Author Archives: Joe Hilbert

  1. How Dangerous is Plastic to Our Food?

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    It is nearly impossible to avoid plastic, it is everywhere. The food we eat is packaged in it, the water we drink is frequently in a plastic bottle and even the toothbrush we use twice a day has plastic. There are many different kinds of plastic products that we come in contact with constantly. Although plastics have made life more convenient, could there be a downside to having them just about everywhere?

    One area of research is looking at how ongoing contact with plastic may unknowingly be causing harm to the human body. Primary care physician Dr. Lawrence Anastasi of Shore Physicians Group in Margate said exposure to plastic, especially BPA, a suspected endocrine disruptor, is something people need to consider. An endocrine disruptor is a chemical that interferes with the normal endocrine or hormonal function of your body.

    Bisphenol A or BPA is of particular concern. Dr. Anastasi explained that BPA is a chemical used to harden plastics in the manufacture of plastic containers. Drinking bottles, infant bottles, drinking cups and food storage containers are but a few of the products Dr. Anastasi mentioned that may contain BPA.

    Is there potential danger in using plastic for food storage or cooking? “Some research has shown BPA can leech into food, raising concerns of possible health effects on the brain and prostates of infants, fetuses and children and may have a possible effect on children’s behavior,” said Dr. Anastasi. He referenced a Mayo Clinic study by Dr. Brent Baurer that shows BPA may also increase the risk of cancer, infertility, fetal development, heart disease, diabetes and may also cause weight gain, acting internally as a hormone.

    Asked if nutritional value is lost during microwaving, Dr. Anastasi said that while it can affect the nutritional content to a certain extent, it does depend on how long it is microwaved. “Any form of cooking depletes nutrients in some way, as some are heat sensitive,” said Dr. Anastasi. “Microwaves use less heat than conventional methods and it involves shorter cooking times, thus generally have the least destructive effects.” Microwaving in plastic containers is not suggested as fatty foods may leech more from the plastic at high temperatures.

    Dr. Anastasi also said that some plastic containers are safer than others. He suggested the use of Pyrex glass containers with lids as a good alternative. He added that if forced to use plastic when microwaving, follow the manufacturer’s directions carefully. Dr. Anastasi suggested that if plastics are going to be used in the kitchen, stick to products with recycle codes 1, 2, 4, and 5 as they are the safest. Products marked with recycle codes 3 or 7 may contain BPA.

    Are we not taking the potential dangers of plastic seriously? Dr. Anastasi said most people are mindful of the plastics that come in contact with food. Further he said, The U.S. Food and Drug Administration has said that BPA is safe at the very low levels that may occur in some foods and that the FDA continues to monitor all research related to BPA effects.

    “The good news,” according to Dr. Anastasi, “due to rising concerns of BPA, plastic makers are now responding by producing a wide variety of BPA-free products. In addition, most food cans are no longer lined with BPA.” In our modern society, it is quite challenging to have a plastic-free kitchen but remember to always follow the manufacturers directions. Dr. Anastasi reminds all to be mindful of the recycle numbers on the plastic containers as a guide.

    To contact or make an appointment with Dr. Larry Anastasi at his Margate office, newly relocated to 9501 Ventnor Avenue, call 609-823-6161.

  2. Vascular Surgeon Dr. Matthew Lawrence, DO, FACOS, to Join Shore Physicians Group in January

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    Shore Physicians Group announced today that board certified vascular and general surgeon Dr. Matthew Lawrence has joined its surgical division in Somers Point and will begin seeing patients in January. Dr. Lawrence comes to Shore Physicians Group with more than 20 years’ experience in vascular and general surgery, serving most recently as a surgeon and faculty member at Hahnemann University Hospital and Drexel University College of Medicine.

    Dr. Lawrence completed his undergraduate at Elizabethtown College and received his D.O. from the Philadelphia College of Osteopathic Medicine (PCOM). During his residency through PCOM he was named the H. Jefferey Tourigian, DO, Surgery Resident of the Year for three consecutive years. He maintains his certification as a Registered Physician in Vascular Interpretation, and is currently a member of the American College of Osteopathic Surgeons, the American Osteopathic Association, and the Society of Vascular Surgeons.

    With extensive experience in endovascular surgical procedures using minimally invasive techniques, Dr. Lawrence is an expert in treating a wide range of vascular conditions. He specializes in treating leg pain and cramping from peripheral artery disease, venous insufficiency and other lower extremity arterial diseases as well as non-healing leg wounds, renal artery stenosis, hemodialysis access, carotid stenosis and aortic aneurysms.

    Mark Stephens, chief administrative officer of Shore Physicians Group, says the addition of Dr. Lawrence will greatly expand its vascular surgery services.

    “Dr. Lawrence is an exceptional and highly skilled vascular surgeon, particularly in complex endovascular procedures. His expertise in this area will help to make Shore Physicians Group’s Surgical Division a leader in treating patients with vascular diseases.”

    If you would like to schedule an appointment with Dr. Lawrence, contact Shore Physicians Group’s surgical division at 609-365-6239. The office is located at 649 Shore Road, Suite O, across from Shore Medical Center.

  3. Supplements Do You Really Need Them?

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    Have you ever stood in the vitamin and supplement aisle and felt totally overwhelmed by the rows upon rows of bottles claiming to help with every malady? These supplements are regulated by the Food and Drug Administration as food and therefore the labels may claim some health benefits. However, if you’re getting what your body requires from the food you eat, then these supplements may not be necessary. We spoke with Shore Physicians Group Hospitalist Dr. Sridevi Yangala to learn more about vitamins and supplements, when you should take them – and when to leave them on the shelf.

    Vitamins in the diet

    Dr. Yangala says that deciding which supplements are necessary should be determined on an individual basis with each patient.

    “Vitamins are organic compounds essential for normal metabolism. They need to be ingested in the body since they cannot be synthesized in the body, with the exception of vitamin D, which comes into the body with the help of sunlight as it is made in the skin upon exposure to sunlight.”

    In her opinion, Dr. Yangala says a healthy adult who consumes a well-balanced diet that includes a variety of fruits, vegetables, grains, nuts and dairy products does not need to take a multi-vitamin. But if a patient prefers to take one multivitamin tablet, it is not a bad thing.

    Vitamins, as Dr. Yangala explained, are classified according to their solubility and are fat or water soluble. The fat soluble vitamins are vitamins A, D, E, and K. The water soluble vitamins are C and B complex. Water soluble vitamins are eliminated from the body through urine. Fat soluble vitamins are absorbed along with fat in the diet and stored in the liver and fatty tissue.

    More is not always better

    Vitamin A is generally not prescribed in developed countries like the United States since we get enough of it directly from the foods that we eat, like milk, butter and eggs. But is taking more of a vitamin a good thing? Not necessarily according to Dr. Yangala. “There is some evidence that higher Vitamin A intake is a risk factor in osteoporosis and fractures. So for patients who consume foods high in Vitamin A, there is no need for them to take a Vitamin A supplement.”

    Vitamin D is a commonly prescribed fat soluble vitamin that helps in maintenance of skeletal health, preventing falls and osteoporosis. It also helps the body’s absorption of calcium. According to Dr. Yangala, calcium levels as well as vitamin D levels should be checked in high risk individuals that include post-menopausal women, elderly patients, those with limited exposure to sunlight and patients who have a known malabsorption problem, such as those patients who have had gastric bypass surgery, and supplement accordingly.

    The recommended daily allowance of Vitamin D is 600-800 IU per day. The American Geriatrics Society and National Osteoporosis Foundation recommend 1000 IU per day for people 65 and above. “Several studies show that there is a reduction in the risk of falls in the elderly following Vitamin D supplementation. The World Health Organization identified an association between Vitamin D deficiency and an increased risk of colorectal cancer, and also cognitive impairment in Alzheimer’s dementia,” said Dr. Yangala. “Recommended blood levels of Vitamin D is about 30-40 ng/ml. There is a risk of Vitamin D toxicity if the levels exceed 60-80 mg.”

    When it comes to calcium, the daily recommended intake for individuals under the age of 65 is 600-800 mg. That amount increases to 1000 mg daily over the age of 65. Dr. Yangala said for women 50 and over and men over 70 it is recommended they take up to 1200 mg/day, including any calcium derived from their daily dietary intake.

    She suggested patients look at their diet and see how much calcium they are getting and added, “There is no need for additional calcium supplements if they are getting adequate calcium via diet.”

    Vitamin C may not cure the common cold but it is touted as protection against immune system deficiencies, eye disease and skin wrinkling, but again, too much is not a good thing. Dr. Yangala said that excess vitamin C can lead to kidney stones.

    Vitamin B 12 is naturally found in animal products only. The only source for people on a vegetarian diet is the milk and fortified cereals. Deficiency causes anemia, neuropathy and gait problems. Vitamin B 12 supplementation is necessary in people on vegan diets as well as those who had bariatric surgery.

    Antioxidants

    “We come across the word antioxidant in the health and nutrition world but most people do not know what they are. The most common nutritional antioxidants are Vitamin C, Vitamin E, and Beta Carotene,” said Dr. Yangala. She pointed out that “free radicals” is another buzz term in the world of health and nutrition that most people are not quite sure what they are. “Free radicals are formed in the body and have been linked to cancer and premature aging. The antioxidants neutralize these free radicals and prevent cellular damage.”

    Get what you need from food

    “I would not recommend supplements to my patients,” said Dr. Yangala. “My advice: eat plenty of fruits and vegetables, yellow and orange fruits and veggies, green leafy vegetables, citrus fruits, tomatoes, nuts, oils, fish, seeds and all types of berries.” She suggested getting antioxidants from certain flavonoids like cocoa and dark chocolate.

    The few supplements that Dr. Yangala did suggest would be glucosamine and chondroitin daily because it has been shown to have positive effects in delaying the progression of osteoarthritis of the knee. She added that there is limited evidence that turmeric may provide some relief of osteoarthritis. Dr. Yangala did say that patients who suffer with anemia or a low blood count will benefit from supplementing iron and that alcoholics will often need to take a Vitamin B and possibly folic acid because many tend to not eat a balanced diet.

    Nutrient rich foods

    Dr. Yangala suggested that before reaching for supplements, there are foods readily available that should provide what the body needs to remain healthy. Get the iron needed to fuel your body from oysters, white beans, soy beans, dark chocolate, liver, lentils, spinach and sardines. Vitamin B 12 is plentiful in beef, liver, chicken, fish, eggs, cheese and milk. Get the recommended dose from green leafy vegetables, salmon, liver, eggs, and legumes like lentils, beans, and chick peas.

    Dr. Sridevi Yangala is a Hospitalist with Shore Physicians Group at Shore Medical Center in Somers Point.

  4. Testosterone Supplements And What You Should Know About ‘Low T’

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    Declining testosterone levels is a fact of life for many men. For some it is age related and for others there is likely a specific cause according to endocrinologist Dr. Matthew Corcoran of Shore Physicians Group. Low testosterone refers to a decrease in the amount of testosterone being produced in the testicles as a result of disorders involving the testes or pituitary or hypothalamus in the brain. Dr. Corcoran added that some chronic medical conditions with a higher risk of low testosterone include Type 2 diabetes, chronic obstructive pulmonary disease (COPD), renal failure, and osteoporosis. The aging process and obesity are also associated with a lowering of the testosterone level.

    Symptoms of Low T

    Some common symptoms and complaints of men who experience low testosterone include decreased energy, diminished libido and depressed mood. Long-standing low testosterone may result in a decrease of muscle mass. When the low testosterone is caused by a testicular disorder, men may present with infertility and/or swelling of the breast tissue (gynecomastia).

    “Our job is to determine if they have a low testosterone level and then figure out why,” said Dr. Corcoran. Evaluation of the testosterone level in the fasting state in the early morning is the best test to evaluate according to the endocrinologist. “We take a history and exam-hear them out, listen to what they are saying. The next step is to do early morning fasting testosterone levels. We rely on 2 to 3 levels to confirm.” From there, they can move forward to determine the course of treatment.

    Chronic Management

    There are many testosterone preparations for use, including gels, patches and intramuscular injections with the goal of delivering a steady dose of testosterone. Often the reason for the low testosterone level is a chronic medical condition, such as Klinefelter’s syndrome, the use of chemotherapy, or a pituitary disorder and it will require the patient to manage their lower testosterone levels long term. Low testosterone is often a chronic condition that will not resolve itself, therefore requiring ongoing therapy.

    Dr. Corcoran did say that patients with obesity may have a low testosterone level directly related to being overweight, and that it may not necessitate testosterone replacement. In this case, lifestyle modification and weight loss may correct the lab abnormality. As for claims that certain foods will boost metabolism and improve testosterone levels, Dr. Corcoran stated that in this case watching total caloric intake and weight loss is the better option to improved health and testosterone levels.

    Testicular disorders associated with low testosterone and infertility-related low testosterone may be treated by other hormonal therapies geared toward addressing the fertility side of things. This may be managed in reproductive endocrinology offices as well, according to Dr Corcoran. He also explained that taking supplemental testosterone will increase the testosterone level but at the same time may be counterproductive to fertility as it may decrease sperm count. For this and many other reasons, testosterone should not be prescribed to men without a documented low testosterone level.

    Low Testosterone Supplements

    There is no shortage of supplements that can be purchased over the counter such as Nugenix or ExtendEz that claim to increase testosterone, stamina, muscle mass and sex drive. Dr. Corcoran does not recommend any of the supplemental products, saying, “In the endocrine world we do not have any good, long-term data on improving testosterone levels with over-the-counter products. The real struggle with supplements is that they are not well studied nor are they well regulated. Our job is to determine if the patient has low testosterone and then understand why they have it and then walk them through the treatment,” said Dr. Corcoran.

    He did voice concern on the improper use of medications designed to combat low testosterone. Dr. Corcoran added that It can be risky and in younger me it will suppress sperm production. Some users will try to use the testosterone to build muscle mass or as a performance enhancer, but there are risks and it could be dangerous if the person taking the testosterone has an underlying prostate cancer, breast cancer, elevated blood count and/or significant obstructive sleep apnea.

    If you think you might be experiencing low testosterone, consider scheduling an appointment with Dr. Matthew Corcoran.

  5. Can Some Fats be Good for Your Diet?

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    Are you afraid of fats? Until recently, fat in foods has been vilified in America. For decades, we were told that cutting even healthy fats out of the diet would help us get the body we want. This couldn’t be further from the truth. Our bodies need fat—more specifically, they need healthy fats. The truth is, according to Registered Dietitian and Certified Diabetes Educator, Tiffany Rios of Shore Physicians Group, “good” fats can lower cholesterol levels, reduce inflammation, promote satiety, and boost brain function. These healthy fats mostly come from unprocessed sources that are high in unsaturated fats as well as omega-3 fatty acids, such as avocados, extra virgin olive oil, nuts, seeds, and wild caught salmon.

    Not all fats are the same
    The rap on fat is that it will add inches to your waistline, raise cholesterol and lead to a long list of health problems. Fat is a type of nutrient, and just like protein and carbohydrates, your body needs some fat for energy, to absorb vitamins, and to protect your heart.

    “Bad” fats, such as artificial trans fats and saturated fats, are guilty of the unhealthy things all fats have been blamed for—weight gain, clogged arteries, and an increased risk of certain diseases.

    “Healthy fats are an essential component of a healthy diet. In fact, they are required in order to properly absorb fat soluble vitamins A, D, E, and K,” said Rios. “What’s more, our bodies synthesize many fats but there are two types of fatty acids that your body is unable to synthesize: linoleic acid (omega-6 fatty acid) and alpha-linolenic acid (omega-3 fatty acid). These are called ’essential fatty acids’ because, unlike other fats, our bodies cannot create them and we must get them from our diet.”

    The bad and even some good about cholesterol
    It helps to understand the difference between good and bad fats and how to include healthier fats in your diet and reduce the bad fat. Dietary fat also plays a major role in cholesterol levels. Cholesterol by itself is not bad. It is a fatty, wax-like substance that the body needs to function properly. But too much of it can have a negative health impact. As with dietary fat, there are good and bad types of cholesterol.

    High density lipoproteins or HDL cholesterol is the “good” kind of cholesterol found in blood. The HDL cholesterol is good because it carries cholesterol from other parts of the body back to the liver. The liver then removes cholesterol from the body. According to Harvard Health, an HDL cholesterol of 60 mg/dL or higher gives some protection against heart disease.

    Low density lipoproteins or LDL cholesterol is the “bad” kind. Patients with elevated LDL levels may have cholesterol clogged arteries and may have an increased cardiovascular risk. The key is to keep LDL levels low and HDL high, which may protect against heart disease and stroke.

    Fats influence cholesterol levels
    Rather than the amount of cholesterol you eat, the biggest influence on your cholesterol levels is the type of fats you consume. So instead of counting cholesterol, it’s important to focus on replacing bad fats with good fats. When Rios is creating a dietary plan for her patients, she includes some fats.

    “As part of a heart healthy dietary plan I recommend a diet high in unsaturated fats and moderate in healthy types of saturated fats. Avocados, nuts and seeds are mainly unsaturated while fats like coconut oil are saturated. Despite its saturated association, coconut oil is also classified as a medium chain triglyceride and the method in which it processes through the liver does not allow for it to be stored like most saturated fats, making it a healthy alternative to some more saturated oils.”

    While every dietary plan that Rios creates for her patients is individualized, the registered dietitian has some go-to saturated fats that have worked well, including grass fed beef, coconut oil, 85% dark chocolate, pasture-raised eggs and chicken.

    To make an appointment with Tiffany Rios RD, CDE for a personalized dietary plan or healthy assistance managing your diabetes, call 609-365-5300. The office is located at 2605 Shore Road in Northfield..

  6. Can Joint Injections Keep Patients Out of Surgery?

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    Chronic knee, hip, ankle or shoulder pain does not necessarily mean your next step is into the operating room. For many patients who have sports-related injuries, osteoarthritis, and a family history of OA or who may be overweight and suffer with joint pain, delaying that joint replacement may be an option. Physical therapy and injections into the knee, shoulder, elbow, ankle, wrists, hip bursa, and even some hand injections are possible to combat joint pain according to Shore Physicians Group Orthopedic Surgeon, Dr. Tuan Mickey Bui. “The idea is to delay joint replacement as long as possible while still being bearable,” said Dr. Bui.

    Why there is joint pain

    All of the body’s joints have their own shock absorbing system. The joint cartilage has special molecules of aggrecan and hyaluronic acid that together provide a hydrated gel structure that gives cartilage load-bearing properties. Dr. Bui says over time those built-in shock absorbers will begin to thin out and break down. “As we age, these molecules degrade. A thinner cartilage is more prone to damage,” said Dr. Bui. “Ironically, when there is ‘full thickness’ area of damage in the cartilage, fluid seeping out from the bone can cause extra fluid in the joint. All of these events increase inflammation in the joint and are the ingredients to make arthritis.”

    The body is a great machine with different categories of joints including synovial joints where the bones join together in a cartilage lined cavity filled with fluid. There are pivot, hinge, saddle, plane, condyloid and ball and socket synovial joints. The knee, elbow and fingers are all hinge joints. The neck and vertebrae are pivot joints and the larger ball and socket joints include the hip and shoulder.

    Where to start

    Before beginning any treatment Dr. Bui said it is first determined where the patient’s joint pain is coming from. “We make sure your pain is due to cartilage damage and not due to anything else in your knee (or other joint). We can prescribe anti-inflamatories, which are stronger versions of what is available over the counter. There are also other types of nerve medications that have shown promising results,” said Dr. Bui.

    Physical therapy is another option open to patients experiencing joint pain. “Strengthening the right muscles allows your joints to operate with minimum stress on them. It is like getting a wheel alignment on your car which can lengthen the life of your tires,” said Dr. Bui.

    There is help for that pain

    Dr. Bui explained that hyaluronic acid used in the injections, also called viscosupplimentation, helps to draw fluid back into the cartilage and helps to restore the joints shock absorbing properties as well as act as a lubricant of sorts. There are a number of different blends of hyaluronic acid, some are made from roosters and the physician said anyone with an allergy to eggs should advise their doctor prior to receiving their injection as there are other formulations available.

    Cortisone steroids serve as an anti-inflammatory. (It is not the same as body builders use). Dr. Bui said that reducing the inflammation will reduce the pain. He said his office also gives the hyaluronic acid or viscosupplimentation injections. “In my office, we can give a combination shot of both using only one needle to give the patient the maximum benefit with a minimum of needles,” said Dr. Bui. The normal course of injections is one a week for three or four weeks.

    How long can surgery be delayed

    There is no set number of times a patient can receive the joint injections before they will need surgery. Dr. Bui said, “There is no limit to the number of times a patient is able to receive the viscosupplimentation but I normally recommend joint replacement when relief from the injections last less than six to eight weeks before the pain returns,” said Dr. Bui. “There are many factors in the decision to have surgery through, and this should be discussed with an orthopedic surgeon.”

    To set up an appointment and consultation with Dr. Bui, call Shore Physicians Group-Orthopedic Surgery, 609-365-6280.

    Dr. Bui’s specializes in hip and knee pain, minimally invasive knee replacement, unicondylar knee replacement, anterior or posterior hip replacement, anatomic and reverse total shoulder replacement, long bone fractures in fingers and hands, carpel tunnel, trigger fingers, sport related injuries and bursitis of elbow, sport related injuries of the foot and ankle, cortisone injections and viscosupplimentation.

  7. Shore Physicians Group to Host Education Event on Joint Replacement Surgery & Recovery Sept. 25

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    New SPG Orthopedic Surgeon Dr. Mickey Bui to Keynote the Event

    In September, Shore Physicians Group will welcome orthopedic surgeon Dr. Mickey Bui to its Surgical Division making him the first orthopedic surgeon to join the practice group. Bui will be the lead speaker at Shore Physicians Group’s community education breakfast on Joint Replacement Surgery & Recovery on Wednesday, Sept. 25 from 10 am to noon at Greate Bay Country Club in Somers Point. The event is a continuation of Shore Physicians Group’s popular “Be Well Connected” education series.

    Bui received his Doctor of Medicine from Northeast Ohio Medical University and completed his residency at Hahnemann University Hospital. In addition to general orthopedics and surgical treatments of the shoulder, hip and knee, he is also passionate about helping people with sports injuries and recently completed a Fellowship in Sports Medicine.

    Joining Bui is Erin Bennis, PT, DPT, of Shore’s Center for Outpatient Rehabilitation, who will share different techniques used in physical therapy for patients with total hip and knee replacements. Shore Emergency Department Social Worker Tracy Fooks, LCSW, LCADC, will speak on managing post-operative pain, and the appropriate use of pain medication.

    The event includes a free continental breakfast, question and answer session, and information on additional resources. To RSVP, call 609-653-3986.

  8. Help for Varicose Veins

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    If you have varicose veins, you may feel a little uncomfortable about showing off your legs. You may also feel pain, discomfort and swelling along with tired and achy legs. It is a myth that varicose veins are a problem only women will have; men can suffer from varicose veins as well, according to Dr. Leonard Galler MD, Board Certified General Surgeon with Shore Physicians Group and Chairman of the Dept. of Surgery at Shore Medical Center.

    How veins work

    The body has what amounts to a system of conduits or tubes that allow for oxygen-rich blood to flow from the heart throughout the body. The blood flows from the heart via arteries and the oxygen depleted blood is carried back to the heart to be reoxygenated through veins. The veins work efficiently by utilizing a series of valves that keep the blood moving. According to Dr. Galler, when those valves do not perform the job they were designed for, blood may leak back. This can weaken the vein walls, cause veins to bulge and may result in swelling or even blood pooling in the lower extremities, according to Dr. Galler. He advised that anti-inflammatory drugs along with other medications may be given to the patient to help reduce the swelling, inflammation and pain.

    How varicose veins normally develop

    Dr. Galler explained that in the legs soft vessels with minimal muscle can collapse over time. “The veins can get dilated,” said Dr. Galler. “There can be a number of other reasons for the veins to dysfunction and lead to the development of varicose veins. There could be a genetic predisposition to varicose vein development. Galler indicated that if parents have varicose veins, their offspring is likely to manifest varicose veins in their lifetimes. There could be damage to the deep system of veins from trauma or surgery that can lead to vein dysfunction. Often after a blood clot, deep vein thrombosis (DVT), varicose veins can develop because of physiological changes.

    Contributing factors for some patients can be obesity, pregnancy, chronic straining and constipation.

    Cosmetics and Symptomatic

    “Most patients do not like how varicose veins look and seek solutions for cosmetic reasons. Many patients have symptomatic varicose veins. They complain of aching legs that are often accompanied by swelling, burning and itching symptoms which can be severe enough to seek help. There are also patients who have developed severe swelling and edema with ulcers who need surgical care. These patients are at risk for infections and significant morbidity. Dr. Galler added that there are multiple recommendations that can be offered from a vascular surgeon to help all these patients regain quality of life.

    Important first steps

    Dr. Galler explained the importance of finding the causes of the varicose veins by ultrasound studies to determine vein anatomy and functionality. The ultrasound will determine blood clots and reflux from the values which will guide treatment.

    Compression stockings are the first line of treatment and often advised by surgeons. Dr. Galler said the compression stockings will help with the swelling by compressing the dilated veins, removing the pressure gradient and reducing weeping of fluid from the veins. Using the stockings along with medication to help with the swelling is beneficial to many patients.

    Treating Symptoms of Varicose Veins and Spider Veins

    Dr. Galler explained that there are several procedures that he performs frequently and that have proven to be very beneficial to his patients. These range from sclerotherapy of veins and spiders veins, laser ablation of veins and sealing of incompetent superficial veins with radiofrequency energy, and surgical removal of veins with minimal invasive techniques. Each of the procedures have their roles with benefits.

    Help Yourself

    There are a number of things someone suffering with varicose veins can do to gain relief of symptoms and help with cosmesis. If simple maneuvers such as exercise, weight reduction and support hose is not effective, it is then best to discuss options with a vascular surgeon such as Dr. Galler who would perform a full evaluation and direct a treatment plan.
    To learn more about what might be the best course of action to help with varicose veins, spider veins, and more or to make an appointment with Dr. Leonard Galler call 609-927-8550.

  9. What is Brain Freeze & Why Do We Get It?

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    Few things taste better on a hot, steamy summer day than an ice cold frozen treat like tall, sweet water ice or a great big ice cream cone. But in the excitement of that delicious treat-in-hand, too much of a good thing too fast can cause sphenopalatine ganglioneuralgia, better known as a “brain freeze.” It is a short-term headache typically linked to the rapid consumption of ice cream, water ice, ice pops, or very cold drinks.

    Brain Freeze Causes
    What happens when we experience that brief, yet quite uncomfortable brain freeze is the quick cooling of capillaries in the sinus and oropharyngeal area resulting in vasoconstriction or narrowing of the blood vessels. The rapid changes near the sensitive nerves in the palate create that sensation of a brain freeze.

    According to research done at Harvard Medical School led by Dr. Jorge Serrado there are several possible reasons for the sudden onset of pain. One theory is that it’s a relationship with the trigeminal nerve, which runs through the upper palate of the mouth. When something cold hits it, it may directly increase blood flow to the brain. Another theory is that a huge gulp of an ice-cold drink cools the blood; body’s quick attempt to warm up again is what causes the pain.

    Dr. Serrado said it is hard to study headaches in a laboratory because it is difficult to recreate what triggered the headache but it is pretty straightforward to recreate what leads to a brain freeze. The researcher said he hopes to take some of the lessons learned from inducing a brain freeze to do further study on headaches in the lab. This explains at times, rare headache disorders, according to Neurologist Dr. Joshua Daniel of Shore Physicians Group.

    The Brain Freeze Cure
    It may hurt, but that pain is brief. Take it slow: These annoying aches happen when there is a rush of cold hitting the palate or roof of mouth at one time, so the key is to pump the brakes and take it easy when licking a frozen treat. This will allow the body to acclimate to the sudden cold temperature as well as let it warm up just a bit.

    Pass on the straw. Sipping from a straw sends the chill straight to the roof of the mouth, just where it needs to go to set off that brain freeze. Press your tongue to the roof of your mouth, it may shorten the duration of the brain freeze by warming the area. There is some research that suggests caffeine prior to indulging in something cold may cut the risk of having a brain freeze due to the slight reduction in blood flow associated with the caffeine.

    To learn more about managing headaches or to make an appointment with Dr. Daniel call 609-365-6206.

  10. Migraine Treatments Show Promising Results

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    A pounding head and blinding headache, loss of production at work, and family time lost are very real for people who battle migraines. The pain is severe and may last from three hours to three days and can be debilitating. But migraine patients of Neurologist, Dr. Joshua Daniel of Shore Physicians Group are having very promising results from new treatments available.

    Dr. Daniel is utilizing a number of treatment options for patients suffering from migraines with very successful outcomes such as Emgality, a calcitonin gene-related peptide targeted therapy along with several others in that class. Dr. Daniel said the therapy is working great for his patients and added that he uses it as a preventative medication, It is also sometimes used as an abortive treatment, adding that it can shorten the duration as well as the severity of the headache.

    What Is a Migraine?

    A migraine is a headache with throbbing pain that is often severe enough to hamper daily activities and may last from four hours to three days if untreated. Migraine is one of the most prevalent diseases in the world, affecting more than 30 million American adults, according to Dr. Eric Pearlman, Senior Medical Director of Lilly Pharmaceuticals. It is three times more common in women than men. Foods, stress, and hormones can be migraine triggers, according to the American Migraine Foundation. Some patients seek the help of a neurologist for their migraines as well as cluster headaches, a less common and different kind of migraine.

    Migraines vs Cluster Headaches

    Migraines and cluster headaches, although both debilitating, feel and act differently, according to Dr. Daniel. While they are both headaches, migraines and cluster headaches have a different mechanism and pathology. People with migraines may experience nausea, sensitivity to light, and vomiting, whereas those with a cluster headache, which is generally felt on one side of the head, experience watery eyes and a runny nose. Some people who experience migraines can predict the onset because it’s preceded by an “aura,” or visual disturbances — flashing lights, zigzag lines, or a temporary loss of vision, for instance. By contrast, cluster headaches come on suddenly, are almost always one-sided and can be confused with sinus headaches. The pain is distinct and can feel like a hot poker in the patient’s eye, according to the American Migraine Foundation. While a classic migraine can be lengthy in duration, a cluster headache can arrive and depart swiftly over a period of time.

    Managing Migraines

    One very effective weapon in the war against migraine is calcitonin gene-related peptide targeted therapy. As explained by Dr. Pearlman, when a person is experiencing a migraine, the levels of CGRP increases and results in a cascade of pain and unpleasant symptoms.

    Dr. Pearlman explained that as a CGRP inhibitor, Emgality binds to CGRP and interferes with its activity, therefore getting rid of or lessening the effects of the migraine. Even more positive news for migraine sufferers is that there is not just one treatment, rather there are other options as well. When asked if there is a lot of encouraging news for people suffering from migraines and other debilitating headaches, Dr. Daniel said, “Absolutely, we have so many treatments now available. I started Shore Medical Center’s migraine infusion center and do probably the most Botox treatments for migraines in the area and now can offer all of these new migraine medications. We are finding success with not only meds but we utilize devices for migraines as well.”

    Migraines are individualized and vary patient to patient there is no one-size-fits-all treatment plan. Dr. Daniel treats strokes, headaches, seizures, neuropathy and other neurological conditions. He is also fluent in Urdu and Punjabi.

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