Author Archives: Joe Hilbert

1. Can You Reverse Your Prediabetes?

   October 7, 2021 1:14 pm Comments Off on Can You Reverse Your Prediabetes?

   Diabetes by the Numbers

   The diabetes numbers in the United States are staggering. The Centers for Disease Control and Prevention indicates that 34.2 million adults in the U.S. are living with diabetes, a number that has more than doubled over the past 20 years, with one in five not even knowing they have it. Diabetes is the leading cause of kidney failure, adult blindness and lower limb amputation. But the number of people who are prediabetic, meaning they have a higher-than-normal blood sugar level, is nearly one in four Americans and more than three-quarters of them are unaware of their risk. Take this CDC diabetes risk assessment to see if you may be one of the 88 million Americans whose blood sugar is elevated enough to be considered prediabetic https://www.cdc.gov/diabetes/prevention/pdf/Prediabetes-Risk-Test-Final.pdf

   Type 1 diabetes, often diagnosed in children and young adults is where your body does not make its own insulin. The insulin helps cells in use up the glucose from blood. According to the CDC, a normal blood sugar level is below 140. A person is considered to be prediabetic with a blood sugar level of 140-199. A blood sugar level of 200 or above would be qualified as type 2 diabetes. Those diagnosed with type 2 diabetes are normally adults when diagnosed. Their bodies do not use insulin well and that caused their blood sugar levels to fluctuate. Those who may be prediabetic, their insulin is not working properly and too much glucose builds up in the blood.

   In Somers Point, Shore Physicians Group registered dietitian and certified diabetes educator Tiffany Rios said while the patient’s blood sugar level may not be high enough to be considered type 2 diabetes yet, without lifestyle changes, adults and children with prediabetes are more likely to develop type 2 diabetes.

   Don’t Just Blame the Genes

   Rios said, “Much like diabetes, genetics does play a role in prediabetes. But environment and lifestyle are key and they can reverse the diabetes process or they can push it toward type 2 diabetes.” So what are the steps to take to avoid developing diabetes?

   Rios said, “Exercise and diet are key. Exercise helps the muscle cells absorb glucose (sugar) more efficiently, thereby normalizing the blood sugar level. Consuming healthy portions and watching the types of carbohydrates make a big impact on our ability to normalize glucose levels.”

   Sugar Lurks in Many Places

   Added sugars are a big culprit that factor into people developing type 2 diabetes, according to Rios. “Added sugars and refined carbohydrates like enriched wheat flour, processed foods like cereal, crackers, pretzels, cookies, breads, pizza, pancakes, waffles, donuts, cakes, pie and ice cream are obvious foods that contribute to type 2 diabetes. But there are also some not so obvious foods that contain added sugars like ketchup, sauces, dressings and yogurts.”

   Rios said a balanced diet coupled with an exercise regime can prevent type 2 diabetes from developing. If someone has been diagnosed with type 2 diabetes, it most certainly can help a person to manage their diabetes.

   The Job of Insulin

   As Rios explained, “Insulin is a hormone that is responsible for helping us utilize the sugar (glucose) from the food we eat. When we eat too many carbohydrates or highly processed carbohydrates it spikes the amount of sugar in the blood and forces insulin to work a bit harder to normalize our blood sugar level. It can also desensitize our cells to insulin if our blood sugar continues to spike. Insulin acts as a lock and key. It has the key to our cells where the food digested from the stomach is then absorbed into the cells and tissue”

   Why Diabetes is so damaging to Heart and Kidneys?

   Diabetes takes a real toll on the body. “When blood sugar levels are high, our blood can run like molasses. This viscous blood damages the arteries and capillaries feeding our major organs-the heart, nervous system and kidneys” said Rios.

   Help Yourself

   Consuming moderate levels of carbohydrates and tailoring them to your activity level are Rios suggestions to keep type 2 diabetes as bay. “A good place to start is 100-150 grams a day,” according to Rios. “Vegetables and proteins are two potent fighters against type 2 diabetes because they help us to absorb sugar at a slower pace, which improves insulin sensitivity and the ability to burn carbohydrates as fuel.”

   Start keeping a food journal. Rios said, “A food journal is incredibly helpful for noting patterns between what foods are spiking your blood pressure. It gives direct feedback on how you are doing daily. You can use a food journal to count your carbs and ensure you are getting enough protein and fiber from vegetables.”

   For help getting your blood sugar under control, creating your food journal and keeping your prediabetes from becoming type 2 diabetes, make an appointment with Tiffany Rios at 609-365-5300.

2. Can You Take the Weight Off and Keep It Off?

   1:02 pm Comments Off on Can You Take the Weight Off and Keep It Off?

   The barrage of ads for fat-burning diets are unavoidable whether it is on your phone, your tablet or just while waiting in the checkout line at the supermarket. Claims of shedding unwanted pounds from taking one miracle fat-burning pill a day are enticing, but is that sustainable? Shore Physicians Group Ambulatory Pharmacist, Dr. David Totton said, “Fat burning diets are thermogenic. That simply means ‘generating heat.’ Heat is a byproduct of al metabolic processes in the body, including fat breakdown. These diets and supplements aim to boost your metabolism, speed up the breakdown of fat and ultimately help you lose weight.”

   Will Fat Burning Produce Weight Loss?

   “Burning fat through these thermogenic diets is a quick way to shed some pounds,” said Dr. Totton. “However, for sustainable weight loss that lasts, lifestyle modification is necessary.” As Dr. Totton explained, “If you rely on a short-term, highly restrictive diet to lose weight and then return to normal eating habits once you reach your goal, there is a high probability that you will put the pounds back on over time. In addition, if you do not limit your caloric intake, it will still be difficult to lose weight no matter the diet you choose. This is why it is generally better to make smaller changes over time that you will be able to adhere to and move toward a healthier lifestyle overall.”

   The fat burning weight loss programs claim they churn up the body’s metabolism to rapidly reach a state of ketosis and increase energy level and the ability to focus at the same time. But can the fat burning process aid in that? Dr. Totton said, “Yes and no. The body’s source of readily available energy typically comes from glucose which the product of carbohydrate metabolism. Since the keto diet entails greatly reducing carbohydrate consumption, this pushes the body to find alternative energy sources including the fat stores in the body. This fat is broken down into ketone bodies that are used as an alternative energy source in the absence of glucose. These ketones are used by the brain and heart for energy so it is very possible that patients feel energized and focused once they are stable on the keto diet. However, when starting the keto diet, or it your macronutrient ratios are off, you may experience what is known as ‘keto-flu.’ Dr. Totton explained, the “keto-flu” occurs because the body no longer has access to adequate glucose and has not yet ramped up the fat burning process leaving an available energy deficit. The “keto flu” typically causes mild, flu-like symptoms as well as upset stomach, dizziness, decreased energy and mood swings.

   Will the Weight Come Back?

   In general, the most effective and safe way to lose weight is caloric restriction along with an increase in aerobic activity, according to Dr. Totton. “Artificially boosting metabolic activity in the body without changing diet and exercise habits may produce a slight reduction in weight in the short-term, however this is likely unsustainable and once the supplement is stopped, the progress made will quickly be lost.”

   Everyone is different and what works for one person may not work for everyone. Dr. Totton warned, Keto diets are notoriously hard to keep up with and typically require that a person get 70-90% of their total caloric intake from fats with only 5-10% coming from carbohydrate sources. This is very limiting and requires constant awareness of all components of the products you consume. In general, less restrictive diets relying on caloric deficit and increased activity will be easier to maintain and therefore, may be more effective in helping reach your weight goals.

   Insulin Resistance

   Looking to lay blame on gaining weight, some diet programs say insulin resistance is the reason you may be having difficulty losing weight. Dr. Totton explained, insulin is a hormone made by the pancreas that helps glucose in your blood enter cells in your muscle, fat and liver where it is used for energy. Insulin resistance, as the name implies, is when your body does not respond as well to insulin causing excess glucose to remain in the blood where it may contribute to weight gain and the risk of diabetes. We do know some of the factors linked to insulin resistance. These would include some that you cannot change such as genetics, family history and race as well as some that you can change such as being overweight and inactive in your daily life. Ultimately it is know that insulin resistance that is not addressed through healthy lifestyle modification puts you at a much higher risk of developing type 2 diabetes and obesity late in life and can definitely make it more difficult to lose weight going forward.

   The Stress of Rapid Weight Loss of the Body

   Dr. Totton explained that rapid weight loss through a keto or any intensive low-carb diet can definitely put a strain on the body. Both the liver and kidneys are involved in the metabolism and breakdown of fat and proteins in the body. Such rapid breakdown of fat and increased protein intake associate with these diets may put stress on these organs and make any underlying conditions worse. Another concern we have is an increase in LDL (or bad) cholesterol levels. If time and attention is not takento limit saturated fat consumption, this may lead to an increased risk of cardiovascular disease and stroke. Additionally, such a limiting diet can put you at risk of nutrient/vitamin deficiencies which can lead to a host of unwanted side effects including constipation, muscle cramps, heart palpitations, and in some severe cases, arrhythmias. “Given the risks associated with this diet it is highly recommended that you discuss with your doctor and possibly a nutritionist before starting a ketogenic diet in order to assess your specific needs and risk factors to determine if it is the right diet for you.

   Organic Does Not Equate to Safe

   Many of the weight loss supplements are organic. But does organic mean the product is safe? Dr. Totton said, “Organic is not always synonymous with safe. An organic product is produced without the use of chemical fertilizers, pesticides or other artificial agents. There are however plenty of naturally occurring substances that are detrimental to your health, and many synthetic and artificial ingredients that are completely safe to take.” The best way to know if a product is tested and safe to consume is to look for the United States Pharmacopeia (USP) seal on the bottle as well as only taking products that are recommended by your primary care provider that have gone through the rigorous FDA approval process. Many dietary supplements that are available online or over the counter do not require FDA approval and the companies are not required to show any safety or efficacy data before marketing and sale of the product, explained Dr. Totton.

   Weight Loss Supplements and Prescription Meds

   Anyone taking a prescription medication should be wary of introducing a weight loss supplement. Dr. Totton said, “Certain weight loss supplements can certainly interfere with prescription medications and may not be safe for patients with a history of cardiovascular disease or who are taking blood thinners. I would recommend that you discuss any supplements that you plan on taking with one of your healthcare providers prior to use.”

   Is Rapid Weight Loss Sustainable?

   Some people are able to rapidly lose weight and then maintain these changes for long periods of time. Unfortunately, this is usually the minority, according to Dr. Totton. “We have seen time and time again that small changes over time and consistency with your diet and exercise habits are the best way to achieve and maintain your weight loss goals. Even strong proponents of the keto diet will tell you that it is not intended to be a long-term solution.”

   With respect to Keto-speed specifically, Dr. Totton explained, the supplement includes beta-hydroxybutyrate (BHB) which is one of the ketone bodies produced during the breakdown of fat in the body. It is thought that supplementing this product will cause the body to recognize that fats are being broken down and speed up ketosis. These products are also marketed as an energy supplement as you are introducing extra fuel into the body from the supplements. However, it has been found that BHB actually negatively reinforces fat breakdown, meaning that the more BHB that is present in the blood, the more your body wants to slow down fat burn so that you don’t go through your backup energy reserves too quickly. This means that artificially supplementing BHB may actually negatively impact your keto weight loss efforts and make it harder to burn your natural fat stores.

   Dr. Totton went on to explain, another concern is that the BHB in these products is typically bound to electrolytes such as sodium, calcium and magnesium. The dosing recommended by the supplement manufacturers can often lead to excessive levels of these electrolytes in the blood which may lead to kidney stones, high blood pressure, muscle cramps, constipation/diarrhea and conduction abnormalities in the heart.

   Additionally, those with diabetes will likely require a reduction in the dose of their medication given the strict carbohydrate limitations. If blood sugars are not closely monitored during initiation of a low-carb diet, these patients are at a very high risk of hypoglycemic episodes.

   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.

3. What That Swelling in Your Leg Could Be Telling You

   12:53 pm Comments Off on What That Swelling in Your Leg Could Be Telling You

   Deep Vein Thrombosis

   Deep Vein Thrombosis or DVT is a serious condition that results from a blood clot forming in one or more of the deep veins. It is most commonly found in the lower leg veins but according to Dr. Leonard Galler, Chairman of the Department of Surgery at Shore Medical Center in Somers Point and a General and Vascular Surgeon with Shore Physicians Group, blood clots can occur in any vein such as those in arms, legs, pelvis, and even renal veins and portal veins. If DVT is untreated significant morbidly and even mortality can occur. An example of a complication is a pulmonary embolism, which is a blood clot that breaks off and dislodges in a pulmonary vein leading to respiratory compromise.

   DVT is a Significant Health Problem

   “DVT is a major vascular problem,” said Dr. Leonard Galler. “It is the third leading vascular issue behind cardiac and stroke issues. Approximately 400,000 incidents of DVT occur in the United States each year. Dr. Galler again emphasized, “There are significant consequences if DVT is not treated. People can die from untreated blood clots.”

   He added that varicose veins can become thrombosed but does not have the risk of a DVT. A varicose vein, which is a dilated vein under the skin where blood can pool, will not break off and travel to the lungs.

   Early symptoms of a DVT blood clot may include swelling and tightness in the legs. There may be a persistent throbbing or a cramp-like feeling in the leg along with some pain or tenderness in the area when walking. There may be some warmth to the affected leg as well. According to Dr. Galler, it is normally noticed by the patient that one leg is more swollen than the other. DVT blood clots can occur bilaterally, in both legs but it is more common to occur in a single location. Patients who experience these symptoms need to be seen by a physician or nurse practioner for evaluation quickly.

   Reasons a DVT May Develop

   As Dr. Galler explained, DVT blood clots may develop for several reasons. There are blood clots that are classified as unprovoked, meaning there is no identifiable, causative reason. There are blood clots that are provoked. A provoked DVT can occur from trauma, a cancer diagnosis, obesity, malnutrition, advanced age, extended bedrest post-surgery, genetic factors, and from medication, such as contraceptives or hormone replacement treatment.

   Genetics may also play a role in the formation of DVT. Dr. Galler said, “Blood factor deficiencies such as Factor V Leiden can cause DVT. Patients who give a family history of DVT need to be worked up for genetic deficiencies of clotting disorders.”

   Finding the Blood Clot

   Dr. Galler explained, if there is a concern of a possible blood clot, an ultrasound, computed tomography (CT scan) or magnetic resonance imaging (MRI) scan may be prescribed to confirm the diagnosis. The most common modality is the ultrasound as it shows the blood flow in the veins and any blood clot that may be there. D Dimer blood tests can also help diagnose a blood clot. According to Dr. Galler, Shore Medical Center and the Vascular Lab at Shore Physicians Group have availability in the hospital and the office setting to perform these diagnostic tests.

   Treating DVT Blood Clots

   Dr. Galler said the standard of care for treating DVT is the administration of blood thinners either by pill, IM injection, or IV infusion. The anti-coagulants block specific clotting proteins from forming clots thus allowing regression and resolution of the clot. Treatment is individualized and may require a three to six month regimen. Some patients may need to take blood thinners for the rest of their lives to keep clots from forming. He added that at times there will be adjustments needed because of an allergy or a patient’s intolerance for one medication over another.

   For those who do not benefit from blood thinners or have contraindications to blood thinners, there are other methods to remove or dissolve blood clots. In some cases, patients may need an IVC filter implanted that will stop a clot from traveling to the lungs thus reducing mortality and morbidity.

   Patients will often be told to wear compression stockings after the start of blood thinners and improvement is noted. Compression stockings are specially designed socks or sleeves. They squeeze or compress the leg in a way that improves blood flow and reduces swelling. The stockings tend to apply the most pressure at the ankle and then the pressure decreases farther up the leg, forcing blood upward. The stockings are designed to ease swelling and engorgement in the lower leg as well as reduce discomfort.

   To make an appointment with Dr. Galler at his office located at 649 Shore Road in Somers Point visit call 609-365-6239.

   The Shore Physicians Group Vascular Lab hours are Monday-Wednesday-Friday 8 a.m.-5 p.m., Tuesday-Thursday 8 a.m. -7 p.m. and the second Saturday each month is 8 a.m.-2:30 p.m.

4. Could a New Diabetes Drug Help You Lose Weight?

   August 10, 2021 1:12 pm Comments Off on Could a New Diabetes Drug Help You Lose Weight?

   Maintaining a healthy weight is not just about the size you wear or the reflection in the mirror – it’s also about keeping your body healthy. Statistically, as a nation, we have a problem with maintaining a healthy weight. Two-thirds of the U.S. population is overweight, with 36.5% suffering from obesity, defined as a BMI over 30. Obesity means having too much body fat, which can lead to heart disease, diabetes, stroke, and more. For many, weight is a constant struggle, but a new medication on the market may help.

   In June, the Federal Drug Administration approved Wegovy (semaglutide), a drug that has proven effective in helping reduce weight. Shore Physicians Group Ambulatory Pharmacist Dr. David Totton said Wegovy was approved for weight loss for patients with a BMI of 27 or greater who also have type 2 diabetes, high cholesterol, or high blood pressure. Patients with a BMI over 30 do not need a second contributing health problem for approval. In both cases, the patient must also adopt a lower calorie diet and increase exercise, with the potential to lose up to 20% of their body weight.

   How Wegovy Aids Weight Loss

   Wegovy belongs to a class of medications called GLP-1 agonists. According to Dr. Totton, these medications mimic the action of glucagon-like peptide, a hormone produced in the intestine that helps regulate appetite and control blood sugar. Another form of the same medication, Ozempic (semaglutide), was originally created for diabetics, but many of these patients also lost weight. That prompted an investigation into its potential to aid in weight loss for non-diabetic patients. Researchers found that GLP-1 agonists are also able to slow the movement of food through your digestive tract and suppress appetite centers in the brain, decreasing food cravings and helping patients (diabetic or not) reach their weight-loss goals.

   Wegovy is not the first medication in this class to be approved for weight loss, in fact. The medication Saxenda (liraglutide) has been used for weight loss for years, however, it only provides a minor benefit, around a 5% reduction in weight compared to Wegovy, which can result in a 15-20% weight reduction in some patients.

   BMI is an Important Number

   Dr. Totton explained a patient is considered overweight when their body mass index (BMI) is 25-30 and obese when their BMI is >30. If you are unsure of your BMI, you can quickly find out by inputting your height and current weight in the CDC’s online BMI calculator.

   “Being overweight or obese greatly increases your risk of heart disease, stroke, and a host of other related conditions, including hypertension, high cholesterol, and diabetes. In addition, holding onto so much weight can cause joint pain and make it even harder to lose weight, especially as you get older. Interestingly, for obese patients with Covid-19, they are five times more likely to require ICU admission and two times more likely to experience respiratory failure than those who are not obese.”

   When you have a combination of obesity, high blood pressure, high cholesterol, or type 2 diabetes, this is known as “metabolic syndrome”, according to Dr. Totton. “The concern is that each of these comorbid conditions can contribute to vascular damage, inflammation, and greatly increase the risk of heart attack, stroke, disability, and untimely death. The reason that weight loss is so important is that obesity can contribute to, and worsen, all of these conditions, further compounding the negative effects.”

   Research Found the Dual Purpose

   Originally Ozempic was solely a drug for treating type 2 diabetes effectively. After examining the findings, the FDA has given the green light to treating obesity with the medication, rebranded for weight loss as Wegovy. Dr. Totton said finding another use for a medication is proof that continuing research may yield many useful results.

   “This is how we discover uses for many different medications. For one condition, a side effect may have a beneficial impact on a different condition. This is just really smart use of an existing medication.”

   Is It Worth The Side Effects?

   Novo Nordisk, the Wegovy manufacturer, has a lengthy list of possible side effects. Dr. Totton weighed in on whether the ultimate goal of losing up to 20% of body weight is worth the possible side effects. Dr. Totton said, “The most common adverse side effects from Wegovy are gastrointestinal and include abdominal discomfort, nausea, vomiting, constipation, and diarrhea. Most of these side effects are rare or self-limiting, meaning the longer a patient remains on the medication, the less severe the side effects should become and, for the majority of patients, will completely resolve.”

   Because Ozempic/Wegovy was originally designed for diabetes to reduce blood sugar, the risk of hypoglycemia was also carefully analyzed. According to Dr. Totton, “It was found that the effects of the medication are highly dependent on the presence of food, meaning that there is little risk of low blood sugar in the general population.” Dr. Totton added, “There are some rare instances where I would caution a patient against taking Wegovy. These include patients with a personal or family history of medullary thyroid cancer, those with multiple endocrine neoplasia syndrome type 2, and anyone with a history of pancreatitis. If you have any of these conditions, an alternate weight-loss medication may be a better option for you.”

   Wegovy is a once-a-week injection, given in increasing amounts as a means of limiting side effects. Dr. Totton explained that slowly increasing a medication dose is a tried and true method for reducing adverse effects when starting medication.

   “We administer the dose in increasing amounts over a period of time as tolerated until we reach the desired effect. This is essential so we don’t shock the system by introducing large amounts of an unfamiliar substance.” Dr. Totton said this strategy was well tolerated in the clinical trials leading to the medication’s approval and thus is the current recommendation when starting Wegovy.

   Do Not Mix With Any Other Weight Loss Products

   The manufacturer stresses Wegovy patients should not take any other weight loss product, including over-the-counter or herbal supplements.

   “The concern with taking multiple weight-loss medications at once is that most of these are not studied together and it is unknown whether the combination will be safe or effective,” said Dr. Totton. “In addition, most of the over-the-counter or herbal weight loss supplements are not regulated by the FDA and are not required to prove their effectiveness in clinical trials.”

   Dr. Totton said, in his opinion, these products are often ineffective and a waste of money. “I recommend you discuss any medications or supplements that you are considering with your primary care physician.”

   Long-term Use and How to Access Wegovy

   “Looking at the trials that led to the approval of Wegovy for weight loss, we can see that patients who came off the medication eventually gained a majority of the weight back. This tells us that patients must stay consistent to see sustained weight loss. This is of course in addition to maintaining proper diet and exercise habits.” Dr. Totton added that if patients decide to discontinue, they do not need to wean off Wegovy.

   To determine if you are a candidate for Wegovy for weight loss, speak with your primary care physician. Dr. Totton shared that the company is offering a discount card to all patients on commercial insurance that guarantees a maximum of $25 co-pay per week for the first six months of therapy. Another important tip from Dr. Totton is that when using an injectable medication such as Wegovy it is important to remember to rotate the injection sites to ensure proper drug absorption. Appropriate injection sites include the abdomen, thigh or upper arm and should be injected under the skin.

   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.

5. Hernias and the Battle of the Bulge

   July 7, 2021 1:48 pm Comments Off on Hernias and the Battle of the Bulge

   A newly discovered bulge that has suddenly surfaced in the abdomen or groin area accompanied by pain could be the first sign of a hernia. Dr. John Millili of Shore Physicians Group in Somers Point, New Jersey said while hernias are quite common, you should not ignore them.
   

   What is a Hernia?

   Dr. Millili explained a hernia is when an organ such as the intestine or even fat will push through an opening or weakness in the muscle wall or tissue of the abdomen. Typically, the first symptom of a hernia is a bulge accompanied by tenderness or pain in that area. Sometimes the bulge will appear to get smaller when they lay down. That is misleading, according to Dr. Millili who said the bulge itself does not get smaller. Instead, the forces on it decrease when they recline. It is not going away. Over time that bulge will likely increase in size and be accompanied by a dull ache. Someone with a hernia will often complain of pain while lifting or experience a sense of feeling full. Occasionally hernias will not have any symptoms and will be discovered during a routine physical exam for an unrelated problem.

   Types of Hernias

   Although there are many different types of hernias, Dr. Millili explained that 95% of them fall into four categories:

   • Inguinal hernia- An inguinal hernia is a bulging of the abdominal contents through a weak area in the lower abdominal wall. Inguinal hernias can occur on either side of the groin, according to Dr. Millili, at the inguinal canals, which are the two passages through the lower abdominal wall. Although hernias are more common in men, a small percentage of women may develop inguinal hernias as well. An inguinal hernia in women may contain part of the female reproductive system, such as an ovary. When this occurs, the peritoneum, the abdominal cavity lining, bulges through a weak area in the abdominal wall.
   • Incisional hernia-An incisional hernia may develop after any type of abdominal surgery when there is a weakness in the abdominal wall. The weakness could allow tissue or an organ to push through and form a hernia. The first symptom of an incisional hernia might be a bulge near the previous incision accompanied by pain, according to Dr. Millili.
   • Umbilical hernia-As its name indicates, the umbilical hernia occurs in the belly button area, where the umbilical cord passed through. Here fat or occasionally intestine will protrude through. The first indication of the hernia will be a bulge near or below the belly button. The bulge, along with the discomfort, is most often noticed when straining or coughing.
   • Ventral hernia-Dr. Millili explained a ventral hernia might occur anywhere along the abdominal wall. He added that surgery to repair the ventral hernia can be complex due to the other organs along the abdominal wall.

   What to do first

   At the first sign of a bulge, Dr. Millili suggests that patients contact their primary care physician who will assess the bulge and then direct the patient to a specialist or a surgeon. “The primary care physician will determine if their patient has a hernia that may need surgery,” said Dr. Millili. “Don’t wait for the pain to go away or for the bulge to go away on its own. It is not going to. If it is a hernia, the patient will need surgery to resolve it.” Surgery for a hernia can be either laparoscopic or open. Dr. Millili said it depends on several factors including the size of the hernia and any other organs that might be near the hernia.

   Dr. Millili said the surgery typically can be completed on an outpatient basis, with a return to normal activities in several weeks. One of the complications of not addressing the hernia quickly, aside from the discomfort of the hernia, is the onset of sudden pain from an incarcerated or strangulation hernia. “This is when the organ, normally the intestine, pushes the wall of the abdomen and the blood flow to that portion of the protruding organ is cut off,” said Dr. Millili. “This is an emergency when it occurs. The organ can suffer necrosis if the blood flow is cut off. This is a “middle of the night” type of emergency surgery when there is an incarcerated or strangulation hernia.”

   Contributing Factors to Hernias

   Dr. Millili said anyone could get a hernia. However, several contributing factors make it more likely for someone to develop a hernia. Examples include, athletes or people whose jobs require them to routinely lift a lot of weight; people with obesity; and smokers and people with COPD. He did add that having one hernia does not mean the person is necessarily prone to have another. There are complications for not taking care of a hernia while it is smaller, such as a bowel obstruction.

   Other factors that make the hernia more uncomfortable include straining while in the bathroom, coughing or lifting anything heavy. Dr. Millili suggested avoiding those things that will cause any more discomfort.

   The good news is that the hernia can be repaired. Dr. Millili said on average a person will be out of work for two weeks and back to their normal activities within a month.

   To schedule an appointment with general surgeon Dr. Millili at his 649 Shore Road office in Somers Point, visit or call 609-365-6239

6. Is Something Uninvited Lingering at Your Summer Barbecue?

   June 1, 2021 5:01 pm Comments Off on Is Something Uninvited Lingering at Your Summer Barbecue?

   Summer is a great time of year for spending days outdoors with friends and family at the pool and at the beach. Summer barbecues are a big and fun part of the summer scene. But if the host is not vigilant, or if they purchased something that might be contaminated, what can come along with those barbecues is a most unwelcome guest – foodborne illnesses.

   According to Dr. Steven Cetel of Shore Physician Group, some of the more common foodborne illnesses are salmonella, campylobacter, E. coli, listeria, clostridium botulinum (botulism) and norovirus. Dr. Cetel said the norovirus is one that is easily spread on cruise ships due to the close personal contact.

   The Food and Drug Administration considers when two or more people get the same illness from the same contaminated food or drink, the event is called a foodborne illness outbreak. The FDA investigates outbreaks to control them, so more people do not get sick and they learn how to prevent similar outbreaks from happening in the future.

   Turn up the Heat

   Even if you love a juicy, rare hamburger right off the grill, it might not be the best plan. Dr. Cetel advised that undercooked meats and seafood are a high risk for foodborne illnesses. “They usually have some viruses and bacteria already in the meat and cooking them fully kills the germs so we do not get infected,” said Dr. Cetel. He added that any handling of raw foods, including eggs, requires hand washing and cleaning the surface before touching anything else.

   Contracting Foodborne Illnesses

   Dairy products and the sun do not make a good match. Dr. Cetel advises that foods containing dairy and those with mayonnaise like potato salad or chicken salad should not be left out for longer than 1-2 hours. With warmer temperatures, that time is reduced. “Bacteria grow and spread much quicker at warmer temperatures. Refrigerating dairy helps to keep bacteria from growing to the point where it could cause any symptoms,” said Dr. Cetel. “The most common way people will contract any foodborne illness is by eating undercooked or spoiled foods. We can also contract them from person-to-person contact.”

   The Centers for Disease Control and Prevention estimates that 1.5 million people in the U.S. get sick annually from Campylobacter, the most common bacterial cause of intestinal distress. The source is normally raw or undercooked poultry or anything prepared nearby that touched it. It can also be contracted as a result of contact with animals or drinking untreated water.

   Avoiding Illnesses

   Dr. Cetel advised cooking meat and seafood fully as the best defense against getting sick. He added that food should not be left outside unless it is in a cooler during in warmer temperatures. Additionally, Dr. Cetel recommended taking basic precautions, like washing hands regularly, especially after using the restroom, and not touching your face helps you prevent the spread of illness when working in the kitchen.

   Listeria is another culprit in many foodborne illness cases each year. It can be found in raw vegetables and fruits like cantaloupe due to contaminated soil or from contaminated manure that was used as a fertilizer. It can also come from unpasteurized milk and certain processed foods like soft cheeses, hot dogs and deli meats, according the FDA. The rule of thumb here is to keep foods cold, wash fruits and vegetables before eating them, and wash hands frequently.

   Symptoms and Treatment of Foodborne Illness or Food Poisoning

   Dr. Cetel said that food poisoning symptoms will come on about 6-8 hours after the exposure to the spoiled food. Symptoms include nausea, stomach cramps, vomiting and diarrhea. “The best way to treat these symptoms is to make sure you stay hydrated. Most of the time antibiotics are not needed and the symptoms will go away within a few days. Limiting solid food intake for a day or so can be helpful to allow the GI tract to heal. The BRAT diet (bananas, rice, apple sauce and toast) is best introduced slowly. When the GI tract is inflamed it does not absorb food well early on and it can make the symptoms worse. The BRAT diet is a good start as those foods are easily digested.

   To make an appointment with Dr. Steven Cetel of Shore Physicians Group in the Northfield office, located at 2605 Shore Road, call 609-365-5300 or in the Margate office located at 9501 Ventnor Avenue in Margate, call 609-822-4800.

7. What is Making Me Sneeze?

   May 4, 2021 1:54 pm Comments Off on What is Making Me Sneeze?

   Beautiful flowers, grass and budding trees are everywhere in the spring and while nature is certainly a season to marvel, those same flowers and trees may wreak havoc on people who suffer with seasonal allergies. The tree pollen allergy is at its peak from March through mid-May. Grass pollen is at its peak season from mid-May to mid-July and ragweed season runs from mid-August through the first frost.

   Beware of the Invaders

   According to Dr. David Totton, Ambulatory Pharmacist with Shore Physicians Group, “An allergy is basically the body’s immune system responding to a substance it identifies as an invader. The body sees it as foreign and the immune system has an allergic response to that invader,” said Dr. Totton. “This time of year, pollen is the most common allergen.”

   The immune system does more to protect the body. As Dr. Totton explained, the immune system recognizes this invader, resulting in mast cells sending a message to release histamines. Those histamines boost blood flow in the area where the immune system detected the invader. If it is pollen, the immune system will launch the trigger, sending histamines to the nose and prompting the thin membrane walls to produce more mucus. That mucus in turn will cause a runny nose, trigger sneezing and may result in coughing and watery eyes; classic allergic reactions.

   The Job of Antihistamines

   In the midst of allergy season people are reaching for something to squelch the nagging sneezing, runny nose and watery eyes. For many, antihistamines will do the trick. Dr. Totton said there are histamine receptors all over the body but said the seasonal type allergies due to pollen and grasses normally affect the lungs and the nose. Antihistamines will suppress or block the histamine-induced response in the body, normally swelling, and it will stop the sneezing, itching, sore throat and watery eyes.

   Types of Antihistamines

   There are different types or strengths of antihistamines, and some will cause drowsiness. As Dr. Totton explained, there are two generations of antihistamines. The first-generation antihistamines block histamine receptors and also cross the blood-brain barrier and block central nervous system and cholinergic receptors as well. These may cause drowsiness, headache and dry mouth, nose and throat. Dr. Totton said diphenhydramine products such as Benadryl are among those first-generation antihistamines that have the unwanted side effect of sedation.

   Shore Physicians Group Ambulatory Pharmacist services include:

   • Medicare Annual Wellness Visit (No copay) Available In Office or Via Telehealth
   • Comprehensive Medication Review:
     • Are all your medications safe and effective for you?
     • Is the Medication you’re on appropriate for all health conditions?
     • Are there any potential interactions between medications that could increase side effects, or reduce effectiveness?
     • Can you save money on your current medications?
   • Answer Your Medication Related Questions:
     • When is the best time to take the medication?
     • Should you take them with/without food, and can you safely take them with your supplements?
   • Review over-the-counter products including, vitamins and supplements
   • Comprehensive Health Risk Assessment
   • Assess Vaccination History
   • Complete Routine Preventative Screenings
   • Many more services included

   Ask to schedule a visit with Ambulatory Pharmacist Dr. Totton when you see your primary care provider.

8. What is that Tingling in Your Hand Telling You?

   1:50 pm Comments Off on What is that Tingling in Your Hand Telling You?

   Pins and needles, mild tingling or your hand feels like it “fell asleep” can happen occasionally to anyone. But when the tingling becomes more frequent or it does not resolve itself, it could be a signal that something more serious is going on and it is time to speak with a physician.

   What Causes the Tingling?

   Orthopaedic surgeon Dr. Jasmine Bauknight of Shore Physicians Group in Somers Point specializes in hand and upper extremity procedures and said tingling and numbness in the hand and wrist are not uncommon. “There are a number of reasons a person would have numbness in their hand and fingers,” said Dr. Bauknight. “It could be something as simple as sleeping in a position where it puts pressure on a nerve. The temporary reduction of blood to the nerve may cause that pins and needles feeling. Many people unknowingly sleep with their wrists or elbows bent and that puts additional tension on the nerve. The numbness in the hand or wrist could also be caused by many other reasons including pressure on the median nerve or carpal tunnel syndrome.”

   Other than carpal tunnel syndrome, Dr. Bauknight said some of the other reasons a person may experience numbness or pins and needles in their hands and wrists could be due to cubital tunnel syndrome, cervical spondylosis, thoracic outlet syndrome, peripheral neuropathy, diabetes, as well as sleep posture.

   Our Complex Hand

   The human hand is amazing. It can pick up, pull, push, grip, grab, and high five and take hold of a hand. The hand is made up of the wrist, palm, and fingers and consists of 27 bones, 27 joints, 34 muscles, over 100 ligaments and tendons, and many blood vessels and nerves. The wrist is made up of eight small bones (the carpal bones) plus the two long bones in the forearm, the radius and ulna.

   As Dr. Bauknight explained, the hand is very complicated, and broken bones, injured ligaments, and pinched nerves can happen anywhere. The kitchen is a prime spot for hand accidents, and cuts that occur in a split second can damage nerves, tendons and ligaments and may require multiple stitches and possibly even surgery.

   Carpal Tunnel Syndrome

   Numbness and tingling in the hand and arm may result from a compressed nerve in the wrist, according to Dr. Bauknight. “Carpal tunnel syndrome is actually a compression neuropathy, where the median nerve is basically getting squeezed under ligaments and tendons as they pass through the carpal tunnel. The nerve does not like to be compressed and may result in tingling, that numb pins and needle feeling. It may also cause weakness in the hand or diminished grip strength and even dropping things, depending upon the severity of the compression.” Dr. Bauknight added that wrist anatomy along with patterns of hand use may contribute to the severity of the individual’s carpal tunnel syndrome.

   Carpal Tunnel Syndrome Treatment

   Treatment for carpal tunnel syndrome may include rest, ice, wrist splints or braces, exercises, cortisone injections and surgery if necessary. Dr. Bauknight said, left untreated, carpal tunnel syndrome can lead to weakness, a lack of coordination in the fingers and thumb and may impact the individual’s ability to grip as well as their range of motion. Dr. Bauknight cautioned that people suffering with symptoms of carpal tunnel syndrome should not put off seeing their physicians because the symptoms can get worse. They may result in irreversible changes such as weakness and muscle-wasting and in some cases, Dr. Bauknight said the beefy part of the palm can flatten out.

   If surgery is necessary, Dr. Bauknight indicated there are two different techniques: open carpal tunnel release or endoscopic. The open carpal tunnel release involves an incision in the wrist. The ligament is cut to allow the release. The endoscopic technique is a done with a small incision in the wrist and using a tiny camera-guided instrument, the surgeon releases the ligament. The more rapid recovery is via the endoscopic procedure but both have a good outcome for the patient. They will need to follow with therapy post-surgery.

   Avocado Hand

   Dr. Bauknight warned that something as simple as making a bowl of guacamole can turn into a trip to the emergency room and possibly require surgery from one quick cooking shortcut. Avocados are a big part of many meals but a sharp knife can easily go right through that leathery and slippery avocado skin and into the hand holding it, Dr. Bauknight said. She adds that cooks will too often try to quickly remove the pit by smacking it with a sharp knife in an attempt to yank it free from the fruit. “The hand is so complex and compact. A sharp knife can go right through the skin and cut nerves and tendons. Stitches to repair the damage is only part of the problem. I can make the repair but there will need to be weeks of physical and occupational therapy for them to regain their full range of motion.”

   To make an appointment with Dr. Bauknight at the new 710 Centre Street Somers Point location to discuss your hand discomfort, call Shore Physicians Group’s Orthopaedic Division at 609-365-6280.

9. Is Food Affecting Your Mood?

   1:47 pm Comments Off on Is Food Affecting Your Mood?

   Mood and food go hand in hand, a reality every person might experience; from the baby that shrieks to be fed to cranky holiday dinner guests when the meal is late. Being hungry, tired, or having unhealthy eating patterns can influence mood swings, according to Tiffany Rios, Shore Physicians Group Registered Dietitian and Certified Diabetes Educator, who added that blood sugar fluctuations and nutritional imbalances are often to blame.

   “The right food can support a healthy mood, but the wrong foods can potentially exacerbate problematic inflammation and underlying causes of depression,” Rios said. To aid the body in improving the symptoms of depression Rios suggested adding probiotics, omega-3 fatty acids, and vitamin D and B-vitamin rich foods.

   Some examples of B-vitamin rich foods include beans, lentils, eggs, leafy greens and bananas as well as omega-3 rich foods like fatty fish, walnuts, chia and flaxseeds. Vitamin D can be found in egg yolks, organic cow’s milk, mushrooms, and fatty fish like sardines, tuna and salmon.

   Sugar Plays a Big Role

   Rios explained that excess sugar consumption is correlated with several disease states including dysbiosis: a condition where there are more harmful bacteria populating in the gut than helpful bacteria. This relates to depression because up to 95% of our serotonin is produced in the digestive system. Serotonin is the key hormone that stabilizes mood, feelings of well-being, and happiness. This hormone impacts your entire body. It enables brain cells and other nervous system cells to communicate with each other. Serotonin also helps with sleeping, eating, and aids digestion. So, if the digestive system is off balance, it really can affect our mood.

   Be On the Lookout for Other Forms of Sugar

   To make improvements, Rios indicates the easiest thing to do is reduce the added sugar in your diet. As a reminder, Rios said sugar can be found in many forms in the foods we consume, like evaporated cane sugar, molasses, and brown rice syrup to name just a few. Sugar might have many aliases, but it is still added sugar intake. When reading the ingredient list on foods look for words ending in “ose” like fructose, sucrose, maltose, or dextrose; they are all added sugars. Be wise to added sugar with ingredients like concentrations of juices, fruit nectars, honey, and agave.

   “Read the ingredient labels and remember, the higher up the list the ingredient is, the more of it there is in the product,” said Rios. “If you see that a food has greater than 8g of added sugar per serving, keep in mind that is equivalent to eating two packets of sugar.” The recommended daily allowance of sugar is about 25mg but Rios said in the case of sugar, less is better.

   “These sugars can exacerbate the growth of harmful bacteria that stunt our ability to digest and absorb the nutrients needed to support a healthy mood,” said Rios. “Try taking a probiotic AND consuming probiotic rich food like kefir, plain yogurt, asparagus, sauerkraut and kombucha,” said Rios. “Non-starchy vegetables are excellent sources of pre-biotic fiber and support a healthy gut as well.”

   Foods That Can Throw the Body Off

   Eating large quantities of fast foods, processed foods, added or refined sugar can alter blood sugar levels, and when blood sugar levels are unstable this can very often lead to fatigue and lethargy, which are often a precursor to depressed mood, according to Rios. “While added sugar can cause issues for our mood, the lack of certain microorganisms may also play a role,” said Rios. “Lastly, alcohol is a known depressant and causes added stress on the liver to detoxify the body. So, if you are feeling down and drinking more than four drinks per week, you might want to reconsider your habits.”

   Can Too Much Protein Have a Similar Effect on Mood?

   Eating too much of anything can make us feel lethargic because it is excess stress on our bodies to store the nutrients as fat. It places a burden on our liver which can throw our metabolism off track. When it comes to protein, choosing the right types of protein is important. Lean meats, fish, eggs and legumes are less associated with depression than fatty meats or fried foods.

   To avoid that sluggish feeling, Rios said to try to stay away from fried foods, large portions and refined sugars.

   Charge It Up!

   Rios suggested that to get your gut health back on track, try to build a diet that is diverse in plant rich polyphenols, fiber and lean proteins. Reduce your intake of added sugars, processed foods and choose more home cooked high fiber meals more often. Choose beans, lentils, eggs, fatty fish, organic dairy products, high fiber grains like quinoa or whole wheat breads, non-starchy vegetables, fresh fruits like bananas and berries, nuts and seeds.

   To schedule a consultation with Tiffany Rios call 609-653-5300.

10. Shore Physicians Group Welcomes Hand Surgeon Dr. Jasmine Bauknight to its Surgical Division

    April 7, 2021 6:29 pm Comments Off on Shore Physicians Group Welcomes Hand Surgeon Dr. Jasmine Bauknight to its Surgical Division

    Shore Physicians Group welcomes hand and upper extremity surgeon Dr. Jasmine Bauknight to its Orthopaedic Surgery Division in Somers Point. She will begin seeing patients April 13 at the Division’s current office at 649 Shore Road, and then will move with the group to 710 Centre Street at the end of April. Dr. Bauknight joins SPG orthopaedic surgeons Dr. Tuan “Mickey” Bui; Dr. Norman Johanson; and Tara E. Chidsey, APN.

    Dr. Bauknight received her medical degree from Brown University’s Warren Alpert Medical School. She completed her orthopaedic surgery residency at Howard University in Washington, D.C. and a fellowship in hand and upper extremity surgery at Allegheny General Hospital in Pittsburgh, PA. During her residency, she won an award for receiving the highest score on the 2017 Orthopaedic In-Training Exam. She is fluent in Portuguese and French and speaks conversational Spanish.

    Dr. Bauknight comes to Shore Physicians Group from St. Mary’s Hospital in Green Bay, Wisconsin, where she worked locum tenens as the only hand and wrist surgeon in a 200-provider group covering a 10,000 square mile area.

    As a hand and upper extremity surgeon, Dr. Bauknight treats a variety of conditions that affect the hand, wrist and even the elbow and shoulder. Some of the most common conditions she treats are carpal tunnel syndrome, trigger finger, osteoarthritis, and traumatic injuries to the hand and wrist, such as “avocado hand”, which happens when someone cuts the hand tendons while improperly removing an avocado pit with a knife – a problem that is actually on the rise due to the popularity of avocados.

    To make an appointment with Dr. Bauknight, please contact Shore Physicians Group’s Orthopaedic Division at 609-365-6280.