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.
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.
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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.
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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.
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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.
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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
