Author Archives: hiroadmin

  1. Tus proveedores que hablan español

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    Bienvenido/a a Shore Physicians Group. Nuestros expertos proveedores están comprometidos en ofrecer los mejores servicios de atención médica. Ofrecemos una amplia gama de especialidades y servicios de atención primaria, y esperamos atenderlo a usted y a sus seres queridos. Para ver a nuestros proveedores en español, haga clic o toque en el menú desplegable de idioma en la parte superior y elija “Español”. Luego, vaya al menú y haga clic o toque en “Proveedores”.

  2. Every 18 Minutes an Aneurysm Ruptures – Are you at Risk?

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    A stealth-like silent bubble could be present in your brain, your abdomen or other blood vessels and you don’t even know it. That bubble is an aneurysm and it has the potential to wreak a great deal of damage. An aneurysm is defined as a weak spot in the wall of a blood vessel. According to the Brain Aneurysm Foundation, there is a brain aneurysm rupturing every 18 minutes with a sobering 40 percent mortality rate.

    Neurosurgeon Dr. Francis Kralick of Shore Physicians Group likened an aneurysm to a bubble that forms a bulge on the outside wall of a tire, stretching and weakening that wall. “Higher than normal pressure on the walls of that tire can cause that bubble to burst, and an aneurysm acts much the same,” said Kralick.

    Where an aneurysm may form
    An aneurysm can form anywhere along the blood vessels in the body, but statistically tend to form at the fork in the blood vessel where they branch off and may be weaker, , according to the American Heart Association (AHA). While aneurysms tend to most commonly be found at the base of the brain, they may also be found in the chest, known as a thoracic aortic aneurysm, which is an abnormal bulging or ballooning of the portion of the aorta that passes through the chest. They can also form behind the knee in the popliteal vessel as well, according to the National Institute of Health.

    Dr. Kralick explained that small berry aneurysms may be present in an individual’s blood vessel but never pose a problem because they are very small and minus symptoms, so they will go undetected. The problem unfolds when an aneurysm grows larger and is still without symptoms until it begins to leak or burst.

    Symptoms of an aneurysm
    The AHA indicates that a brain aneurysm that becomes enlarged presses on nerves in your brain and may cause signs and symptoms. These can include droopy eyelid, double vision or other changes in vision, pain above or behind the eye, a dilated pupil coupled with numbness or weakness on one side of the face or body.

    Symptoms of an abdominal aneurysm include tenderness or a pain in the chest.

    Thoracic aortic aneurysms often grow slowly and usually without symptoms, making them difficult to detect. Some will experience back pain, hoarseness, a cough and shortness of breath. Some aneurysms will never rupture. Many start small and stay small, although many expand over time. How quickly an aortic aneurysm may grow is difficult to predict.

    For a person with a peripheral aneurysm that has formed behind the knee, the patient may notice significant discomfort with walking along with swelling of the extremity.

    If the brain aneurysm ruptures, the symptoms include a sudden onset of a severe headache, nausea and vomiting along with a stiff neck, loss of consciousness and signs of a stroke. Dr. Kralick said any of these symptoms require immediate medical attention.

    Treatment options for an aneurysm
    Dr. Kralick explained that treatment depends on the size and location of the aneurysm and whether it has ruptured. The former method to treat an aneurysm was surgical clipping, which, according to Dr. Kralick, had a longer recovery time. Because it involves general anesthesia and opening the skull, it is used dependent upon the needs and overall health of the patient. Doctors may use a coil method that keeps the aneurysm from rupturing. Or, they may opt for the more common and less invasive endovascular method of treatment.

    The endovascular repair method calls for the physician to thread a thin catheter that guides a stent graft through small incisions in the groin. The graft is inserted into the aneurysm and seals it from within.

    Imaging is an important diagnostic tool
    A CT scan will normally be used to see if the aneurysm has been bleeding, according to Dr. Kralick. Also used is an MRI to get 3-D slice pictures of the area. Cerebrospinal fluid will be drawn to see if there are any red blood cells present in the fluid that surrounds the spine. Dr. Kralick said if there is blood in spinal fluid that will tell the neuroradiologist that the aneurysm may be leaking or has possibly ruptured.

    Risk factors for aneurysms
    Researchers are finding that like so many other health conditions, heredity plays a role in who may be at risk for an aneurysm. Other risk factors include smoking, drug use, high blood pressure or hypertension, polycystic kidney disease, and congenital abnormalities that have been present since birth in the artery wall. Women have an increased incidence of aneurysms and they are more common over the age of 40. Ruptures of aneurysms are twice as high in the African American population compared to whites.

    Preventing an aneurysm

    1. Make Healthy Diet Choices: Diets high in calories, saturated and trans fats, and sodium can lead to high blood pressure, high cholesterol, atherosclerosis and obesity, all risk factors for aneurysms. Modify eating habits to offset the risk of aneurysm; choose fresh, whole foods over processed, packaged snacks. Limit fatty cuts of meat, like brisket and steak. Eat fried and fast food only in moderation. Reach for the low-fat or fat-free dairy rather than full-fat dairy. Incorporate whole grains and complex carbohydrates, such as brown rice or whole-grain bread, rather than refined, white carbohydrates, like white rice or white bread. Limit sugar-sweetened beverages, including soda, fruit juice, and energy drinks. When cooking, reach for heart-healthy oil, like olive, over coconut, palm kernel, and palm oil.
    2. Keep Blood Pressure Levels in Check: Hypertension is a risk factor for aneurysms, and in November 2017, the American Heart Association and the American College of Cardiology lowered the guidelines for the diagnosis of hypertension from 130/80 to 120/80. Those new numbers put nearly half of Americans in jeopardy of having high blood pressure. To manage hypertension, eat a healthy, low-sodium diet, exercise regularly, quit smoking, manage stress, and maintain a healthy weight. The AHA recommends men limit alcohol to one to two drinks a day and women limit it to one drink a day. Take any medication for high blood pressure as prescribed.
    3. Lower High Cholesterol: Cholesterol is a waxy substance that your body needs to build cells, but high cholesterol can lead to arteriosclerosis, or hardening of the arteries. A modified diet lowers bad cholesterol and raises HDL or good cholesterol. To lower bad cholesterol, limit saturated and trans fats, and to help promote good cholesterol, eat more foods rich in omega-3 fatty acids.
    4. Make Exercise Routine: A regular exercise program can lower blood pressure and triglycerides, raise good cholesterol, and, in combination with a healthy diet, promote weight loss. The U.S. Dept. of Health and Human Services recommends 150 minutes of moderate intensity or 75 minutes of vigorous activity weekly. For patients diagnosed with an aneurysm, vigorous exercise will likely not be recommended. Seek a low-impact program from a healthcare professional.
    5. Take Steps to Reduce and Manage Stress: Stress and high blood pressure seem to go hand in hand. When a person is stressed, the body will release adrenaline which increases heart rate and blood pressure. Dr. Kralick said stress does not cause an aneurysm but that the surge of hormones when a person gets angry or upset is capable of raising a person’s blood pressure and in turn trigger an aneurysm to burst. “We cannot hide from daily stressors, it is how we react that can make a big difference,” added Dr. Kralick.
    6. Treat Obstructive Sleep Apnea: Obstructive sleep apnea is associated with the progression of thoracic aortic and abdominal aortic aneurysms, and can lead to poor outcomes for those with brain aneurysms. A study published in March 2018 in the Journal of Neurosurgery found brain aneurysms that rupture or result in vasospasm are a result of uncontrolled obstructive sleep apnea.
    7. Quit Smoking: Smoking is a significant risk factor for the formation and rupture of brain and aortic aneurysms, but quitting can go a long way to reducing the risk.
    8. Avoid Certain Prescription Drugs and All Recreational Drugs: Blood thinners and certain prescription medication, such as ephedrine and amphetamines, can contribute to the formation of an aneurysm, according to the Brain Aneurysm Foundation. Recreational drugs like cocaine should also be avoided because they damage the blood vessels.
    9. Talk to Your Doctor about Screening Tests: If there is a personal or family history of aneurysms, be sure to inform the primary care physician and report any symptoms immediately.
    10. Know the Signs of an Aneurysm: Although aneurysms can occur without warning, it’s important to recognize the signs and symptoms. If you experience pain, sharp or dull, or unexplained symptoms, don’t chance it. Call the doctor or go to the nearest emergency room.
    11. Stick with a Treatment Plan: If you have been diagnosed with an aneurysm or suffered a rupture or dissection, it’s important to stay up-to-date on screenings, take all medication as prescribed and work to lower risk factors.

    To learn more or to make an appointment with Neurosurgeon Dr. Francis Kralick of Shore Physicians Group, located at 649 Shore Road in Somers Point, call 609-365-6239.

  3. Seven Steps to Lessen Anxiety at your Next Doctor Appointment

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    How many times have you walked out of the doctor’s office only to realize you forgot to ask something while you were there? It happens, but there are some easy things you can do before the appointment to help to make the next one more successful.

    “Patients can be anxious when they come to the office and can overlook certain things,” said Cindy Nunan, DNP, FNP-BC, Nurse Practitioner at Shore Physicians Group. “I completely understand it. That is why I try to take the time to understand their concerns and put them at ease, but I need a little help from them as well so that we can have the most successful outcome from the visit. If they could bring in a list of the current medications they are taking or bring in the medications themselves, either is a great start to the office visit. I need to know what they are currently taking before I can fully assess their health care needs. With the senior population, that information is vital.”

    Nunan said she tries to learn something about her patient’s background, like the foods they eat and what is important to them. This helps her understand the patient as an individual and not just their symptoms.

    Sometimes, just getting an older loved one to the office can be daunting, Nunan acknowledged. “Some older patients may be anxious and have trouble remembering everything that was discussed during the visit. When they come in with a caregiver, it can really help the patient get the best outcome because the caregiver is often able to provide missing information and ask questions important to the patient.” In order to make the most of your doctor visit, be sure you’ve done the following before your appointment:

    1. Decide ahead what it is you want from the appointment.
      • Is this a well visit, a preventive checkup, or a follow-up?
      • Are you looking for a diagnosis or a name to match your symptoms?
      • Do you need a new treatment plan or tweak of what you are currently doing?
      • Do you want to discuss your prognosis and what the future will bring?
    2. Gather your medical information.
      • Bring your detailed medical history for your initial visit.
      • Prepare a list of your current medications including prescription, over the counter, and supplements, including natural and herbal, as well as the dosage.
      • If you were instructed to complete testing prior to the appointment, call ahead to make sure the results have been delivered.
    3. Prepare a list of your symptoms.
      • When did symptoms start?
      • Explain the symptoms, like feeling achy, burning, stiffness, swelling, or if there have been changes in a cut or sore.
      • Make a note about what seems to trigger symptoms, how frequently they occur and their duration.
    4. Prepare a list of questions you want to ask your health care professional.
      • What diagnostic tests do I need?
      • What will the results tell me?
      • What treatment options do I have?
    5. Make a contact list.
      • Include emergency contact numbers.
      • List all the doctors who treat you along with phone and fax numbers and office address.
      • Make sure to include your pharmacy number, fax and address.
    6. Make sure to have all insurance and referral authorizations in advance of the appointment.
    7. Have a plan for documenting what you learn.
      • Bring a notebook or use your phone to write the answers to questions and other notes.
      • Bring a caregiver to take notes so you are able to focus on what the doctor is saying.

    The most successful visits at the doctor’s office begin with a little effort from the patient ahead of the appointment. Nunan suggests that taking a few minutes to gather this information in advance of the visit will go a long way in helping your physician provide you with a more complete assessment.

    To make an appointment with Cindy Nunan in the Northfield office, call 609-365-5300.

  4. Successful Surgical Outcome Entices Philly Police Officer to Shore

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    Big name hospitals in the City of Brotherly Love have beckoned patients to make the trip from the shore area to Philadelphia for years. A complete reversal of that trend proved to be the best choice when a Philadelphia man headed to Shore Medical Center for treatment for his debilitating back pain.

    Neurosurgeon Dr. Francis Kralick of Shore Physicians Group said emphatically that surgery is not the solution for everyone and not always the answer for a patient’s problem or pain. But for retired Philadelphia Police Detective Robert Parrotti the lumbar fusion performed by Kralick earlier this year was the perfect answer for his problem.

    Parrotti said he had been treated at a major Philadelphia hospital, received multiple injections to help alleviate the chronic back pain he was living with but inevitably the pain would return after the injections. Parrotti said, “I was miserable. I could not stand, I could not walk and I could not sleep because I was in so much pain and I went to doctors who told me that at my age (76), I would just have to bear it. That is tough to hear at any age when you have pain every single day. I started to avoid going to events because when you are in that much pain, it’s just hard to be around people.”

    Then a friend told Parrotti of a doctor he knew and trusted from his days at Hahnemann Hospital, Dr. Francis Kralick who since had moved to the area permanently and was now a member of Shore Physicians Group. “My friends questioned why I was heading to the shore for a doctor when I am in Philadelphia with all these great hospitals and doctors,” said Parrotti. “But I had been to doctors in the city and no one was giving me a reason to be optimistic so I called Dr. Kralick on the advice of a friend and I will tell anyone, it was one of the best decisions I have ever made. He took the time to talk with me and to be honest with me.”

    Kralick agreed to see Parrotti and it was after that initial meeting with the neurosurgeon that Parrotti felt he finally had a reason to be optimistic. He took the time to talk with me and to be honest with me.” Parrotti said when he spoke with Kralick that the doctor resonated confidence and that gave him confidence and sense of trust. Kralick weighed all the factors and provided Parrotti with the information and prognosis as he saw it. “I make my assessment and then provide the patient with the information so it will allow them to make their own conclusion,” said Kralick. “And I encourage patients to get a second opinion.”

    The neurosurgeon said he will possibly see 20 patients in a day but only recommend surgery for one or two. Kralick said that for him to recommend surgery for a patient there needs to be a number of mitigating factors including the expectation of improvement for the patient. He said it is very important for the best possible outcome for the patient that the surgery be appropriately timed to assure the most successful outcome for the patient.

    Kralick said that in cases like Mr. Parrotti, patients are living with significant pain that is impacting the quality of their life. And while the physician says he never gives his patients false hope and never says he can alleviate their pain 100 percent, if in his assessment performing surgery will significantly improve the patient’s quality of life he will recommend it.

    Weighing all of Robert Parrotti’s factors that were contributing to his chronic back pain Kralick performed a lumbar fusion (L2-L5). For the patient, the outcome was nothing short of spectacular. “The surgery 100 percent improved the quality of my life. My family and my friends can’t believe it. I appreciate the little things I was missing now that I have my life back,” explained Parrotti.

    For the full benefits of the lumbar fusion to be realized Kralick told his patient it will be nine months to a year. Parrotti said as part of his daily routine he walks every day, something he had not been able to do for years. He is also diligent about doing aqua therapy in the pool and doing his stretches in water.

    A grateful patient, Parrotti heaped accolades on his surgeon but it did not end there, he had high praise for Shore Medical Center Advanced Spine and Orthopedic Unit fourth floor nursing team helping him to get back on his feet, quite literally. Kralick likewise praised the Shore ASOI team for their focused commitment to patients post operatively and said the care his patients receive after surgery is one of the reasons making the choice to travel from Philly to South Jersey for surgery is a good one.

    To learn more about Shore Physicians Group and options for spinal and lumbar surgery as well as a complete list of physicians and specialists visit

  5. Can You Die From A Broken Heart?

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    When former President George H. W. Bush passed away at the age of 94 in November his family spoke openly of how much he missed his beloved wife and a daughter, Robin, who had died years prior. Did the loss of his wife take its toll on him after the couple’s 73-year marriage? There is no doubt the loss of a life-long companion is profound and one thing doctors agree on is that there are physical changes and symptoms that can be triggered by the loss of a loved one or the onset of sudden stress.

    Asked if he had ever treated a patient with broken heart syndrome, Dr. Gene Iucci of Penn Cardiology, Somers Point said yes. It is a very real thing and that he has treated many patients with cardiomyopathy, the condition commonly called broken heart syndrome. He added that a number of other acute stress related situations that can trigger this condition such as car accidents, fights, new cancer diagnosis, or the loss of a child.

    Broken heart syndrome
    Medically, broken heart syndrome is stress-induced cardiomyopathy or takotsubo (taken from the name of octopus traps that resemble the pot-like shape of a stricken heart) cardiomyopathy. While it is more common in women than men according to the American Heart Association, it can strike anyone. It presents often as angina or chest pain along with shortness of breath on the heels of acute stress. But unlike a heart attack, there’s no evidence of blocked heart arteries in broken heart syndrome.

    Cardiomyopathy is a disease where the heart muscle weakens and has difficulty pumping the amount of blood to the rest of the body. While the disease has many causes, signs and symptoms, in most cases cardiomyopathy causes the heart muscle to become enlarged, thick or ridged. While can be frightening to the patient, Iucci said it can be treated and its effects reversed.

    Internist Dr. Michael Giunta of Shore Physicians Group likewise said broken heart syndrome is a very real condition that he has encountered with his patients. Giunta said sudden loss, like the death of a spouse is enough to trigger stress induced cardiomyopathy. He said while it gives initial symptoms like a heart attack and may result in a temporary enlargement of an area of the heart, an EKG will show there is no permanent damage to the heart.

    Grief and depression
    Giunta said grief plays a large part in how a person will feel following the death of a loved one or some other emotional event. The physician advised that grief has its place and that it can be different for everyone. He added, when someone dies, the surviving person is brokenhearted. For many the loss of a loved one, especially in seniors’ results in them feeling isolated and lost because the person who they have talked to across the table is suddenly no longer there. If the survivor was the caregiver, they can often feel in the short term as though they have lost their sense of purpose. “It is perfectly normal for the person to have many emotions that they have to work through and it can be seemingly overwhelming but for the most part, people will cope and adjust somehow to their situation,” said Giunta. “What is a concern is if that period of grief goes on for a long time. When grief and the feelings that go along with it extend longer than six months or so, then it is really time to sit down and talk with your doctor.”

    The bad news and the good news
    The bad news is that broken heart syndrome or cardiomyopathy may lead to short-term heart muscle failure. But the good news is that it is treatable and normally there is no long term damage to the heart muscle, unlike a heart attack that may cause permanent damage to the heart muscle. Once the doctor has ruled out a heart attack from the symptoms the patient is experiencing the patient can expect to make a full recovery, normally within a matter of weeks.

    Dr. Michael Giunta sees patients at Shore Physicians Group’s Somers Point office, located at 401 Bethel Road, and its Marmora office at 4 Roosevelt Blvd. For more information or to schedule an appointment with Dr. Giunta, call 609-365-6200 for the Somers Point office or 609-814-9550 for Marmora.

    Dr. Gene Iucci sees patients at Penn Cardiology-Somers Point, 155 Medical Center Way, Somers Point NJ 08244. Make an appointment at or call 215-662-7366.

  6. What You Don’t Know About Kidney Stones Can Hurt You

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    Anyone that has ever experienced a kidney stone knows they can stop you in your tracks with the sudden onset of severe pain. Meredith Jankowski, DO, Urologist, Shore Physicians Group, in association with Jersey Urology Group, said kidney stones are the number one reason people call their urologist. The number one cause of those kidney stones is dehydration, with patients experiencing difficulties voiding a close second. But the doctor said people can be their own advocate for healthy kidneys by doing a few simple things like drinking enough water and monitoring the amount of salt and potassium in their diet.

    Who gets kidney stones?
    Dr. Jankowski said kidney stones do not play favorites and effect men and women rather equally. According to statistics provided by, 1 out of 11 people will experience a kidney stone over the course of their adult life. Roughly 13 percent of men and 8 percent of women will develop a kidney stone with pain significant enough to land them in their doctor’s office or in the emergency room.

    Heredity may play a role in the likelihood of a person having a kidney stone. Dr. Jankowski also advises her patients that if they do have a kidney stone, their chances of having a second one are 50 percent higher than the general population. If they have had two stones the chances skyrocket to 80 percent to have more.

    What causes a kidney stone to form?
    Dr. Jankowski explained that the kidneys act as the bodies filter and remove waste products from the body, balance the body’s fluids and release hormones that regulate blood pressure, control the production of red blood cells and produce an active form of vitamin D that promotes strong bones. She said the stones that form in the kidney and ureters (the tubes that lead from the kidneys to the bladder) are made of salts and minerals like calcium and particularly uric acid that are present in the urine. Those salts and minerals form small pebbles in the kidneys and when start to move they can be quite painful. Kidney stones can also form in the bladder.

    “The most common thing we find with patients is that they are dehydrated; they just do not drink enough water. I advise patients to drink at least two liters of water a day,” said Jankowski. “A simple way to know if you are sufficiently hydrated is if your urine has very little color to it. This is the baseline amount that will help to keep the kidneys functioning properly.” While she acknowledges that sometimes it can be difficult to manage that much fluid, she advises patients to do their best.

    A common misconception about kidney stones
    “Most people think the pain associated with the kidney stone is its movement as it is trying to pass,” said Dr. Jankowski. “That’s not it. The pain is caused by the amount of urine that is backed up and the patient is unable to pass it because the kidney stone is blocking the path. That pain can be quite significant.”

    While most patients are able to pass a kidney stone of 5 mm or smaller on their own by increasing the amount of water they drink, those patient with stones larger than 5 mm will need to go another route. One method used by Jankowski to give the patient relief is lithotripsy. The doctor explained that this method uses sound waves to try and break up the stones. While laying on their side, the patient has an external gel pack placed over the area of their kidneys and then sound waves are used to try and break up the stone. The optimum outcome is that the broken particles will pass in the urine. This does not require surgery and it is done as an outpatient procedure.

    The other method is a three-part procedure where the physician goes in and removes the stone because it is too large to pass on its own. First, a stent is placed at the blockage and allows the urine to flow around the blockage and into the bladder. The next part of the procedure the physician is the removal of the kidney stone or blockage. A second stent will then be placed to allow the area where the stone was removed to heal. That stent will be removed in a matter of days and the patient should be back to functioning normally.

    Symptoms mimic UTI
    For many, the symptoms of a urinary tract infection and a kidney stone can be quite similar but knowing the difference could save the patient a lot of discomfort. According to the National Kidney Foundation, if a person should immediately contact a urologist if they experience the following: if they see blood in their urine, notices it has a strong odor or is cloudy, has fever and chills, is nauseous or is vomiting, is only able to pass a very small amount of urine despite feeling the urgency to go, and are experience back pain just below their ribs. This is especially true for those patients who are is overweight and diabetic.

    Preventing kidney stones
    Drink water, drink water and then drink more water is the advice of Dr. Jankowski. She suggested adding a lemon or lime slice to the water to increase the citric acid. To add some flavor to your drink, Jankowski suggested using Crystal Light. She also advises not to take more than the recommended daily dose of vitamins C and D, limit the salt in your diet, and eat a balanced diet that is not too high in protein.

    Changing some of what you eat might not prevent all kidney stones, but for people who have a history of certain kinds of kidney stones some dietary changes may be beneficial. But Jankowski warned, everything is good in moderation. Adding certain foods and dietary supplements may also increase the risk of kidney stones if too much is consumed so discuss plans with your physician. She gives her patients the following dietary suggestions for preventing future kidney stones.

    Plan meals and snacks that are low in oxalate. Suggested foods include;

    • Corn, kale, parsnips, and squash
    • Beef, chicken, pork, turkey and fish
    • milk, butter, cheese and yogurt

    Foods that are medium-high in oxalate, plan to eat only once in a while- these include;

    • Bread
    • Brown rice
    • English muffins
    • Figs
    • Popcorn
    • String beans
    • Tomatoes

    Limit very high-oxalate foods including;

    • Black tea
    • Coffee
    • Dark green vegetables
    • Nuts

    To make an appointment or to speak with Dr. Meredith Jankowski at the Shore Physicians Group office located at 649 Shore Road in Somers Point call 609-365-6241.

  7. Beating that Ho Ho Holiday Stress

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    The holiday lights, the music and the songs are here in full swing but not everyone is happy to see the holidays approaching, and according to Shore Physicians Group Internist, Dr. Ulices Perez, some people can be downright sad during the holidays and he had some suggestions for what families might do to help their loved ones cope with the season.

    Perez said for many, the level of joy at the holidays is directly affected by their life conditions. He spoke of a recent patient who said they often experience sadness at the holidays. To understand his patient, Perez said he wanted to learn more about the root cause of his problem. “Speaking with my patient’s wife I learned that he was an only child and orphaned when he was very young and never had any brothers or sisters in his life and that around the holidays that joyful and sharing part of his life was missing. Later he had his own family but now that they are all grown and he does not get to see them as often as he would like, it really bothers him around the holidays.”

    Perez said there are so many things to celebrate and to be joyful about at holiday time that include spending time with family and friends. In so many cultures, the holidays mark party time but for some, but at the same time the arrival of the cold weather along with the holidays trigger depression. “Seasonal depression is a real thing. There are patients who have difficulties as the days get shorter. Basically it is the lack of exposure to the sun,” said Perez. “They are missing the stimulus of the melatonin and they are finding themselves less energetic and will often not have the drive to do more. It might be 4 p.m. and they may want to take a nap rather than start something new.”

    The physician said he tells his patients the first thing they need to do is expose themselves to things that normally bring them joy. “You need to go to the mall, walk around, take in the sights and sounds all around and force yourself into increased physical activity. While some patients might complain at first, once they start to increase their activity level they will begin to feel better,” said Perez. “You have to keep doing things that make you feel better.”

    But Dr. Perez warned of red flags that signal the person will need more to cope with their feelings. “When it’s not just a seasonal mood disorder, when a person experiences definite changes then it is time to look for help,” said Perez. “When a person is unable to sleep, they are anxious and stressed, that is not just a seasonal type of depression that they need to sit down and talk to their doctor about. I tell family members to look for red flags like the person takes no joy in the things that they have normally enjoyed, for example if a person enjoyed watching TV and all of a sudden will not even watch something on the TV you should note that and discuss that with your doctor. We are getting more pro-active and pre-screen patients who may be at a greater risk for depression. That depression in the elderly is even greater according to Perez. “Their kids are gone, they are often living alone and they are lonesome. Depression in the elderly is significantly more common than people might think.

    As for dealing with the stress of the holidays, Perez noted that some of that is a creation of our society. “We have people spending a lot of money and possibly buying things that they do not need out of a kind of pressure because others are doing it and it is the holidays. I remind people not to fall into that trap as it will only create more problems.”

    Dr. Ulices Perez is a member of Shore Physicians Group with offices located at 9710 Ventnor Ave. in Margate, call 609-822-4800 and also Harbor Village Shopping Plaza, 501 Zion Rd. Egg Harbor Township, call 609-927-8069.

  8. Five Ways to Weather Seasonal Arthritic Pain

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    Arthritis can make you feel like you have a built-in barometer in your body that lets you know – quite painfully – when bad weather is brewing. It’s probably a talent you’d gladly trade in, but the good news is that there are steps you can take to manage your weather-triggered arthritic pain.

    With the cooler, wet weather approaching, now is a perfect time to adopt habits that can keep weather-related arthritic pain at bay. We checked in with Manpreet Tiwana, MD, a rheumatologist with Shore Physicians Group’s Bethel Road office in Somers Point, who offers this advice for getting through bouts of bad weather:

    1. Stay Active: You might be worried that exercise will exacerbate your arthritis and joint pain, but it is actually one of the most important steps you can take to reduce pain. Exercise helps because it helps reduce the swelling. The best exercises for people with arthritis are water-based activities, like swimming and aqua aerobics, and non-weight-bearing exercises like riding a bike. Joining a fitness center with an indoor pool can help you develop a consistent routine. “It’s important to make exercise a part of your everyday life to avoid deconditioning and maintain good muscle and joint health,” says Dr. Tiwana. “If you need help, talk to your doctor about finding a physical therapist or fitness trainer who can help you find the right exercises and a consistent routine that works for you.”
    2. Watch Your Weight: “Excess weight on joints can increase discomfort, especially in weight bearing joints like the ankles, knees and hips,” Dr. Tiwana says. Try to also incorporate more anti-inflammatory foods that contain omega-3s, like salmon, mackerel, anchovies and walnuts. If you need help managing your weight, Shore offers an outpatient nutrition counseling program, which is covered by most insurance plans.
    3. Reduce Stress: Stress can worsen pain related to arthritis. “If you find you are often stressed, consider participating in activities like yoga, Pilates and meditation. These are great for overall wellbeing and controlling your discomfort.”
    4. Stay Hydrated: Another way to improve your arthritic pain is to simply increase your intake of water. The recommended rule is 64 oz. of water in a day. You may need even more when you are active or in hot weather. “Drinking enough water each day is not just beneficial for our overall health and wellbeing, but it also helps with joint pain. Certain inflammatory types of arthritis, like gout, are more likely to occur when you are dehydrated. Avoid drinking sugary drinks, as they dehydrate you. Not only that, sugar itself has an inflammatory potential, so it can actually trigger joint pain.”
    5. Rest after Activity: Make sure you give your body ample time to rest after activities and at the end of the day. “Get a good night’s sleep, try a relaxing warm bath, or even a light massage. These are very helpful for reviving your body and mind,” says Dr. Tiwana.

    By following the recommendations above, you can better manage your weather-related arthritic pain. However, if you need help with lifestyle changes, consider seeking help from the appropriate professionals. If you suspect you may have arthritis but have not yet been diagnosed, it’s important to schedule an appointment with a rheumatologist. Rheumatologists like Dr. Tiwana specialize in arthritis and diseases of the muscles, bones and joints and they can develop a treatment plan to help you manage your joint pain.

    To schedule an appointment with Dr. Tiwana, contact 609-365-6200. To learn more about Shore Physicians Group’s Rheumatology Division, visit