallstones in the United ation can be performed laparoscopically. This means that the States. Risk factors for the formation of cholesterol stones surgery can be performed with several small incisions with the include female sex, increasing age, obesity, medications, use of a specialized camera and instruments. This minimally pregnancy, and any disorder which may lead to gallbladder invasive technique allows for an outpatient procedure, faster stasis. Colic occurs when a gallstone blocks the cystic duct recovery time, and even improved patient satisfaction. W R thus blocking the outflow of bile from the gallbladder. Bile usually exits the gallbladder with gallbladder contraction M. Brinson Hargraves, MD, is a General Surgeon at St. Bernards Medical Center in Jonesboro, Arkansas. In addition, she also works for Jonesboro during normal digestion. If the gallstone only temporarily Surgical Associates. Specializing in thoracic, vascular, endocrine and blocks the duct, then the pain should subside without general surgery, Dr. Hargraves has also been published in multiple medical journals and is also involved in various surgical research projects. intervention. If the gallstone blocks the duct for more than a few hours, then the gallbladder may become inflamed and warrant more aggressive intervention such as surgery. M. Brinson Hargraves, M.D. Jonesboro Surgical Associates In general, less than half of patients with gallstones will 1005 East Matthews Avenue, Jonesboro, AK 72401 become symptomatic. Once symptoms begin to occur, the 870-935-1242 frequency and duration of symptoms will vary as will the www.jonesborosurgical.com character of the associated pain. Some patients will notice

38 TheWaitingRoomMagazine.com Feed Your Eyes: THE IMPORTANCE OF NUTRITION FOR VISUAL HEALTH

Vision is one of our most precious senses. In a survey, loss of vision is one of the top 3 health concerns for men and women 45-65 years of age, however, most of us do not get regular eye examinations and take our ocular health for granted.

utein and zeaxanthin (ZE-ah-zan-thin) are E helps control free radicals to protect the retina and vascular nutrients that are highly concentrated in the system. Vitamin E is enriched in vegetables, nuts and seeds. central retina (known as the macula). Lutein and L zeaxanthin are found in green leafy vegetables, Zinc is a less well known antioxidant coenzyme which means egg yolk, and corn. They function to filter harmful high- that it helps proteins to clean free radicals. It also plays an energy light rays. Low dietary intake of lutein is associated important role in the health of cell membranes. Zinc is found in with an increased risk of Wet Macular Degeneration, which is red meats. the leading cause of severe vision loss in people over age 50. Omega-3 fatty acids are long chain polyunsaturated fatty The Age Related Eye Disease Study (AREDS) was designed acids are highly concentrated in the retina. The omega-3’s act to better understand the roles of nutrients in the protection as building blocks to maintain cell protection systems. They of eye health in patients with Macular Degeneration. are found in oily fish. Studies have shown a decreased risk of This study enrolled approximately 5,000 patients aged Macular Degeneration in individuals who eat oily fish more often. 55-80 years old. Over a 5-year follow-up period, the patients who received vitamins A, C, E, and zinc showed a 25% In addition, there is evidence that supplementation with decreased risk of progression of their Macular Degeneration vitamins B6, B12, and folic acid reduced the risk of AMD in and a 19% reduction in vision loss compared to placebo. women over 40 at risk for heart disease. It is important when starting any new supplements to discuss the risks and benefits Vitamin A is essential to the retina to sense light and with your physician. WR convert it to a signal the brain can understand. Vitamin A can be found in liver, carrots, and broccoli. Deficiency of vitamin Marc Harold Shomer, MD, is a Clinical Instructor of Ophthalmology at the Doheny Eye Institute at USC and owner of a private practice in Upland, CA. A can produce night-blindness and severe eye dryness. He completed his residency in Ophthalmology at the prestigious Jules Stein Caution should be taken when supplementing vitamin A in Institute at the UCLA School of Medicine (top 3 in the nation). He graduated from the UCLA School of Medicine, where he was given a full scholarship individuals with a history of smoking or who may be pregnant. and earned both a MD and PhD degrees. He also earned a bachelor’s degree from UCLA with Highest Departmental Honors, Summa Cum Laude with Phi Vitamin C is a water-soluble antioxidant, also known as Beta Kappa. ascorbic acid. It is very highly enriched in the fluid of the eye known as aqueous humor. Deficiency of vitamin C Marc Howard Shomer, MD in the extreme form can cause a disease called Scurvy. 974 West Foothill Boulevard, Vitamin C can be found in citrus fruits and vegetables. Upland, CA 91786 909-981-9800 Vitamin E is a fat-soluble nutrient, which is highly www.shomer.com/marc concentrated in the outermost layer of the retina. Vitamin

TheWaitingRoomMagazine.com 39 Modern US Healthcare WHERE ARE WE GOING?

We spend a great majority of our lives contributing to society, and we expect our healthcare system to provide for our healthcare needs. Yet, it is a system that primarily focuses on disease management rather than health promotion. Unfortunately, even the very function of disease management may not have been satisfactorily performed by our current system. Does it sound all too familiar to some of us who have experienced the so-called health insurance “run-around”? Under the pretense of an attempt to control healthcare costs, certain tests are only partially covered or are not approved at all, and prior authorization is often required for this test or that medication, and yet insurance premium shows no sign of decline. Is such an insurance-driven disease-based healthcare system the only way for modern healthcare delivery?

he American ideal is founded upon liberty, and expenditure with higher co-pays and deductibles, more freedom cannot truly exist without choices. choices should be offered to consumers and especially to However, this is precisely the problem we now those who may be interested in services not traditionally T face with our healthcare system, its lack of covered by insurance plans. The idea that someone else will options. For some strange reason, the cost of healthcare pay for all our healthcare needs has long gone. Since we has been inflated so high that only the wealthiest can progressively have to pay more and more, would we rather afford unless there is health insurance. But then it becomes pay for services that focus more on health promotion than obvious that every individual who subsequently seeks just disease management? healthcare has to go through the same loop, the insurance hurdle, and comes with it the various types of restrictions! Our healthcare system may seem to be part of a giant In an ideally free society, there must be choices, and network of conspiracy. With the growth of both the healthcare is of no exception. By offering more options, fast food and processed food industries, we are rapidly we are not encouraging healthcare disparity but rather becoming an unprecedented obese society. With the promoting diversity. In an era when healthcare consumers increasing level of stress from our work responsibilities, are increasingly responsible for their own healthcare family duties, interpersonal relationships, and financial

40 TheWaitingRoomMagazine.com obligations, we progressively become more engaged in our cars. We would not prefer to go to our car mechanics emotional eating and less in therapeutic exercise. Such a only when our vehicles break down. Hopefully, we would society thus imposes upon our population a greater risk change the oil and tune up our vehicles even though our of developing stress and obesity-related diseases. Due to car insurance does not necessarily pay for those services. the increasingly dwindling insurance reimbursement, most We would still wear seat belts and drive prudently despite healthcare providers can no longer afford adequate time the fact that we have car insurance. When our cars do break for lifestyle counseling but need to resort to a high volume down, we could easily change parts or even get new ones. practice in order to make their ends meet, and thus they However, this is not so easily achievable for our bodies, and simply have to rely more on medications to treat their after all, we believe we are worth more than our vehicles. patients, who perpetually may become more dependent on Therefore, let our healthcare providers help us to stay drugs, without which their conditions inevitably will recur and healthy and vibrant through prevention. The healthier we worsen, let alone the side effects of which that may demand are, the less we have to worry about being sick and feeling even more medications to be taken in order to counter the miserable, and the less we have to concern about arguing initial adverse reactions, and interestingly this may appear to with health insurance companies for coverage. Perhaps be exactly what the pharmaceutical industries desire. the time has come for an alternate model of healthcare delivery in the 21st century, one that changes from the Thus, what could be the solution? First, we need to fast-paced, drive-through, assembly-line, impersonalized, understand the concept of health and disease. Absence of and reactive conventional medicine to the time-devoted, illness does not automatically mean achievement of health! quality-driven, patient-oriented, individualized, and Not being poor does not mean being wealthy; and not proactive integrative holistic medicine that focuses on failing an exam does not mean obtaining an “A”. Health span prevention and wellness; addresses the whole person, is a spectrum, a continuum, like a rainbow, and cannot be body, mind and spirit; incorporates complementary and categorized simply as all or none, sick or not sick. Disease alternative medical therapies; and promotes optimal health is at one end of the spectrum whereas health occupies far beyond the mere absence of disease! the other. Health insurance should really be interpreted as disease insurance. Despite the fact that modern medical To gain a hundred victories in a hundred battles is not highest technologies may prolong life span, they do not necessarily excellence; to subjugate the enemy’s army without doing improve health span. Being alive does not equate to being battle is the highest of excellence. lively! Quantity does not always lead to quality. Disease - Sun Tzu management is not the same as health promotion! To fight and conquer all illnesses is not supreme excellence; Second, we need to appreciate the importance of health to break the disease’s resistance without fighting is supreme promotion through prevention. Despite having the highest excellence. Prevention is the key. WR healthcare expenditure in the world, we do not rank the Kevin Y. Chan, DO, MS, FASA, has a family practice in Phoenix, Arizona. healthiest when compared with other industrialized nations. He specializes in integrative lipidology and arteriology, in which he In fact, we are now witnessing an increased incidence of synergizes functional medicine with Chinese herbology and medical chronic diseases with an earlier onset. This implies that our acupuncture. Dr. Chan is a certified Meta-Medicine Health Coach by the International Meta-Medicine Association and a Fellow of the American population is becoming sick at a younger age, and since we Society of Angiology. He is in the process of completing fellowships in can now live longer due to advanced medical technology, Anti-Aging Regenerative and Functional Medicine at the American Academy of Anti-Aging Medicine, Integrative Medicine at the University we will utilize the healthcare system longer, and thus of Arizona, and Integrative Cardiometabolic Health at the Institute for creating more burdens to the already stressed system. Integrative Medicine. Most healthcare experts would agree that prevention is potentially the most cost-effective and beneficial route Kevin Chan, D.O., M.S., F.A.S.A. to improve health. Numerous studies indicate an annual Foothills Family Medicine-Rejenesis savings of $100 billion as well as increased longevity and 4530 E. Ray Rd., Ste. 172, Phoenix AZ, 85044 quality of life if healthcare providers promote prevention. (480) 961-2366 Thus, we should not go to our healthcare providers only www.foothillsfamilymed.com when we are sick. The same concept can be applied to

TheWaitingRoomMagazine.com 41 Opening the door for more convenient patient outreach through Social Media

We’ve all been there – moving to a new town and desperately trying to familiarize ourselves with the lay of the land. Part of that, especially if you have a family, is finding a good primary healthcare provider - whether that is a Nurse Practitioner or a Primary Care Physician’s office.

rowing up, the process of finding a doctor was That is about as far as you can take that analogy of food service usually rather straightforward: your parent or and medicine because we all know a physician’s care is not at guardian would bring you to a pediatrician all like a well-made lasagna or steak. These are people whom G whom you probably had known since you have dedicated large portions of their life to becoming educated were cognizant of visiting the doctor. Once we became adults, and practicing medicine on human beings. Thus, for me, when it’s almost a market-place methodology we take to finding our reading reviews of potential healthcare providers, from a service primary care healthcare provider. Naturally, we shop around. such as Google+, I tend to take these reviews with a grain of salt. Depending on different PPOs and medical insurance policies, we’re limited in whom we may solicit to become our primary Regardless of whether you allow your opinion of a healthcare care provider. Sometimes the practice is located in a hard-to- provider to be positively or negatively affected by customer find location. There are innumerable factors that go into reviews, we all must admit that there is a solace we take in what used to be quite a simple process. seeing we’re not the first to have walked through those doors and report back on the quality of care we received. Before the Thus enters the role of Social Media. Increasingly, services Age of Social Media, we were often limited to the opinions of such as Twitter, Google Reviews, Angie’s List, and even our close friends, family, and relatives for advice on healthcare Facebook, have become pivotal in helping us find the providers. Now, it is relatively common to read a review of a healthcare services we need. When faced with an uncertain complete and total stranger and gain some insight onto the number of healthcare providers, it’s nice to be able to narrow quality of healthcare we might receive. the list based upon client feedback. While the people who review healthcare providers may often require things you or I In conclusion, the tools at your disposal when shopping wouldn’t, it’s still nice to see someone had taken the time to around for healthcare are way more diverse than they have write a conscientious review of how their service went. ever been. These tools can assist us in all sorts of decisions that we make but increasingly are also being used for the The downside of this aspect is often times our view of a crucial and important decisions we make about our health and healthcare provider, whom we have never actually visited, how we spend our money towards that health. As the social can be negatively affected by a dissatisfied client. Does this age progresses forward, it will not be uncommon to see a mean a certain doctor’s office is incapable of providing you or chronological list of reviews for nearly every healthcare provider I decent and affordable service? Absolutely not! Like if you saw in your town or city. Regardless of these reviews, the best policy the reviews of your favorite restaurant and noticed someone always remains in talking to your potential healthcare provider had not received the quality of service you’ve come to expect, candidly about your expectations and needs. This will never you would already have known that the restaurant was still be replaced by online reviews and will remain a good policy in a restaurant you enjoyed. ensuring you receive the care you and your family deserve. WR

42 TheWaitingRoomMagazine.com Members’ Reactions to the Supreme Court Ruling on Obama’s Health Care Law

The Leading Physicians of the World sent out an email to all of our member physicians to learn their reaction to the Supreme Court ruling on the 2010 Health Care Law. Many members responded to the challenge revealing strong opinions on the matter. Some members are obviously supporting the law while others are clearly opposing its stipulations.

idely regarded as the new and revolutionary uninsured patients will benefit and it will increase our number Health Care Reform Law, the Barack Obama of visits per day.” says Jaime D. Dominguez, MD, from Quincy, Patient Protection and Affordable Care Act WA. “It’s a good law. Good for my poor patients. No more W along with the Health Care and Education problem of Medicaid running out. Everybody can now be cared Reconciliation Act of 2010 were upheld by the US Supreme f o r.” , states Gregory Emili, MD, from Bronx, NY. The extended Court, preserving Obama’s landmark legislative achievement. dependant coverage, the prohibitions on life time and annual The healthcare system has constantly represented the driving limits, or the elimination of pre-existing conditions are among force for countless political debates ever since Medicare was the positive key plan design issues defended by the supporters introduced by President Lyndon Johnson in 1965. Accordingly, of the Obama Affordable Care Act. “I am a patient advocate. many times people’s beliefs on different healthcare reforms Preventing the exclusion of pre-existing conditions is a good were influenced by their political sympathies, agreeing or thing. Health insurance for all is a good thing for patients and disagreeing with a law out of principle. But, while political for providers. Some of the patients should not pay for the rest views are clearly disclosed and made public every day on of the patients who did not plan ahead. Individual Providers media, the opinions of the practicing physicians often should not have to write off thousands in free care because remained unspoken or, even worst, unheard. many are with no coverage. Preventive care should be available”, specifies Dr. Susan M. Dimick from Edmond, OK. To a large extent, the Healthcare Reform Law is said to provide new coverage options, provide the tools necessary to make an informed choice health wise and establish stronger consumer protections. But what do our doctor members actually think about the law? Do they agree with the Supreme Court WR ruling? How do they think it will affect their practice or their patients? Surprisingly, their opinions clearly show that the Healthcare Reform Law has equally supporters and opponents.

Those who favor the key features of the law declare that it will not have a negative impact on their practice or on their patients. “I like it, the law is not perfect but it is a good start in the right direction. Price standardization for services, medications, labs, X-ray needs to be added on. I think many my

TheWaitingRoomMagazine.com 43 In contrast, those medical specialists who totally disagree “MORE government regulation is not what I want. The insurance with the Supreme Court ruling consider that “despite a companies have all the control on their side to deny treatment - how few minor provisions that I believe are worth keeping in many hoops do we have to jump through? I spend half my time doing this bill … I believe that much of it will be damaging, not paperwork rather than seeing patients. We need to opt out of insurance only to the future of medical practice, but to small coverage and return to fee for services. Fair competition keeps the business and the economy as a whole. The so-called “tax” price lower, not insurance games. Personally, I have catastrophic coverage will have a negative impact on a suffering middle class, and pay out of pocket for everything else. I do not want to see health not to mention other hidden taxes within the bill” as insurance become a punitive system wherein patients without health Michelle Capdeville, MD, from Chesterland, OH mentions. insurance will be penalized or jailed for lack of insurance. This is awful. “The lack of limits on liability will now encourage more I do agree with doing away with pre-existing conditions and children widespread defensive medicine. The rationing by retail being able to remain under their parent’s coverage until the age of 26 pharmacies will add to the cost of patient care because of given that the economy is still suffering. I am disgusted that our substandard care producing more illness. The push to congress even passed this bill because THEY DID NOT READ IT! dispense generics will decrease the drive for innovation Congress should not be allowed to pass bills if they haven’t even read it and new drug development”, adds Leslie Huszar, MD, from first. We will discover more bureaucracy and red tape, denials, extensions, Vero Beach, Florida. “The insurance companies have all etc. in the coming months and years now that this bill has passed. the control on their side to deny treatment - how many AND CAN YOU TELL ME HOW WE ARE GOING TO PAY FOR THIS?” hoops do we have to jump through? I spend half my time Danette L. Sutton, DC | Scotts Valley, CA doing paperwork rather than seeing patients” declares Danette L. Sutton, DC, from Scotts Valley, CA, and many “For practicing physicians this is a huge disappointment. There is no agree with her in this respect. comprehensive tort reform in the bill; therefore medical expenses will possibly bankrupt this country. No physicians who take care of patients The Healthcare Reform law has noticeably challenged the support it. I will personally work hard to get the Republicans back in beliefs of the advocates and critics both. Nurturing their charge in D.C.” opinions on realistic and clear arguments, our members Richard R. Heuser, MD, FACC, FACP, FESC, FSCAI | Phoenix, AZ reveal new facets of the Obama Law and expose the standpoint of the practitioners. “I am absolutely delighted! It restores my respect for the Supreme Court. Also the press from the GOP on this is just another attempt to “Yes, agree with Supreme Court ruling on health care law. burden the middle class. Now millions will have health coverage - and This law will have no effect on my practice. Insurance especially the 20 something’s (to 26) who are trying to create a future premiums SHOULD be less.” for themselves and who at the same time have no income to pay for A. Lawrence Ossias, MD, FACP | New York, NY health insurance.” Robert Gledhill, MD | San Antonio, TX “My reaction to the Health Care Reform: Great! I am so happy.” Sam Kad, MD, FACP, MS, MPH, MBA, FAAIM | Louisville, KY “I can’t believe that normal people with common sense can make this decision. Our country will be collapsed. Welcome to Rome or Soviet Union.” Aleksandr Livshits, PhD, MD | Brooklyn, NY

“The support of the health care plan is wonderful. It helps all people to get adequate support and takes away the awful problem of ‘pre-existing conditions.” W. Theodore Kniker, MD | San Antonio, TX

“I believe the Affordable Health Care act will eventually be viewed much like Social Security and Medicare, pieces of legislation and social policy which extend basic benefits to all citizens. Those who believe we should rely only on our own efforts will be opposed. Since I care for a

44 TheWaitingRoomMagazine.com substantial number of low-income patients I expect they will have better and more reliable coverage. Perhaps I will get paid a little more. Beyond that it is hard to know how it will all play out. There is much work to be done to make health care efficient affordable and universal.” Michael Taymor, MD | Palo Alto, CA

“I am pleased. I take care of those challenged by not having health insurance. Recent patient’s lost hers when her husband died 6 years ago. She is an independent contractor with 2 jobs; raises 4 foster children...her income may be too high to qualify for Medicaid, and she allowed her cancer to grow to where it is now commercial insurances – premiums will sky rocket. 3) To keep clearly untreatable. Even the ACA does not fix the lunacy of losing premium low and compete with the Government system insurance; too rich to qualify problem. The “we lost our freedom” commercial insurance companies will limit the benefits that MRI’s, argument is utter nonsense. The “health care premiums are rising” CT scan’s, Pet scan’s and then the surgical procedures will require is indeed true caused by insurers trying to garner profits where I pre auth and peer to peer review means Dr. has to be on the welcome the rebates to those covered if the insurer does not phone for more than twenty minutes to explain that why this test spend 80% on providing care rather than “administrative cost.” or procedure is necessary. If as a physician you make $400,000 The “government take-over” is a capitulation to maintain private per year you have to pay 2.5% of your income to get govt insurance. insurance industry; single payer remains a better option to cost Well I can go on and on. We are heading towards one payer constrain but than the rationing word is used to scare people into system. Now Canada and England : One payer system just works continuing to overuse and physician to over-order under the guise fine. But they have added commercial insurance as well where of protecting from malpractice. The system is quite dysfunctional, you buy your own coverage if somebody wants extra care. If we and this is a beginning. Berwick was a breath of fresh air admitting add 20% more patients to Medicaid and the reimbursements are many CMS regulations are foolish time wasters and government minimal: Doctors will not be able to afford to take care of these bureaucracy is indeed awful, but better that the utter nonsense of the patients unless one doctor accommodates 7-8 patients per hour free-riding, free-loading I don’t need insurance crowd that floods ER’s.” and thus guess the care delivered to the patient. ALWAYS Andrew T. Turrisi, III, MD | Detroit, MI REMEMBER ONE THING: BEFORE THINGS GET BETTER THEY HAVE TO GET WORST FIRST. That is where we are heading.” “I think the Health Care Reform Act was drafted in haste to get Navtej S. Purewal, MD | Greenfield, WI anything passed before scrutiny paralyzed the process. It is a very poorly drafted piece of legislation that has so many “pot-holes” in “In my opinion this health care plan is not in the best interest of it that implementation is going to be a nightmare. A typical example quality health care...Look at the other countries who have adopted is the analysis of “The Independent Payment Advisory Board: this type of plan. Time will tell, whether this decision was genius PPACA’s Anti-Constitutional and Authoritarian Super-Legislature,” or just plain dumb.” Cato Institute, June 14, 2012. For this “small” section read James B. Lago, BA, DDS | Park Ridge, IL hundreds more. We desperately need reform and accessibility but this is going to end up being worse than the tax code once all the “It is a horrible and gravely concerning decision totally unconstitu- exemptions, waivers and other band-aids start to poor in after tional. It will socialize medicine in this country. Patients will reality replaces euphoria and/or anger about there process.” receive inferior care and I believe that the private insurance Louis Mes MD | Lafayette, LA companies will eventually be eliminated; Middle class and small business will pay the greatest price. Doctors will have no incentive “There are few good things in the law. e.g. 1.) Taxing young to work hard if all they will get is Medicare like rates. If the individuals who do not want to pay to buy health care. But when government can force us to buy Obama care there is no end on they get sick taxpayers have to pay for them. $695 per year is not what they can do to squash our freedom of choice. Our founding good enough. This amount barely covers two doctor visits for fathers are rolling in their resting places and we are witnessing upper respiratory tract infection with medications. 2.) All preventive government take over of every sector of our lives.” care is covered. 3) All chronic illnesses have to be covered by the Tomi T. Prvulovic, MD | Goshen, NY WR

TheWaitingRoomMagazine.com 45 The Alternative To Shoulder Surgery In Impingement

Shoulder impingement is one of the most common ailments in athletes and non- athletes alike. It can be from an overuse repetitive injury or from a traumatic strain of the arm. The rotator cuff consists of four tendons that surround and grab the ball of the joint, called the humeral head, and function to move the arm in space. It also functions to stabilize the joint, pulling the humeral head down into the socket or the glenoid. Impingement simply means the cuff gets pinched between the humeral head and the bone above it, the acromion. Left untreated, this can progress to a rotator cuff tear. While a full thickness tear most often needs surgery, impingement most often does not. In fact, this surgery called arthroscopic subacromial decompression or acromioplasty is the most over-performed shoulder surgery in America.

here are 3 types of acromion shapes in impingement. An inflamed cuff is not only tender and easier to Type 1 is flat, type 2 curved and type 3 hooked. The pinch, but is also weaker. A weaker cuff allows the latter two decrease the space available for the cuff, humeral head to rise up and come in closer contact T increasing the risk of impingement. The acromion can to the acromion. Additionally, the joint becomes more also have lateral down sloping, and can develop bone spurs unstable which causes the cuff to work harder to primarily anterior and laterally due to rubbing overtime. These can stabilize the joint, which in turn causes more further decrease the supraspinatus outlet narrowing the space inflammation and thus the problem will continuously available for the rotator cuff. If the cuff gets pinched, it becomes cycle until either the cuff tears completely or proper inflamed. treatment stops the process.

46 TheWaitingRoomMagazine.com The examiner then passively raises the arm up. If the Neer sign was positive, and pain is eliminated during this test, it is a positive Noy Scapular Tilt Test. The implication of a positive test is it predicts that surgery will probably not be necessary and should not be the primary option.

The most common complaints of impingement include pain ability to increase the intensity of the rehabilitative program. with reaching, lifting and lying on the shoulder at night. The exercises are often done under the guidance of a There are special tests to diagnose impingement on physical therapist, but can be done at the gym by examination including Neer sign, Hawkins Sign, painful arc knowledgeable motivated patients. and Neer impingement test. The latter is an injection of lidocaine, a numbing agent, into the subscapular space Patients who have similar or worse pain on the Noy test (the space above the cuff and below the acromion) to see compared to the Neer sign are more likely to require surgery if the pain goes away. Kibler more recently described to open the space available for the cuff by removing some of the retracted scapular test which the examiner forces the the acromion and/or bone spurs. In my experience, this is scapula, or shoulder blade, backwards, and has the patient less common. actively raise the arm forward. Improved strength and motion and/or decreased pain are also signs of impingement. In conclusion, arthroscopic surgery for impingement is usually not necessary and overdone in the United States. I have developed a similar test which is a variation of this A positive Noy Scapular Tilt Test can predict that a patient concept, and have been using it for the past several years does not need surgery, and following the principles of the called the Noy Scapular Tilt Test. The difference with this “No Pain Principle Shoulder Rehab Program” will usually be test is that it helps predict whether surgery will be necessary. successful in eliminating symptoms. WR The patient actively retracts the scapula by asking them to Ron Noy, MD, FAAOS, is currently practicing orthopedic surgery at Prestige stick their chest out, with the arms dangling loose at the Orthopedics and Sports Medicine, a practice he founded in Manhattan, sides. The examiner then passively raises the arm up. If the New York. He is board certified in orthopedic surgery and sports medicine Neer sign was positive, and pain is eliminated during this by the American Board of Orthopaedic Surgeons, and most often sees sports related injuries. A team physician for many sports teams of various test, it is a positive Noy Scapular Tilt Test. The implication of levels, he also covers charity games as a team physician. In addition, many a positive test is it predicts that surgery will probably not be patients fly in internationally to seek him for their surgeries. necessary and should not be the primary option. Instead, a good scapular strengthening program, which is part of my Ron Noy, MD “No Pain Principle Shoulder Rehab Program” will more than Prestige Orthopaedics & Sports Medicine likely be successful in treating the impingement. This 424 Madison Avenue at 49th Street, 9th Floor, includes painless cuff strengthening, scapular stabilization, New York, NY 10017 posterior capsular stretching and icing after exercising. 646-862-0180 If necessary, a cortisone injection into the subacromial space www.PrestigeSportsMedicine.com can help temporarily reduce the inflammation allowing the

TheWaitingRoomMagazine.com 47 Why Do You Experience

Headaches? Types, Causes and Common Interventions for Headache Symptoms

The most frequent reason for patients to seek the care of a neurologist is head- aches. There are multiple headache types; headaches are broadly classified as being either primary or secondary headaches. The majority of headaches are primary head- aches; that is, there is no specific, underlying structural or metabolic abnormality causing the headaches. The following are classified as primary headache disorders: chronic tension-type headaches, which is the most common headache type; cluster headaches and other trigeminal autonomic cephalalgias; and migraine headaches. It is not uncommon for patients to experience more than one headache type. Specific headache triggers have been identified in some instances, which include stress, certain foods, hormonal changes, and alteration of sleep-wake cycles.

Common Etiologies for instance, an intracranial hemorrhage, a central nervous A number of secondary headaches are attributed to system (CNS) infection, metabolic abnormalities, or possibly disorders associated with facial or cervical structures: an intracranial structural lesion such as a brain tumor, temporomandibular joint (TMJ) disorders; cervicogenic arteriovenous malformation, aneurysm, or other structural headaches, the etiology of which is in the neck; and sinus lesion. Excluding a more serious underlying etiology is the headaches. However, secondary headaches may also be first and most crucial step in the neurological evaluation of indicative of a more serious underlying medical problem— a headache.

48 TheWaitingRoomMagazine.com Diagnostic Procedures have also proven effective—namely, biofeedback, behavioral Sophisticated radiological imaging and laboratory studies modification, neurostimulation, physical therapy, and are used in conjunction with a neurological examination OnabotulinumtoxinA injections. in the work-up and evaluation of headaches. MRI and MR angiography scans provide exquisitely detailed images of At present, there are a number of reasonably effective the brain and of the intracranial circulation, respectively. therapeutic modalities available, both pharmacologic and CT scans and CT angiography is also utilized. CT scans non-pharmacologic, which have proven to be successful of the brain are extremely sensitive in identifying an in the treatment of primary headache disorders. There acute intracranial hemorrhage, which is one of the most continues to be ongoing research in an effort to develop important abnormalities that must be immediately newer, innovative treatments for headaches, and to enhance excluded in a patient with a new and acutely severe currently available therapies. At this juncture in time, headache that is paroxysmal in onset. If an intracranial patients now have access to many diverse and realistically hemorrhage is suspected and a CT scan proves unrevealing, viable treatment options specifically geared toward or if a CNS infection is suspected, then a spinal tap is achieving optimal headache relief. WR completed on an emergent basis for further evaluation. Camille Y. Keene, MD, has extensive expertise in neuromuscular diseases and electromyography (EMG); practicing in Lakeport, California. Medical Interventions Fellowship trained in EMG and neuromuscular diseases, she is also the author of “Fulminant Rhabdomyolysis in a Patient With Once a more serious etiology has been absolutely Dermatomyositis”; an inflammatory muscle disease characterized excluded and the primary headache type has been defined, by inflammation and a skin rash. then therapy can be initiated. Pharmacologic treatment of primary headache disorders involves utilization of Camille Y. Keene, MD medications that target distinct headache types. Classes Neurologist, EMG-Neuromuscular Disease Specialist of medications commonly employed in the management 2005 Injo Drive, Lake Havasu City, of headaches include triptans, anticonvulsants, AZ 86403 antidepressants, calcium channel blockers, beta blockers, 928-302-1921 barbiturates, and NSAIDs. Other therapeutic modalities

At present, there are a number of reasonably effective therapeutic modalities available, both pharmacologic and non-pharmacologic, which have proven to be successful in the treatment of primary headache disorders.

TheWaitingRoomMagazine.com 49 From The Dark Room To The Waiting Room

Just what are radiologists, such as myself, and how do we contribute to patient care? While some of us may be skilled at fixing radios (do they still exist?), we do a bit more.

irst and foremost, a radiologist is a physician Radiological organizations such as the American College who went to medical school to acquire a basic of Radiology (ACR) and the Radiological Society of North core of knowledge and skill. The basics include America (RSNA) address the paramount importance of F developing an effective level of dialogue with imaging safely and effectively. Examples of initiatives patients and performing a physical examination (which is include the Image Wisely campaign of the ACR, RSNA, oftentimes all that is necessary to diagnose and sometimes ASRT ( American Society of Radiologic Technologists) and treat). Upon graduation from medical school, the budding AAPM (American Association of Physicists in Medicine) radiologist then embarks upon a minimum 4-year period and the Dose Index Registry created by the ACR. What can of specialty training (don’t need to bring a radio). In the you, the patient. do? The answer is to ask your health care old days, the training involved largely the interpretation provider whether the imaging test is truly necessary for of X-Ray pictures for broken bones, pneumonia and the like, the diagnosis and management of your condition. If it is with the X-Rays developed in Dark Rooms. necessary (in many cases it is crucial), then rest assured that any imaging facility accredited by the ACR will have Well, let us fast forward 40 years. The Dark Rooms are gone. personnel and equipment that meet nationally-accepted The physician radiologist still interprets pictures but they standards, including with regard to safety guidelines. now include (but are not limited to) ultrasounds, CT scans, mammograms, MRI and PET scans. The radiologist also The physician radiologist is but one of many important performs an ever increasing number of procedures such members of your healthcare team, none of whom is as as biopsies of potential tumors located almost anywhere important as you, the patient. As the “Captain of the Ship”, in the body, that are now accessible by virtue of ever more I encourage you to ask the necessary questions so that you sophisticated imaging technology. In many cases, it is the will receive the best possible care. WR radiologist who determines the cause of the patient’s ailment. Eric Mark Wilner, MD, works for Northeast Radiology Associates LLP in Examples include diagnosing gallbladder attacks on ultra- Newburyport, Massachusetts. Board certified in diagnostic radiology, sound, appendicitis and kidney stones on CT scans, trauma to he is a member of the Radiological Society of North America, Massachusetts Radiological Society, the New England Roentgen Ray the brain and body organs on CT scans and cancer anywhere Society and the American College of Radiology. He is a Member of the in the body including breast cancer on mammograms. Radiology Delegation to South Africa and was a member of the People Radiologists also treat an array of disorders including to People Citizen Ambassador Programs in November 2009. placing grafts or stents in major blood vessels such as in the heart and legs, draining abscesses and other collections Eric M. Wilner, MD of fluid in the body as well as draining blocked kidneys. Radiologist Northeast Radiology Associates LLP With the ever increasing use of imaging, legitimate 25 Highland Avenue Newburyport, MA 01950 questions have emerged regarding the safety of the 978-463-1120 imaging (i.e. radiation dose). Mission statements of all

50 TheWaitingRoomMagazine.com Wash Your Lower Back Pain Away Hydrodiscectomy can relieve your Bulging disc pain in just 20 minutes

Have you been suffering from significant back pain for years now? Does this symptom disrupt your normal daily routine, depriving you from getting a good sleep? Well, you may be suffering from a herniated disc pain. And unless you do something about it, such discomfort may even get worse in the days to come.

onsulting a doctor about it is the best thing that This procedure requires no cut, no hospitalization, you can do. After some radiographic findings, nor long hospital stay. And most of all, this is FDA you may be diagnosed to with a herniated disc or approved, making it the safest intervention for C bulging disc problem. The doctor may advise you herniated disc problems. WR to undergo an invasive surgical procedure. But before you make your final decision, you need to know that there is For more information visit: www.washawaybackpain.com another treatment option that has been proven to be effective in 40,000 surgical cases globally. This employs a high speed Tomi Prvulovic, MD, works at Healthspine and Anesthesia Institute in Goshen, New York and Cedar Knolls, New Jersey. Board certified water stream to correct your herniated disc. Such procedure is in anesthesiology and pain medicine, Dr. Prvulovic is a Diplomate called “Hydrodiscectomy”. of the American Board of Anesthesiology and of the American Academy of Pain Medicine. Dr. Prvulovic holds honors/awards including the American Medical Association Award (1988), Dr. Prvulovic has been known to be the expert when it comes Academic Excellence Scholarship (1987) and the Dubois to Hydrodiscectomy procedure. In fact, a lot of his patients Competitive Scholarship (1985). can attest to his expertise. One of his patients was Tim who developed a bulging disc after falling from a 35 foot high Eric M. Wilner, MD Tomi T. Prvulovic, MD Radiologist building. He received a lot of epidural injections without any Healthspine & Anesthesia Institute Northeast Radiology Associates LLP relief. However, after a 20 minute Hydrodiscectomy procedure, 70 Haffield Lane, Suite 201 Goshen 10924 25 Highland Avenue Newburyport, MA 01950 he was able to walk and got his life back. The same thing (845) 294-2006 978-463-1120 happened to Rima. She resumed her regular job after undergoing www.healthspinemd.com the same treatment.

TheWaitingRoomMagazine.com 51 Understanding Gout

Gout has long been considered a disease of kings and the consequence of gluttony. Although there is truth to these associations, gout is a complex disease resulting from many factors. Gout may be provoked by excessive consumption of foods that contain purines in susceptible individuals. Dietary sources of purines include meats, shellfish, anchovies and large quantities of lentils to name a few. Alcoholic beverages, particularly beer, and high fructose corn syrup containing drinks also increase uric acid production in the body.

ot all individuals are susceptible to developing gout. Purines in the body originate both from food intake and from the production of purines Nby the body itself. These purines can either be eliminated from the body as uric acid, the key compound causing gout attacks, or purines may be recycled in the body. Individuals who fail to eliminate enough uric acid, as a result of the balance between the amount produced and the amount the kidney can get rid of, are prone to gout. Genetics plays an important role in how the body produces and eliminates uric acid. Certain medications like aspirin and water pills can shift this balance as can certain diseases such as kidney disease, leukemia, thyroid problems and chemotherapy.

Although dietary modification may decrease the frequency and severity of gout attacks, treatment with medication is the ultimate solution. Gout attacks are extremely painful and classically occur in the big toe. Any location in the foot or ankle is common, but attacks also occur in the elbows, knees and hands. Longstanding gout is associated with nodules or lumps of uric acid that can protrude under the skin. Generally gout can be treated very successfully which is Some patients also develop uric acid kidney stones. gratifying for both the patient and the physician. WR

At the onset, painful gout attacks are treated with anti- Jason Faller, MD, is a rheumatologist with a practice in New York City’s Columbus Circle. A Founding Fellow of The American College of inflammatory medications such as colchicine, steroids and Rheumatology, Dr. Faller is also the Chief of the Arthritis Clinic at non-steroidal anti-inflammatory drugs. Once the attack Roosevelt Hospital. subsides, the uric acid level in the body can be reduced with medications such as allopurinol or Uloric. As with all Jason Faller, M.D. medications, patients must be aware of the risk of certain Rheumatologist side effects and monitoring is required. When the uric acid 333 West 57th St., Suite 104, New York, NY 10019 level has been reduced over a period of time, the risk of new 212-307-6880 gout attacks is decreased and, ideally, ultimately eliminated www.jasonfallermd.com so long as the patient continues to take the medication.

52 TheWaitingRoomMagazine.com A Unique, Powerful, Drugless Way to Neutralize Pain

A good chiropractor wants to offer the best care available, and reads many technique ads with testimonials, but few like this one: “Well Known M.D. Amazes Patients By Turning Off 100% of Trigger Point Pain With P.N.T.!”

he testimonial, was written by Terry Chappell, M. D. could relieve their pain from tender trigger points. after taking a Pain Neutralization Technique (P.N.T) A dozen people...put me on the spot. To my amazement, training. After putting on a seminar introducing to the patients’ amazement, to the audience’s amazement, T these techniques, he states that “I bravely decided every person who volunteered reported complete relief of to take my chances by asking for volunteers ...to see if I tenderness after less than a minute of treatment.”

Jason Faller, M.D. Rheumatologist 333 West 57th St., Suite 104, New York, NY 10019 212-307-6880 www.jasonfallermd.com

TheWaitingRoomMagazine.com 53 The techniques work on principles based on classical neurology: the very solid science of nerves, where they travel and how they function. These advanced approaches tend to require fewer treatments and last much longer.

Trigger points are tender areas in muscle, that radiate rotation also responded well. These are just some of the conditions pain to other areas when stimulated. They are oxygen- these methods helped people with in part of one day’s work! deprived from muscular tension compressing blood vessels. Many experts feel that the vast majority of The techniques work on principles based on classical neurology: patients with chronic pain have painful muscular trigger the very solid science of nerves, where they travel and how they points causing or aggravating their pain. As I’ve learned, function. These advanced approaches tend to require fewer even when there’s disc trouble, arthritis or abnormal x-ray treatments and last much longer. findings, P.N.T often resolves the problem by restoring normal blood flow. Rather than treating the trigger point, The concept is similar to rebooting a “frozen” computer. we help it cease to exist. Whatever internal conflict was creating a spasm in the computer system ceases to exist when you start it up again. After visiting http://www.painneutralization.com, I became a student of Dr. Stephen Kaufman’s work. He teaches his I have to state that no therapy works for everybody and that students—among them medical pain management your own results may vary. Still, I have found P.N.T. to be highly specialists, chiropractors and acupuncturists--how to turn effective in most cases. WR off trigger points associated with pain on a LONG-TERM Stuart C. Marmorstein, DC, is the staff chiropractor for Head to Foot, LLC in basis. The work is extremely gentle and safe. Patients Houston, Texas. He has been focused on helping patients with acute and can’t believe how quickly chronic tenderness disappears chronic pain, health and energy problems through Applied Kinesiology and from light fingertip pressure. various types of cranial work since 1979. He has been studying and using Pain Neutralization Technique in his practice since 2011 to eliminate myofascial trigger points and the painful symptoms they cause. Based on the real clinical results that I get in my office, I have never looked back. One typical Friday, I treated Dr. Stuart C. Marmorstein people who came in after falling over furniture, getting Head to Foot LLC bitten by a snake, and others with a bad fibromyalgia 3730 Kirby Drive, Houston TX 77098 flareup, post-surgical hip pain and the facial and head 713-831-6875 pain that goes with Bell’s Palsy. People with acute www.headtofoot.info shoulder pain, TMJ (jaw) pain and neck pain with limited

54 TheWaitingRoomMagazine.com Take A Bite Out of Your Headache

What if you could take a big bite out of your headache? How would you feel? Headaches have been around since the dawn of man and can be caused by a huge list that includes spouse, boss, co-workers, children of all ages, driving in heavy traffic, economy and other stresses that pop up into your daily life.

ell there’s a possibility that your headaches Wcould be caused by your bite and TMJ. And there’s the infamous migraine that many people seem to have but don’t have all the classic symptoms such as the throbbing temporal pain, aura, light sensitivity, cold hands and feet, etc.

In many cases if you have had orthodontics, fillings, crowns, implants, they could be the source of your headaches. Even natural teeth without any work could be a source of the problem.

Your “bite” is not limited to your orthodontic relationship of your upper jaw and lower jaw and the way your teeth meet when you look at them from the front and sides. They can look ”normal” after orthodontics but the way they meet individually may not be in balance and harmony. Using this high tech analysis will ensure that your “bite” is balanced side to side and your muscles are in balance so We are talking about the actual “bite” you take when you bite there isn’t any excess forces causing you to “grind” or clench down whether your chewing gum or food. It’s the individual on purpose or hit excessively while chewing that can lead to teeth hitting the opposite teeth that could be the source of headaches, sore jaws and joints. your headaches especially when they don’t strike in harmony like an orchestra in synchronization. One tooth hitting early So the next time you have a headache, perhaps you can or late causing vibrations up the jaw to the joint and causing greatly reduce or eliminate it by having your high tech muscles on same side to work harder to be in balance with dentist use these valuable instruments. WR the other side leading to TMD type symptoms like muscles spasms in your neck, shoulders, and causing headaches. Russell Chin, DDS, has a private dental practice in Pawtucket, Rhode Island and has been there since 1977. He is also the current Treasurer for the New England Society of Clinical Hypnosis. A general and cosmetic New technology can now measure the individual force of dentist, he is also part of the American Dental Association and Rhode Island Dental Association. each tooth and measure the muscle activity of facial and head muscles. Advanced instrumentation can check the type of vibration in the TMJ that could also be a source of headaches. Russell S. Chin, DDS 1288 Newport Ave, Pawtucket, RI 02861 TekScan maps out the forces into 6 points for each tooth 401-728-1450 while BioPak records and analyses the vibrations in the TMJ 401-727-1488 joint and the EMG part measures muscle activity which can www.extremesmile.com be associated with headaches.

TheWaitingRoomMagazine.com 55 Preventing The Top Seven Health Threats for Men

Prevention is the only known solution for you to age gracefully and respectably. Every day, your health is exposed to so many risks that prevention can seem like a real challenge. And yet, the leading health threats can be prevented simply by reducing or eliminating risk factors and by adopting more positive and healthy habits.

1. Avoid Cardiovascular Disease by Making 2. Cancer Risks Can Be Reduced

Lifestyle Changes Cancer is one of the most dreaded conditions. There are According to the Center of Disease Control and Prevention (CDC), numerous forms of cancer but the leading causes of heart condition is the main cause of death in the United States cancer death among men are lung cancer, prostate cancer, and thus the first health threat that you need to worry about. colorectal cancer, and liver cancer. In addition to the Smoking should be avoided or eliminated while a healthy prevention list for heart disease, there are three other diet based on fruits, vegetables, whole grains, and lean ways that you can reduce the risk of developing cancer. protein is imperative. Exercise is not an option but a must. First, limit or even eliminate alcohol from your diet. Thirty minutes of physical activity every day could save your life. Secondly, do not underestimate the power of early Chronic conditions have to be kept under control by regular detection and get regular checkups. Thirdly, exposure to checkups and proper long term treatment. And, do not let stress sunlight must be limited and when you must control your life. go out, use sunscreen.

WR

Patrick R. Felice, M.D. Dermatologist Dr. Felice’s Youthful Images 580 Cottage Grove Blvd., Ste 103 Bloomfield, CT 06002 Ph 860.242.0505 | Fax 860.243.3913 [email protected] www.youthfulimages.com

56 TheWaitingRoomMagazine.com 3. Accidents Can Be Avoided Eliminate smoking and alcohol or, at least, reduce them. Follow healthy living principles in your dietary plan. There is nothing that you can do to prevent natural catastrophes but there is something that you can do to avoid car accidents. Wearing your seat belt can save your 6. Type 2 Diabetes Controlled With life and that of your family. Following speed limits is not Lifestyle Changes a matter of respecting the law but a matter of safety. More importantly, you should not drive if you feel tired, Diabetes is not only dangerous because it is a serious stressed, or if you are having a bad day. Driving under the disease but because it can trigger other serious conditions influence of drugs or alcohol is not an act of bravery and it such as eye disorders, nerve damage, heart conditions, and could get you, and others, killed. others. Controlling diabetes can help you control your risk factors. Therefore, you need to manage your weight 4. Chronic Lower Respiratory Diseases Can permanently, introduce exercise in your daily routine, adopt a healthy diet, and get regular checkups. Be Avoided Respiratory conditions are very difficult to control and treat 7. Suicide Is Not The Solution Depression once they have settled in. However, you should know that chronic respiratory conditions, such as bronchitis or Can Be Treated emphysema, can be prevented. Reduce the risk of getting Suicide is perhaps the most difficult to prevent of all health respiratory infections by having flu shots on time, or even threats since getting help defeats the very purpose of pneumonia vaccines. Smoking is a high risk factor and you suicidal thoughts. Depression is known as the leading should exclude it from your habits. Do not forget secondhand triggering factor in suicide cases. What you need to smoking which can cause just as much damage. You also need understand is that suicide is a disease which can be treated

Patrick R. Felice, M.D. to limit your exposure to chemicals and other forms of pollution. just like any other condition. Noticing and acknowledging Dermatologist symptoms is the first step while getting help is the second Dr. Felice’s Youthful Images 5. Stroke Risk Can Be Reduced and most important step in preventing suicide. 580 Cottage Grove Blvd., Ste 103 Bloomfield, CT 06002 Ph 860.242.0505 | Fax 860.243.3913 Stroke can be triggered by factors which are out of your Now that you are informed about health threats and their [email protected] control such as age, race, or genes. But, you can control other prevention, you should continue by adopting healthy living www.youthfulimages.com contributing factors such as chronic diseases, smoking, diet principles that could save your life. Essentially, prevention is and alcohol. You have to manage all chronic diseases, nothing more than living healthy and living healthy should including diabetes, high blood pressure, or high cholesterol. be a lifestyle not an exceptional case. WR

TheWaitingRoomMagazine.com 57 Concussion, Mild Traumatic Brain Injury and Post Traumatic Headaches

The Centers for Disease Control (CDC) reports that head injuries result in nearly 1.4 million emergency room visits, 275,000 hospitalizations and 52,000 deaths per year. In youth recreation and sports, an estimated 62,000 injuries occur per year in those 15 – 19 years old. State legislatures are increasingly passing laws mandating rules for return to play. In the military, it is estimated that more than 350,000 returning service members have sustained mild head injuries during their deployment.

eadache is among the most prominent, and Patients should be aware that the expected time of recovery most persistent, of the symptoms that linger for most symptoms is typically 7 – 10 days. Failure to return after mTBI. The prevalence of post-traumatic to baseline neurologic status within 30 days requires more H headache (PTH) in the general population careful evaluation. In youth and professional sports, the CDC is not known, but among those with war related blast recommends that athletes should not return to play until injuries, greater than 90% have headaches, mostly of the they are symptom free. The Department of Defense has migraine type. recommended one day of forced rest after first concussion,

58 TheWaitingRoomMagazine.com Patients should be aware that the expected time of recovery for most symptoms is typically 7 – 10 days. Failure to return to baseline neurologic status within 30 days requires more careful evaluation.

7 days of rest after second concussion within 12 months have also been shown to work. Amitriptyline and gabapentin and, after a third concussion in 12 months, return to duty may help to prevent severe headaches. Ultimately, avoidance must be based upon evaluation by a medical provider. of further injury may be the best protection against Guidelines for assessment of baseline and follow-up future problems. WR evaluations and treatment have not been established for Alan G. Finkel, MD, FAAN, FAHS, works at the Carolina Headache Institute civilians and regular patients. in Chapel Hill, NC. He holds adjunct appointments as a full professor in the School Dentistry and the departments of Anesthesiology and Psychiatry at the University of North Carolina School of Medicine. In addition, he is a Acute post traumatic headache should be evaluated by a contractor for the Defense and Veterans Brain Injury Center at The qualified professional. It may have features of migraine or Womack Army Medical Center in Ft. Bragg NC where he is a neurologist tension type headache and will generally resolve itself within and consultant to the Concussion Care Clinic; and is current chairman of the post-traumatic headache section of the American Headache Society. 3 months. Resulting CAT and MRI scans are typically normal. His interests include migraine, chronic and secondary headache, traumatic After the acute period, persistent symptoms may require brain injury and chronic post-traumatic headache and health care policy. more specialized evaluations. Sleep problems, emotional upset, and problems with memory and thinking are common, Alan G Finkel, MD FAAN FAHS and may make resolution of the headaches more difficult. Carolina Headache Institute Acute headaches are self-limited and acetaminophen is 103 Market Street, Chapel Hill, NC 27516 the best immediate therapy. For more chronic headaches, 919-942-4424 an anti-inflammatory, such as ibuprofen or naproxen are www.carolinaheadacheinstitute.com mainstay treatments, but triptans that are used in migraine

TheWaitingRoomMagazine.com 59 Chronic kidney disease A rising threat in these modern times

The great advances in the biological sciences in the last century have led to dra- matic breakthroughs in the fields of medicine and public health, thereby prolonging human life span far beyond what it had been for many millennia. The increasing age of the population, however, has also lead to a sharp rise in the incidence of chronic kidney disease (CKD).

ur kidneys are vital organs which excrete urine; anemia; high blood pressure, shortness of breath metabolic waste products; maintain the and swelling of the legs from salt and water retention; balance of acidity and minerals in the insomnia, impairment of higher mental functions, tremors O body; produce a hormone that regulates and convulsions; and abnormal heart beat or cardiac arrest blood pressure and another that stimulates red blood cell from retained potassium. Untreated end-stage kidney production by the bone marrow; and they covert Vitamin disease is fatal unless the patient is treated with dialysis or D into an active form involved in calcium absorption given a kidney transplant. from the gut and maintenance of bone integrity. CKD will therefore compromise all these functions, leading to The more common causes of CKD are diabetes; various symptoms, which unfortunately may not appear hypertension (high blood pressure); systemic inflammatory until the disease has reached a fairly advanced stage. conditions that also involve the kidneys, such as systemic These symptoms include fatigue, loss of appetite, nausea, lupus erythematosis (SLE); various diseases that originate vomiting, altered taste sensation, breath that smells like in the kidneys themselves; AIDS; hepatitis B and C;

60 TheWaitingRoomMagazine.com More important than treatment, however, is prevention.

This includes excellent control of blood sugar and cholesterol

in diabetics, weight loss for the obese, good control of blood

pressure and avoidance of high-salt diet in the hypertensive,

smoking cessation, and avoidance of drugs injurious to the kidneys.

excessive use of certain pain killers; Illicit drugs like Dr. Asad Bakir is Professor of Medicine, Section of Nephrology, at the University of Illinois College of Medicine at Chicago, Medical Director at cocaine; some antibiotics; other drugs like cisplatinum for Congress Parkway Kidney Center in Chicago, Consulting nephrologist at certain cancers or lithium for depression; heavy metals like Rush Oak Park Hospital in Oak Park, Illinois, and Volunteer Senior lead; certain blood cancers like multiple myeloma; some Attending Physician in the Department of Medicine, Division of Nephrology at John Stroger Jr. Hospital in Chicago. His interests lie in the parasitic diseases like malaria; and hereditary conditions fields of primary kidney diseases, lupus nephritis, hypertension, diabetic like polycystic kidney disease. nephropathy and treatment of chronic and end-stage kidney disease. He is board certified in internal medicine and nephrology and has practiced and taught nephrology since 1977. He has many publications in various kidney In the United States and other advanced countries the and internal medicine journals, and also has the unique distinction of increasing population age, “Western” life style and over- being educated in three countries: England, Baghdad, and the United States. eating has caused a steep rise in the incidence of the

“metabolic syndrome”, which includes obesity, diabetes, Asad A. Bakir, MD, FACP hypertension and high cholesterol and uric acid. Diabetes Nephrologist has therefore become the leading cause of end-stage 3410 West Van Buren Street, kidney disease in the United States. Chicago, IL 60624 708-937-1060 Treatment of CKD remains far from satisfactory, and the majority of cases ultimately progress to end-stage kidney failure requiring dialysis or kidney transplantation. More important than treatment, however, is prevention. This includes excellent control of blood sugar and cholesterol in diabetics, weight loss for the obese, good control of blood pressure and avoidance of high-salt diet in the hypertensive, smoking cessation, and avoidance of drugs injurious to the kidneys. Periodic urine testing may uncover the existence of unsuspected or early kidney disease, as the presence of protein in the urine is the hallmark of diabetic and many other kidney diseases. Once kidney disease is established, dietary protein restriction and certain drugs in the family of captopril and losartan may retard its progression.

Chronic kidney disease is much more common than most people think, and we all need to be vigilant about prevention and early detection, especially the diabetics among us. Much remains to be learned about the various mechanisms of kidney disease and therefore the discovery of more targeted preventive measures and therapies. WR

TheWaitingRoomMagazine.com 61 healthy PARENTING

Do You Think Your Child Has A Kidney Disease?

Kidney diseases can be silent, and a few signs may help parents suspect their child suffers from one.

a wealth of information, identifying cysts, stones, kidney anomalies (i.e., single kidneys, horseshoe kidneys, etc), and suspect blockage (obstruction), just to name a few. Nuclear scans, tests for reflux, or other complex imaging studies can be ordered later, as the case dictates.

For some glomerular diseases, a more precise diagnosis is necessary, established by examination of the tissue under the microscope (biopsy). The biopsy is performed with ultrasound (more frequently) or CT guidance, under sedation. et’s start with the urine, which on some occasions becomes the “mirror” of the kidneys. Just by looking Aside from maintaining the body composition by excreting at the color, transparency, persistent foaming, some of the “metabolic waste”, kidneys contribute to the L or sediment (in infants a diaper stain) the parent production of enzymes (for blood pressure regulation or can suspect a problem and bring it to the attention of their activation of vitamin D) and hormones (i.e., erythropoietin for physician, aiding in early diagnosis. maturation of red blood cells). Lack of energy, fatigue, loss of appetite, poor weight gain and short stature may be signs of Fever is a late sign of urinary tract infection (UTI), and UTIs can kidney failure, and blood tests (such as serum creatinine) are be suspected if urine is cloudy, foul-smelling, or the child has needed. Kidney failure affects all these “tasks” in various painful and frequent urination. A urine culture is needed to degrees, and patients may not experience any symptoms until clarify this issue. the kidney function is severely reduced. Therefore, awareness of kidney disease has earned its high priority status. WR The skin color, swelling (so-called edema), high blood pressure (hypertension), or a rash along with urine changes, can suggest Alex Constantinescu, MD, is the Medical Director of pediatric nephrology a kidney problem, which may be sudden in onset (acute), or at Joe DiMaggio Children’s Hospital in Hollywood, Florida. His clinical interests include nephrology, treatment of children with nephrotic persistent for a while (chronic). A few examples are nephrotic syndrome, chronic renal failure, on dialysis or post-transplant, and syndrome (characterized by protein losses in the urine, low treatment of children with hypertension. Dr. Constantinescu’s original research has been published in many peer-reviewed medical journals, blood protein levels and edema of the face and/or ankles) and and he maintains a faculty position at Nova Southeastern University as glomerulonephritis (inflammation of the kidney filtering units, a Clinical Professor of Pediatrics. known as the “glomeruli”). It is important to note that the majority of children have a secondary identifiable cause of Alex. R. Constantinescu, MD hypertension, compared to adults. Joe DiMaggio Children’s Hospital 1150 N 35th Ave, Ste. 499, Hollywood, FL 33021 A few tests are essential in establishing the diagnosis of 954-265-9344 kidney disease, the most common being the kidney www.jdch.com sonogram. It is non-invasive, easy to perform, and gives us

62 TheWaitingRoomMagazine.com healthy PARENTING

Mirror, Mirror on the Wall…

Healthy body image and it’s best friend, high self esteem, are hardest to find in teenage girls, but let’s not forget that teenage boys and kids of all ages can potentially suffer from an unhealthy or distorted body image (not to mention adults). Your child’s self-image isn’t plain to see, so monitoring it can be challenging. But, by the same way we can prevent illness by being proactive about healthy habits, we can help prevent unhealthy body image in our kids by encouraging healthy self-image and high self-esteem. Here are five ways you can support your child’s healthy body image.

1. Be a good role model 2. Keep it positive Your kids are watching you, subconsciously and even when Even those of us without teenagers know they are extremely Alex. R. Constantinescu, MD you think they’re not. What kind of attitude toward beauty sensitive, and often have distorted and over-dramatized Joe DiMaggio Children’s Hospital 1150 N 35th Ave, Ste. 499, Hollywood, FL 33021 and physical appearance do you have? Before you start to interpretations of reality. Never make a negative comment 954-265-9344 analyze your kids behavior, take a look at your own eating about your child’s physical appearance. If you feel the need www.jdch.com and exercise habits, and your relationship with TV, to say something, do whatever you can to keep it positive. magazines, online media, and the mirror. Also, if you overhear negative self-talk from your child, seize

TheWaitingRoomMagazine.com 63 healthy PARENTING

the opportunity to chime in and ask them to re-think what they 5. Start young just said. Ask “do you really believe that?” Another negative habit When most adults meet a very young girl or boy for the teens often struggle to avoid: comparing themselves to others. first time, they are tempted to make comments like “aren’t you cute!” or, for girls, “you look so pretty in that 3. Emphasize Inner Beauty dress!” Steer away from this temptation. Ask kids questions Compliments about physical appearance are skin-deep. While to engage them instead, and refrain from commenting there’s nothing wrong with telling your kids how cute you think on how they look. Point out their strengths instead. they are, go out of your way to emphasize how much you enjoy and appreciate the traits they have that have nothing to do with We all struggle from time to time with our body image, their appearance: how creative, hard working, kind, persistent or but remember your worth should not be dictated by the imaginative they are. Telling them what a good friend, daughter/ way you look, but by the way you behave. son, or sibling they are is also a great way to emphasize how they treat others over how they look to others. Stay well and enjoy being yourself. WR

Chrystal de Freitas, MD, is a pediatrician with a special interest in

4. Start a conversation about media family health education. She presently works at a private practice, This one is particularly important for parents of teens and Carmel Valley Pediatrics, in San Diego, CA. The San Diego County pre-teens, especially girls. In magazines, on TV and online, Medical Society and San Diego Magazine selected Dr. de Freitas as one of the area’s top doctors in 2006. In 1993, Dr. de Freitas founded girls are bombarded with images that are over-sexualized, Healthy Chats LLC and began to provide family health education unrealistic, often-digitally-altered, and generally damaging to information through detailed seminars, books, DVD kits, and the Internet. their self-image and self-worth. Boys too can adopt an unhealthy attitude toward and expectation of girls (not to mention their Chrystal E. de Freitas, M.D., F.A.A.P. own masculinity) simply by being exposed to the media that Carmel Valley Pediatrics is part of our society. Point out to your kids how unrealistic 12395 El Camino Real Ste 315, San Diego, these images are, and the negative stereotypes they reinforce. CA 92130 | (858) 794-5437 Train them to see media images with a more keen eye, www.carmelvalleypediatrics.com not a blindly accepting one.

While there’s nothing wrong with telling your kids how cute you think they are, go out of your way to emphasize how much you enjoy and appreciate the traits they have that have nothing to do with their appearance: how creative, hard working, kind, persistent or imaginative they are.

64 TheWaitingRoomMagazine.com healthy PARENTING

Allergies: Nothing to Sneeze At

One out of every five children is diagnosed with allergic rhinitis (also called hay fever or seasonal allergies). It is often a chronic condition that occurs every year, and it is important that kids’ symptoms are controlled to improve their quality of life.

here is often a family history of allergies, if a child already has such a diagnosis. Smoking outside is that is commonly inherited from parents and not enough, as smokers will carry irritating particles on their grandparents. It is caused by an overreaction of clothes and hair back into the house for others to inhale. T the immune system to a foreign substance (called an allergen). Pollens are Allergies cannot be treated with antibiotics. Having a one of the most common allergens. In spring, the most runny nose without fever is not due to bacterial infections, common pollen is from trees, while grass becomes which antibiotics fight against. Taking such medications more prevalent in summer. From late August to the haphazardly leads to antibiotic resistance, which is a serious first frost, ragweed pollen causes the most symptoms. and growing problem in medicine. Children can also be allergic to animal dander, dust, Discuss with your physician if your child has allergic mold, and even cockroaches. symptoms and how to best treat this condition. By doing so, you can keep your child active and healthy for the future. W R The most common symptoms of allergies include runny nose; itchy, watery, red eyes; sneezing; cough; dry throat; James Uhles, MD, is a pediatrician for Illini Medical Associates in or feeling congested. Needless to say, these symptoms Carrollton, Illinois. His clinical interests are infectious diseases, asthma and allergic disorders, pediatric psychiatry, and preventing antibiotic can greatly impact a child’s ability to function and can resistance. He holds membership in the American Academy of Pediatrics adversely affect their performances in school or athletics. and the American Medical Association. Uncontrolled allergies can also lead to asthma, another chronic condition in children that can be debilitating. James Uhles, MD, Pediatrician Illini Medical Associates The best thing for parents to do for their children who 523 S Main St, Carrollton, IL 62016 have allergies is to not smoke. Cigarette smoke exposure 217-942-3326 increases the likelihood of allergies, asthma, and ear/sinus www.illinimed.com infections, as well as making these conditions even worse

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Childhood Obesity Pandemic

An alarming ONE THIRD of children in the US are either obese or overweight, with a body mass Index (BMI) of more than the 85th percentile. Obesity leads to heart disease, diabetes, cancer, muscle and bone problems, breathing and behavioral problems. Childhood obesity has become a pandemic and is a threat to global health and increasing the disease and death at an alarming rate. It has been predicted that for the first time in the history of the United States the present younger generation may have a life expectancy LESS than that of the older generations mainly because of obesity and its complications.

hildhood obesity is very complex and it should be fought at every level. Childhood obesity is more prevalent in lower socioeconomic, racial and C ethnic minority populations in United States. Among African Americans and Hispanics about 50% of the children are obese/overweight.

It was not like this before. Before when we were kids many of us used to walk to school and played outside most of the time and ate home cooked food sitting with our family around the table. Now children are going to school by car or bus, and do not want to get out and play. They are engaged in watching TV, Playing videogames, texting or surfing the internet. Parents work long hours and they do not have time for home cooked family meals. Children are flooded with commercials showing large portion size fast foods and sugary drinks.

Eating high calorie foods with low micronutrients which are present in abundance in fresh fruits, nuts and vegetables make the children fat but undernourished. This leads to debilitating and costly health problems. A similarly inactive lifestyle also increases these risks. So the American Academy of Pediatrics has come up Nusrath M. Habiba, MD, FAAP, is currently an Assistant Professor in the with some easy ways to remember goals for the children. Those are Department of Pediatrics, University of North Texas Health Science Center at 5 2 1 0. That is 5 servings of fruits and vegetables, only 2 or less Fort Worth, Texas. A board certified pediatrician, her interests lie in the field of obesity prevention and diabetes, with a separate interest in preventive hours of TV watching/ Video games/Computer time unrelated to pediatrics. Her medical education took place in India as well as Texas Tech school work, 1 hour of vigorous activity and 0 sweetened drinks University in Amarillo. which include sodas and fruit juices in a day. Nusrath M. Habiba, M.D., Assistant Professor It is only the beginning. We have a long way to go. Nutritious University of North Texas Health Science Center food, good eating behaviors and increased physical activity have Department of Pediatrics an incredible prospect to reduce childhood obesity. If each and 855 Montgomery Street, Fort Worth, TX 76107 every one of us do our part and work in unity we certainly can 817-735-2566 reach our goal. WR

66 TheWaitingRoomMagazine.com healthy PARENTING

Innocent Heart Murmurs in Childhood

Imagine you have just been to the pediatrician for your child’s well-child check up and the pediatrician said he or she has a heart murmur that hasn’t been heard before. Although the doctor said it is nothing to worry about, you are still concerned and wonder if he or she should see a children’s heart specialist, a pediatric cardiologist. When you get online and search heart murmur, the first source says heart murmurs are a sign of a heart problem and, the next source says they usually aren’t a problem, so now what? What is a heart murmur anyway?

hen the heart beats it makes sounds due to the closing of the heart valves. The first sound happens when the valves between W the upper and lower chambers close, the “lub.” The second sound happens when the valves between the lower chambers and the artery leading to the lungs and the artery leading to the body close, the “dub.” In children it is common to hear an extra sound that is similar to a whooshing sound that occurs between the “lub” and the “dub.” That sound is a murmur. A murmur is not a diagnosis, it is simply an extra sound. You can think of it like a heart “cough.” Like a cough it can be a temporary sound that is not a sign of an underlying problem, like a tickle in the throat, or it can be a sign of a more serious problem. Very often your doctor can tell based on your child’s history, your family history and the sound of the murmur whether or not the murmur is innocent or nonpathologic (nothing to worry about) or pathologic Dr Denfield is an Associate Professor of Pediatrics in the division of pediatric cardiology at Baylor College of Medicine and Texas Children’s Hospital in (something to potentially be worried about). Additional Houston, Texas. Her primary area of clinical practice and research interests tests or referrals are usually not necessary because most, are in cardiomyopathies, heart failure and cardiac transplantation in although not all, murmurs in children are innocent. children, while maintaining an interest in general pediatric cardiology. She has co-authored more than 75 text book chapters and scientific journal articles primarily on cardiomyopathies, heart failure and cardiac Although the estimates vary, innocent murmurs occur in up transplantation in children in addition to writing for publications for parents. to 60% of infants (60 per 100 infants) and 75-90% of children (75-90 per 100). The prevalence of congenital Susan W Denfield, MD, FAAP, FACC heart disease at birth is about 6 per 1000 and 4 per Texas Children’s Hospital 1000 in school age children. So the odds are, if your 6621 Fannin Street, Houston TX 77030 pediatrician hears a heart murmur in your child who is 832-826-5682 otherwise healthy, he or she is unlikely to have www.texaschildrenshospital.org a heart problem. WR

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Iron Deficiency, Prolonged Bottle-feeding, and Racial/Ethnic Disparities

Children with prolonged bottle-feeding and Mexican-American children are at higher risk for iron deficiency. Screening and nutritional counseling should be targeted at these high-risk groups.

ottle-feeding your child milk for too long can put The Problem your child at risk for iron-deficiency and anemia. Iron deficiency is the most common nutritional deficiency in As we speak, there are about 3.8 million children early childhood. Iron-deficiency anemia in infancy and early B at risk for iron-deficiency/anemia because of childhood is associated with behavioral and cognitive delays, this problem – being bottle-fed past 12 months of age. including impaired learning, decreased school achievement, and lower scores on tests of mental and motor development. Mexican-American children are especially at high risk, Sufficient dietary intake of iron is essential for toddlers to with almost 4 out of every 5 (310,000) still being bottle- maintain a positive iron balance and thus to prevent iron- fed past 12 months of age and 2 out of every 5 (271,000) deficiency anemia. The American Academy of Pediatrics being bottle-fed past 24 months of age. recommends that infants be introduced to the cup around 6 months of age and be fully weaned from the bottle by 15 months to optimize appropriate feeding patterns.

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What should parents do? • Educate parents about the importance of giving their • Parents should introduce the cup at 9 months of age. children iron-rich foods. Give out lists of iron-rich By 12 months of age, their child should be completely foods and anticipatory guidance materials on best weaned from the bottle, drinking only from a cup. nutritional practices during well-child visits • Give toddlers iron-rich foods, including beans, meats, • Ask parents whether they are bottle-feeding children fortified cereals, eggs, and green leafy vegetables such older than 12 months; this will help identify children as spinach. at risk for iron deficiency. WR • Toddlers older than 12 months should drink no more than 2 cups of regular milk a day; drinking more than Jane Brotanek, M.D., M.P.H. is a pediatrician currently working at Ridgefield Pediatrics, a pediatric practice in Ridgefield, CT. Her areas of 2 cups/day decreases a child’s appetite for iron-rich foods. research interest encompass asthma, infant feeding practices and iron • We encourage parents to speak to their child’s deficiency, and cultural/language barriers to care among Latino children. In 2006, she received a Robert Wood Johnson Foundation Physician physician about best nutritional practices to prevent Faculty Scholars Program Award for her work on iron deficiency and early iron deficiency. childhood nutrition.

What should pediatricians do? Jane M. Brotanek, MD, MPH, FAAP • Educate parents about the dangers of prolonged bottle- Ridgefield Pediatric Associates, P.C. feeding early on, during their child’s first year of life. 38B Grove Street, Ridgefield, CT 06877 • Encourage parents to transition their child to the cup 203-438-9557 at 9 months of age, and wean their children from the www.ridgefieldpediatrics.com bottle by 12 months.

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BONE HEALTH AND OSTEOPOROSIS

Low bone density has been reported to affect 44 million women and men age 50 and older in the United States and is reported to be on the rise. With increasing awareness in the media, more women and men are gaining interest in learning about osteoporosis prevention and bone health.

steoporosis is the Silent Disease of Terrific I have listed some of the factors reported to increase one’s Consequences. It is characterized by low bone risk for Osteoporosis and fracture: density and deterioration in the structure of the • Advanced age O bone tissue that leads to bone fragility and • Low bone mass fractures (bones breaking). • Family history of osteoporosis/ fragility fracture • Under weight Osteoporosis leads to no pain until a fracture occurs. • Fracture of bone after age 50 Fractures may lead to health deterioration. These fractures • Menopause may be caused from little trauma or injury, such as falling • Low testosterone levels in men from a standing height, bumping into furniture, lifting • Low lifetime calcium intake and Vitamin D deficiency objects, etc… • No exercise

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• Cigarette smoking Osteoporosis medications may be prescribed by a health • Excessive use of alcohol care provider (HCP) when indicated. • Certain medications (corticosteroids and others) Additional information may be obtained from The diagnosis of osteoporosis is possible by a Bone Mineral www.nof.org and www.clevelandclinic.org/OsteoGuide, density test (BMD) and by assessing certain risk factors. Your and other resources. HCP can prescribe this test for you. I cannot emphasize enough the importance of early BMD testing is recommended for: detection of osteoporosis (before a fracture occurs) and • All women 65 years and older the importance of preventive care to a path for healthier • Younger postmenopausal women with one or more bones. Osteoporosis treatment and prevention of risk factors fractures are possible with appropriate medications • Patients who present with fragility fractures (to confirm and management approach. WR the diagnosis and determine disease severity). Feyrouz T. Al-Ashkar, MD, is the Section Head of Medical Specialties • Men above age 70 years at Cleveland Clinic Lorain Family Health and Surgery Center, where • Other medical conditions she practices internal medicine and rheumatology. A Fellow of the American College of Rheumatology, she has also been recognized as America’s Top Physician by the Consumers’ Research Council of The best prevention of fracture is optimal bone health and America in 2009, as well as becoming a member of medical societies such as the International Society of Clinical Densitometry and fall precaution. National Osteoporosis Foundation. Professionally, she serves the International Society of Clinical Densitometry and the National Fall precaution includes adequate exercise and muscle Osteoporosis Foundation. strengthening, improving balance with walking, removing obstacles in the living area that may be potential for fall Feyrouz Al-Ashkar, MD, FACR, CCD or tripping. Cleveland Clinic Lorain Family Health and Surgery Center Bone health recommendations include weight bearing 5700 Cooper Foster Park Road, Lorain, OH 44053 exercise, insuring the recommended calcium and vitamin D 440-204-7400 intake, avoiding smoking, avoiding excessive alcohol and www.clevelandclinic.org caffeine intake.

I cannot emphasize enough

the importance of early

detection of osteoporosis

(before a fracture occurs)

and the importance of

preventive care to a path

for healthier bones.

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A Successful Visit to the Doctor

Some changes in our aging body cannot be reversed no matter how much we would like to believe the promises we hear on television or read in magazines and newspapers. The best way to accept this fact of life is to become an informed partner in your health care.

condition treatable? Is there anything I should be doing differently? Why do I need this medication? Are my concerns justified and my expectations reasonable?”

The Best 15 Minutes Typically, the time you have with your physician during an office visit is very limited. Therefore, being prepared can help you “stretch” the time. • Being organized and writing down your questions before your visit can help you and your doctor make the most of the time. Prioritize by listing your most pressing questions and concerns first. • During every office visit, make sure to mention if you have seen any specialists, if you have had any changes in your Start with being an informed partner medications, and if you have noticed any functional changes. in your health care • If you are accompanied by a caregiver, ask him or her to First, learn as much as you can about your medical condition. voice any concerns or changes about your caregiving needs. However, be sure to choose your sources carefully. • Make sure to bring copies of any laboratory results or The amount of information on the Internet is overwhelming, reports from specialists you have seen since your last visit. and some of it is not based on facts. • Most importantly, listen carefully to any explanations Second, ask questions. Do not be afraid to ask your physician and recommendations. Taking notes during your visit if you do not understand something. Medicine is often very can help you remember your doctor’s advice so you can complex and difficult to understand. follow the instructions. WR Third, if you are concerned about the plan of care, go for a Juergen H. A. Bludau, MD, is the Clinical Chief and Director of Clinical second opinion. Sometimes, speaking to another physician Geriatric Service at Brigham and Women’s Hospital, where he practices can help you better understand your options and alleviate internal medicine and geriatrics. He is currently a member of the American Geriatrics Society and the Gerontological Society of America. your concerns. He devotes his time not only to practicing medicine, but teaching at the prestigious Harvard Medical School and writing. Communication and Trust

In addition to being well informed, you must be able to Juergen H. A. Bludau, M.D. speak openly with your physician for a successful Geriatrician partnership. Open communication requires both trust and 1620 Tremont Street, Boston, MA 02120 honesty from both you and your doctor. Tell your doctor what 617-525-7432 you can and are willing to do, and what you can accept and www.brighamandwomens.org live with. Ask for straight answers to your questions: “Is my

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Cataract Surgery… New Options

Could you benefit from the latest advancements in cataract surgery?

ust a few years ago when one was diagnosed with a the computer and read less reliance on glasses post- cataract there were not a lot of options to consider. operatively. Based on her patient feedback, spectacle freedom He or she simply scheduled surgery and hoped for an is the main reason for selecting this lens option. Tecnis J eventual return to normal activities. Now, cataract Mutifocal provides better vision for an active life. patients of Dr. Bovelle at Envision Eye & Laser Centers are educated on several different surgical options and for many, a return to AcrySof Toric – This type of lens provides a unique opportunity a normal lifestyle is happening faster than ever. Local surgeon to correct astigmatism and cataracts at the same time. The precise Renee Bovelle, M.D. is a clinician who strongly believes in the design on the lens allows for the reduction or elimination of efficacy of new cataract technologies. Her vast experience, her corneal astigmatism. This provides quality distance vision proven results and most importantly her patient feedback are without glasses postoperatively. all gauges she uses as she moves her practice forward. Dr. Bovelle is one of the few area surgeons that has the credentials, Approximately 3 million cataract surgeries are performed in the experience and the proven results to offer the above cataract the U.S. every year. A cataract is the loss of clarity or change in surgery options. With that in mind, if you or a family member, color of the crystalline lens. The lens, behind the colored part friend or neighbor is in need of cataract surgery, you owe of your eye, acts much like the lens of a camera, sending light it to yourself find out which options are best for you. Call and images to the retina, which then transmits them to your Dr. Bovelle’s office at 301- 805-4664 to schedule an evaluation. brain. Our lenses cloud naturally as we age, gradually resulting in blurred vision and difficulty seeing at night which can These procedures may not be suitable for every patient. All patients hinder one’s ability to perform even the simplest of daily tasks. must be evaluated by a physician as to the appropriateness of performing the procedure. No medical procedure is risk free. Dr. Bovelle offers a few options to help combat the effects of Associated potential risks and complications should be discussed the aging eye. One of the first things she will determine by with the physician rendering this procedure. WR having an open dialog with her patients is the type of cataract lens that best fits the medical and personal lifestyle needs Renee C. Bovelle, MD, works at Envision Eye and Laser Center in Glen Dale, Maryland. Dr. Bovelle and her team perform procedures including compre- of that particular patient as all options are not suitable for hensive eye care, cornea and refractive surgery, refractive cataract surgery, everyone. These Intraocular Lens options include: LASIK, Botox, dermal fillers, dry eye, diabetic eye exams, glaucoma, keratoconus and ptyergium. Her work has been published in medical textbooks nationally and internationally, and she has served several countries Standard Monofocal (Traditional) - This is the typical cataract by participating in health fairs and medical mission trips; she has been to surgery offered by most surgeons, designed to provide good Jamaica, Africa, and India in her international travels thus far. distance vision at a fixed focal point. However, most patients will most likely need glasses after surgery. Renee Bovelle, MD Envision Eye and Laser Tecnis Multifocal - This type of lens uses fixed zones that are 12200 Annapolis Rd, Suite 116, Glenn Dale, MD 20769 built into the optics of the lens. This option has become a 301 805 4664 larger part of Dr. Bovelle’s practice because of the overwhelming www.envisioneyeandlaser.com number of patients that have the ability to see at a distance,

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Patients’ Testimony to Support Innovative Therapy for RLS

In medical terms, RLS or Restless Leg Syndrome is defined as a neurological disorder that causes an irresistible urge to move in order to stop uncomfortable or odd sensations in the legs. RLS can have a destructive impact on the personal, social and professional life of patients.

ymptoms occur in moments of quiet wakefulness, surgical methods. If a patient has restless leg symptoms when trying to sleep, at meetings, in church, in classes, and clinical evidence of varicose veins, a work-up for venous while driving or sitting in the plane. They can range insufficiency should be considered. This work-up involves a S from mild itching to pain, aching, tickling, and limb duplex ultrasound evaluation of the leg veins. jerking during sleep. Patients clearly show that the Restless Leg Syndrome ends up running their lives. Then, if venous insufficiency is diagnosed, a therapeutic trial of conservative treatment including that of compression The challenges of RLS go beyond the need to move whenever stockings, leg elevation, regular exercise and weight loss is they should relax. It prevents sufferers from getting enough prescribed. If the patient remains symptomatic at the end quality sleep and in the end RLS diminishes their work of this period, definitive endovenous therapy is offered. performance, increases stress, triggers frustration, and impairs We have noted from the above treatment regimen of venous their private life. insufficiency, the majority of patients had a significant resolution of symptoms along with a decrease in medications. Currently, there are medications that promise to alleviate some of the symptoms. However, with time, they require a dosage The recent testimony of Dr. Nambiar’s patient who has increase and eventually stop working. Patients are ready to try suffered from RLS for the past thirty years comes to support anything just to enjoy a night’s rest. They replace their beds the success of his pioneering therapy. She was on the verge of and chairs, go to massage and chiropractors. They lay with breaking down into an anxious nervous wreck and was also their legs straight in the air, do kicks and scissors, or rub their on the maximum allowed dosage with her meds. She had legs. They even take cool and hot baths, or do alcohol and tried everything but nothing seemed to work. After having vinegar rubs. They do it all with the hope that it might work. Dr. Nambiar’s procedure on both of her legs, she stands In most cases, nothing works. completely amazed as she sees her legs rest peacefully on the bed while she is reading a book. WR The Leading Physicians of the World has the exclusive Dr. Rajesh Nambiar is a board certified interventional cardiologist who privilege to announce the addition of Dr. Rajesh Nambiar to has been practicing in Amarillo Texas for the past three years. He is the ranks of premier professionals as a result of his phenomenal also trained in various advanced and complex coronary procedures. He contributions in the field of medicine including the development has received training in comprehensive endovascular management of peripheral arterial and venous disorders. of an innovative therapy for the Restless Leg Syndrome.

His experience led him to discover that venous insufficiency Rajesh Nambiar, M.D.; F.A.C.C.; F.S.C.A.I is often missed as a cause of RLS. However, when recognized, Amarillo Heart Group. it is easily treatable and can lead to resolution of symptoms. 1901 Port Lane, Amarillo. Texas. 79106. Treatment of RLS is aimed at endovenous management of (806) 358 4596 chronic venous insufficiency with minimally invasive, non- ww.amarilloheartgroup.com

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Glaucoma What the average person should know and why

Glaucoma is one of the leading causes of blindness in America yet the average person rarely thinks about it or understands what it is. Even scientists still strug- gling to define what it is and what causes it. What is known is that the end result is loss of vision or blindness. It is rarely detected early without a thorough eye exam because it is usually a quiet disease. If it goes undetected and untreated it can cause complete blindness.

hat is glaucoma? In the past it was described pressure. Additional evaluation of the optic nerve is done by as elevated pressure in the eye that causes the physician’s direct observation. Technology now allows damage to the optic nerve resulting in loss a more objective evaluation of the optic nerve for damage. W of vision. There are, however, exceptions to The peripheral vision is usually the first part of the vision this definition. For example, there are people who have low affected by glaucoma. A Visual Field test is necessary to assess pressures that still meet the criteria to be diagnosed as having early loss. Treatment can help control the eye pressures and glaucoma. There are also people who have elevated pressures prevent loss of vision. Treatment options consist of medicinal but have no other exam findings consistent with the diagnosis eye drops, laser treatments and actual surgery. WR of glaucoma. Regardless of whether the pressures are high, low or normal, the common denominator is optic nerve Tina Tillis, MD, is a board-certified, fellowship-trained glaucoma specialist who also provides comprehensive eye care at her private damage. The optic nerve is the main connection of the eye to practice in Jacksonville, Florida. She has been named one of America’s the brain. I liken it to a cord to a lamp. That cord is made of Top Ophthalmologists in glaucoma for the past 5 years. Most recently, she served as Assistant Professor and Chief of Glaucoma at the several little wires that are combined to create a solid cord. University of Florida in Jacksonville. There, she developed a glaucoma If you loose a few wires no real problem but if you lose too service from the ground up. Now, she brings those skills and dedication many it will begin to affect the connection. Eventually there to the Tillis Eye Center. is not enough of a connection to allow the flow of electricity

and therefore there is a loss of light. The optic nerve is Tina N. Tillis, MD Rajesh Nambiar, M.D.; F.A.C.C.; F.S.C.A.I similar. It is made of several fibers that correspond to spots Tillis Eye Care Center Amarillo Heart Group. of vision. If enough of these fibers are damaged it affects the 580 West 8th Street, Jacksonville, FL 32259 1901 Port Lane, Amarillo. Texas. 79106. flow of information from the eye to the brain and can cause 904-244-9382 (806) 358 4596 blindness. There is no cure but there is control. Screening for www.tilliseyecarecenter.com ww.amarilloheartgroup.com glaucoma includes measurement of the vision and the eye

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New Hope for Dry Macular Degeneration

Traditionally, the only treatment Retinal specialists have had to offer their patients has been a supplement of antioxidant vitamins and minerals based on the Age-related Eye Disease Study (AREDS). These vitamins have shown a 25% reduction in moderate vision loss in patients with moderate to severe dry macular degeneration associated with drusen. A tremendous amount of research in the field has yielded new approaches to the treatment of this potentially devastating disease: retinal neuroprotection, visual cycle modulation, and complement inhibition.

etinal neuroprotection is aimed at protecting retinal tissue, and currently three novel drugs are being evaluated. Ciliary neurotrophic factor R (CNTF) is a growth factor capable of rescuing dying photoreceptors and protecting them from degeneration. An implant holding cells that produce CNTF can be placed in the eye with a minor surgical procedure. Results from a Phase 2 study showed an increase in retinal tissue thickness as well as improvement in vision in patients with good initial visual acuity. Brimonidine is used in the treatment of glaucoma and has been shown to be protective of certain retinal cells in animal and other The complement cascade is part of the body’s natural immune experimental models. It has been shown to have a positive system, and has been found to be over-activated in some patients effect on the retina in several types of disease states, with macular degeneration. By slowing down this pathway, and is currently being evaluated through an injected drug destruction of retinal cells may be avoided. Several new agents delivery system. Tandosporine is protective of retinal cells by are being tested in injection form. blocking cell death in times of high stress, and is currently being evaluated in a topical form in a phase 2 trial. Dry macular degeneration is increasing in incidence, and new research is being performed to combat this important public health risk. WR

Visual cycle modulation attempts to prevent vision loss by Karim N. Jamal, MD, sees patients at Retinal Consultants of Arizona in a slowing the accumulation of toxic byproducts in the retina. number of offices in the Phoenix area. Recently, Dr. Jamal has received the Acucela’s ACU-4429 is an oral medication currently in trial, AKEB Professional Achievement Award, has been named one of America’s top Ophthalmologists by the CRCA, and has written and contributed to and thus far has had a good early response. Fenretinide, several book chapters and peer-reviewed publications. a derivative of vitamin A, can down-regulate the visual system by binding a transport molecule. In a phase 2 trial, Karim N. Jamal, MD Fenretinide slowed the progression of atrophic macular Retinal Consultants of Arizona degeneration and reduced the conversion to wet macular 1101 E Missouri, Phoenix, AZ 85014 degeneration. This medication is currently moving into a 602-222-2221 phase 3 trial. It must be mentioned that any medicine that www.retinalconsultantsaz.com slows the visual cycle can cause trouble with night vision.

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Forget something? 10 Tips to Boost Your Memory

1. Exercise Your Body To Train 6. Easy Memory With Mnemonic Your Brain Devices Physical exercise allows more oxygen to reach the brain, Mnemonic devices are clues that trigger memory. reducing the risk of disorders associated with memory It may be anything from images to acronyms, acrostics, loss. Also, exercising stimulates the areas of the brain that or rhymes. Chunking information is also a great solution to are responsible for memory and learning. challenge your memory and enhance the learning process.

2. Sleep For A Good Memory 7. Get Your Senses Involved Memory is not a one-stage process. In fact, memory Memory can become stronger if you involve as many senses consolidation occurs during the deepest stages of sleep. as possible. Smell, hear, see, touch and taste and you will Therefore, for optimal memory it is important not only to encode memory much more efficiently. You can easily get enough sleep but also to get enough deep sleep. remember the name of a person if you shake his hand, pro- nounce his name or look him in the eyes as you meet him. 3. Socialize To Boost Your Memory Studies reveal that people with active social lives are 8. Eliminate Stress Factors less exposed to the risk of memory decline. Human Stress kills brain cells especially affecting the interaction maintains the brain healthy through hippocampus responsible for recording and storing permanent exercise. long and short term memories. You can eliminate stress through meditation, massage or other methods with 4. Nurture Your Brain With proven efficacy in this respect. The Right Food The brain is made of cells and cells need food. Without 9. Teach New Info To Someone Else food, brain functions are not performed in an optimal When you teach others, you are basically speaking out manner. You can eat foods that specifically target brain loud. Just like reading out loud, this process will allow health such as omega 3 fatty acids, fruits, vegetables, you to understand and recall better the material you wish green tea, or wine. Limit fat intake as it can impair to remember. As you teach, you organize information in memory and other cognitive functions. such a way that it is easy to understand and in this way you enhance the memory process. 5. Use Your Brain or Lose Your Memory 10. Pay Full and Undivided Attention Memory is no different than muscles in this respect. Although it seems obvious to pay attention in order You either use it or you will lose it. Therefore, do not to recall what you are presented with, the truth is that indulge in familiar tasks and work out your brain with people are not fully dedicated in this respect. Distracted new activities that will allow it to develop new brain by all kinds of factors, you end up forgetting the name of pathways. Stay sharp with brain games and you will have a person who has just been introduced to you. Block all a strong memory. distracting factors and focus on one task at a time. WR

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15 Tips To Live Beautifully And Age Graciously

As the aging process takes over, it becomes more and more difficult to restrain its effects. But what if you could live by a code of habits that would ultimately allow you to maintain your youth longer and age graciously? Slowing down aging is possible because the way you age is the product of how you lived your life. What you do can slow down or accelerate aging. It is all in your hands!

1. Use the Benefits of DHEA 4. Eat Blueberries A precursor to other hormones, DHEA supplements may Blueberries are very rich in flavinoids and antioxidants. help boost immunity, increase muscle strength, prevent Flavinoids trigger the synthesis of certain enzymes depression, obesity, lupus or adrenal insufficiency, which protect the body from age related ailments decrease insulin resistance, treat osteoporosis, improve including cancer, tooth decay, and heart disease. skin in older people, and enhance the cognitive function. Blueberries are the perfect anti-aging remedy.

2. Boost Your Vitamin C Intake 5. Meditate Vitamin C is vital for the production of collagen, an Meditation works by bringing down the heart rate and essential protein to the skin. As an antioxidant, it regulating blood pressure thus diminishing the risk of reduces wrinkles and perfects skin texture. Vitamin C cardiovascular conditions. Meditation stimulates the brings down cardiovascular risk and keeps off other synthesis of telomerase, an enzyme that plays a significant illnesses associated with aging. role in reducing the risks of cancer and diabetes.

3. Avoid Pre-Packaged Foods 6. Exercise More Pre-packaged foods are poor in nutrients but contain Physical training minimizes the shortening of telomeres high amounts of sodium, additives, fats such as which is the primary cause of aging at the cellular level. hydrogenated oil, and added sugars. All of these Exercising triggers the production of telomerase, the increase the risk of developing diabetes, high enzyme that stabilizes the telomeres, thus fighting the cholesterol, heart disease, obesity, or stroke. aging process where it starts off.

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Slowing down aging is possible because the way you age is the product of how you lived your life. What you do can slow down or accelerate aging. It is all in your hands!

7. Control Stress Levels Melatonin helps the skin rejuvenate and builds up the Stress triggers early onset aging by damaging DNA. The immune system. Melatonin is the only antioxidant that stress-aging relationship can be controlled by reducing can cross the brain barrier, protecting brain cells from stress levels through various methods such as enjoying free radical damage and forestalling brain disorders. nature, walking your dog, playing with kids, meditation, massage, exercising, and more. 12. Eat Chocolate The anti-aging benefits of chocolate are incredible. 8. Drink Red Wine Apart from being n effective antioxidant, chocolate also Drinking one glass of red wine every day will hinder the normalizes blood pressure and cholesterol levels. development of aging, allowing you to live longer. Red Furthermore, it has anti-inflammatory properties and wine contains numerous antioxidants from the skin and works as an anti-depressant. seeds of the grapes. Antioxidants are the enemies of free radicals that cause cell damage and consequently 13. Not a Day without a Smile trigger aging. Laughter can avert aging in many ways. Laughter exercises inner organs, stabilizes blood pressure and 9. Avoid Carcinogens blood sugar levels, enhances digestion, and stimulates There are factors that simply invite cancer to settle in. the immune system. Moreover, laughter decreases By reducing the exposure to these factors, you can slow muscle tension and helps you heal quicker. down the aging process. These factors are known as carcinogens and include smoking, secondhand smoking, 14. Eat More Fish and exposure to direct sunlight. Fish is a great anti-aging combatant when consumed at least twice a week. Rich in omega-3 fatty acids, fish is 10. Eat Garlic Every Day one of the most powerful anti-inflammatory foods Known for its beneficial effect on the immune system which ward off a number of age-related illnesses such and for increasing strength and endurance, garlic also as Alzheimer’s, osteoporosis, heart disease, or cancer. plays a significant role in lowering high blood pressure and clearing the arteries. A natural antibiotic, garlic fights 15. Hydrate your Body effectively many age related conditions including cancer. The elixir of life, water is essential for every cell in your body. Drink at least 8 glasses a day to hydrate your organs, 11. Develop A Sleep Schedule muscles and skin and battle off aging. Water helps main- During sleep, a hormone called melatonin is released. tain a moisturized skin and removes wastes from the body. WR

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Rise Up Against Sitting Disease

Sedentary disease is becoming the malady of the century. Millions and millions of lives are affected by the sitting disease that spreads almost like a virus. It has become a lifestyle and combating it is no longer a luxury but a necessity. Today, modern society is exposed to some of the most serious health issues of our times, triggered by the escalating rate of sitting disease. Heart disorders, diabetes, obesity, and depression can all be activated or aggravated by sitting from morning to bedtime.

itting disease, unlike other types of illnesses, can be with the kids in the back yard and not in front of the computer. controlled. Promoting physical training at the gym Make it a rule to tide up your home daily and you will consume does not improve the situation as long as people are a lot of energy. Also, exercise your calves as you brush your S otherwise inactive. You must rise against inactivity teeth. Basically, back up any sedentary activity with a bit of in all forms so that you go back to feeling good, enjoying life motion. Try dancing while you are on the phone, and your and being healthy. health will thank you.

Rise Against To Sedentary Living Regain Your Freedom To Move At The Office Take the stairs instead of the elevator. This is the golden rule. People spend more and more time at the office sitting down No matter where you are, shopping, visiting, or working, always and working. It may be great for your career but it totally take the stairs no matter if it is for one floor or ten floors. ruins your health. Therefore, get up and move whenever you Weed your garden or clean up the leaves, and you have have the chance. Exercise while you are on the phone, use a another way to burn down calories. Take the dog for a walk pedometer, replace the classic chair with an exercise ball, have and play with your pet. If you do not have a pet, get a dog. face-to-face walking meetings instead of video conferences, It is a great calorie burner. Park your car away from your or walk 15 minutes after you’ve had lunch. You can also park shopping point and carry the bags yourself. your car as far as possible from your office. You can enjoy a nice walk on your way in and on your way out. These are not difficult The gift of human life is so unique and precious that wasting things to do but they can add up to a lot of burnt calories. it is beyond justification; sitting disease is essentially misusing life, wasting it, throwing it away. It is not the result of some Put An End To Sedentary Living tragic circumstances but the result of sacrificing quality of life At Home in favor of comfort. Sedentary disease may not seem the At home you may just want to sit on the couch and watch TV. greatest challenge society has to face but it is a threat to the As you are living in the century of speed and there is no time very purpose of society: the quality of life its members. It is in to go to the gym, why would you not use this precious time your hands to regain control of your life and free yourself from that you are wasting sitting down? Stretch out while watching the reign of sedentary living. Every small step is a huge step your favorite episodes, clean the windows yourself, and play towards conquering the sitting disease. WR

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Early Detection and Prevention of AMD

Age-related macular degeneration (AMD) is the number one cause of blindness in Americans older than 50 and affects over two million people. Age-related macular degeneration (AMD) is a progressive, painless, breakdown of the macula, the critical part of the eye that captures images in your central vision (much like the film in a camera). “AMD causes loss of central vision, affecting your ability to perform activities such as reading or driving, both of which require good central vision,” says Via Christi Clinic Ophthalmologist Dr. Tamim Qaum.

here are two types of AMD: dry and wet. About Tamim Qaum, MD, MD, CPE, COE, CASC, CPHIT, CPEHR, CSSGB, 90 percent of people with AMD have the dry form, OCS, serves Via Christi Clinic PA in Wichita, Kansas. A Fellow of the American Academy of Ophthalmology, his clinical interests in which a usually gradual decline in central vision include cataract surgery, glaucoma, diabetic eye disease, macular occurs. The other ten percent have the wet form, degeneration, dry eyes, corneal abrasions/ulcers, urgent eye care T and retinal tears. Dr. Qaum’s research article on diabetic retinopathy, in which abnormal retinal blood vessels grow and leak, published 10 years ago, is now one of the Top 50 Most Frequently leading to a rapid and severe loss of central vision. Cited Articles according to the Association for Research in Vision and Ophthalmology. Many people do not discover that they have macular degeneration until their loss of vision becomes pronounced. This is because Tamim Qaum, MD CPE COE sometimes only one eye loses vision while the other continues CASC FAWM CPHIT CPEHR CPHIE CSSGB OCS to see. It is when both eyes become affected or when one eye Via Christi Clinic is covered that the vision loss becomes more quickly noticed. viachristiclinic.com Therefore, people over 50 should see their ophthalmologist every 316.858.2020 one to two years for a comprehensive dilated eye examination. WR

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Dr. Glenn Brottman Attending To The Health Of The Mind And Body

Plato, an enlightened mind of the past, uttered these wise words more than two thousand years ago with a profound regret for mankind: “The greatest mistake in the treatment of diseases is that there are physicians for the body and physicians for the soul, although the two cannot be separated.” If Plato were here today he would feel rewarded to encounter Dr. Glenn Brottman, a pioneer in treating both the soul and the body of patients.

r. Brottman is the physician who conceived at Cook County Hospital. Dr Brottman continued his and perfected a life-saving procedure to treat pursuit for knowledge and exploration of medicine with a depression without invading the body, neither General Surgery internship at Cornell’s New York Methodist D with surgery nor with drugs. He eloquently Hospital in Brooklyn. He engaged in his residency training called this amazing treatment TMS or Transcranial Magnetic in Psychiatry at St. Luke’s Roosevelt Hospital where he is Stimulation. TMS was recently approved by FDA as an effective, currently performing as an Attending Psychiatrist. non invasive and safe treatment for depression. Recognizing the significance of this major breakthrough, the famous Dr. Oz Dr Glenn Brottman is presently in private practice as a invited Dr. Glenn Brottman as a guest on his show. clinical psychiatrist, specializing in addictive disorders and treatment of resistant depression. As he developed the TMS TMS treats the body while healing the mind. The TMS treatment, he founded the TMS Center in New York. technology sends low-dose magnetic pulses to those parts of Dr Brottman has a full and active career that very few the brain associated with depression. Essentially, Dr. Brottman medical physicians enjoy. He has accrued more than 20 uses the properties of magnetic waves to stimulate the brain years of experience and is currently recognized as one of in a non invasive manner. 10 to 25% of women and 5 to 12% the best specialists in diagnosing, treating and preventing of men will become clinically depressed during their life time. mental illness. Understanding that the mind and the brain Anti depressants do not work every time and their side effects cannot be separated from each other, Dr Brottman’s expertise are already common knowledge. On the other hand, the ultimately led to the development of the TMS technology, results of the clinical trials for TMS are impressive and they a blessing for depressed patients and a major achievement promise a normal life to those who struggle with depression, for the world of psychiatry. WR a disease that deprives them of their joy for living. Glenn A. Brottman, MD Dr Glenn Brottman holds a Bachelor’s Degree in Biology 119 West 57th Street, New York NY 10019 from the Union College. He obtained his medical degree 212-969-1899 from the Chicago Medical School. He then left the benches www.tmscenterofnewyork.com of the Chicago Medical School to start his clinical training

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Cure for Cataracts: The “PILL” or the “DIAMOND.”

You have likely heard someone say “we will all get cataracts if we live long enough!” That is true generally, however, we must also appreciate that how we live, and what we do with our eyes, can influence cataract formation.

o understand what I am about to tell you, we must We have discussed the connection of our little brain to first appreciate that the eye is a brain. It is the big one and to our bodies. We have emphasized formed, embryologically, beginning the first month the importance of oxygen. But what’s a body to do T of gestation, as an out pouching of the frontal lobe without oxygen? of the brain, forming the optic vesicles. We have all been taught that the Optic Nerve connects the eye to the brain, yet Let us now understand the lens of the eye, and we will the Optic Nerve is really not a nerve in a true anatomic sense. quickly learn its fate. It is a fiber tract of the Brain itself. During the first and second months of gestation, the optic If we begin by understanding that the eye is a brain, the role vesicles protrude from the forebrain to touch the skin tissue of oxygen becomes clearer. Diabetes, glaucoma, macular of the developing embryo’s forehead (ectoderm). This touch degeneration and several other debilitating eye problems are by brain tissue (neuro-ectoderm) causes a disc of forehead actually oxygen deprivation syndromes to various and specific skin (the lens placode) to turn inside out. This invagination blood, and thus oxygen delivery to the eyes. forms the human lens, whereby the cells that divide are inside a capsule (a basement membrane). The lens is Water (H2O) makes up about 70% of our tissues; less well therefore a cyst! A cyst continues to grow and will increase recognized is that water is 80% oxygen. We can live many in size and mass unless it is confined. When this lens is days without water, but only a few hours without oxygen! forming it has a blood supply. Before birth, however, the blood supply withers, like a vine without water, and the cystic This is important in that the little brain, (our eyes), is very lens is left to make its own energy without delivered oxygen. dependent on the health of our bodies, good posture and the You may have heard of the Krebs’ cycle (anaerobic glycolysis). ability of our lungs to capture oxygen from the air we breathe. It is the making of sugar for energy without oxygen.

Glenn A. Brottman, MD 119 West 57th Street, New York NY 10019 212-969-1899 www.tmscenterofnewyork.com

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Most of us experience this change as presbyopia, or the need to remove our glasses or contacts to read if we are nearsighted, or the need for reading glasses or bifocals if we are farsighted. Most of us do not appreciate that this process (nuclear sclerosis) is the manifestation of a cataract!

Thus, two things are now happening to the little cyst we call This brings us to the fix. At present, the only solution is to our lens. The more we work it, the more energy it must remove a cataract from its capsule and replace it with a bionic manufacture. The longer we grow it, the bigger it gets. But, lens (an intra ocular lens implant) specifically selected for a the eye stops growing at about 20. The lens continues to precise, desired correction. These lenses can be single vision, grow all our life. It runs into things, like the jelly (vitreous multifocal, accommodating, or astigmatic. While we still live body) behind it, or the color of our eye (iris) and the fluid with some limits of prescription and function, almost all eyes (aqueous) in front of it. with intra ocular lenses can be optically refined by Laser Vision adjustment of the cornea after surgery, if necessary. It ultimately gets squeezed, and the water within its cells is displaced from the oldest lens fibers in the center (the Currently, diamond micro-knives are most commonly used to nucleus) which then becomes hard (sclerotic.) Most of us make the largest incision (about 2mm, less that 1/10th of an experience this change as presbyopia, or the need to remove inch) in the cornea to remove a cataract by a combination of our glasses or contacts to read if we are nearsighted, or the ultra-sound and suction. Lasers are now also being used to need for reading glasses or bifocals if we are farsighted. make these incisions, and to separate the hardened nucleus Most of us do not appreciate that this process (nuclear of the cataract. sclerosis) is the manifestation of a cataract! So, what of the pill? Perhaps now you know that it is naive to The word cataract, from its Greek origin, means waterfall! expect a pill to stop the lens from growing, unless, of course Water, of course, wherever it is, will fall towards gravity. If you it contains Arsenic! think of the lens like the shape of an M & M when young, as the water falls it sags, and warps, like a teardrop. This causes At present, the diamond is a better option. WR lenticular or cataract induced astigmatism. We can no longer Wesley K. Herman, MD, is a LASIK vision specialist in Plano, Texas at correct this with external devices like contacts, glasses or Vision Quest. Fascinated at an early age by the similarities of the even LASIK. photography process and the eye, Dr. Herman is one of a select group of North Texas surgeons who are fellowship-trained in corneal and anterior segment surgery. He holds 13 US and international patents, and is Hopefully, I have helped you to understand that all of us will regarded as one of the top ophthalmic microsurgery and LASIK specialists likely experience cataracts. The important message is not IF in the country. they should be removed, but WHEN. Several reasons that involve the permanence of visual correction for high Wes Herman, MD refractive errors like nearsightedness, farsightedness and/or Vision Quest astigmatism, or to enhance the management of glaucoma, Medical Director: SurgEyeCare, Inc. diabetes, retinal disorders or certain corneal infections related EyeCare and Surgery Center to decreased oxygen in the tear film are specific. Each could 5421 La Sierra Drive, Dallas, TX 75231 play a part in the decision of WHEN or WHY you elect to have (214) 361-1443 Ext 110 a cataract removed.

84 TheWaitingRoomMagazine.com doc SPOTLIGHT

Dr Tamim Qaum An Explorer and Healer of the Eye

Ophthalmology is a challenging medical field populated by some of the most talented and extraordinary surgeons and diagnosticians in the world. Throughout his professional experience, Dr Tamim Qaum has permanently demonstrated the vision, skill, and expertise to be considered among the best in his line of work.

r. Tamim Qaum launched his career with a VEGF to be normalized, reduces leucocytes adhesion, Master’s Degree with Honors in Ophthalmology endothelial cell injury, and blood-retinal barrier breakdown. from one of the most prestigious institutions in It also decreases the levels of certain VEGF mediators such as D the field, the Harvard Medical School. He retinal eNOS, nitric oxide, protein kinase B, and MAP kinase. continued his journey to success with an Internship at the Riverside Regional Medical Center, in Newport News, Vancouver. Within this context, the angiopoietin-1 becomes the only Additionally, his residency developed at the Duke University Eye naturally occurring protein that has the amazing capacity to Center in Durham, North Carolina. As he explored the mysteries protect the vasculature of the retina in case of diabetes, of ophthalmology, Dr Tamim Qaum discovered his specialties in macular degeneration or even certain types of glaucoma. cataract surgery, glaucoma, diabetic eye disease, macular This extraordinary triumph is the credit of Dr Tamim Qaum, degeneration, dry eyes, retinal tears, and corneal abrasions. an ophthalmologist dedicated to his profession entirely.

But the contribution of Dr Tamim Qaum to the progress of Considering that diabetes has been an increasing concern in ophthalmology is far greater than his achievements in cataract the United States over the recent years, the achievement of Dr surgery. His pioneering research in discovering a medical Tamim Qaum holds an even greater significance. solution for diabetic retinopathy has revealed that anti-VEGF therapy can be used to prevent damage to the retina caused by According to the Association for Research in Vision and diabetes. Today, millions of people across the globe suffering Ophthalmology, the article published in 2002 by Dr Tamim from diabetes can prevent blindness with a simple injection in Qaum on anti-VEGF therapy for diabetic retinopathy is highly the eye. Statistically, diabetic retinopathy affects 80% of people regarded as one of the top 50 most frequently cited articles. suffering from diabetes for more than 10 years. The accomplishments of Dr Tamim Qaum are not only recog- Diabetic retinopathy is the principal cause of irreversible nized by the ophthalmologic community but also by former blindness. It commences with the adhesion of leukocytes to US President Bill Clinton as well as former New York City Mayor the retinal blood vessels which ultimately leads to injury of the David Dinkins. Dr Tamim’s involvement in community service endothelial cells and breakdown of the blood-retinal barrier. activities has been officially appreciated by former First Lady The process manifests with overexpression of the retinal Hillary Clinton and former New York Governor George Pataki. WR Vascular Endothelial Growth Factor or retinal VEGF. Dr Tamim

Qaum discovered through documented research an anti-VEGF Tamim Qaum, MD CPE COE therapy based on the intravitreal administration of CASC FAWM CPHIT CPEHR CPHIE CSSGB OCS angiopoietin-1. Thus, angiopoietin-1 does not only prevent the Via Christi Clinic | viachristiclinic.com adhesion of leucocytes to the retinal vasculature but it can also 316.858.2020 reverse the process if already ensued. Angiopoietin-1 allows the

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THERE IS NO EXCUSE FOR NO DENTAL CARE

I have been practicing clinical dentistry and been on this planet long enough to have heard every reasonable excuse for avoiding dental care. I have yet to hear a good one.

ur dental practice in Maryland has successfully or in-patient facility. Mobile vans are fully equipped to handle treated thousands of phobic, anxious, most dental problems. Mobile teams use hand-held x-ray mentally challenged, autistic, and medically units with self-developing films or laptop instant imaging O compromised patients. We’ve been able to systems to diagnose problems. Portable x-rays with protective accommodate infants through Alzheimers patients. What I radiation barriers, are coupled with mobile dental carts, and have learned is whatever the reason given for avoiding the provide the same dental procedures available at the office. dental office, there’s always a way to overcome the problem. Whatever reason kept you or your loved one away from the Are you afraid of the dentist? Perhaps walking through dentist, the road back is readily available and easier than you the office will calm you down, or learning more about the think! Over the past 38 years our practice has successfully treatment using videos or demo models will make you less performed over 32,000 oral sedations in our office. 3% of afraid. If it doesn’t, we can prescribe pills or liquid drugs that the time oral sedations at our office couldn’t be done, or you can take right before your appointment. If you’re even failed due to autism, severe combativeness, or major medical more apprehensive, you can also take an oral sedation pill concerns. Those patients were able to receive treatment, before going to bed the night before your appointment, and safely and successfully, with the help of an anesthesiologist be treated with nitrous oxide (laughing gas) to relax you in a hospital operating room. during treatment. Other options to deal with anxiety include behavior modification, hypnosis or acupuncture. Whatever excuse I hear for someone not going to the dentist, know that there’s always a way to overcome it. What is not If your loved one is an infant, or is mentally challenged, acceptable are the complications resulting from the lack of autistic, or suffers from Alzheimers, they can also receive dental care – from bad breath to infections that start in the effective dental treatment. Intravenous sedation can be mouth and threaten your health. WR offered in an office setting, or these patients can be treated Harvey Levy, DMD, MAGD, works at Dr. Harvey Levy & Associates, PC in in a hospital or surgical center operating room. There, the Frederick, Maryland. Specializing in the treatment of anxious and special needs patients, he ran the 2002 Winter Olympic Torch in honor of his patient is totally asleep while all the needed work is being dental care for special-needs patients. Dr. Levy holds eight fellowships, performed, and has no recollection when they awake. four diplomates, and has earned Mastership and three Lifelong Learning An extremely anxious patient can also be treated in this Service recognition awards from the Academy of General Dentistry and ADA Access to Care Award. manner, with the advantage that work that would take several visits to the office can be successfully performed in Harvey Levy, DMD, MAGD only one visit to the O.R. Dr. Harvey Levy & Associates, PC 198 Thomas Johnson Drive, Frederick, MD 21702-4437 If you cannot come to the office due to mobility issues, age, or 301-663-8300 medical complications, dentists with portable equipment can www.drhlevyassoc.com come to you, be it in a nursing home, private home, institution,

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FUNCTION OR AESTHETICS? BOTH.

Traditionally the focus of dentistry has been on biological care such as cavities, gum disease and overall oral health. Treatment planning was solely based on these factors and aesthetics was the very last factor, often not a factor at all. With the new generation of dentistry there is a new shift towards balancing health, function and beauty. A beautiful smile today is more important than in the past few decades as people pay more and more attention to their appearances alongside social influences. Dentists now have more capabilities to create the best smile possible for patients without neglecting function.

s a dentist, my main goal of aesthetic dentistry In the last decade with the development of new equipment, is to develop a harmonious balance between the materials and technology, smile design has become masticatory system and the rest of the face. more accessible and sophisticated but more importantly A There are key principles of aesthetics dentistry that predictable. We can now design and visualize the end are important to consider when designing a patients smile. result prior to any dental work. This also enables easier communication between dentists, patients and laboratory

Harvey Levy, DMD, MAGD 1. Tooth Proportion – size and contrast between teeth technicians to achieve the best results possible. Now patients Dr. Harvey Levy & Associates, PC and gums can see the end results and customize their own smile 198 Thomas Johnson Drive, Frederick, MD 21702-4437 2. Patients Desire - what the patient wants based on their own preferences. 301-663-8300 3. External Influences – social and cultural www.drhlevyassoc.com 4. Dentist’s own artistic vision and ability Behind the technology is the dentists’ own artistic vision and 5. Communication between the dentist and the laboratory knowing the basic principles of beauty and following them.

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Dentistry and art are interrelated in that symmetry, harmony 3. Patient Sex (Upper Incisors) – For female patients these and proportion are key. If these factors are not considered, in teeth should be round edged, soft and smooth and most cases you will not have a happy patient. It’s like painting for male patients these should be more rectangular someone’s portrait with perfect features but moving the nose and strong. away from the midline of the face. You may have great features but something just looks slightly off. I believe in order to 4. Patient personality (Canines) – Pointy and longer cusps achieve the perfect smile, the following main factors must be appears more aggressive and blunt and shorter cusps considered and incorporated into the smile design: appear softer.

1. Midline of the face – Ideally the midline of the two upper 5. These are just basic principles that I believe are central teeth should be parallel and inline with the midline essential to consider and/or follow, but there are more of the face. It is generally still acceptable if the midline that must be considered. Lastly, never forget to factor in of the teeth are parallel and 2-4 mm away from the the patients desire. WR midline of the face. To the normal eye this still appears to be symmetrical. However, if the midline of the two central Dr. Keivan Ansarian received his doctorate of dental surgery in 1992 and since then he has had his focus on comprehensive restorative teeth are not parallel to the midline of the face the normal dentistry and implants. He is a member of the ITI and has been eye will catch the asymmetry immediately. involved with the clinical practice of implant dentistry since 2003. He currently resides and practices in Toronto.

2. Upper central teeth – These serve as a starting point to smile design because every other tooth in the smile line Keivan Ansarian, DDS has to be proportional to these two teeth and the position 46 John Street, Toronto, of the teeth also dictate the gingival level. When the mouth Ontario M5V 3W2 is in a relaxed position and open slightly, the ideal visibility 416-340-2727 of the central teeth is 3.5mm in young individuals. As we age, www.ansarian.com there is less tooth display because of masticatory functions.

BEFORE: AFTER:

We can now design and visualize the end result prior to any dental work. This also enables easier communication between dentists, patients and laboratory technicians to achieve the best results possible. Now patients can see the end results and customize their own smile based on their own preferences.

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Restoring Keivan Ansarian, DDS 46 John Street, Toronto, Ontario M5V 3W2 Worn Dentition 416-340-2727 www.ansarian.com

When someone’s teeth show signs of extreme wear, not only can it be very uncom- fortable and affect whole body health, but restoring the teeth to their natural state can be very difficult and very expensive.

ortunately, advances in dentistry have been huge few years, to restore their teeth step-by-step instead of all- over the past decade thanks to extensive research at-once. This makes for shorter appointments, easier treatment, and development. New materials allow more utilization of insurance benefits, and spacing of financial F conservative treatment options and spacing treat- obligations. Now people who need major restorative dentistry ment out over time to help manage the expense of major have access to it when it used to not be an option. W R dental work. There are some situations in which a person’s teeth are worn or decayed to a point that the entire bite Dr. David Slaughter works at Austin Cosmetic Dentist, his private practice in Austin, Texas. Specializing in restorative dentistry, he is currently a needs to be rebuilt. This is known as a full mouth member of the American Dental Association, Texas Dentist Association, rehabilitation. Traditionally, this would involve placing Capital Area Dental Society and the Academy of General Dentistry. Dr. Slaughter also served as Co-Chairman of Capital Area Dental Society’s crowns on every tooth—usually all in one appointment. Young Dentist Committee, and was awarded with a New Dentist of the Most people cannot afford this type of treatment, ultimately Year award in 2003. resulting in the loss of teeth. A newly developed laboratory

fabricated composite has allowed us to develop new David A. Slaughter, DDS techniques for these situations. We can rebuild someone’s 15004 Avery Ranch Blvd., Building C, Suite 100, teeth with this material for a fraction of the price of Austin TX 78717 traditional restorative materials. This is not a definitive 512-258-2233 restoration, but rather a way to get someone to a stable bite www.austindentist.net and proper oral health. Now this person has time, even a

TheWaitingRoomMagazine.com 89 healthy SMILE Say Yes To NO (Nitric Oxide)

SAY NO to High blood pressure, heart attacks, Strokes, Diabetes, Arthritis, Kidney Disease and more.

hat is NO? How is it made: It is a signaling molecule that is one atom One pathway comes from an amino acid L-Arginine (a of nitrogen and one atom of oxygen. It is a component of protein food such as meat, fish, dairy, beans and W gas when it is created which when released nuts). This process is sparked by an enzyme called Nitric Oxide easily penetrates nearby membranes in our bodies and Synthase known as NOS. NO is also derived from nitrite and signals the arteries to relax and expand, immune cells to nitrate. Many doctors including myself supplemented patients kill bacteria and cancer cells and brain cells to communicate with L-Arginine. However, when this occurs only 3% of it is with each other. It is not to be confused with nitrous oxide converted to L-Arginine and studies have shown this is an (N2O). NO sends signals within every cell, tissue, organ and ineffective way to boost your NO levels. Niroglycerin works via body system. Its most important function is the signaling the NO route. It is transformed into nitrite and converted into function within our circulatory system. The endothelium is a NO. As with most drugs the effect is only good for a short single cell lining of all our blood vessels. If you took all the period of time and becomes ineffective. As we eat foods high endothelial cells and laid them out flat in our bodies they in nitrites (NO2-) and nitrates (NO3-) this helps our bodies would cover a soccer field!. No signals the smooth muscle make NO. New research shows Nitrates are broken down in our outside your blood vessels to relax reducing blood pressure, mouths by bacteria to nitrites. When the nitrites are send to the increasing blood flow and oxygenation of your tissues. With acid in the stomach they form NO which is in turn send out enough NO you also help prevent build up of plaque which thru the circulatory system in the body. One pathway that is lessens your risk of heart attacks, strokes and cardio- more effective in achieving a higher conversion of L-Arginine vascular disease. to NO is using the amino acid L-Citrulline.

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NO signals the smooth muscle

outside your blood vessels to relax

reducing blood pressure, increasing

blood flow and oxygenation of

your tissues. With enough NO

you also help prevent build up

of plaque which lessens your risk

of heart attacks, strokes and

cardiovascular disease.

What foods have high levels of Nitrites and Nitrates with high How to test NO levels and what other supplements to take if levels of NO in our bodies: your levels are too low: Kale is at the top of the list as well as other dark green There is new technology to check NO Levels. A company veggies. The No index for some foods would be Kale-6825, called Neogenis (www.neogenis.com) developed a litmus Swiss chard-2055, arugula-1452, spinach-1123, boc Choy 775, paper to put in your saliva that will match to a scale to read Beet-632 and at the low end Hog dogs-1, Bacon-1, Ham-0. your NO levels. Most people I have tested are low or depleted. You get the idea. I recommend juicing to help increase your It seems only people like me and others that juice and eat a levels with lots of raw dark green veggies. lot of raw dark green veggies had adequate amounts of NO. They also developed a tablet usually initially taken twice a What other things increase NO in our bodies besides food: day called Neo-40 that will help restore your levels. I use this Exercise one of the reasons it is so important to cardio- when diet or lifestyle is not adequate. For further info on NO vascular health-it generates NO and improves blood flow and I highly recommend the book “The Nitric Oxide Solution” by lowers blood pressure. Also increasing NO allows you to Nathan S. Bryan, PhD. WR exercise more! Fish Oil supplements increase NO. Deep Mark Berkowitz, DDS, has had a private practice in Morganville, New breathing generates NO. We have higher concentrations of Jersey for the last 20 years. He is an accredited dentist and serves on the NO in our nasal passages. As we deep breathe thru our noses Board of Directors with the International Academy of Oral Medicine and more NO is picked up and sent to our lungs which open the Toxicology (IAOMT). Dr. Berkowitz serves the teaching faculty of the American College of Integrative Medicine and Dentistry (ACIMD), and has circulation in our lungs and increase oxygen flow. Hydration lectured with Dr. Robert O. Young (The Ph Miracle) regarding nutrition and increase NO too. A study showed that men that drank 5 mercury toxicity. glasses of water a day had a 46% lower risk of having a heart attack, TCM or traditional Chinese Medicine also has been Mark Berkowitz, DDS, NMD, IBMD, C.Hom found to increase levels.. Chanting OM or one and relaxation 459 State Route 79, techniques have been found to increase levels. A sauna Morganville, NJ 07751 especially a far infrared sauna will also raise levels of NO. 732-591-1112 Lastly proper length and quality sleep will increase levels. Increasing NO will allow you to sleep better.

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LIVE A LONGER AND HEALTHIER LIFE!

Treating disease and infection before it hurts or breaks is the best method to prevent future problems and escalated costs. It has been said that the eyes are the window to the soul, but I think the mouth provides a better view of the body as a whole. As a dentist, I see signs of disease everyday. Some of the earliest signs of Diabetes, Cancer, Immune Disorders, Hormone Imbalances, and Drug Issues show up in the gums, teeth and tongue—sometimes long before a patient knows anything is wrong.

n addition to seeing signs of systemic diseases in If you want to minimize your risk for inflammation and dental pain: the mouth, there is significant data showing 1. Get an examination to find out and treat decay and gum a direct correlation between inflammation in disease and remember, pain is NOT a good indication. I the mouth and inflammation in the body. 2. Maintain your preventive visits as recommended based on We now know that inflammation in the mouth can harm your risks for decay and gum disease. a patient’s general health, raising the risk of Diabetes, 3. Keep your dentist informed of any changes in your health, Heart Disease, Stroke, Pneumonia, and Cancer and diet, or medications you take. Pregnancy Complications. Further, the most common diseases in humans are tooth decay and gum disease, We all know that you will live a longer, healthier, and more which can be diagnosed early and prevented. Studies fulfilling life if you take care of your body. Do not forget to are conclusive that people who keep their mouths take care of your mouth as well! WR healthy actually live longer. In fact, it has been proven that people that floss every day and see their dentist Frank Orlando, DDS, FAGD, FICOI maintains a private practice in Midtown Manhattan. Dr. Orlando specializes in conservative cosmetic and implant at least 2 times per year for maintenance live 6.5 years dentistry with a holistic and individualized approach. Dr. Orlando is a Fellow in longer than those that do not. both the Academy of General Dentistry and the International Congress of Oral Implantologists. He is also a founding member of the American Academy of Oral Systemic Health, a group that encourages collaboration between dentists Prevention is the key. Treating disease and infection and other health care providers to improve total patient care. before it hurts or breaks is the best method to prevent future problems and escalated costs. A major mis- Frank Orlando, DDS, FAGD, FICOI conception with dentistry is that your teeth and gums Founding Member of the American Academy Of are healthy unless you feel pain. This, in fact, is false! Oral Systemic Health Though it would be hard for your family doctor to look 24 West 57th Street, Suite 701, New York, NY 10019 at you and say, “You’re going to get sick next month”, in (646) 926-7402 dentistry, we can confidently tell people, “If you don’t fix www.drfrankorlando.com this issue (tooth or gums), it will start hurting soon.”

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It’s Not Just a Cleaning!

Approximately 40,000 new cases of oral cancer will be diagnosed this year in the United States alone. If diagnosed in the early stages, oral cancers have an 80-90 percent survival rate. Unfortunately, most are found at a late stage which has a 45 percent death rate at five years from diagnosis. This is a very alarming statistic, especially since the occurrence has been increasing steadily for the last five years.

valuable new tool for the early detection of oral I have had patients miss their cleaning appointments for as cancer is now available. It utilizes visible light long as two or more years, citing a lack of insurance or other and a special filter to help locate oral cancer reasons. I feel very strongly that patients should be aware A before it can be seen by the naked eye or even that they are not missing just a cleaning but also an with magnification. Early detection is the key to increasing important examination and screening. If oral cancer is the survival rate for oral cancer, so it is comforting for diagnosed, I would feel more comfortable telling a patient: patient and dentist alike to know a potential problem was it was not present at your appointment just six months ago. not there just six months ago. All statistics in this article were taken from The Oral Cancer When my patients come in for their dental cleaning appoint- Foundation, Inc. WR ments, I do a thorough dental examination, checking for cavities, broken teeth, or fillings. I then perform an oral cancer Carrie L. Polster, DMD, has a private practice in Midland Park, New Jersey. Also on staff at Valley Hospital in Ridgewood, she is a long-standing member screening. This includes checking the cheeks, tongue, lips, of the American Dental Association, New Jersey Dental Association, Bergen and tissue inside the mouth as well as glands and lymph nodes County Dental Association, the Academy of General Dentistry, and the in the neck. I also examine the gums for periodontal disease. Academy of Facial Esthetics. She is also a founding member of the Ridgewood Valley Study Club.

The primary reason for tooth loss in an adult is periodontitis

(gum disease). If caught early we can treat and prevent the Carrie Polster, DMD progression of this infection. If you have a heart valve or 30 Prospect Street, Midland, NJ 07432 joint replacement, you need to take antibiotics prior to dental 201-444-5675 treatment. I feel this alone should be a sign that there is a www.drcarriepolster.com link between your overall health and the health of your teeth and gums.

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Take a Chill Pill Oral sedation helping to make the bad dental memories and phobia fade

Whimsical. Remember that popular 70’s phrase? It offered quick, easy & free psychotherapeu- tics to those perceived ‘uptight’. To digress for a quick second, why is it that more “stuff ” came out of the 70’s? Examples abound even beyond phraseology. Think style (tie dyes, bell bottoms, wide ties & hair). Think anti-establishment (counter-culturists & recreational habits). Think revolutions (anti-war & prosex). Likely (due to the aforementioned ‘habits’), the 70’s was our most creative decade, for better or worse.

K (you’re saying) the dental connection please… the response for the majority of them. Perversely, those First, the answer (respecting 70’s visionary who most desperately need early intervention and simple “The Great Carnac”), is oral sedation dentistry. treatment are the ones who just say no to oral care. O Second, the question … Who’s not ‘uptight’ when faced with the prospect of significant dental treatment? Enter sedation dentistry, and with it this virtually rhetorical question. “If there was a way, with sedation, that a dental Discomfort associated with today’s state-of-the-art dentistry patient could have their treatment accomplished in minimal is vastly different than a even a few decades ago. However, visits (as little as 2 or 3), with complete confidence of try telling that to the multitude of adults who develop sweaty comfort and little memory of the experience, would this be palms just thinking about a visit to the dentist. The fear is more encouraging?” Add in an exemplary safety record real and it has no boundaries. It can affect all types of and it’s no wonder today’s oral sedation is helping make people. There is no age, sex, economic or race discrimination the bad dental memories and phobia fade like a really cool guidelines. Research shows that almost 30% of our population pair of jeans. WR avoids going to the dentist due to fear. DOCS’ (DDS William J. Schlotz, DDS, works at Plaza Health Dentistry in St. Louis, Organization for Conscious Sedation) estimate is closer to 50%. Missouri. Specializing in conservative implant and cosmetic dentistry, Dr. Schlotz is the creator and author of a column in a local St. Louis newspaper; the articles focus on cosmetic, preventive, and specialized I attended a DOCS conference recently in Boston, MA. minimally invasive procedures. With a focus on patient education, The attendees’ fear of dental treatment was quantified Dr. Schlotz brings patients tomorrow’s dentistry today. by hidden ballot. Of these dental professionals surveyed,

40% were either moderately or severely anxious of the thought William J. Schlotz, DDS of having dental work done on them. Plaza Health Dentistry 9420 Watson Road, St. Louis MO 63126 A huge segment of our population has intense, realistic, 314-843-0500 palm-sweating, sick-to-the-stomach, eye-popping and www.TheConservativeDentist.com sleep-depriving fear. Avoidance of dental treatment is

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DESIGNED TO PERFECTION

My first grandchild was born today. He came equipped with ten perfect fingers and toes, perfect little arms and legs, and a pair of eyes that bore into the camera that took his first portrait. His tiny fingernails, lips, and nose are also flawless—all testaments to the perfection of the design of the human body. More mysterious is how the heart knows how to beat, the lungs to breathe, the muscles to move, and the eyes to blink.

hat part of this perfection of the human body eventually rubs directly against bone with every chewing, should we discard? Would anyone desire the swallowing, yawning or speaking movement. future loss of an eye or a limb? And yet, W every week I hear someone say, in regard to Modern dentistry has remarkable restorations for damaged his teeth, “Just pull it, Doc, and someday I’ll get a set of dentures.” teeth or unsightly smiles. Missing teeth can and should be replaced. My wish for my grandson is the natural smile that Our natural teeth give us important information. Because of was designed for him. My wish for you is the same. WR ligaments that connect the teeth to the underlying bone, Dr. Anita Myers became interested in dentistry when she was just fourteen we are alerted to the presence of undesirable ingredients years old, after suffering from a rare dental condition. She is the owner of such as pits or shells in our foods. Our teeth alert us about Bella Vita Smiles in Spring, Texas. A Pankey Scholar, Dr. Myers also temperature extremes in advance so we are less likely to participates in the Give Back a Smile program, helping those who are victims of domestic violence smile again. injure the tongue or throat. Teeth help us chew and absorb more nutrients so our bodies can thrive. Anita Myers, DDS Bella Vita Smiles We also use our teeth to communicate with one another, 8111 Cypresswood Drive, Spring, TX 77379 offering a smile of friendship or send a warning with a 281-379-7353 threatening snarl. Front teeth help us speak more clearly, www.bellavitasmiles.com and the back teeth not only help us grind our foods, they also provide a stable support system for the jaw joint and chewing muscles.

Healthy teeth fit together with perfect synchronicity, evenly distributing the forces that our muscles can apply when we clench. And boy, do we clench! Some of us clench when we sleep, when we’re stressed, or just when we’re concentrating. Other people grind, sliding their jaws one way or another

William J. Schlotz, DDS that results in “wear,” the permanent loss of enamel. Plaza Health Dentistry With the loss of a single tooth, the bite can become 9420 Watson Road, St. Louis MO 63126 unbalanced and cause many people to suffer from the 314-843-0500 headache-like pain that results from spasms of the jaw www.TheConservativeDentist.com muscles. Others endure breakdown of the internal mechanism of the jaw joint, a process where bone

TheWaitingRoomMagazine.com 95 doc SPOTLIGHT

Dr. Margareta D. Gavrila An Outstanding Advocate Of Dental Health

With an admirable commitment to excellence, Dr. Margareta D. Gavrila is acknowledged among the most prestigious dentist professionals in the world. A famous Greek philosopher, Aristotle, concluded that “Excellence is an art won by training and habituation. We do not act rightly because we have virtue or excellence, but we rather have those because we have acted rightly. We are what we repeatedly do. Excellence, then, is not an act but a habit.” The career of Dr. Gavrila comes to testify for the truthfulness of his words, thousands of years later.

ltimately, Dr. Margareta D. Gavrila feels rewarded community can also be noticed through her donations of for her dedication, diligence, and perseverance dental materials as well as other items. Dr. Margareta Gavrila as she is running her restorative and cosmetic encourages the members of her community, especially young Udental practice. With the responsibility of the hearts, to become socially responsible and allow good deeds medic extensively trained and certified in TMJ-TMD treatment, to become part of their lives. To this purpose, she organizes implant restoration and Invisalgin, she continues to advocate contests such as the Good Deed Contest through which for optimum dental health, prevention and proactive care. children are rewarded with a computer for a good deed Her client-oriented approach focuses on using her skills and they have done and presented in an essay. As a promoter of expertise to secure the lowest rates of dental problems among dental health, Dr. Margareta Gavrila has voluntarily thought her patients. Dr. Margareta Gavrila embraces the principles of classes for 7 years at the USC Dental School. Although she adequate dental care which grant her patients not only comfort has left her native country almost 30 years ago, Dr. Margareta but also confidence to smile, chew, laugh, and enjoy life. Gavrila has returned to Romania once for every year of her practice in the United States to volunteer her time and also Moreover, she gets involved in philanthropic projects which to lecture at local dental school and promote excellence include providing free dentistry services to the less fortunate in dental care. WR ones. Understanding that more and more people sacrifice dental health care because they cannot afford insurance Margareta M. Gavrila, DDS co-payments, Dr. Margareta Gavrila is sponsoring a Dental 13197 Central Avenue, Suite 202, Chino CA 91710 Emergency Day when her clinic invites community members 909-628-3912 to come in and have free dental cleanings, simple extractions www.gavriladds.com and fillings for emergency needs. Her contribution to the

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The Fulfillment Of Life After A Successful Career

Unexpected Doors are Opened

Life opens unexpected doors. I have been in full time practice since 1987. A year before the tsunami hit in 2004 I was in my back yard cutting down a tree. A heart surgeon walked up to me and said he was looking around the neighborhood where he had grown up some 40 years ago. He was also excited about just coming back from Iran and he gave me the contact information. Well, a year later the tidal wave hits and, like many, I wanted to help but I was just leaving for Venezuela and could not cancel that trip. When I returned, I started to consider what I could do during my next vacation. I remembered Iran and out of a sense that a door had been given me, I called and indeed they needed an anesthesiologist in the near future. My daughter, friends, and staff at work expressed their fears. I practiced my captivity speech and off I went with open arms to meet up with a group of people I had never met or worked with before.

ife after a career is another career. After my medical mission to Iran in 2005, I decided to join the ranks of those seeking to help in areas of great L need. Poverty, political isolation and large refugee populations all mean shortages of medical care based on financial deficits or lack of personnel. This may be especially true for anesthesia and surgery. Procedures that we may consider basic, and not necessarily due to trauma, are not available. There are many good programs and individuals

Margareta M. Gavrila, DDS that reach out to tackle these great needs. 13197 Central Avenue, Suite 202, Chino CA 91710 909-628-3912 I am impressed with the rich cultural diversity that exists in www.gavriladds.com our world and the gentle and appreciative natures within that diversity, very much unlike the political posturing we

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frequently see. Countries are affected by historic circumstances that reduce the availability of, or increase the need for, medical care. Vietnam had a war, Cambodia lost its intellectuals to massacres, Iran suffers from isolation, India welcomed large numbers of Tibetan refugees, and Jordan, a stable but not a rich country, is open to influxes from all over the Middle East.

Yes, we have our needs in this country as well, but there is the additional benefit of programs abroad, knowing people on their own ground, of feeling the pulse of another culture, the warmth of its people, the pressure of its needs, the success of embracing and healing someone we did not understand before.

I had the pleasure of meeting Taruna and her family in India. Born with clubfeet, she lost one foot to infection and her second foot was also in need of amputation. Unable to attend school she was getting sicker sitting at home. She had her Medical Diplomats International, a not for surgery, and was fitted with new feet. At the shoe store she profit organization, is an effort to expand was elated, as she had never worn shoes before. When we foreign programs in the area of surgery and realized that she could not use the normal family bathroom anesthesia in such a way that interpersonal facilities, she was given her own chair. relations are developed and cultures are appre- ciated. The website is MedicalDiplomatsInternational.org. I can People in developing countries see medical care as a gift not be reached at [email protected]. WR a right. They do not have the same sense of entitlement and therefore are so overwhelmingly grateful for what we give Carolyn LaFleur, MD, is an anesthesiologist at Columbia Memorial Hospital in Hudson, New York; a position she has held since 1987. In addition to that it just touches your heart. That gift of appreciation her job at Columbia, she is the founder and CEO of Medical Diplomats makes it easier not to be overwhelmed by the difference in International. This is a not for profit organization providing surgery and anesthesia care in India, Jordan, and other underserved areas around the standards of living, and putting the physical conditions aside, globe. Her goal in the future is to develop more medical programs in people are pretty much alike whatever language they speak. countries that may be misunderstood by the American people because of their politics/religious beliefs.

As I develop programs in countries where Americans are conflicted by some preconceived notions about political and Carolyn LaFleur, MD religious issues, I hope that seeing people in need of relief Columbia Memorial Hospital | www.columbiamemorial.com from emotional and physical suffering will motivate all of us 71 Prospect Avenue, Hudson, NY 12534 to share our talents and energy to raise the quality of life 518-828-7601 whenever and wherever we can.

People in developing countries see medical care as a gift not a right. They do not have the same sense of entitlement and therefore are so overwhelmingly grateful for what we give that it just touches your heart. That gift of appreciation makes it easier not to be overwhelmed by the difference in standards of living, and putting the physical conditions aside, people are pretty much alike whatever language they speak.

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Psychotherapy May Lead You To A Road Of Increased Awareness And Creativity

We all need to get in touch with feelings, events, and thoughts which we have pushed away. They were pushed into the unconscious parts of our mind because of some anxiety experienced in the past. They have become unavailable for our conscious experience at the present time. The fact that anxiety-, shame-, and guild-laden issues have disappeared from our conscious life does not mean that they have lost their influence. They unconsciously interfere with our goals in work and in interpersonal relationships. They force us, unbeknownst to us, to repeat aspects of the past.

ithout knowing about it we are compelled to to what we wish to achieve most in life. Through therapy, handle situations repeatedly in less than success in work and relationships becomes ‘allowed’ where optimal ways or we avoid new and enriching previously it was ‘forbidden’. The enjoyment of sexual life, W ways of experiencing. We repeat interpersonal freer from inhibitions, usually becomes more intense. problems while having the sense that we should be able to handle them better. While we may have found The often-held belief that one has to be somehow ‘crazy’ ways to get along with each other, we do not allow more joy to undergo psychotherapy is mistaken. On the contrary, and freedom to enliven the relationship. Our sexual life may psychotherapy can be recommended to anybody who is be less free and fulfilling than we suspect that it could be. curious about his or her inner life. The aim of therapy is solely this: Unnecessary, often self-punitive barriers to As we talk about ‘what comes to mind’, the psychotherapist success and pleasure should be removed in favor of can see patterns indicating rigidity and repression and can increased awareness and creativity. WR give us feedback about his or her observations. Unconscious conflicts, once more fully understood, can be experienced Antal F. Borbely, MD, has a private psychiatric practice in New York City. He specializes in helping patients with creativity, career, and relationship and resolved in a non-judgmental atmosphere of trust. problems; he has extensive experience in psychopharmacological This happens slowly because we resist getting in touch with treatment. Castle Connolly voted Dr. Borbely one of the Top Doctors in the New York Metro Area, from 2010 to present. issues we unconsciously fear. Once made conscious they are much less frightening than we expected. Often we encounter an unconscious phantasy that we did something “bad” in Antal F. Borbely, M.D. the past. Almost anything can be turned into something Psychiatrist unconsciously experienced as bad: Normal occurrences like 675 West End Ave. #1A aggression against a loved-one, rivalry with a parent or New York, N.Y. 10025 sibling, sexual experiences like masturbation, etc., can give Tel.: (212) 222-1678 cause to unconsciously punish ourselves by erecting barriers

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“Go For It!”

There are many reasons for going after our dreams: It’s possible that we might succeed right out of the gate. It’s possible that we might not succeed initially, but learn from our efforts, hone our skills, and succeed at future attempts. It’s possible that we will discover that we don’t have the chops, that we’re not good enough to compete in this realm, and then we switch gears, pursue another dream project and realize success in this alternative venue.

any people have started out seeking fame and It would serve us well to keep in mind, when we are fortune in one area, have encountered resistance afraid to pursue our dreams because of our fear of and repeated failures, only to have succeeded failure, that we all can’t be Rocky Balboa, we all can’t M beyond their wildest dreams when they put beat Apollo Creed or Clubber Lang. But that’s not what aside that path and found the right form of expression of made Rocky great. their passion. What made Rocky Balboa great was that he took his Certainly, there’s always the disappointing scenario that shot, he went the distance. That was his success. we pursue our dreams, things don’t work out, we change Facing his fear and going after his dream in spite of it course, things still don’t work out, and we finally give up. was his Eye of the Tiger. The important point to realize, should this outcome happen (which is the one possibility that keeps most of us Facing our fear and going after our dream in spite of from going after our dreams in the first place), is that shame it is our Eye of the Tiger. Our success is in our doing, from rejection and failure will not kill us, that we can and whether we win, lose or draw. WR will get over it, and that it’s best to discover if we can pull off our dreams or not, because if we can’t, then it behooves Dr. Walter E. Jacobson has a private psychiatry practice in California. He is the author of Forgive to Win!, a manual on getting what us to accept this, put our energy into counting our blessings, you want out of life and ending self-sabotage. Dr. Jacobson also being grateful for what we’ve got, and making the most conducts lectures on a number of topics, ranging from marriage out of our lives, rather than coexisting with angst therapy to spiritual self-help. and frustration.

Walter E Jacobson, MD Bottom line: In more cases than not, it’s worth it to take our shot 18300 Roscoe Boulevard, and not sit on the sidelines because, oftentimes, the process of Northridge, CA 91325 going after our dreams yields all sorts of adventures and unique 818-885-8500, ext. 3724 life experiences that make the journey worthwhile, even if we www.walterjacobsonmd.com never reach our fantasy destination.

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are you prepared for that curve ball life throws at you?

Sometimes as physicians, the toughest patient encounters are about discussing advance directives and end of life care. This is more so an issue when our patients seem apparently healthy and physicians more than patients feel uncomfortable in discussing them.

was once called to evaluate a patient in the ICU Finally we woke the patient up from sedation and disclosed the who could not be extubated. He was a 60- year- diagnosis. After having a prolonged discussion with patient and old apparently healthy guy who had just returned his family, he decided to go to hospice care. I from a trekking trip to the Amazon. The ICU team, thinking that he had developed pneumonia from his This is not an uncommon situation for physicians and patients recent travel, intubated him when he became severely to be in. In fact, I have had this discussion with my physicians short of breath. But every time the ventilator was as well. As medicine continues to advance rapidly in the 21st turned down he became short of breath. Further century it is possible to prolong life of our patients. Whether multiple chest x-rays were all clear and the cause of the quality of life that accompanies it is worth prolonging is his shortness of breath remained a mystery. As I looked something for all of us to think about even when we seem closely at his chart, I noticed that he had complained healthy. WR of occasional cough and difficulty in clearing his secretions on and off for the last 3 months. Raghav Govindarajan, MD is the chief resident in the department of neurology at the Cleveland Clinic Florida. He is a member of the American Academy After running a battery of tests including nerve of Neurology, American Medical Association, American Association of conduction studies and EMGs he was diagnosed Neuromuscular and Electrodiagnostic Medicine (AANEM), and Florida Society of Neurology. He was recently awarded the best abstract award from AANEM. with Lou Gehrig’s disease.

When I disclosed the diagnosis to the patient’s wife she Raghav Govindarajan, MD wanted us to remove the tube immediately. The patient Department of Neurology had no living will, had no advance directives and since 2950 Cleveland Clinic Blvd., he seemed apparently healthy he never had any Weston, FL 33331 discussion with his family about end of life care and 954-659-5670 even his physicians did not have a discussion with him.

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