Spring is officially here, and with the extra hours of daylight and sunshine many enjoy, others are already in the throes of their seasonal allergies. Even on the prettiest days, they can be miserable with symptoms like a runny nose and sneezing, watery eyes, and a scratchy throat.
Dr. John Kulin, urgent care medicine physician and director of Shore Urgent Care in Northfield, said it is tree pollen that has allergy sufferers sneezing and sniffling this time of year. “Tree pollens can really trigger the body’s allergic response, and this is the time of year when trees are getting ready to bloom. We walk outside in the morning and see that fine coating on top of the car, that is pollen, and some people can have a very strong reaction to it. March to June is peak tree pollen season,” said Dr. Kulin. “In June through early September, grass pollens will cause most of the allergic reactions. Molds and dust mites can be present throughout the year and are worse on hot, damp days.”
What is an allergic reaction? When the sniffles and the itchy eyes start, we think the allergic reaction is in the nose or eyes, but as Dr. Kulin explains, those are the symptoms of the allergic reaction. The allergic reaction really stems from the immune system going overboard. “Our immune system has a very important job and that is to defend our body against an invader such as bacteria or virus that might harm it. But when a person has an allergic reaction, the immune system releases antibodies, and the cells send out histamines and other chemicals, which causes blood vessels to expand and trigger the allergy symptoms. Allergies occur when the body’s immune system recognizes a harmless substance as a threat, causing the body to produce an over-the-top response to it.”
Antibodies are quite specific, according to Dr. Kulin. Each antibody will target only one type of allergen, which is why a person can have a strong allergic reaction to ragweed but not to tree pollen. He added that people’s individual immune system, stress, and even family history may factor into the body’s allergic response.
Managing allergic reactions According to Dr. Kulin, when the pollen is heavy in the spring, most of us may have a mild reaction to it. An allergic reaction to pollen would be nasal congestion, often accompanied by a chronic mild cough as well as red, irritated, and watery eyes.
Dr. Kulin said many seasonal allergies can be managed using over-the-counter products. Nasal sprays such as Nasonex or Flonase will help to reduce the swelling in nasal passages. Antihistamines such as Zyrtec are helpful for allergy sufferers. Zyrtec and Claritin block the histamine that causes the itchy eyes, runny nose, and hives the body makes during an allergic reaction.
Dr. Kulin did not recommend the common antihistamine Benadryl to relieve allergy symptoms. “Although Benadryl is a strong antihistamine, it will likely make the person drowsy, so I do not advise it for relieving milder allergy symptoms. Both Zyrtec and Claritin are better for managing mild to moderate allergy symptoms,” said Dr. Kulin.
Patients who use over-the-counter medications like Zyrtec and Claritin should use them daily and not rely on them on an ‘as-needed basis.’ “These medications are much more effective when taken daily for allergy symptoms,” said Dr. Kulin.
Seeking help for allergies “If any pain or pressure in the cheeks or the head accompanies nasal congestion, or if they develop a fever, they may be at risk of developing a sinus infection. If so, it is time to seek medical attention,” said Dr. Kulin. “They can go to their primary care provider, or if they cannot get into their primary care quickly, they can easily go to their local urgent care center.”
Dr. Kulin suggests they meet with an allergist for bad allergies or those not well controlled by over-the-counter medications. They will be able to do testing to see specifically what the patient has the strongest reaction to and may be able to desensitize the person over time.
Epi-Pen Patients who have the potential for a severe reaction may need to carry an epi-pen with them at all times. “Food and nut allergies can be severe. They can have swelling of the lips and tongue. They might start wheezing and need an Epi-pen to shut down the symptoms quickly. But people need to understand that the Epi-pen is merely a bridge until the person gets emergency help. If they need to use the Epi-pen, they need to also seek immediate medical help,” Dr. Kulin said emphatically.
He went on to explain, “People’s reactions can escalate. A food allergy or a bee sting may have caused a mild reaction the first time they were exposed. It can be a month later or years later before that reaction is triggered again, and while the hope is that it is mild, it can be much more severe. For that reason, people who carry an Epi-pen need to make sure it is not expired. They last about a year before they need to be replaced,” said Dr. Kulin.
Poison Ivy and other outdoor allergens When we are outside, there are a number of plants innocently growing in the yard that can cause strong allergic responses, like poison ivy or poison oak. The oil from these plants is the culprit. Dr. Kulin advised using over-the-counter products like TechNu Skin cleaner to get the plant oil off the skin. “People also need to take off the clothes they have been wearing and wash them in a strong soap. Likewise, they need to wash whatever kind of shop rag they have been using in the garden,” said Dr. Kulin.
Topical products may work for mild reactions. According to Dr. Kulin, more severe poison ivy reactions may require oral steroids to control. He added that you should not use hydrocortisone products on the face as they may cause damage to the skin.
Primary Care or Urgent Care When patients are having allergic reactions, they need to decide what is best for them. “If they can get in to see their primary care provider quickly, that is a great option. If they choose to visit their urgent care center, they can get the same treatment and have the same medications prescribed to solve their problem. At Shore Urgent Care, we have made it as easy as possible to ‘get in line and save time.’ Patients are seen quickly. They can register from home on our website, know how many people are in front of them and get a call to head in when they are third in line,” said Dr. Kulin. “We know how important our patients’ time is.”
Comments Off on Shore Physicians Group Welcomes Board Certified Primary Care Provider Dr. Alexandra Buford
Shore Physicians Group (SPG) announced today that Alexandra Buford, DO, has joined its Primary Care division. Dr. Buford is Board Certified in Family Health with additional training in allergy and aerospace medicine, and she has a special interest in women’s health. Dr. Buford will begin treating patients on Tuesday, April 5, at the Shore Physicians Group office in Somers Point, located at 401 Bethel Road. She will transition her patient care to the new Shore Physicians Group location coming to the Festival at Hamilton Plaza in Mays Landing later this year.
A native of Mays Landing, NJ, and a graduate of Stockton University and the Philadelphia College of Osteopathic Medicine, Dr. Buford returns home to Atlantic County after serving full time in the United States Air Force since 2013. Her impressive Air Force career includes serving as the Medical Director at the Shaw Air Force Base in South Carolina and as the Medical Director of the Flight Medicine Clinic at the Moody Air Force Base in Georgia. In addition to seeing patients with Shore Physicians Group, she serves in the Reserves one weekend each month as a physician at the Langley Air Force base in Virginia.
To schedule an appointment with Dr. Buford, please call 609.365.6200.
Comments Off on What is Good for Baby can be Heart Healthy for Mom
Healthcare providers encourage new mothers to try breastfeeding their baby because of the benefits for the newborn. Researchers have found that breastfeeding is also very beneficial to the mother as well.
The Centers for Disease Control and Prevention released a study in July 2021 that shows breastfeeding can reduce the mother’s risk of high blood pressure, type 2 diabetes and both breast and ovarian cancer. The numbers bear out that mothers who breastfed their newborns have a lower incidence of some cancers and type 2 diabetes, and high blood pressure was also less common for breastfeeding mothers.
Before the baby arrives
Maggie Stanley of Shore Physicians Group’s OB/GYN Midwifery practice said she encourages expectant mothers to breastfeed at their initial appointment and continues to reinforce it throughout pregnancy to initiate education as well as readiness. “We also hope to identify any barriers or misconceptions that the expectant mother may have about breastfeeding,” added Stanley.
International Board Certified Lactation Consultant Lauren Matalucci of Shore Medical Center said for new moms who may be hesitant to breastfeed, “We always let our patients know that we support all infant feeding choices. But we do promote breastfeeding as it is an ideal nutrition for infants, and provides so many benefits to the newborn and well as the mother.”
Advantages to the newborn
Midwife Joanna McGrath of Shore Physicians Group OB/GYN said breastfeeding brings tremendous advantages to the newborn baby including a reduced incidence of asthma, allergies, respiratory illness, ear infections, obesity and type 2 diabetes. “Also, the breast milk composition actually changes to meet the optimal nutrition demands of a growing infant,” said McGrath.
“The advantages to the newborn are vast,” said Matalucci. “Just a few include increased brain development, a lower risk of sudden infant death syndrome (SIDS), and it aids in the development of the infant’s immune system. When a mother is exposed to certain viruses or diseases, the mother will produce extra antibodies to be transferred to the baby through her milk.”
New mothers benefit as well from breastfeeding
“Primarily, bonding is facilitated through breastfeeding,” said Stanley. “Not to say mothers who bottle feed do not bond with their baby – of course they do – but the skin-to-skin contact of breastfeeding is paramount to promote bonding.” Other advantages to the breastfeeding mother include the extra 400-500 calories burned daily and the oxytocin that is released to shrink the uterus back to pre-pregnancy size, according to Stanley.
Breastfeeding in some cases will delay the start of the mother’s period after the birth of the baby, but not always. It is also linked to a decrease in the risk of early menopause, according to McGrath. The theory is, slowing of egg loss during pregnancy and breastfeeding delays menopause.
According to research, lactation decreases the insulin levels in the blood due to decreased glucose present in the blood. There is evidence that lactation also decreases the activity of the pancreatic cells which preserves their function.
Breastfeeding and stress
According to Matalucci, the hormone oxytocin that is secreted when breastfeeding naturally lowers the stress response. Breastfeeding mothers also have a natural contraceptive and experience a lower incidence of post-partum depression.
Convenience is a big advantage
When the newborn is screaming in the middle of the night because they are hungry, breastfeeding is a convenient fix. “It is right there, it is the right temperature and it is free,” added Matalucci. “There are no bottles to wash, or formula to mix or warm up and it is eco-friendly.”
Stanley added, “Ideally women should exclusively breastfeed for six months as recommended by the American Academy of Pediatrics. With expectant mothers, we emphasize that any amount of time breastfeeding is preferable to no breastfeeding.”
Statistically, about 80% of new mothers will try breastfeeding, according to Matalucci, who is also a childbirth educator and Director of Shore Beginnings: Prenatal and Wellness program. “Many, however, choose not to continue for various reasons. It is important for all new breastfeeding mothers to have bountiful support. In the hospital setting and beyond, I provide patients with breastfeeding education, correct latch and position techniques and what to expect during their breastfeeding journey. We support all infant feeding choices, but promote breastfeeding as it is an ideal nutrition for infants, providing benefits for both the baby and the mother.”
Top 20 Reasons to Breastfeed Your Baby
Breastfeeding promotes bonding between mother and baby.
Breast milk provides perfect infant nutrition.
Breastfeeding reduces the risk of ovarian and breast cancer.
Breastfeeding is associated with a higher I.Q. in infants.
Breast milk contains immunities to diseases and aids in the development of the baby’s immune system.
Breast milk is more digestible than formula.
Nursing helps mom lose weight after the baby is born.
Breastfeeding reduces the chances of baby developing allergies/asthma.
The DHEA, (a hormone produced in the adrenal gland to make androgens and estrogens) in human breast milk cannot be replicated.
Breastfeeding reduces the baby’s risk of ear infections.
Breastfeeding reduces the risk of the development of type 2 diabetes.
Breast milk is always available and always the right temperature.
Breastfeeding reduces the risk of sudden infant death syndrome.
Breastfeeding protects baby against vision defects.
Breastfed babies are statistically healthier than formula fed babies.
Breastfeeding is a natural contraceptive.
Breastfeeding helps reduce the infant’s risk of obesity later in life.
Breastfeeding becomes less time-consuming than bottle feeding.
Breast milk is free. (The average cost of formula for the first year of life is $2,000)
It is what babies were designed for.
To learn more about Shore Physicians Group’s new OB/GYN and Midwifery practice or to make an appointment with Certified Nurse Midwives Joanna McGrath or Maggie Stanley, call 609-365-5300.
For more information on the benefits of breastfeeding, lactation support, or for any questions contact Shore Beginnings: Prenatal and Wellness at 609-653-3500 x 2860.
Comments Off on Being Heart Smart at the Dinner Table
What you eat has an effect on how your body functions, including your heart. Changing eating habits may seem like a daunting task but it is one that can provide benefits in the long run.
Shore Physicians Group Registered Dietitian and Diabetes Educator, Tiffany Rios, RD, CDE works closely with patients, getting them on the right track to a healthier life and a healthier heart. Each individual is different. Rios said, “The first step in prescribing the right type of diet is determining what the cardiac related issue is. While it’s true most dietitians agree that the Mediterranean diet is a healthy diet, there are very important nuances related to each cardiac issue. For example, if you have congestive heart failure, sodium and fluid intake are carefully monitored. If you’re taking blood thinners such as Warfarin or Coumadin, you are most likely having your PT/INR monitored, which are biomarkers for the thickening of your blood. In this case, monitoring the quantity and eating consistent amounts of Vitamin K is necessary.” She advises patients about food and drug interactions with grapefruit. (Many drugs are broken down with the help of an enzyme in the small intestine. Grapefruit juice may block that enzyme. According to the Federal Drug Administration, instead of the drug being metabolized, more of the drug enters the blood and stays in the body longer. The result is too much of the drug in your body.) If the main problem is high cholesterol or elevated LDL, the Mediterranean diet is a great approach.
Head to the Mediterranean (diet)
“The reason the Mediterranean diet gets all the hype is that it is centered on healthy fats such as avocado, nuts, seeds, and olive oil which makes it a great candidate for a heart healthy diet,” explained Rios. “What’s more, the Mediterranean diet is generally high in fiber because it promotes the intake of chickpeas and a wide array of vegetables. Since soluble fiber attaches to cholesterol in the small intestine and helps to remove it in the feces, fiber plays an important role in cholesterol reduction.”
Controlling risk factors
An important part of achieving a healthier heart is to control risk factors. Patients with type 2 diabetes need to get their A1C down. Rios said, “When I work with patients who have type 2 diabetes we co-create a tailored list of low glycemic carbohydrates and a strategy for how to balance them with proteins and healthy fats. We use the plate method to structure meals: ½ plate vegetables, ¼ protein, and ¼ healthy fat. This is a simple tool that makes portion control easier. Eating vegetables prior to the rest of the meal can also improve satiation with the meal, and help regulate appetite.”
While the plans are similar, Rios said, “The common denominator with all healthy diets is a large focus on non-starchy vegetables and plants, with a healthy balance of protein and fat.”
Diet pitfalls
When you are trying to be heart smart, there are some foods that need to be avoided. Rios said at the top of the list is trans fats. Usually identified as hydrogenated oils on packaging labels, they can wreak havoc on “good cholesterol,” or HDL that absorbs cholesterol and carries it back to the liver where it is then flushed out with toxins. Next is fast food. While it is convenient, fast food is typically high in industrial seed oils (canola, corn, cottonseed, soy, sunflower, safflower, grapeseed, and rice bran) and traditionally loaded with excess sodium. The third healthy diet pitfall is processed foods. Rios said packaged crackers, cookies and chips are usually laden with added sugars, synthetic fats/industrial seed oils, and unbalanced micronutrients. “These foods impact your blood sugar, and when consumed in excess, can result in inflammation and even cause weight gain because they do not satiate your body and leave you hungry for more food.”
Hold the salt, please
Rios advised to watch the salt intake. She explained, “Salt is a solute (a substance that dissolves in another substance such as sugar dissolving in water) and solutes generally attract water/fluid to balance out the blood chemistry. In consuming excess sodium we are increasing the volume and pressure in the blood vessels which can also increase stress on the heart.”
How much protein is too much?
Too much of anything can be bad for you. Rios advised that too much protein, particularly from the wrong sources, can be the real problem. “Excess protein can put stress on your kidneys, and since most protein sources come from an animal, the extra cholesterol and saturated fat will not do much to help heart health. So think fried meats, including poultry, and excess saturated fats.” The Keto diet promotes a high intake of protein to achieve weight loss. So for the person who is trying to maintain a heart smart diet and lose weight, Rios suggests to patients, “Before they try the Keto diet, I encourage a modified low carbohydrate diet that emphasizes high fiber carbohydrates like beans, lentils, and berries. The standard Keto diet is 70% fats, 20% protein, and 10% carbs,” said Rios. “Since 70% is a large percentage, it is understandable that if caution is not used with the types of fats consumed, this could potentially be negative for overall heart health.”
To aid in portion control, Rios suggests a person consume a portion the size of your palm and then add slightly until you feel full. “This is a good way to determine what is the right portion for you,” said Rios. “Seeing a dietitian can be very helpful to determine your own protein needs.”
White or red?
Wine, in moderation, can be a good thing for your heart. Rios said, “Red wine has been found to have more polyphenols and resveratrol than white wine, although both are touted as heart healthy. But don’t be fooled, too much of a good thing can have diminishing returns.” She suggests women limit their intake of wine to one 5-ounce glass per day and for men, one to two 5-ounce glasses per day.
Easy heart smart diet add-ins
Rios suggested adding extra virgin olive oil, olives, and nuts, seeds such as chia and flaxseed, avocados, fatty fish such as wild caught salmon, mackerel, and sardines.
To schedule a consultation with Tiffany Rios call 609-653-5300.
Comments Off on The Twenty Minute Screening That Can Save Your Life
The carotid arteries are the main blood vessels from the heart to the brain, supplying it with life-sustaining blood flow. There is a carotid artery on both sides of the neck, each one feeding one side of the brain. When there is carotid stenosis present, meaning the carotid artery is narrowed or blocked by plaque, it can lead to a stroke. According to General and Vascular Surgeon Dr. Matthew Lawrence of Shore Physicians Group in Somers Point, finding any carotid stenosis early is so important. Vascular screening is the number one tool used to find any stenosis or any other irregularity in the arteries and veins. Dr. Lawrence said,“Our goal is to catch any carotid stenosis before it becomes symptomatic.”
Symptoms of carotid stenosis
Dr. Lawrence said symptoms of carotid stenosis are very similar to that of a stroke. There could be weakness on one side, slurred speech, and an inability to grab something, weakness in one arm or leg and even facial droop. “The symptoms are not bilateral. They would appear primarily on one side or the other indicating there may be some blockage. I would want to look further with vascular screening.” Dr. Lawrence said some people may have symptoms that affect their vision. He added, “The blood flow to the back of the eye occasionally will be affected by carotid stenosis. While it might be short-lived, it is an indication of something we need to really look into further to understand why it occurred.”
Stroke statistics
According to the Centers for Disease Control and Prevention, stroke is a leading cause of death in the United States and is a major cause of serious disability for adults. About 795,000 people in the United States have a stroke each year.
Carotid stenosis, along with carotid artery disease, is caused by a buildup of plaques in arteries that deliver blood to the brain. Plaques are clumps of cholesterol, calcium, fibrous tissue and other cellular debris that gather at microscopic injury sites within the artery. Carotid arteries that are clogged with plaques are stiff and narrow. Clogged carotid arteries have trouble delivering oxygen and nutrients to vital brain structures that are responsible for your day-to-day functioning.
Screening for carotid stenosis
Dr. Lawrence says that vascular screening at Shore Physicians Group Vascular Testing and Diagnostics Center is an invaluable tool. “The ultrasound does such a good job in helping to detect any irregularities,” said Dr. Lawrence. “The testing is not stressful, it takes about 20 minutes, and there is no need for an IV and no need for radiation. We are able to take pictures of the patient’s arteries and see what is going on.”
Because ultrasound technology is efficient in helping to detect any narrowing of the arteries, it gives the physician a baseline for the patient. The advantage is being able to plot the best course for the patient.
Managing carotid stenosis
Dr. Lawrence said patients who have some narrowing may be able to manage it medically, at least early on. “If they make some lifestyle changes it will help. If they make the decision to stop smoking, get their blood pressure under control and begin managing their cholesterol level with a statin we can continue to monitor,” said Dr. Lawrence.
Once the ultrasound studies have been done and the carotid artery is significantly narrowed or blocked, surgery is often the only option. Dr. Lawrence said, “The open surgical option, an endarterectomy, is where we open up the carotid artery and put a patch on the artery to permit proper blood flow to the brain, and it really does take care of the problem. It is a quick rebound for the patient. They are normally only in the hospital overnight and go home the next day, most with nothing more than an extra strength Tylenol and bandage on their neck. The risk of any complications is very rare.” The patient returns to have sutures or staples removed in a week to 10 days and again for a checkup in a month, six months and a year as we continue to follow them.”
Getting you back to your life
Dr. Lawrence said patients will ask if they should take it easy. “I tell them, they got the repair so they can get back to their life and I encourage them to do it. If they are used to taking a walk, they should feel comfortable taking a walk. That patch that I put in is very strong and we know it can take the pressure of blood pumping through there, it can certainly handle a walk or going to the gym.”
Managing your numbers
Dr. Lawrence said it is so important for long term health to manage the numbers critical to remaining healthy. “Keep your cholesterol in check, get your blood pressure under control, and watch your diet along with watching the scale. Right now we have an epidemic of obesity. We have too many people, even young people in their 20s and 30s who are sedentary, and the long term effect is unhealthy. Get up and get some exercise every day,” concluded Dr. Lawrence.
To make an appointment with Dr. Matthew Lawrence or to be evaluated for vascular screening at the Shore Physicians Group Vascular Testing and Diagnostic Center, call 609-365-6239.
Comments Off on Eye Exams are for more than Vision
The eyes may be the window to the soul, but they can also tell you a lot about your health. Problems spotted in a patient’s eyes might be a signal of problems lurking somewhere else in the body. Some abnormalities might only be visible by the ophthalmologist when the eyes are dilated. Advanced Practice Nurse Dawn Specht of Shore Physicians Group in Somers Point said looking into her patient’s eyes may reveal changes that warrant further investigation.
Here’s looking at you
During an annual exam, going a step beyond vital signs and evaluations and examining a patient’s eyes may go a long way to assessing your overall health. “The eye exam involves assessing exterior and interior structures. The eyes’ exterior structure is what you see when you look in the mirror,” said Dawn Specht APN. “You see your eyelids, eye lashes, sclera, or the white part of your eye, the iris, or the color portion of your eye, and the dark pupil in the center. Changes in the eye may indicate that more investigation is necessary.”
Seeing more than meets the eye
As Specht explained, one change in the eye that would cause concern is a yellowing of the sclera. “This could indicate a problem with your liver. A common problem is hepatitis or an inflammation of the liver. The inflammation could be from alcohol, infection or even your gallbladder.”
Eyelids that are red or swollen may be a common finding for an allergy sufferer. “But if you notice sediment in your eyelashes that resembles dandruff it may indicate that allergies are not the problem but eyelid inflammation, also known as blepharitis. The conjunctiva or pink lining inside your eyelid might swell and appear red, indicating conjunctivitis that could be caused by a bacteria or a virus.”
Evaluating eye movement
Your eyes have highly specialized muscles and nerves. Specht said, “The movement of the eyes is evaluated to test both the muscles and the nerves in the eye. If the pupil does not constrict and dilate smoothly or if the eyes are not able to move in all directions, further investigation is warranted. The inability of the eye to move freely might indicate pressure on the cranial nerve. That pressure could be coming from changes in the brain such as swelling, bleeding, or even a mass.”
Getting to the real challenge
The need to get to the back of the eye to examine the retina, macula and optic disc is the real challenge, according to Specht. “This is done most effectively and efficiently during a dilated eye exam with specialized equipment in the optometrist’s or ophthalmologist’s office. The back of the eye is examined to detect glaucoma, macular degeneration and retinopathy. While normal aging increases the risk of changes being detected in the back of the eye, high blood pressure and uncontrolled diabetes may also damage the back of the eye.”
During the dilated eye exam the provider may be able to detect the formation of retinal hemorrhages. “A brain bleed or a brain mass may cause swelling of the optic nerve, referred to as papilledema. Uncontrolled diabetes may cause changes in the blood vessels of the retina. They may swell, change shape or even form new branches. These changes are called diabetic retinopathy and need to be treated to prevent the permanent loss of vision,” said Specht. “The diagnosis of diabetic retinopathy tells us that we need to improve blood pressure and blood sugar control. Hypertensive retinopathy tells us we need to do a better job at controlling blood pressure. Papilledema tells us that we need to examine the brain for problems causing increased intracranial pressure.”
Diabetes and vision
Uncontrolled or undiagnosed diabetes can be detrimental to vision. Specht said, “The Centers for Disease Control identifies diabetes as the leading cause of new cases of blindness in adults. Changes in the blood vessels in the diabetic’s retina may result in swelling, fluid leakage or new blood vessel formation. These changes are referred to as diabetic retinopathy. Diabetic retinopathy has various stages and types. During the first stage there are no symptoms. This may help us understand the estimate that 1 in 29 diabetic patients over the age of forty have diabetic retinopathy. The only way to diagnose this complication and prevent vision loss is with a dilated eye exam. Over time the small blood vessels that supply the retina can be blocked by too much sugar and the eye will attempt to compensate by growing new blood vessels but the new vessels are weak and typically leak and bleed. This is called proliferative diabetic retinopathy. Treatment now exists for proliferative retinopathy but it requires diagnosis with a dilated eye exam.
As a primary care provider, Specht said she advises patients to be wise about their eyes and follow the National Eye Institute, a branch of the National Institute of Health, and schedule a dilated eye exam every one to two years for anyone over the age of 60, or for African Americans over the age of 40 or anyone with a family history of glaucoma. For those with diabetes or high blood pressure, a dilated eye exam should be scheduled every year.
To schedule an appointment with Dawn Specht, APN, call 609-365-6200.
Families can be sent reeling with a diagnosis that their loved one’s forgetfulness could be dementia or Alzheimer’s disease, one the most common forms of dementia. While researchers continue to work on treatments and medications for this disease that has no cure, there is hope for delaying progression.
Caffeine’s antioxidant benefit
Coffee drinkers, don’t fret over that second cup; research suggests that caffeine may offer a delay in the onset of dementia. Neurologist Dr. Joshua Daniel of Shore Physicians Group in Somers Point said, “Coffee may provide a theoretical benefit due to the antioxidant benefit. It is the same as eating healthy as well. The brain and body go hand-in-hand. Fruits and vegetables have even more antioxidants. Coffee is not really magical, but it is one way to get that antioxidant benefit.”
But before upping the daily consumption of coffee, Dr. Daniel said, “According to a study done at Harvard, too much coffee may be harmful as well. Like everything, there is a fine balance and it is best to speak with your physician.”
Sticking with a diet plan and common sense
Without a cure, researchers continue to look for risk factors and ways people can lower their risk of cognitive decline. A study of patients who consumed a diet with a large amount of pro-inflammatory foods, those heavy in trans-fat and processed foods, were at a greater risk for dementia.
Dr. Daniel said he reminds his patients that there is a connection between the brain and the body and encourages them to eliminate some foods while following a healthy diet. “It is really common sense, but I tell my patients eating fast foods and processed foods are not only unhelpful, they can be detrimental. Get rid of the sugars and the processed foods. The Mediterranean diet has proven to be very helpful. I encourage my patients to follow the Mediterranean diet that is rich in fruits, vegetables, whole grains and heart-healthy fats.”
The role of sleep and controlling risk factors
Dr. Daniel said getting the proper amount of sleep is important for cognitive health. “Sleep apnea is important to assess. Likewise, controlling vascular risk factors like hypertension and diabetes are important along with proper diet, exercise, and maintaining a healthy lifestyle,” said Dr. Daniel.
According to Dr. Daniel, it is also very important for patients and families to understand there are many different types of memory problems as people age, from mild cognitive impairment to mild dementia to Alzheimer’s disease. Knowing signs and symptoms and speaking with your neurologist is very helpful. There are some reversible disease processes that may mimic dementia and early lab workup is key.
Current Alzheimer’s disease research
The Federal Drug Administration recently approved the drug Tauvid, a protein tracer developed to detect tau protein. Dr. Daniel explained the use of Tauvid and its role in detection and diagnosis of Alzheimer’s, indicating it is not for treatment of Alzheimer’s disease.
“Two proteins, tau and amyloid, are recognized as hallmarks of Alzheimer’s disease. In patients with Alzheimer’s disease, pathological forms of tau proteins develop inside neurons in the brain, creating neurofibrillary tangles. After Tauvid is administered intravenously, it binds to the sites in the brain associated with the tau protein misfolding. The brain can then be imaged with a PET scan to help identify the presence of tau pathology.” Dr. Daniel said while Tauvid could prove to be helpful, it is too early to really say definitively.
Family and caregiver support groups
Support groups for families and caregivers of Alzheimer’s patients offer a range of services, from offering help on how to get services for the person diagnosed to just finding a place to speak to others of shared experiences. Dr. Daniel recommends the monthly Alzheimer’s Association Caregiver Support Group offered through Shore’s Center for Family Caregivers.
Director of Care Management and Director of the Caregiver Center at Shore Medical Center, Christine Bracey, MSW, LSW, said the Alzheimer’s disease support group meets the second Tuesday of each month to assist families and caregivers with the tools they need to best navigate care for their loved one and to avoid burnout.
“We help our caregivers understand the resources in the community that are in place to assist them,” said Bracey. “It is important for caregivers to be educated and to understand things such as palliative care and other community resources.”
In addition to support groups, Shore Medical Center’s Center for Family Caregivers serves as a resource library with the most up-to-date information available from the Alzheimer’s Association and other organizations. Some of the most common concerns of caregivers include knowing who to contact to learn about additional services, and whether they need and qualify for home care services. “The Center is also a place of peace and respite. Sometimes people just need to take a break,” added Bracey.
Shore Medical Center’s Center for Family Caregivers is a free resource located adjacent to the main lobby for people who are caring for a loved one with a chronic condition or disability and connects them to a trained caregiver coach any time they need support, Monday – Friday, 9:30 a.m. to 3:00 p.m. But the Caregiver Center is also the central hub for all of Shore Medical Center’s support offerings, including monthly support groups and one-on-one counseling sessions covering a wide range of topics. As of this month, the Center introduced two new virtual support groups – Vet 2 Vet Café and Caring Together, Living Well.
The support group, Caring Together, Living Well, will be held the 2nd Wednesday of each month from 3-4 pm and will cover a wide range of topics including grief and loss, aging well and more. The session will be held virtually until further notice.
For information on these support groups, or for those seeking support from a Caregiver Coach to help them cope with the challenges of caring for a loved one, visit www.shoremedicalcenter.org/center-family-caregivers or contact a Caregiver Coach at 609-653-3969.
To schedule an appointment with neurologist Dr. Joshua Daniel call 609-365-6202.
Comments Off on Shore Physicians Group Welcomes James J. Tayoun, DO, to its Surgical Division
Shore Physicians Group (SPG) announced today that James J. Tayoun, DO, has joined its Surgical Division. Board Certified in general and vascular surgery, Dr. Tayoun brings more than 20 years of experience to Shore Physicians Group. He will begin seeing patients Jan. 3, 2022 at 649 Shore Road, Somers Point and will be on staff at Shore Medical Center.
Dr. Tayoun uses advanced minimally invasive surgical techniques to treat a wide range of conditions that affect the stomach and colon including severe acid reflux disease; hiatal, inguinal, incisional and diaphragm hernias; pathologies of the colon including diverticulitis and tumors; gallbladder surgery, and more. He is also skilled in minimally invasive vascular surgeries to treat aortic aneurysms, varicose veins, and conditions that affect the arteries of the legs including peripheral artery disease.
Dr. Tayoun earned his Doctor of Osteopathy from the Philadelphia College of Osteopathic Medicine and completed his vascular fellowship at Deborah Heart & Lung Center. He has been in practice in the Greater Philadelphia region his entire career. Prior to joining Shore Physicians Group, Dr. Tayoun served as Chairman of the Department of Surgery and Director of Wound Care for Jennersville Regional Hospital in West Grove, PA. He was also the Chairman of the Department of Surgery at St. Francis Medical Center and St. Agnes Medical Center. Dr. Tayoun is a Fellow of the American College of Osteopathic Surgeons.
In addition to his clinical experience, Dr. Tayoun has also taught extensively, serving as a Clinical Instructor of Surgery at Jefferson Medical College, and at Philadelphia College of Osteopathic Medicine where he also served as Associate Program Director of its Residency Program and Director of its Vascular Fellowship Program. In joining Shore Physicians Group, Dr. Tayoun will work alongside two of his former residents, SPG reconstructive surgeon Dr. Mohit Sood and SPG general and vascular surgeon Dr. Matthew Lawrence.
“We are proud to welcome Dr. Tayoun as a part of our family here at SPG. His expertise in advanced minimally invasive surgical techniques along with his knowledge and compassion make him a great addition to an already great team,” says Mark Stephens, Chief Administrative Officer of Shore Physicians Group. “He will be a valuable member of our Shore medical community.”
To schedule an appointment with Dr. Tayoun, please call 609.365.6239.
Comments Off on Behind the Scenes – Surgical Division
In this month’s Behind the Scenes feature, we highlight the Shore Physician Group Surgical Division team at 649 Shore Road in Somers Point. These compassionate and dedicated professionals have an integral role in our patients’ journeys, guiding them through the entire process.
Surgery is a journey for people whether it is a few short months or a series of procedures needed to ensure the patient’s quality of life. SPG Surgical Division Practice Manager Zeika Gomez said, “The people in the office are a big part of the patient’s journey. Starting at the front desk, each person plays an important role, coordinating everything so we are getting the patient best prepared for their procedure or surgery and assuring them of the safe environment.”
The team members in the Surgical Division work in unison to assure each and every patient’s needs are met. “We are here to help. We check their eligibility with the insurance company, check on Covid 19 screening, along with all pre and post-surgical test scheduling,” said Patient Service Representative Monique Donaldson. “We understand a trip to the physician might be stressful for some of our patients and we really want to help them in whatever way we are able to make their experience less stressful so when they leave the office they have everything they need.”
Offering support and working with every team, making sure the office works smarter, streamlining efforts so each patient’s experience is positive is the goal of Surgical Div. Supervisor James Curtis. “We deal with patients every day. We want to give them a light of hope and confidence that we are with them.”
Surgeries are scheduled through the office, and scheduler Sara Weber educates as well as coordinates care and offers encouragement. Understanding the emotional and mental health aspects of healing is important. Patients facing surgery along with their family members or those who recently had surgery might be feeling stressed and overwhelmed. They have questions and for Nurse Kameesha Blake, finding all the answers that will allow them to feel more informed is very important. “I am happy to speak with every patient on the phone, in person or through the portal. They really do feel your energy and I think they know we go that extra mile for them so they can clarify instructions or answer any questions they may have.”
The medical assistants lead patients from their consult appointments to the very last post-operative appointment of care, according to Medical Assistant Ashley Sprigg. “Ensuring them the entire way we will do our best to make sure their prep, surgery, and post care are at all no stress for the patient.” The MA’s process orders alongside the providers, triage and manage phone calls of concerns, and provide any wound care necessary. Patients truly become comfortable with MA’s being their “go to” person.
Beyond procedures and surgery, the new Shore Vascular Testing and Diagnostic Center is located within the Surgical Division. Registered Vascular Technician Tracey Nadel works closely with patients to help them relax as they prepare for their screening where they perform noninvasive ultrasound exams to evaluate the arterial and venous system of the neck, abdomen, legs and/or arms, depending on the patient’s symptoms.
James Curtis said, “We understand and communicate with each patient that it is our privilege to help successfully navigate our patients on their journey to better health.”
Vaccines might be controversial right now, but historically they have always been a part of our lives. From the early polio and smallpox vaccines that were part of life in the 1960s to the current measles, mumps and rubella vaccines that are administered to infants and toddlers, we rely on vaccines to keep us healthy and save lives. Dr. David Totton, Ambulatory Pharmacist with Shore Physicians Group in Somers Point, weighs in on vaccines and provides some clarity and guidance.
Why do we need vaccines?
According to Dr. Totton, “Vaccination is a preventative tool that allows us to build immunity to a variety of infectious diseases without first becoming infected and getting sick. Much of what we do in medicine today is preventative. We would much rather be proactive and prevent illness than be reactive and deal with the negative consequences of the illness.”
Should I get a vaccine if I feel a cold coming on?
“In general, vaccination should not be delayed in the event of a mild illness such as the common cold as long as there is no fever. However, in light of the Covid-19 pandemic, it would be prudent to first speak with your primary care provider who will assess your symptoms and recommend Covid testing prior if necessary,” said Dr. Totton.
The flu vaccine
Flu clinics are opening up in the region. Dr. Totton said typically flu season will run from November through March. The peak of flu season typically falls in February. He suggests getting the vaccine annually no earlier than September and no later than the end of October if at all possible to provide maximum protection through the length of the flu season.
The 2020 flu season was mild, leaving people to wonder if they should plan to get a flu shot this year. Dr. Totton said, “Luckily we saw that our infection mitigation efforts through mask-wearing and social distancing were fairly effective last year which resulted in a mild flu season. This, however, may not be the case going forward. Pandemic restrictions are generally more lax at this point than they were this time last year and we will likely see a bit of an uptick in flu cases. In addition, there is some concern that with such low exposure to the influenza virus over the past year, our natural immunity may be a bit lower than normal, potentially leading to more serious outcomes. In addition, we are still concerned about overwhelming the healthcare system and reaching hospital capacity. A big focus going forward will be to reduce unnecessary hospitalizations due to preventable diseases such as the flu.”
Will the flu shot give me the flu?
A big question many people have every year is ‘will the flu shot give me the flu?’ Dr. Totton said emphatically, “No. Currently, 99% of all influenza vaccinations given are classified as ‘inactivated influenza vaccines.’ This means that they contain no intact influenza virus or genetic material that would allow the virus to replicate. For these reasons, it is physically impossible to contract the flu from an inactivated influenza vaccine.”
He added that some patients may experience mild flu-like symptoms post-vaccination, however this is due to the body’s natural and expected immune response to the vaccine. This is evidence that the vaccine is being recognized by the body, actively building immunity to the virus, and should only last for a day or two.
The concern is also, ‘can I get the flu even if I have a vaccine?’ Dr. Totton explained the influenza vaccine contains four of the most common strains of the flu that are expected based on previous flu seasons and variants seen in the southern hemisphere, which has its flu season during what is summer for us up north.
“There are, however, many other strains of the influenza virus that can potentially infect humans. Another factor to consider is that the influenza virus tends to rapidly mutate which can reduce the effectiveness of current vaccines. On average the flu vaccine is about 40-60% effective in preventing illness in any given year. So yes, it is possible that you can still get the flu even if you have received the vaccine; however, the infection will likely be less severe, you will recover more quickly, and your risk of hospitalization and death is much lower,” said Dr. Totton.
Pneumonia vaccine
The older population is at somewhat of a greater risk for complications from diseases such as pneumonia. There is a pneumonia vaccine and it is available only to those 65 and older. Dr. Totton said current Centers for Disease Control and Prevention (CDC) recommendations are that everyone over the age of 65 should receive one dose of Pneumovax-23. Those at higher risk of pneumonia may also be advised that they should receive a dose of Prevnar-13 one year before Pneumovax. This means that they would get Prevnar-13 on or after their 65th birthday and then Pneumovax after turning 66.
Dr. Totton explained that the pneumonia vaccine is used beyond the over-65 population as well. “The pneumococcal vaccination is actually part of our routine pediatric vaccination schedule these days. We also commonly administer this vaccine to smokers and those with high-risk conditions including heart and lung disease. Pneumococcal vaccination does become more important as you age because both the risk of pneumonia and potential risk of negative outcomes increase as you get older.”
Dr. Totton advised even those who receive a pneumonia vaccine should absolutely plan on getting a flu shot as well. “The agents that cause pneumonia and the flu are completely different. Pneumonia is caused by a host of bacterial and viral organisms, however, we only vaccinate against bacterial causes. In contrast, the flu is only caused by the influenza virus. This means that getting vaccinated against one will not protect you from the other,” said Dr. Totton. Getting both shots at the same time is acceptable and he added, “There is usually only concern over co-administration of vaccines when using a live vaccine product. Since all injectable flu vaccines and all pneumonia vaccines are inactivated, patients can receive both vaccines at the same time. In the event of simultaneous administration, it is advisable to request that one vaccine is administered in each arm to reduce the risk of adverse effects such as pain at the injection site.”
HPV vaccine
The human papillomavirus or HPV vaccine used to only be available for girls age 12 to 16 and now it is recommended for boys and girls with the first dose around 11. Dr. Totton said, “It is important to receive the HPV vaccine as early as possible. This is because HPV is a sexually transmitted infection and once a person becomes infected, the virus stays locally inside the cells where it can evade the immune system. There is currently no cure for HPV meaning the earlier we can vaccinate and protect our teens, the less likely they are to have problems down the line and spread the virus to others.”
The current HPV vaccine contains inactive proteins from nine strains of HPV that have been implicated in the development of various cancers. It is administered in a three-dose series. No booster doses are recommended at present. HPV infection has been associated with many serious complications including cervical, vulvar, vaginal, anal, head, and neck cancers, as well as genital warts.
Dr. Totton explained how the HPV vaccine helps keep an individual from developing certain cancers 30 years after it is administered.
“HPV infection is usually asymptomatic, meaning a person will not immediately become aware that they were exposed. Once infected, certain strains of the virus may cause changes to the cells they contact and force them to divide rapidly. If left unchecked, this will develop into cancer down the line. HPV infection is typically only discovered years later when a patient goes for a routine pap smear or develops a complication such as cervical cancer. In our eyes, this is much too late and can be prevented with a few simple vaccinations,” said Dr. Totton.
Shingles vaccine
Shingles, much like HPV, can lie dormant in your body for years and then suddenly appear. Not everyone will develop shingles, so why is it prudent to get the shingles vaccine?
Dr. Totton explained, “Shingles occurs when the varicella virus (the virus that causes the chickenpox) reemerges from nerve cells where it lays dormant. Due to how widespread the varicella virus is, even if you have no recollection of getting chickenpox, it is believed that we are all exposed at some point and therefore are at risk of developing shingles. Active shingles infection causes an often very painful and uncomfortable rash and may leave some patients with lasting nerve pain even after the rash subsides. The newer shingles vaccine, Shingrix, is recommended for everyone age 50 and up and I encourage all of my eligible patients to receive the vaccine.”
But patients ask, ‘if I had the chickenpox vaccine, should the immunity from the chickenpox vaccine keep me from getting shingles?’ Dr. Totton said, “Unfortunately, no. Even though the virus that causes chickenpox and shingles is the same, the dose of the shingles vaccine is larger and it also contains an adjuvant. These both help your body produce a strong enough immune response to protect against the emergence of shingles.”
Covid-19 vaccine
The biggest question of the year is ‘why is it important to get the Covid vaccine?’ Dr. Totton said, “The Covid vaccine is the best tool in our fight against Covid. A recent study from the Department of Health and Human Services reports that the vaccine has prevented an estimated 265,000 infections, 107,000 hospitalizations, and 39,000 deaths among just the Medicare population in the first five months of 2021. These are promising numbers, however the longer it takes to get everyone vaccinated, the longer the virus is allowed to mutate and potentially reset the clock on all the progress we have made. Getting vaccinated is the only way we are going to suppress new Covid cases enough to return to normal life.”
We hear in the media about Covid-19 variants. Why are variants like delta and mu showing up? Dr. Totton said, “We know that, unfortunately, the Covid virus tends to mutate quickly. When a virus mutates, it changes the proteins on its surface to evade our immune system and, in some cases, the vaccines that target the virus. This is not a new concept and we now have a lot of experience with influenza which requires constant monitoring for variants and routine changes to annual flu vaccinations to correspond with these mutations. These mutations only occur when the virus is allowed to spread and continue to proliferate inside each new host. What this means is that the best way to slow the emergence of new variants is to protect yourself and others from the current strain through vaccination, mask-wearing, and distancing as recommended.”
Covid-19 booster shots
The status of booster shots is changing in concert with CDC recommendations. Those over 65, immune-compromised and front-line personnel are eligible. Dr. Totton said on the expansion of booster shots, “This is where some distinction between additional doses and booster doses is needed. We consider a third dose of an mRNA vaccine in someone who is immunocompromised to be an ‘additional dose.’ This is because we have seen that 2 doses of an mRNA vaccine do not produce the same immune response in these patients when compared to the normal population. The third dose is acting to bring their immunity to the level of those who are not immunocompromised,” said Dr. Totton.
Recently, the FDA and CDC authorized booster doses for those who received the Pfizer vaccine. They recommend the booster dose six months after their second dose for people over the age of 65; those who reside in a long-term care facility; or those aged 50-64 with certain underlying conditions. They also say that those aged 18-49 with underlying conditions or those 18-64 at increased risk of occupational exposure may get a booster dose.
“Keep in mind that at the current time, this only applies to those who received the Pfizer vaccine. We are still awaiting data from Moderna and Johnson & Johnson before a booster dose is approved. However, stay tuned, from what I am hearing we should expect to see more on this by the end of October,” said Dr. Totton.
As for booster shots, Dr. Totton said there is some good news. “From what we have seen in the booster dose trials, we can be fairly confident that a third dose of mRNA vaccine should produce similar effects as the second dose.”
Breakthrough cases of Covid-19 in vaccinated persons persist. While a vaccinated individual may still contract a mild version of Covid-19, can they spread the virus to someone as well? Dr. Totton said, “While the Covid vaccines are our best tool in the fight against Covid, nothing is ever 100%. There is still a small chance that you will become infected, especially in light of some of the newer variants we have been seeing. However, it is much more likely that you will have a mild case that does not result in hospitalization, ventilation, or even death. We are also seeing that in the event of a breakthrough infection, the virus is still able to be transmitted and cause further infection. This is the reason that the CDC still recommends following all pandemic precautions whether you are vaccinated or not.”
Can I get the flu vaccine and the Covid vaccine at the same time?
It is safe to get the flu and Covid vaccine at the same time. “Recently the CDC has made the official recommendation, based on the experience we have with other vaccines, that it is safe and actually encouraged to receive both vaccines at once if eligible to ensure all required vaccinations are received on time,” said Dr. Totton.
Dispelling myths
The Covid-19 vaccine has become a flashpoint with wide-ranging opinions and claims on its use, whether it should be mandatory and even claims of alternate cures for Covid-19. Dr. Totton offered his scientific opinion on several of the claims that have been made about the Covid-19 vaccine.
Myth: The Covid vaccine has aluminum in it and 5G technology will be able to track individuals that receive the vaccine.
Fact: Dr. Totton said this is a baseless conspiracy theory and has no grounds in reality. The ingredients in the vaccine are readily available online and all components of each vaccine are rigorously tested for safety and evaluated by the FDA.
Myth: The Covid-19 vaccine is putting Covid into my body and will give me Covid.
Fact: According to Dr. Totton, this is false. The Moderna and Pfizer vaccines are mRNA-based, meaning that the only part of the Covid virus that is injected is a small strand of genetic material that codes for the outer “spike” protein. They do not contain any other components of the virus that would allow it to replicate and cause infection. The Johnson & Johnson vaccine contains a weakened viral vector. This is a special viral vector that is incapable of replication and expresses Covid virus proteins. In both cases, there is no way for the virus to multiply and cause illness.
Myth: The approval of the vaccine was rushed so it is not safe.
Fact: The Covid vaccines that are in use today were approved through what’s called an emergency use authorization (EUA). Much of what is expedited in the approval process of an EUA involves advertisement, marketing, and planning about the rollout and distribution of the medication/vaccine. Safety and efficacy trials are virtually the same as a normal FDA approval process and may just be lacking in long-term follow-up data. Due to the nature of this global pandemic, many companies were able to work together with the federal government to speed up some of the unnecessary or time-consuming steps of the full approval process and instead focus on the important clinical data to get the vaccine out quickly. The FDA will only approve products that have shown that their benefits outweigh the risks.
Myth: Ivermectin kills the Covid-19 virus.
Fact: Dr. Totton said, “At the present time, there is not enough data to say whether or not ivermectin is safe or effective for treating Covid-19. Historically, ivermectin has been used as an antiparasitic medication (dewormer) and has never been used against viral illness. For now, it is not recommended to take ivermectin for Covid-19 outside of a clinical trial designed to test its effectiveness. We simply have little-to-no data about whether this medication works against Covid-19 and it does come with its own risks. Recently, I have also seen news stories about people taking things into their own hands and purchasing ivermectin meant for animals to self-treat Covid. This has already led to multiple hospitalizations as the doses and inactive ingredients may not be consistent or even safe for human consumption. If you have any concerns about the treatment or prevention of Covid-19, I highly encourage you to speak with your primary care provider about your options and discuss which is right for you.
David Totton, PharmD, is the ambulatory care pharmacist on staff with Shore Physicians Group. He consults with physicians regularly about medication management, conducts Medicare annual wellness visits, provides comprehensive medication reviews, and more. Dr. Totton sees patients in Marmora, Ocean City, Somers Point, Margate and Northfield. Click here to learn more about how an Ambulatory Care Pharmacist can help you. To find an SPG primary care provider, click here.
