Author Archives: Trudy

Osteoarthritis

by Paul Chite, M.D.

Osteoarthritis (OA) is a chronic condition characterized by a gradual loss of cartilage from the joints. Common symptoms of OA include joint pain and stiffness, some loss of joint motion, and distorted joint shape. Osteoarthritis most often affects the hands, knees, hips, and spine. The joint pain associated with OA is aggravated with activity and relieved with rest. Morning stiffness is a common symptom of OA and usually resolves within 30 minutes of rising, although it may recur throughout the day during periods of inactivity. Advancing age is one of the strongest risk factors for OA. Women are two to three times more likely than men to develop OA. Obesity is strongly linked to the development of OA. Exercise and weight loss appears to lower this risk and may reduce joint pain in weight-bearing joints such as the hips and knees.

Physical therapy and exercise improve flexibility and facilitate strengthening of muscles surrounding the joints. Well-cushioned shoes and orthotic shoe inserts may reduce stress on spine and leg joints while braces can provide external joint stabilization. Applying heat and cold to arthritic joints can alleviate joint pain and stiffness. Heating pads should be set on a timer and used for no more than 20 minutes at a time. The heating pad can be reapplied after 20 minutes of no use.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) relieve pain and reduce inflammation. Glucocorticoid (steroid) injections can also suppress inflammation and relieve arthritis symptoms when injected into arthritic joints. Glucocorticoid injections may be recommended for people who have OA confined to a few joints, or who have pain uncontrolled with NSAIDs. Joint injections may also be recommended for people with OA who cannot take NSAIDs. Joint injections are limited to three to four injections per joint per year so as to not cause further joint degradation.

Surgery may be used to realign bones that have become misaligned to shift weight to healthier cartilage and relieve arthritis pain. It may also be used to permanently fuse two or more bones together at a severely damaged joint for which joint replacement surgery is not appropriate. Surgery is generally reserved for severe OA that significantly limits physical activities and does not respond to other treatments.
If you or a loved one suffers from OA, make an appointment with your healthcare provider to discuss options for the treatment of osteoarthritis and the effects of arthritis on daily living.

 Paul Chite, M.D.Dr. Chite joined Maryland Primary Care Physicians, LLC in 2011 and is certified by the American Board of Family Medicine. He received his medical degree from American University of the Caribbean, Saint Maarten, N.A. in 2005 and completed his residency program in Family Medicine at Creighton University Medical Center in 2011.

Heart Scans: A Valuable Diagnostic Tool

by David Jackson, M.D.

An ounce of prevention is worth a pound of cure. This couldn’t be more true than in the field of cardiology. Once an individual is diagnosed with heart disease, we have amazing modalities to treat patients, ranging from new age pharmaceuticals to drug eluting coronary stents. But, once a patient is diagnosed with advanced heart disease, this is the culmination of a process that has been going on for many decades. Heart disease is silent throughout most of a patient’s life until a lipid plaque becomes so obstructive that it results in progressive angina or a heart attack.

Heart scans to the rescue. This new radiology test can detect early, asymptomatic heart disease in middle aged individuals who are at risk for developing strokes and heart attacks. This is a CT scan (x-ray) of the heart, gated to the heart beat. There is no IV, no injection, and no dye. The test detects coronary artery calcification, this being a marker of arteriosclerosis. Normal arteries do not have calcium. Diseased arteries, where cholesterol plaque begins to develop, will be lined with calcific deposits (hardening of the arteries). A Heart Scan (other equivalent terms include Calcium heart test score, Virtual Scan, Virtual Physical) can detect these early deposits. This knowledge can then help the physician and patient develop a strategy for making sure the arteriosclerosis does not progress. This can take the form of treatment for diabetes, hypertension, and elevated blood lipids.

Heart scans are safe, economical, and have become invaluable as a tool to screen appropriate patients for heart disease. There are many centers throughout the area performing this test.

David Jackson, M.D.Dr. Jackson is a Maryland Primary Care Physicians, LLC partner and is certified by the American Board of Internal Medicine in both Cardiovascular and Internal Medicine. Dr. Jackson is a graduate of Harvard College in Cambridge, MA. He received his medical degree from Mount Sinai School of Medicine in 1980 and completed his residency program in Internal Medicine at St. Luke’s Roosevelt Hospital Center in 1983. Dr. Jackson completed his cardiology fellowship at Norwalk Hospital, an affiliate of Yale University School of Medicine, in 1985.

Vitamin D Deficiency is a Common Problem

Vitamin D insufficiency and deficiency are very common findings in primary care practice today. Low vitamin D levels are found year-round but are more prevalent in the winter months. The main source of our vitamin D is the sun, but with concerns about skin cancer and premature aging of the skin many of us avoid sun exposure and wear sunscreen.  While that is appropriate for those concerns, we are failing to get the adequate amount of vitamin D necessary for optimal health.

Vitamin D occurs naturally in limited foods like fish, eggs, mushrooms and beef liver.  Some foods are fortified with vitamin D, like milk, cereals, and cheese, but are still inadequate in providing sufficient amounts.

Here in Maryland from approximately November through March, even the sun cannot supply enough vitamin D. Additionally, depending on your skin color, you may have more difficulty absorbing vitamin D from the sun since higher melanin in the skin decreases natural absorption. Many of us will need to take a vitamin D supplement to maintain adequate levels.

Vitamin D along with calcium is important for bone health. Without enough vitamin D we are at increased risk of osteoporosis and bone fractures. Some people with decreased levels of vitamin D suffer with bone and muscle pain and fatigue. Low vitamin D has also been implicated in cardiovascular disease, diabetes, multiple sclerosis and many other chronic health conditions, and the research is ongoing.

To determine your vitamin D status, you will need to have your blood level checked.  Your healthcare provider can then determine if a supplemental dosage is needed and how frequently this should be monitored.

 

WPMeade_LLisa Meade, Physician Assistant, practices in MPCP’s  Arundel Mills office. She holds a Bachelor of Science degree in Community Health Education from Towson University, and received her Physician Assistant certification from Essex Community College. Ms. Meade has over 25 years of experience as a certified Physician Assistant in primary care medicine.

How Primary Care Can Save Your Life

by Neil Padgett, M.D.

Dr. Neil Padgett, is a Partner and Clinical Director for Maryland Primary Care
Physicians in Glen Burnie, MD with 20 years experience as an internist and epidemiologist. In a recent interview he had the following to say about the vital role primary care medicine plays in the early detection and treatment of life-threatening illnesses.

In the early 20th century the three most common fatal diseases were pneumonia, tuberculosis, and diarrhea. With the introduction of antibiotics and improved housing and sanitation, these problems are now much less common. Although they remain challenges in many third world countries, in western industrialized nations, infectious diseases like these are major public health threats only with people weakened as a result of illness, and smokers.

In their place, today’s three top causes of death in the developed world are heart disease, cancer, and stroke; all of which are “silent killers” that take years, even decades to develop and present symptoms. The real danger of these diseases is by the time they progress to the stage at which they are discovered, it’s generally too late. A sobering statistic that Dr. Padgett used to drive this point home is the fact that the first symptom in heart disease 20% of the time………. is death.

The mission of primary care physicians, beyond treating the common illnesses that prompt most people to see a doctor, is to improve the quality of life of their patients. This is accomplished by screening for these less obvious diseases, so they can be detected and treated at early stages. Some of the most common screenings are for prostate, colon and breast cancers, as well as diabetes, hypertension and high cholesterol. The ultimate goal being detection and treatment of these diseases as early as possible, increasing the odds of a patient living a full and healthy life.

Dr. Padgett cites a recent example of a patient who came to his office for a same day appointment complaining of back pain that had been bothering him for two weeks with no improvement. The attending physician, Dr. Allison Williams was concerned with the way the pain was radiating into the patient’s back so she ordered a chest x-ray. The x-rays showed a spot on the lung, therefore Dr. Williams ordered additional tests, which indicated a potentially serious problem. The patient was referred to an oncologist, who confirmed early stage lung cancer and performed surgery shortly thereafter. As a result of early detection and intervention, this patient is now cancer-free. In speaking with Dr. Williams about what prompted her to pursue such a thorough screening process for a seemingly minor ailment, she said that her sensitivity to and recognition of the less obvious signs of cancer had been heightened by the experience she went through in losing her mother to lung cancer four years ago.

In conclusion, Dr. Padgett emphasizes the importance of seeing your primary care physician on a regular basis. He explains when a doctor has an established relationship with a patient, he’s both familiar with that individual’s medical history, and he knows when a reaction or behavior is out of character, which can signal a potential problem.

Neil Padgett, M.D.Dr. Padgett is a Maryland Primary Care Physicians, LLC partner and is certified by the American Board of Internal Medicine. He received his medical degree from the University of Maryland School of Medicine in 1984 and completed his residency program in Internal Medicine at University of Maryland Medical Center in 1987.