Posts made in September, 2012

What Questions Should I Ask My Doctor?

Posted by on Sep 27, 2012 in News | 0 comments

Not everyone can reach his or her healthcare provider whenever health-related questions come up between office visits. Therefore, many of us may have numerous questions in mind and wonder what to ask during the office visit. A majority of the time, office visits are scheduled for 15 minutes or 30 minutes if a physical exam is needed. You want to get the most out of the visit and obtain helpful information on how to manage conditions that you may have. While you may be able to find information on numerous medical conditions online, some of the questions require personalized answers from your primary care provider who knows your detailed medical history.

Here are some samples questions you should ask during the office visit to your doctor, based on different chronic conditions.

If you have diabetes, you might want to ask these important questions:

  1. What time of the day should I check my blood glucose?
  2. How often should I check my blood glucose?
  3. Should I keep a record of my blood glucose when I check it at home?
  4. What is hemoglobin A1C?
  5. What medications work together with insulin (if you take insulin)?
  6. Can I adjust my own insulin (if you are on insulin)?
  7. How often should I go in for an eye exam and why?
  8. Do I need to see a foot doctor?
  9. Always tell your doctor if you are experiencing pins and needles sensation in your arms or legs and sexual dysfunction.

If you have high blood pressure, the following questions are important:

  1. What goal should I set for my blood pressure?
  2. Do I need to monitor my blood pressure at home?
  3. How often should I check my blood pressure?
  4. Where can I check my blood pressure between the office visits?

If you have high cholesterol:

  1. What goal should I set for my cholesterol?
  2. What should my LDL cholesterol be?
  3. Do I need to take statin?
  4. What can I do to lower my cholesterol?

Heart disease and stroke:

  1. Am I at risk for heart disease if one of my parents had heart attack?
  2. Do I need to take over-the-counter baby aspirin?
  3. How often do I need to get blood test for my INR (for people who are on blood thinner)?
  4. What medications do I need to avoid if I am taking nitroglycerin?
If you’re seeing a different primary care physician for the first time, you should always let him or her know about your past medical history and family history of diabetes, high blood pressure, high cholesterol, and heart disease. This applies to everyone regardless of your age. In addition, you might want to inquire what screening tests are appropriate for your age.

Contributed by Christoper Pease M.D. and Patricia Hsiao M.D.
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Overcoming Insomnia Doesn’t Have to be Difficult

Posted by on Sep 24, 2012 in News | 0 comments

Most of us experience difficulty falling asleep once in a while. Insomnia is defined as having poor quality of sleep due to difficulty falling asleep, difficulty maintaining sleep, or waking up too early. Ultimately, it will result in daytime sleepiness or fatigue, poor concentration, and irritability. Today, insomnia is a very common medical complaint in doctor offices. A national survey indicated that approximately 35 percent of adults have insomnia in any given year and about 10 percent of adults reported to have chronic (long-term) insomnia. Insomnia is even more common among the elderly. While it’s true that you tend to sleep less as you get older, the number of hours of sleep per night varies from person to person.

You can have acute or short-term insomnia from jet lag, stressful life events, and recent illness, but it often resolves on its own. On the other hand, long-term or chronic insomnia lasts for more than a month and may be related to medical/psychological conditions or medications you take. Your doctor will try to find the underlying causes of insomnia. If no causes are found, the doctor may try cognitive behavioral therapy, medications, or a combination of behavioral therapy with medicines. Cognitive behavioral therapy consists of stimulus control, relaxation, sleep restriction therapy, and cognitive therapy. Studies have shown that for short-term (6 weeks) treatment, both cognitive behavioral therapy and combination therapy have similar improvements in the amount of time it takes to fall asleep, time awake after sleep begins, and total sleep time compared to the time spent in bed. That being said, the best outcome was seen with combination therapy, initially followed by cognitive behavioral therapy without medication in a long-term treatment.

Before looking for over-the-counter sleep medications, there are a few changes you can make to improve your sleep hygiene. Here are some of the tips:

  • Maintain a regular sleep schedule. For instance, try to go to bed the same time and wake up the same time every day
  • Try not to take naps during the day. If you must do so, make sure you don’t nap for more than an hour
  • Try to minimize light and noises in the bedroom. Keep a moderate temperature and turn off the TV or radio
  • Try to finish your regular exercise 3-4 hours before bedtime
  • Avoid eating heavy meal close to bedtime
  • Avoid caffeinated drinks after lunch
  • Avoid nicotine close to bedtime
  • Avoid drinking alcohol late in the evening

Over-the-counter products

There are a few over-the-counter products available for insomnia, but many of them are not regulated by the FDA. Therefore, it’s difficult to be sure how effective or how safe they are for consumers. Among them, melatonin and valerian are well known products. Melatonin is a hormone produced by the pineal gland in the brain. Melatonin appears to prevent jet lag when crossing time zones. Some studies have shown that melatonin may decrease the time it takes to fall asleep, increase the number of sleep hours, and keep you alert during the day when taken for short-term (a few days or a week). A few studies suggested that melatonin works best for people over 55 years of age. Valerian and L-tryptophan are popular herbal products in the U.S, but may have potential side effects, thus why it’s best to talk to your doctor before using them. Always let your doctor know if you’re using over-the-counter products.


Contributed by Patricia Hsiao M.D.
Sources: Medscape, The National Center for Biotechnology Information, The Jama Network, University of Maryland Medical Center
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Can Victoza (Liraglutide) Help Diabetics Lose Weight?

Posted by on Sep 19, 2012 in News | 1 comment

Victoza (liraglutide) has been on the market for several years for the treatment of type 2 diabetes. It’s often recommended that patients also incorporate exercise and changes in diet for maximal benefit from the drug.

Victoza is similar to the hormone incretin and works by lowering sugar produced by the liver and increasing insulin release to high levels of sugar in the body. The drug also slows down stomach emptying and reduces appetite. The drug is usually injected once a day.

As far as weight loss is concerned, most of the studies done have been sponsored by the manufacturer of the drug, so inevitably the results are always positive.

From anecdotal reports, the weight loss induced by liraglutide is minimal.

Liraglutide by itself does not induce weight loss like metformin. In order to reduce weight with liraglutide, one has to incorporate exercise and changes in diet. Just injecting the drug and sitting on the couch won’t help anyone lose weight.

Liraglutide is not only an expensive medication, but in animal studies is known to cause certain types of thyroid cancer. So far it has not been determined if the same thing happens in humans.

For diabetics who would like to lose weight metformin is still the best drug. Not only is it cheap, but it’s the gold standard against which other diabetic drugs are compared to.


Contributed by Dr. Steven Bhimji, M.D.
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Should I Take Aspirin for Heart Disease Prevention?

Posted by on Sep 18, 2012 in News | 2 comments

You may have heard from the media, friends, family members, or coworkers that aspirin can lower your chance of heart attack. Thus, you may wonder whether you should take a daily aspirin to prevent heart disease. Before you go to the pharmacy and purchase over-the-counter aspirin, there are a few things you need to know.

What is aspirin and how does it work?

Aspirin is one of the medications in NSAIDs (nonsteroidal anti-inflammatory drugs) group. It’s been used for pain relief and to reduce swelling. In recent years, low dose aspirin is used to prevent heart disease. Heart disease includes heart attack, stroke, and peripheral arterial disease in which there is poor circulation in the legs. At low dosages aspirin prevents platelets (blood cells that play a role in blood clotting) from clumping. Without platelets, you can bleed to death when you cut yourself or have an injury to your tissues and organs. At the same time, platelets can form clots in the coronary arteries that supply your heart and can cause a decrease in blood flow. When there’s insufficient blood supply to the heart, it results in heart attack due to the death of heart muscles. Reduced blood flow to the brain can result in stroke. Therefore, the role of low dose aspirin is to prevent platelets from clumping and keep the normal blood flow in the arteries.

Who should take daily aspirin?

You shouldn’t take daily aspirin unless prescribed by the doctor. Your doctor may put you on daily aspirin if you fit any of the following criteria:

  • If you have a history of heart attack
  • If you have a history of ischemic stroke or transient ischemic stroke (TIA)
  • If you have stable or unstable angina
  • If you have had a coronary artery bypass graft (CABG procedure)
  • If you have had angioplasty
  • If you have atrial fibrillation (A-Fib)
  • If you have heart valve disease

Your doctor will decide what dosage is right for you. Some people may get baby aspirin (81 mg) while others may get a regular strength (325 mg). If you take ibuprofen or other NSAIDs for chronic conditions such as arthritis, chronic pain, or back pain, talk to your doctor.

People who do not belong to the above group

You’re at a higher risk for heart disease if you have diabetes, high cholesterol, obesity, and higher blood pressure than the general population, but it doesn’t mean you should start taking daily aspirin on your own. Many studies have been done on men and women who did not have heart disease and who are over 55 years of age. Aspirin, like many other medications, comes with side effects, such as bleeding more than usual when you have a cut. Some people experience stomach bleeding, especially if they have ulcer. Another concern is hemorrhagic stroke (bleeding in the brain). Aspirin also causes stomach upset side effects such as nausea, vomiting, heartburn, and stomach pain. This has lead some to believe that the benefit of aspirin on heart disease is greater than the risk of side effects.

Many studies concluded that whether you should be on daily aspirin must be determined by an individual’s risks and benefits from aspirin. Some people may benefit more from aspirin, while it may cause more harm to others. Hence, the decision should be made by your primary care doctor.


Contributed by Patricia Hsiao M.D.
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Combination Drug Therapy for Type 2 Diabetes: Is it Safe?

Posted by on Sep 17, 2012 in News | 1 comment

A wide combination of diabetic drugs is now frequently being used to treat type 2 diabetes. In the past, the available drugs didn’t always allow for safe combinations, but with newer and safer drugs, combination therapy appears to be the norm.

Just recently, the combination of metformin with the relatively new diabetic drug linagliptin was announced. In Europe, this combination is already available as a single tablet taken twice a day. This combination is intended for type 2 diabetics whose blood sugars are not controlled with maximum doses of metformin alone.

In a recent trial, this combination proved to be safe and effective for type 2 diabetes. In addition, the combination did not cause any significant changes in body weight. More important, adverse effects were not common. However, hypoglycemia was slightly more common in patients treated with metformin/linagliptin and a sulfonylurea.

So far it appears that the combination of metformin with linaglitpin is effective in lowering blood sugars in type 2 diabetics who still have residual pancreatic function.

For type 2 diabetics who have high glucose levels while on maximal metformin therapy, the addition of linagliptin may prove beneficial. Unfortunately, linagliptin is an expensive drug. For those who do not have the money to afford linagliptin, exercise and lowering bodyweight may be two good options.


Contributed by Dr. Steven Bhimji, M.D.
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