Author Archives: Joe Hilbert

1. Oh, My Aching Joints

   April 3, 2019 7:17 pm Comments Off on Oh, My Aching Joints

   If your morning starts out with joint stiffness, do you just chalk it up to your age or blame the gardening you did over the weekend? Or, is it possible that what is causing the discomfort is some form of arthritis? According to Rheumatologist Dr. Manpreet Tiwana of Shore Physicians Group, it is important to understand what is causing that discomfort because some forms of arthritis, if left untreated, may result in irreversible damage.

   “Any form of arthritis can be life changing, as it impacts quality of life, but with so many advancements and treatment options, better outcomes can be achieved. Early diagnosis and control of arthritis along with being compliant with treatment is very important for overall good joint health,” said Dr. Tiwana.

   Types of arthritis

   There are more than 100 types of arthritis according to the Arthritis Foundation, but the three most common types of arthritis are osteoarthritis, rheumatoid arthritis and psoriatic arthritis. All three varieties of the disease will cause joint stiffness and pain and will often be accompanied by swelling, but what they can do to the joints and how they are treated are different.

   Osteoarthritis

   Dr. Tiwana said osteoarthritis is the result of the regular wear and tear on our joints from injuries and aging. It is a degenerative condition, which means it gets worse over time as the smooth cartilage that cushions the joint breaks down. Bone spurs at the side of the joints can form and the bone underneath the cartilage hardens. These changes cause pain, swelling and problems moving the joint.

   There is no cure for osteoarthritis, and Dr. Tiwana said treatment of the disease is more about treating the symptoms -trying to reduce discomfort with various medications or joint injections with the goal of improving the patient’s range of motion. In some cases surgical intervention is a consideration.

   Rheumatoid Arthritis

   Rheumatoid arthritis is an inflammatory arthritis that is associated with the autoimmune process. That means that the body’s immune system begins to start fighting its own joints. If left untreated, rheumatoid arthritis can cause permanent deformities in the joints.

   Once a diagnosis of rheumatoid arthritis is confirmed, Dr. Tiwana said she works quickly to control the inflammation in the effort to avoid permanent joint damage. She added that every patient is unique and will need a plan that includes immunosuppressive medications to block the mechanism leading to swelling and joint damage tailored specifically to them that works in conjunction with any other medical conditions they may have.

   Psoriatic arthritis

   Like rheumatoid arthritis, psoriatic arthritis is an autoimmune disorder. The swelling and joint pain is also often accompanied by a rash. Nearly 30 percent of people who have psoriasis, a skin condition that causes red, scaly, thick patches on the skin that often form over joints, are likely to develop psoriatic arthritis according to the Arthritis Foundation. It can affect any joint in the body. Dr. Tiwana said that medication for this autoimmune disorder is tailor made for each patient utilizing a variety of medications. Various treatment options can lead to remission of the condition but medications will most need to be taken most likely lifelong. Professional golfer Phil Mickelson has psoriatic arthritis and attributes his physician, the use of nonsteroidal anti-inflammatory drugs (NSAIDS) and other antirheumatic drugs for getting him back on the golf course, according to Golf Magazine.

   See your Rheumatologist

   There have been tremendous advancements in the treatment of arthritis. Dr. Tiwana said it is important for people who are waking up in the morning with stiffness to determine how long it is affecting them. If the joint pain is associated with visible swelling in joints or persisting for more than six weeks with morning stiffness lasting longer than one hour, it is advisable for that person to consider seeing a physician for evaluation, said Dr. Tiwana.

   The physician added, if left untreated, rheumatoid arthritis and psoriatic arthritis patients may develop permanent damage to joints and they can lose complete joint function and risk losing the capacity to walk..

   Diet and Exercise

   Dr. Tiwana said diet and exercise are vital to good arthritis control. “There is a component of inflammation in all variations of arthritis, whether it is osteo, rheumatoid or psoriatic. Foods which have anti-inflammatory properties like fish or fish oil and turmeric have all been found to be beneficial. Foods which are fried, processed and have processed sugars are found to increase inflammation. Exercise is vital for any type of arthritis as it maintains good muscle tone and health that promotes good joint function,” according to Dr. Tiwana.

   To discuss symptoms or to set up at appointment with Dr. Tiwana, who is certified in both internal medicine and rheumatology, or a member of the Shore Physicians Group Rheumatology team located at 700 Shore Road in Somers Point, call 609-365-6212.

2. Know Your Numbers: Getting Technical about Diabetes

   7:11 pm Comments Off on Know Your Numbers: Getting Technical about Diabetes

   Diabetes is a disease that occurs when the body’s blood glucose level, also called blood sugar level, is too high. Blood glucose is our body’s main source of energy, which comes from the food we eat. Our pancreas produces a hormone called insulin, which takes the glucose that comes from food and helps get it into our cells, where it is used for energy. Sometimes the body does not make enough insulin or it does not use the insulin well and the glucose stays in the blood and does not reach the cells. Over time, too much glucose in the blood can cause a wide range of health problems.

   Know your numbers
   Shore Physicians Group diabetes educator Denyse Gallagher, APN, has been helping patients and the community-at-large understand and manage their diabetes for the past decade. Patients diagnosed with Type 1 or Type 2 diabetes have to monitor the sugar level in their blood. “Diabetes patients really need to know their numbers,” explained Gallagher. “Not just what their blood sugar level is right now, but they need to know their A1C levels as well so they can keep their goals in focus.”

   Gallagher explained that a person’s A1C number is the measure of a person’s blood sugar level over a three-month period. People with Type 1 and Type 2 diabetes need to check their blood glucose levels daily (for some it is multiple times a day) to make sure they are keeping it within a manageable range. Keeping track of their A1C number allows them to see the trends in how their body is responding to certain foods. It allows them to set goals and make changes so they can get to and stay within safe levels. She cautioned that even for patients who are normally able to remain within safe A1C numbers, managing diabetes means being vigilant about the number because life happens and something like excess stress or even an infection unrelated to the diabetes may cause the A1C numbers to fluctuate.

   Thanks to new technology, it has become easier for patients to manage their disease. The old method meant a finger prick to get a drop of blood each time to measure their glucose level and insulin injections. Now, glucose monitors like Free Style CGM Libre continuously track glucose levels giving the patient the information they need to make management quicker and easier without the need for the finger sticks. The information may be downloaded as well. Insulin pumps can deliver the proper amount of insulin through a pump without the need for an injection.

   “The continuous monitoring is a two-fold benefit to the patient because it will show a trend. For example, if the number is 110, the patient will also know whether it is going up or down and how quickly is it going down. The patient is able to use those numbers as a predictive tool,” said Gallagher. “Every time you have a number, you have an opportunity to make a choice.”

   Types of Diabetes
   The most common types of diabetes are Type 1, Type 2 and gestational diabetes . For those with Type 1 diabetes, their body does not make insulin and their immune system attacks and destroys the cells in the pancreas that make the insulin. Type 1 diabetics must take insulin every day.

   Patients with Type 2 diabetes, the most common type of diabetes, do not make or use insulin well. People can develop Type 2 diabetes at any age, even during childhood. However, this type of diabetes occurs most often in middle-aged and older people. Gestational diabetes develops in some women when they are pregnant. Most of the time, this type of diabetes goes away after the baby is born. However, those who have had gestational diabetes have a greater chance of developing Type 2 diabetes later in life.

   According to the National Institute of Health, diabetes affects 1 in 4 people over the age of 65 and as of 2015, 30.3 million people have been diagnosed with diabetes. Gallagher estimated that on top of those 30 million who have been diagnosed, one in three people are walking around with diabetes or may be pre-diabetic but do not know it.

   Who is more likely to develop type 2 diabetes?
   You are more likely to develop Type 2 diabetes if you are age 45 or older, have a family history of diabetes, or are overweight. Physical inactivity, race, and certain health problems such as high blood pressure also affect your chance of developing Type 2 diabetes. You are also more likely to develop Type 2 diabetes if you have prediabetes or had gestational diabetes when you were pregnant.

   What health problems can people with diabetes develop?
   If you ignore the symptoms of diabetes, Denyse Gallagher said you are flirting with disaster. These symptoms include frequent urination, feeling very thirsty, feeling very hungry even though you are eating, extreme fatigue, blurry vision, cuts and bruises that are slow to heal, weight loss even while eating more, and tingling, pain or numbness in the hands or feet
   

   “The sooner someone sees their healthcare professional, understands what is going on with their symptoms, and gets it under control, the better. Left unchecked, the symptoms of diabetes can lead to significant health problems,” said Denyse Gallagher.

   Diabetics are at risk of heart disease, stroke, kidney disease, eye problems, dental disease, nerve damage and foot problems that can lead to amputation. While there is no cure for diabetes, it is a disease that can be managed through medication and lifestyle. Understanding their disease, knowing their numbers and keeping their goals in focus can make living with diabetes manageable.

   Denyse Gallagher, APN, treats patients at Shore Physicians Group’s office located at 2605 Shore Road in Northfield. For questions about diabetes or to make an appointment with Gallagher or another member of the Shore Physicians Group endocrinology team, call 609-365-5300.

3. Does Gum Disease Increase the Likelihood of Alzheimer’s Disease?

   March 13, 2019 6:16 pm Comments Off on Does Gum Disease Increase the Likelihood of Alzheimer’s Disease?

   A diagnosis of dementia or Alzheimer’s disease is enough to scare anyone. With more than 5.5 million Americans over the age of 65 currently diagnosed with Alzheimer’s disease, and that number is expected to double by the year 2050 according to the Alzheimer’s Association. Understandably, people are desperate to find causes, treatments and cures which despite ongoing research remain elusive.

   When studies seem to yield any solid data, the media is quick to splash headlines that grab the attention of families hopeful for better understanding of who at risk of getting the disease or if there is a way to treat or minimize the effects of Alzheimer’s. A May 2018 study published online in the Journal of Alzheimer’s Disease linked periodontal disease and an increased likelihood that gum disease may play a role in predicting Alzheimer’s disease.

   Size of the Study Does Matter

   Neurologist Dr. Joshua Daniel of Shore Physicians Group, said unfortunately the sample study was too small to establish a definite link between periodontal health and the likelihood that people with gum disease are at a greater risk to develop Alzheimer’s disease.

   Researchers in England, Drs. John Crean and Sim K. Singhro, examined brain tissue samples donated by 10 patients without dementia and 10 patients with dementia. They found gum disease bacteria, lipopolysaccharides, in the sample from four of the people with dementia and none of the people who did not have dementia. Bacteria can enter the bloodstream through everyday activities such as eating, chewing and brushing teeth and once in the bloodstream, the bacteria can be carried to other parts of the body. The researchers hypothesized that when the bacteria reaches the brain, it may trigger an immune system response (like it does in the mouth), killing brain cells. This immune response could be one mechanism that leads to changes in the brain, which is typical in Alzheimer’s disease. It could play a role in causing symptoms such as confusion and deteriorating memory.

   Study Linking Biomarker to Alzheimer’s Disease

   One recent study Dr. Daniel thought may show promise looks for a protein in the blood, a neurofilament light, which could be a biomarker for Alzheimer’s disease. A paper published in March 2018 supports the idea that dying neurons release a slew of proteins into the brain and traces of those neurofilament proteins make their way into the blood.

   In the largest study to date on neurofilament light proteins in people with dementia, Swedish scientists at the University of Gothenburg reported high levels of this protein in the blood of people with Alzheimer’s disease and mild cognitive impairment. Neurofilament light was also associated with worsening cognitive scores over time and with brain atrophy. While it is not sensitive or specific enough to stand alone as a diagnostic marker, the protein distinguishes Alzheimer’s disease and mild cognitive impairment from healthy control patients who do not have a diagnosis of Alzheimer’ about as well as the presence of tau in cerebrospinal fluid from a spinal tap. Tau is a normal protein in the brain that changes and may damage brain cell structures in patients with Alzheimer’s disease, and is identified through a spinal tap. Blood neurofilament light would be a more easily accessible biomarker for prognosis and progression. Washington University researcher Anne Fagan reported in Alzforum, a news website and information resource for Alzheimer’s disease and related disorders research, that the work with the neurofilament light plasma marker needs to be replicated, but if the blood testing performs as well as the cerebral spinal fluid then it could have a huge impact.

   Dr. Daniel said that while the studies are encouraging and may help with early diagnosis they still need more data and more information. Having a path to cover the expense of the testing could be difficult, adding that getting the insurance companies to cover it will be the biggest challenge.

   Neurofilament light research is not limited to Alzheimer’s disease and mild cognitive impairment. It is also suggested as a marker for neurodegeneration in everything from amyotrophic lateral sclerosis (ALS) to traumatic brain injury and atypical Parkinson’s disease. Research is ongoing.

   To make an appointment with Dr. Joshua Daniel at Shore Physicians Group, located at 649 Shore Road, Suite O in Somers Point, call 609-365-6202.

4. 4 Nutrient Deficiencies that Could be Causing your Headaches

   6:06 pm Comments Off on 4 Nutrient Deficiencies that Could be Causing your Headaches

   “Oh, my head is pounding.”

   We have all muddled through days when a headache gets in the way of what may have been planned. Before you grab that over-the-counter remedy to silence the drum banging in your head, experts say there could be several deficiencies that are contributing to your headache.

   Dehydration

   Water, water everywhere, but yet if we fail to drink enough it can spark a headache. According to the National Headache Foundation, even mild dehydration can cause a dehydration headache or even a migraine. Since it’s often not clear what is causing a headache, drinking a full glass of water and continuing to sip more fluids during the day is a simple way to ease the pain.

   Magnesium Deficiency

   Neurologist Dr. Joshua Daniel of Shore Physicians Group said many migraine headache sufferers are found to be deficient in magnesium when they have blood work done. He instructs patients to take magnesium not only to prevent the onset of future migraines because it stops the transmission of pain but also because there are no side effects. Magnesium is affordable and available over the counter, according to the physician.

   Magnesium is abundant in the body but for some, it is not absorbed readily. It can be a genetic deficiency that keeps a body from absorbing sufficient magnesium or it could be inherited renal magnesium wasting where the magnesium is lost through the kidneys, excretion of excessive amounts of magnesium, stress, low nutritional intake or several other factors, according to information provided by the National Institute of Health.

   Dr. Daniel said he includes magnesium with the IV fusion therapy to treat migraines that has proven to be very helpful with patients. He added that it is safe and has no contraindications for patients.

   Fight Deficiency with Diet

   Low levels of magnesium may contribute to migraines, according to Chris Kozmor, RN, M.Ed., director of the Shore Medical Center Cardiac and Pulmonary Rehabilitation Center. Kozmor suggests including plenty of magnesium-rich foods like spinach, avocado and almonds into a well-rounded diet to keep those headaches at bay.

   Vitamin D Deficiency

   Why does that sun (in moderation) feel good on your skin? While it warms you on a chilly day, it is also supplying vitamin D to your body. Most of us get an ample supply through our diets with fatty fish and dairy products, orange juice and cereals, and just by being outside. Vitamin D deficiency can cause a number of side effects, but recent studies have also shown a possible link between the deficiency and headaches. On the flip side, too much vitamin D can have its own problems. Follow the recommended daily allowance for vitamin D according to age to help cut down on the frequency of headaches. The National Institutes of Health recommends 600 IU of vitamin D for adults ages 19 to 70. Adults 71 and older need 800 IU.

   Vitamin B2 Deficiency

   The B vitamins help to protect from headaches, according to the National Headache Foundation, but it is B2 (riboflavin) that really stands out and where a deficiency may lead to headaches. Eating foods high in vitamin B2 or supplementing with a quality vitamin may help improve energy metabolism and decrease the incidence of migraine headaches. Foods high in B2 include eggs, lean meats, green vegetables along with fortified grains and cereals. The NIH recommends 1.3 mg for males and 1.1 mg for females.

   Each of the B vitamins (B1, B2, B3, B5, B6, B12, biotin, and folic acid) have a recommended daily allowance according to the National Institute of Health.  https://ods.od.nih.gov/factsheet