Category Archive: Physician Articles

  1. Spring can be a Real Pain in the Neck, Back, and Knees

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    For so many of us, we spent the winter months sitting more and exercising less than is recommended. The American Heart Association says only one in five is getting the heart-pumping exercise our bodies need for optimal health each week. But seasons change, and those early beautiful spring days beckon us to be outdoors. Whether we are weekend warriors on the tennis court, the soccer field, or in the garden, early spring sore muscles and achy backs can be the result. Jumping into activities without ramping up, stretching, and conditioning can be a real pain.

    Stretch it out
    Primary Care and Sports Medicine physician Dr. Steven Cetel of Shore Physician Group in Somers Point said everyone needs to make sure they are prepared when they head out in the spring for sports or heavy chores. “In the spring, we see an uptick in sprains, strains, knee injuries, shoulder injuries, and concussions with people involved in sports. We will see more knee and back pain with people working in their garden,” said Dr. Cetel. “Stretching is so important, both before and after an activity, to cut down on injuries. I remind patients to start with bending whatever the joint is they might be pushing. They also need a strong core. A weak core leaves you susceptible to back pain and knee pain.”

    Getting to the core
    For athletes, whether on the varsity squad or with the over 40 men’s baseball league, injuries are a part of the game. “To avoid injuries, it is important to have strong mechanics and a strong core. There is a reason for spring training, to get athletes ready for their sport and to ramp up to whatever activity they plan,” said Dr. Cetel. “For those who may be older, start low and slow. You cannot go from sitting on the couch to playing tennis or pulling weeds in the garden for four hours. That is how people wind up with problems.”

    Core exercises train the muscles in your pelvis, lower back, hips and abdomen to work in harmony. This leads to better balance and stability, whether on the playing field or in daily activities. In fact, most sports and other physical activities depend on stable core muscles.

    “For my older patients planning to do work in their garden, I remind them to work up to it by bending over for a few minutes and remaining active,” said Dr. Cetel. “To avoid injury, sometimes people need a reminder to bend from the hips and not from their back. Once again, a strong core helps keep pain at bay.”

    Kneeling is another cause of discomfort and injury. Dr. Cetel explained that knee pain is often due to arthritis. He reminds patients that kneeling for an extended period will result in pain. Kneel for shorter periods and use some type of knee pad or protection to cut down on knee pain or injury.

    RICE is always nice for sprains
    The classic advice Dr. Cetel offers patients is the acronym RICE, which stands for “rest, ice, compress, elevate”. RICE still holds true for strains and sprains, but according to Dr. Cetel, the amount of time someone should follow RICE has changed over time. “That guideline is for right after the injury. It used to be that if you sprained your ankle, you stayed off of it and followed RICE protocol for a longer period. Now we want to make sure you are getting your range of motion back earlier. When the swelling goes down, start moving around as much as you are able. But on the flip side, if it is too tender for you to walk on that ankle, you need to come in for an evaluation.”

    A sprained ankle is an injury that occurs when you roll, twist or awkwardly turn your ankle. These injuries can stretch or tear the tough bands of tissue or ligaments that help hold your ankle bones in place. The ligaments stabilize joints and prevent excessive movement. A sprain happens when the ligament is forced beyond its normal range of motion.

    A high-ankle sprain is different and, according to Dr. Cetel, will take longer to resolve or heal. A high ankle sprain is when you tear or damage the high ankle ligaments that connect the tibia to the fibula. The ankles connect the leg bones to the foot bones. Dr. Cetel said, a patient with a high ankle sprain might need crutches or wear a boot to keep weight off the area until it heals. Sometimes, the high ankle sprain may require surgery, depending upon the severity of the strain. Football players may get a high ankle sprain and be out for weeks until it heals. Baseball players sliding into a base can experience a similar injury.

    Shouldering the season
    “The best way to avoid shoulder injuries is to maintain proper mechanics,” said Dr. Cetel. “You need a strong shoulder, upper body, and scapular muscles to avoid pain. We often sit stooped in our chair, or worse, stooped with a phone in our hand, texting. That is just setting you up for pain,” said Dr. Cetel.

    Shoulder injuries are common in the garden as well. Dr. Cetel explained that people may use improper form to lift heavy landscaping rocks or do repetitive work too often. “They should be lifting with their legs and glutes, not with their back,” said Dr. Cetel. “People in pain should move as quickly as possible to avoid getting stiff.”

    Help for those knees
    For an acute knee injury that results from a direct blow, unusual twisting, bending, or falling on the knee, Dr. Cetel suggests stopping the activity and RICE. For pain caused by arthritis, Dr. Cetel said strengthening activities, possibly physical therapy, can help the affected area get stronger. He also suggested glucosamine chondroitin may help. “In some cases, a brace on the knee might be helpful. The patient and their doctor could also look at the possibility of steroids or gel injections to help alleviate pain and promote healing.”

    For shoulders, knees, and even hamstring pulls, Dr. Cetel said it is important to strengthen the area surrounding the injured joint to make it stronger. “It is our goal to make sure they heal safely. Included in that equation is also good nutrition, proper sleep, and staying hydrated. All of those factors will help everyone get back to the baseball field, the tennis courts or out in the backyard, pulling weeds and planting flowers.

    Dr. Cetel recently served as the team physician for the Metro Atlantic Athletic Conference at Boardwalk Hall in Atlantic City. He also served as the NBA League Delaware Blue Coats Asst. team physician as well as team physician for the University of Delaware men’s and women’s basketball and lacrosse teams.
    To make an appointment with Dr. Steven Cetel call 609-365-5600 for the Primary Care in Northfield office or 609-365-6280 for the Orthopedic office in Somers Point.

  2. Look Out, Allergy Sufferers

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    Spring is officially here, and with the extra hours of daylight and sunshine many enjoy, others are already in the throes of their seasonal allergies. Even on the prettiest days, they can be miserable with symptoms like a runny nose and sneezing, watery eyes, and a scratchy throat.

    Dr. John Kulin, urgent care medicine physician and director of Shore Urgent Care in Northfield, said it is tree pollen that has allergy sufferers sneezing and sniffling this time of year. “Tree pollens can really trigger the body’s allergic response, and this is the time of year when trees are getting ready to bloom. We walk outside in the morning and see that fine coating on top of the car, that is pollen, and some people can have a very strong reaction to it. March to June is peak tree pollen season,” said Dr. Kulin. “In June through early September, grass pollens will cause most of the allergic reactions. Molds and dust mites can be present throughout the year and are worse on hot, damp days.”

    What is an allergic reaction?
    When the sniffles and the itchy eyes start, we think the allergic reaction is in the nose or eyes, but as Dr. Kulin explains, those are the symptoms of the allergic reaction. The allergic reaction really stems from the immune system going overboard. “Our immune system has a very important job and that is to defend our body against an invader such as bacteria or virus that might harm it. But when a person has an allergic reaction, the immune system releases antibodies, and the cells send out histamines and other chemicals, which causes blood vessels to expand and trigger the allergy symptoms. Allergies occur when the body’s immune system recognizes a harmless substance as a threat, causing the body to produce an over-the-top response to it.”

    Antibodies are quite specific, according to Dr. Kulin. Each antibody will target only one type of allergen, which is why a person can have a strong allergic reaction to ragweed but not to tree pollen. He added that people’s individual immune system, stress, and even family history may factor into the body’s allergic response.

    Managing allergic reactions
    According to Dr. Kulin, when the pollen is heavy in the spring, most of us may have a mild reaction to it. An allergic reaction to pollen would be nasal congestion, often accompanied by a chronic mild cough as well as red, irritated, and watery eyes.

    Dr. Kulin said many seasonal allergies can be managed using over-the-counter products. Nasal sprays such as Nasonex or Flonase will help to reduce the swelling in nasal passages. Antihistamines such as Zyrtec are helpful for allergy sufferers. Zyrtec and Claritin block the histamine that causes the itchy eyes, runny nose, and hives the body makes during an allergic reaction.

    Dr. Kulin did not recommend the common antihistamine Benadryl to relieve allergy symptoms. “Although Benadryl is a strong antihistamine, it will likely make the person drowsy, so I do not advise it for relieving milder allergy symptoms. Both Zyrtec and Claritin are better for managing mild to moderate allergy symptoms,” said Dr. Kulin.

    Patients who use over-the-counter medications like Zyrtec and Claritin should use them daily and not rely on them on an ‘as-needed basis.’ “These medications are much more effective when taken daily for allergy symptoms,” said Dr. Kulin.

    Seeking help for allergies
    “If any pain or pressure in the cheeks or the head accompanies nasal congestion, or if they develop a fever, they may be at risk of developing a sinus infection. If so, it is time to seek medical attention,” said Dr. Kulin. “They can go to their primary care provider, or if they cannot get into their primary care quickly, they can easily go to their local urgent care center.”

    Dr. Kulin suggests they meet with an allergist for bad allergies or those not well controlled by over-the-counter medications. They will be able to do testing to see specifically what the patient has the strongest reaction to and may be able to desensitize the person over time.

    Epi-Pen
    Patients who have the potential for a severe reaction may need to carry an epi-pen with them at all times. “Food and nut allergies can be severe. They can have swelling of the lips and tongue. They might start wheezing and need an Epi-pen to shut down the symptoms quickly. But people need to understand that the Epi-pen is merely a bridge until the person gets emergency help. If they need to use the Epi-pen, they need to also seek immediate medical help,” Dr. Kulin said emphatically.

    He went on to explain, “People’s reactions can escalate. A food allergy or a bee sting may have caused a mild reaction the first time they were exposed. It can be a month later or years later before that reaction is triggered again, and while the hope is that it is mild, it can be much more severe. For that reason, people who carry an Epi-pen need to make sure it is not expired. They last about a year before they need to be replaced,” said Dr. Kulin.

    Poison Ivy and other outdoor allergens
    When we are outside, there are a number of plants innocently growing in the yard that can cause strong allergic responses, like poison ivy or poison oak. The oil from these plants is the culprit. Dr. Kulin advised using over-the-counter products like TechNu Skin cleaner to get the plant oil off the skin. “People also need to take off the clothes they have been wearing and wash them in a strong soap. Likewise, they need to wash whatever kind of shop rag they have been using in the garden,” said Dr. Kulin.

    Topical products may work for mild reactions. According to Dr. Kulin, more severe poison ivy reactions may require oral steroids to control. He added that you should not use hydrocortisone products on the face as they may cause damage to the skin.

    Primary Care or Urgent Care
    When patients are having allergic reactions, they need to decide what is best for them. “If they can get in to see their primary care provider quickly, that is a great option. If they choose to visit their urgent care center, they can get the same treatment and have the same medications prescribed to solve their problem. At Shore Urgent Care, we have made it as easy as possible to ‘get in line and save time.’ Patients are seen quickly. They can register from home on our website, know how many people are in front of them and get a call to head in when they are third in line,” said Dr. Kulin. “We know how important our patients’ time is.”

    To register online in advance at Shore Urgent Care, located at 2605 Shore Road in Northfield, NJ, visit https://shorephysiciansgroup.com/shore-urgent-care/ or 609-365-5333.

  3. Platelet-rich Plasma: Shore Physicians Group brings MVP-worthy treatment to Somers Point

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    On May 17, the Associated Press reported that Philadelphia Phillies superstar and reigning National League MVP missed a game against the San Diego Padres as he recovers from a platelet-rich plasma injection in his right elbow.

    Harper had the injection Sunday because of a small tear in the ulnar collateral ligament of his right elbow that limited the slugging right fielder to play only as Philadelphia’s designated hitter because his throwing motion was impacted by the tear.

    As baseball fans in the area await Bryce’s return to outfield, many may be wondering what exactly is a platelet-rich plasma injection and why would a patient choose to receive one.

    Shore Physicians Group orthopaedic hand surgeon Dr, Jasmine Bauknight and non-operative sports medicine doctor Dr. Steven Cetel, who are treating patients with platelet-rich plasma injections at the Shore Physicians Group Orthopaedic Division in Somers Point offer valuable insight on this subject.

    Platelet-rich plasma therapy

    Platelet-rich plasma (PRP) therapy uses injections of a concentration of a patient’s own platelets to accelerate the healing of injured tendons, ligaments, muscles and joints. A small amount of blood is drawn from a patient, and then the drawn blood is placed into a device called a centrifuge. The centrifuge rapidly spins the sample, separating out the other components of the blood from the platelets and concentrating them within the plasma.

    Dr Bauknight explains, “The platelets release small healing factors to damaged tissue. It can be an effective for tennis elbow, golf elbow, tendonitis, other tendon issues and joint arthritis. My patients who were suffering from tennis elbow have had success with it. PRP therapy can be useful when other options have not worked, and if successful it can be a way for a patient to prevent or delay surgery.”

    Dr Cetel added, “Platelet-rich plasma has been shown to be highly effective in acute tendon injuries more so then chronic injuries. High level athletes have been using Platelet-rich plasma at much higher rates over the past few years due to the ability to avoid surgery and get back to play sooner.”

    Baseball fans who are following the news on Harper’s recovery may be asking themselves why is it taking so long for him to get back in right field. The reality is that while PRP can be effective, it is not a quick fix or instant cure.

    “I want people to understand that PRP therapy is not a short term pain reliever like a cortisone shot,” said Dr Bauknight. “PRP a long-term healing process. It takes time, as the tissue is repairing itself. For example, patient who receive an injection in their Achillies tendon can expect to be sore for up to a week, and maximum improvement can take several weeks to months, although benefits can last for several months to years.”

    Dr. Cetel echoed this sentiment by stating, “It is not an immediate fix and the injury has to heal – but PRP and physical therapy can get you back sooner. It is still an experimental treatment but results have been very good so far.” For an appointment with Dr. Bauknight or Dr. Cetel to see if PRP might be an option for you, call 609.365.6280.

  4. What is Good for Baby can be Heart Healthy for Mom

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    Healthcare providers encourage new mothers to try breastfeeding their baby because of the benefits for the newborn. Researchers have found that breastfeeding is also very beneficial to the mother as well.

    The Centers for Disease Control and Prevention released a study in July 2021 that shows breastfeeding can reduce the mother’s risk of high blood pressure, type 2 diabetes and both breast and ovarian cancer. The numbers bear out that mothers who breastfed their newborns have a lower incidence of some cancers and type 2 diabetes, and high blood pressure was also less common for breastfeeding mothers.

    Before the baby arrives

    Maggie Stanley of Shore Physicians Group’s OB/GYN Midwifery practice said she encourages expectant mothers to breastfeed at their initial appointment and continues to reinforce it throughout pregnancy to initiate education as well as readiness. “We also hope to identify any barriers or misconceptions that the expectant mother may have about breastfeeding,” added Stanley.

    International Board Certified Lactation Consultant Lauren Matalucci of Shore Medical Center said for new moms who may be hesitant to breastfeed, “We always let our patients know that we support all infant feeding choices. But we do promote breastfeeding as it is an ideal nutrition for infants, and provides so many benefits to the newborn and well as the mother.”

    Advantages to the newborn

    Midwife Joanna McGrath of Shore Physicians Group OB/GYN said breastfeeding brings tremendous advantages to the newborn baby including a reduced incidence of asthma, allergies, respiratory illness, ear infections, obesity and type 2 diabetes. “Also, the breast milk composition actually changes to meet the optimal nutrition demands of a growing infant,” said McGrath.

    “The advantages to the newborn are vast,” said Matalucci. “Just a few include increased brain development, a lower risk of sudden infant death syndrome (SIDS), and it aids in the development of the infant’s immune system. When a mother is exposed to certain viruses or diseases, the mother will produce extra antibodies to be transferred to the baby through her milk.”

    New mothers benefit as well from breastfeeding

    “Primarily, bonding is facilitated through breastfeeding,” said Stanley. “Not to say mothers who bottle feed do not bond with their baby – of course they do – but the skin-to-skin contact of breastfeeding is paramount to promote bonding.” Other advantages to the breastfeeding mother include the extra 400-500 calories burned daily and the oxytocin that is released to shrink the uterus back to pre-pregnancy size, according to Stanley.

    Breastfeeding in some cases will delay the start of the mother’s period after the birth of the baby, but not always. It is also linked to a decrease in the risk of early menopause, according to McGrath. The theory is, slowing of egg loss during pregnancy and breastfeeding delays menopause.

    According to research, lactation decreases the insulin levels in the blood due to decreased glucose present in the blood. There is evidence that lactation also decreases the activity of the pancreatic cells which preserves their function.

    Breastfeeding and stress

    According to Matalucci, the hormone oxytocin that is secreted when breastfeeding naturally lowers the stress response. Breastfeeding mothers also have a natural contraceptive and experience a lower incidence of post-partum depression.

    Convenience is a big advantage

    When the newborn is screaming in the middle of the night because they are hungry, breastfeeding is a convenient fix. “It is right there, it is the right temperature and it is free,” added Matalucci. “There are no bottles to wash, or formula to mix or warm up and it is eco-friendly.”

    Stanley added, “Ideally women should exclusively breastfeed for six months as recommended by the American Academy of Pediatrics. With expectant mothers, we emphasize that any amount of time breastfeeding is preferable to no breastfeeding.”

    Statistically, about 80% of new mothers will try breastfeeding, according to Matalucci, who is also a childbirth educator and Director of Shore Beginnings: Prenatal and Wellness program. “Many, however, choose not to continue for various reasons. It is important for all new breastfeeding mothers to have bountiful support. In the hospital setting and beyond, I provide patients with breastfeeding education, correct latch and position techniques and what to expect during their breastfeeding journey. We support all infant feeding choices, but promote breastfeeding as it is an ideal nutrition for infants, providing benefits for both the baby and the mother.”

    Top 20 Reasons to Breastfeed Your Baby

    1. Breastfeeding promotes bonding between mother and baby.
    2. Breast milk provides perfect infant nutrition.
    3. Breastfeeding reduces the risk of ovarian and breast cancer.
    4. Breastfeeding is associated with a higher I.Q. in infants.
    5. Breast milk contains immunities to diseases and aids in the development of the baby’s immune system.
    6. Breast milk is more digestible than formula.
    7. Nursing helps mom lose weight after the baby is born.
    8. Breastfeeding reduces the chances of baby developing allergies/asthma.
    9. The DHEA, (a hormone produced in the adrenal gland to make androgens and estrogens) in human breast milk cannot be replicated.
    10. Breastfeeding reduces the baby’s risk of ear infections.
    11. Breastfeeding reduces the risk of the development of type 2 diabetes.
    12. Breast milk is always available and always the right temperature.
    13. Breastfeeding reduces the risk of sudden infant death syndrome.
    14. Breastfeeding protects baby against vision defects.
    15. Breastfed babies are statistically healthier than formula fed babies.
    16. Breastfeeding is a natural contraceptive.
    17. Breastfeeding helps reduce the infant’s risk of obesity later in life.
    18. Breastfeeding becomes less time-consuming than bottle feeding.
    19. Breast milk is free. (The average cost of formula for the first year of life is $2,000)
    20. It is what babies were designed for.

    To learn more about Shore Physicians Group’s new OB/GYN and Midwifery practice or to make an appointment with Certified Nurse Midwives Joanna McGrath or Maggie Stanley, call 609-365-5300.

    For more information on the benefits of breastfeeding, lactation support, or for any questions contact Shore Beginnings: Prenatal and Wellness at 609-653-3500 x 2860.

  5. Being Heart Smart at the Dinner Table

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    What you eat has an effect on how your body functions, including your heart. Changing eating habits may seem like a daunting task but it is one that can provide benefits in the long run.

    Shore Physicians Group Registered Dietitian and Diabetes Educator, Tiffany Rios, RD, CDE works closely with patients, getting them on the right track to a healthier life and a healthier heart. Each individual is different. Rios said, “The first step in prescribing the right type of diet is determining what the cardiac related issue is. While it’s true most dietitians agree that the Mediterranean diet is a healthy diet, there are very important nuances related to each cardiac issue. For example, if you have congestive heart failure, sodium and fluid intake are carefully monitored. If you’re taking blood thinners such as Warfarin or Coumadin, you are most likely having your PT/INR monitored, which are biomarkers for the thickening of your blood. In this case, monitoring the quantity and eating consistent amounts of Vitamin K is necessary.” She advises patients about food and drug interactions with grapefruit. (Many drugs are broken down with the help of an enzyme in the small intestine. Grapefruit juice may block that enzyme. According to the Federal Drug Administration, instead of the drug being metabolized, more of the drug enters the blood and stays in the body longer. The result is too much of the drug in your body.) If the main problem is high cholesterol or elevated LDL, the Mediterranean diet is a great approach.

    Head to the Mediterranean (diet)

    “The reason the Mediterranean diet gets all the hype is that it is centered on healthy fats such as avocado, nuts, seeds, and olive oil which makes it a great candidate for a heart healthy diet,” explained Rios. “What’s more, the Mediterranean diet is generally high in fiber because it promotes the intake of chickpeas and a wide array of vegetables. Since soluble fiber attaches to cholesterol in the small intestine and helps to remove it in the feces, fiber plays an important role in cholesterol reduction.”

    Controlling risk factors

    An important part of achieving a healthier heart is to control risk factors. Patients with type 2 diabetes need to get their A1C down. Rios said, “When I work with patients who have type 2 diabetes we co-create a tailored list of low glycemic carbohydrates and a strategy for how to balance them with proteins and healthy fats. We use the plate method to structure meals: ½ plate vegetables, ¼ protein, and ¼ healthy fat. This is a simple tool that makes portion control easier. Eating vegetables prior to the rest of the meal can also improve satiation with the meal, and help regulate appetite.”

    While the plans are similar, Rios said, “The common denominator with all healthy diets is a large focus on non-starchy vegetables and plants, with a healthy balance of protein and fat.”

    Diet pitfalls

    When you are trying to be heart smart, there are some foods that need to be avoided. Rios said at the top of the list is trans fats. Usually identified as hydrogenated oils on packaging labels, they can wreak havoc on “good cholesterol,” or HDL that absorbs cholesterol and carries it back to the liver where it is then flushed out with toxins. Next is fast food. While it is convenient, fast food is typically high in industrial seed oils (canola, corn, cottonseed, soy, sunflower, safflower, grapeseed, and rice bran) and traditionally loaded with excess sodium. The third healthy diet pitfall is processed foods. Rios said packaged crackers, cookies and chips are usually laden with added sugars, synthetic fats/industrial seed oils, and unbalanced micronutrients. “These foods impact your blood sugar, and when consumed in excess, can result in inflammation and even cause weight gain because they do not satiate your body and leave you hungry for more food.”

    Hold the salt, please

    Rios advised to watch the salt intake. She explained, “Salt is a solute (a substance that dissolves in another substance such as sugar dissolving in water) and solutes generally attract water/fluid to balance out the blood chemistry. In consuming excess sodium we are increasing the volume and pressure in the blood vessels which can also increase stress on the heart.”

    How much protein is too much?

    Too much of anything can be bad for you. Rios advised that too much protein, particularly from the wrong sources, can be the real problem. “Excess protein can put stress on your kidneys, and since most protein sources come from an animal, the extra cholesterol and saturated fat will not do much to help heart health. So think fried meats, including poultry, and excess saturated fats.” The Keto diet promotes a high intake of protein to achieve weight loss. So for the person who is trying to maintain a heart smart diet and lose weight, Rios suggests to patients, “Before they try the Keto diet, I encourage a modified low carbohydrate diet that emphasizes high fiber carbohydrates like beans, lentils, and berries. The standard Keto diet is 70% fats, 20% protein, and 10% carbs,” said Rios. “Since 70% is a large percentage, it is understandable that if caution is not used with the types of fats consumed, this could potentially be negative for overall heart health.”

    To aid in portion control, Rios suggests a person consume a portion the size of your palm and then add slightly until you feel full. “This is a good way to determine what is the right portion for you,” said Rios. “Seeing a dietitian can be very helpful to determine your own protein needs.”

    White or red?

    Wine, in moderation, can be a good thing for your heart. Rios said, “Red wine has been found to have more polyphenols and resveratrol than white wine, although both are touted as heart healthy. But don’t be fooled, too much of a good thing can have diminishing returns.” She suggests women limit their intake of wine to one 5-ounce glass per day and for men, one to two 5-ounce glasses per day.

    Easy heart smart diet add-ins

    Rios suggested adding extra virgin olive oil, olives, and nuts, seeds such as chia and flaxseed, avocados, fatty fish such as wild caught salmon, mackerel, and sardines.

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

  6. The Twenty Minute Screening That Can Save Your Life

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    The carotid arteries are the main blood vessels from the heart to the brain, supplying it with life-sustaining blood flow. There is a carotid artery on both sides of the neck, each one feeding one side of the brain. When there is carotid stenosis present, meaning the carotid artery is narrowed or blocked by plaque, it can lead to a stroke. According to General and Vascular Surgeon Dr. Matthew Lawrence of Shore Physicians Group in Somers Point, finding any carotid stenosis early is so important. Vascular screening is the number one tool used to find any stenosis or any other irregularity in the arteries and veins. Dr. Lawrence said,“Our goal is to catch any carotid stenosis before it becomes symptomatic.”

    Symptoms of carotid stenosis

    Dr. Lawrence said symptoms of carotid stenosis are very similar to that of a stroke. There could be weakness on one side, slurred speech, and an inability to grab something, weakness in one arm or leg and even facial droop. “The symptoms are not bilateral. They would appear primarily on one side or the other indicating there may be some blockage. I would want to look further with vascular screening.” Dr. Lawrence said some people may have symptoms that affect their vision. He added, “The blood flow to the back of the eye occasionally will be affected by carotid stenosis. While it might be short-lived, it is an indication of something we need to really look into further to understand why it occurred.”

    Stroke statistics

    According to the Centers for Disease Control and Prevention, stroke is a leading cause of death in the United States and is a major cause of serious disability for adults. About 795,000 people in the United States have a stroke each year.

    Carotid stenosis, along with carotid artery disease, is caused by a buildup of plaques in arteries that deliver blood to the brain. Plaques are clumps of cholesterol, calcium, fibrous tissue and other cellular debris that gather at microscopic injury sites within the artery. Carotid arteries that are clogged with plaques are stiff and narrow. Clogged carotid arteries have trouble delivering oxygen and nutrients to vital brain structures that are responsible for your day-to-day functioning.

    Screening for carotid stenosis

    Dr. Lawrence says that vascular screening at Shore Physicians Group Vascular Testing and Diagnostics Center is an invaluable tool. “The ultrasound does such a good job in helping to detect any irregularities,” said Dr. Lawrence. “The testing is not stressful, it takes about 20 minutes, and there is no need for an IV and no need for radiation. We are able to take pictures of the patient’s arteries and see what is going on.”

    Because ultrasound technology is efficient in helping to detect any narrowing of the arteries, it gives the physician a baseline for the patient. The advantage is being able to plot the best course for the patient.

    Managing carotid stenosis

    Dr. Lawrence said patients who have some narrowing may be able to manage it medically, at least early on. “If they make some lifestyle changes it will help. If they make the decision to stop smoking, get their blood pressure under control and begin managing their cholesterol level with a statin we can continue to monitor,” said Dr. Lawrence.

    Once the ultrasound studies have been done and the carotid artery is significantly narrowed or blocked, surgery is often the only option. Dr. Lawrence said, “The open surgical option, an endarterectomy, is where we open up the carotid artery and put a patch on the artery to permit proper blood flow to the brain, and it really does take care of the problem. It is a quick rebound for the patient. They are normally only in the hospital overnight and go home the next day, most with nothing more than an extra strength Tylenol and bandage on their neck. The risk of any complications is very rare.” The patient returns to have sutures or staples removed in a week to 10 days and again for a checkup in a month, six months and a year as we continue to follow them.”

    Getting you back to your life

    Dr. Lawrence said patients will ask if they should take it easy. “I tell them, they got the repair so they can get back to their life and I encourage them to do it. If they are used to taking a walk, they should feel comfortable taking a walk. That patch that I put in is very strong and we know it can take the pressure of blood pumping through there, it can certainly handle a walk or going to the gym.”

    Managing your numbers

    Dr. Lawrence said it is so important for long term health to manage the numbers critical to remaining healthy. “Keep your cholesterol in check, get your blood pressure under control, and watch your diet along with watching the scale. Right now we have an epidemic of obesity. We have too many people, even young people in their 20s and 30s who are sedentary, and the long term effect is unhealthy. Get up and get some exercise every day,” concluded Dr. Lawrence.

    To make an appointment with Dr. Matthew Lawrence or to be evaluated for vascular screening at the Shore Physicians Group Vascular Testing and Diagnostic Center, call 609-365-6239.

  7. Eye Exams are for more than Vision

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    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.

    To see the scope of what happens in a dilated eye exam, visit https://www.nei.nih.gov/learn-about-eye-health/healthy-vision/get-dilated-eye-exam.

    Follow National Eye Institute advice

    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.

  8. Call the Midwife

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    Midwifery

    Midwifery may sound like a practice from generations ago, but it is an important trend in women’s healthcare. Midwives have been helping women bring their babies into the world for hundreds of years. The title “midwife” comes from old English meaning “with women” and refers to the person who is with the mother giving birth. Today, midwives are providing women from puberty to beyond menopause with a continuous and compassionate healthcare partnership.

    The Scope of Midwifery

    Midwifery as practiced by certified nurse-midwives encompasses a full range of primary health care services for women from adolescence menopause and beyond. These services include gynecologic and family planning services, preconception care, care during pregnancy, childbirth, and the postpartum period. Midwives provide initial and ongoing comprehensive assessment, diagnosis, and treatment. They conduct physical examinations; prescribe medications and contraceptive methods; admit, manage and discharge patients; order and interpret laboratory and diagnostic tests and order the use of medical devices. Midwifery care also includes health promotion, disease prevention, and individualized wellness education and counseling.

    Midwifery Training

    New York was the first state to require midwives to be licensed in 1719. Doctors at that time were often not formally educated, so midwives were utilized for childbirth due to a greater base of knowledge and experience, according to Midwifery Today. Midwives today meet extensive education requirements in order to attain their license as certified nurse-midwife.

    Joanna McGrath, MSN, CNM, of Shore Physicians Group OB/GYN and Midwifery services, earned her certification as a nurse-midwife from Georgetown University after more than twenty years working with women as a labor and delivery and obstetrical nurse. Maggie Stanley, RN, APRN, CNM, also of Shore Physicians Group OB/GYN and Midwifery services, earned her certification as a midwife from Frontier Nursing University and has more than 20 years working with women as a labor and delivery nurse and midwife.

    Certification for midwives is a graduate-level program that must be accredited by the Accreditation Commission for Midwifery Education. Their courses require classwork that emphasizes women’s health, childbearing care, and primary care. They also must complete a significant number of clinical hours that dovetail with their curriculum. Those nurses aspiring to be certified must pass a national certification exam.

    Midwifery today

    The scope of midwifery today is far more than pregnancy and childbirth. Midwives are with their clients from puberty to beyond menopause. “Pregnancy, puberty, and menopause are normal physiological processes for women, they are not medical conditions or illnesses. We help them through these life experiences to help eliminate fear and empower them to be a part of their own OB/GYN care. When there are medical complications related to these normal life processes, we will treat them or seamlessly collaborate with specialists and physicians when necessary to ensure they receive that advanced care,” said Stanley.

    “As certified nurse midwives, we see ourselves as partners in our client’s pregnancy journey. We work with our clients to help them develop and achieve their birth wish list while helping them manage expectations,” said McGrath. “We develop a partnership of care. We talk about their expectations as well as their fears. We get to know our patients very well and we are with them throughout this journey and there to support them in whatever decision they make.”

    Midwifery beyond childbirth

    While midwives are closely associated with childbirth, their true scope of care encompasses women’s gynecologic health from the onset of puberty and their first period to life beyond menopause.

    “We have young women who will come to us with their mothers when they are 12 or 13-years-old and I tell them not to be afraid. First of all, we are not going to do an internal exam. We are just going to talk with them and ask questions and they are going to likewise ask questions of us on what to expect as they get older,” said Maggie Stanley. “We will speak with women in their 20s, 30s, and 40’s asking if they are content in their sexual health and if they are happy with the way things are. It opens the door to allow the client to speak freely about themselves. I have had so many women thank me because for the first time they were able to speak frankly with a healthcare provider and because they felt someone was truly taking the time to listen to their concerns.”

    McGrath added, “Our goal is to empower women of every age to take a role in their own health. We deal with normal aspects of their gynecologic health such as abnormal bleeding, birth control, management of menopause, vaginal dryness, and painful sex just to name a few. As a midwifery practice, we offer compassionate and knowledge-based services to women of all ages.”

    To learn more about Shore Physicians Group’s new OB/GYN and Midwifery practice or to make an appointment with Joanna McGrath or Maggie Stanley, call 609-365-5300.

  9. Could Coffee Help Delay Dementia?

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    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.

  10. Hernias and the Battle of the Bulge

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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