Tag Archives: Q&A

Type 2 Diabetes: Your Health Is in Your Hands

Q&A with Dr. Jose Zarzuela

Q: What is diabetes?

A: Diabetes is a chronic health condition when your body can’t properly use the glucose (sugar) you get from food, causing it to build up in your blood to unhealthy levels. If not controlled, diabetes can lead to heart and blood vessel disease, stroke and kidney failure, among other things.

Q: How many people have diabetes?

A: Type 2 diabetes, the most common kind of diabetes, is a growing problem. An estimated 23 million Americans have it, and many more are at risk for developing it.

Q: How do you get type 2 diabetes?

A: Risk factors include a family history of diabetes and ethnicity: African Americans, Hispanics and American Indians have higher rates. But negative factors in our American lifestyle, including obesity, inactivity and stress, can also increase your risk. In fact, 80% of people with type 2 diabetes are overweight.

Q: If I get type 2 diabetes, will I be on medicine the rest of my life?

A: No. Medicine is often helpful, but many of my patients have made lifestyle changes to successfully manage their diabetes and minimize its effects on their health. You can, too.

    1. Improve your diet: Keep track of your carbohydrates so you don’t go overboard, and stay away from sweet drinks and other sugary foods. Get lots of dietary fiber through plant-based foods like fruits, vegetables and whole grains. Avoid foods with trans fats, and get lean protein from sources such as fish, chicken, dairy, beans or vegetables. You doctor may also refer you to a nutritionist to help you eat better.
    2. Get up and start moving: 30-60 minutes of moderate exercise each day, like walking, biking and swimming, can help you lose weight and keep it off.
    3. Reduce your stress: Stress pushes up blood glucose and raises your blood pressure. Ways to reduce stress:
      • Do breathing exercises
      • Tense your muscles and then release them
      • Go on a walk or jog
      • Stretch
      • Do an activity you enjoy, like a hobby
      • Replace negative thoughts with positive ones.

As you do the right things to bring your blood sugar back to normal and keep it there, your  doctor can provide support and tools to help you succeed  ─ like a glucose monitor to help you stay on track. In many cases, patients who make healthy lifestyle changes are eventually able to stop taking diabetes medicine.

Managing your diabetes starts with making the changes that can make you healthy again. You’ll see for yourself – your health is in your hands.

Jose Zarzuela, M.D.

Dr. Zarzuela received his medical degree from the University of Maryland School of Medicine and is certified by the American Board of Internal Medicine. He sees patients in MPCP’s Pasadena office.

Making the Most of Your Doctor Visit

A Q&A with Rafeena Bacchus, M.D.

Most of the time, your primary care physician is your first contact for health care. When you make an appointment, knowing how to prepare and what to expect will help you get the most out of your visit.

Q: What kind of appointments can I get at MPCP?
A: We offer two types of appointments:

  • A problem visit addresses a new problem or revisits an old one.
  • A physical examination is a preventative visit to review your history, examine your body from head to toe, check appropriate blood work (like blood sugar and cholesterol), administer age-appropriate immunizations, and offer age-appropriate screening referrals (like mammograms and colonoscopies).

Making the right kind of appointment will ensure that your doctor can effectively address your health needs.

Q: Can I do anything to get ready for my appointment?
A: There are several steps you can take ahead of time to make sure your appointment runs smoothly:

  • Be very clear about what you need when you make your appointment. This allows your doctor to properly prepare for your visit. For example, if you have abdominal pain, your provider can offer you a drape so you can undress from the waist down for an exam.
  • Know what referrals you need.
  • Take a few minutes to write down notes and questions to make sure all of your concerns get addressed.
  • If your provider asked you to monitor your blood sugar or blood pressure, remember to bring those logs in with you.
  • If you want to discuss tests ordered by a provider outside of MPCP, don’t assume that we have received these records, even if you asked for them to be sent. Track them down and bring them with you. If you need help tracking down records, call your provider’s assistant a day or two prior to your appointment to alert MPCP to this request.

Asking for copies of test results when you are seen elsewhere is always a good idea. It facilitates your bringing them to your provider for discussion and helps eliminate duplicate testing. Feel free to ask for the records and test results – they belong to you.

Q: When should I arrive for my MPCP appointment?
A: Come 10-15 minutes early to complete paperwork, use the bathroom and gather your thoughts. Turn off your cellphone. This will ensure your entire appointment is used for face-to-face time with your doctor.

Q: How long will my appointment last?

A: Appointment lengths vary from 10 minutes for simple problems to 30 minutes for physical examinations or complex problems.

While your provider would like to be able to address every concern you have, this may not be possible due to time limits. You may need more than one visit or visit type to address all of your concerns.

Q: Sometimes my visit is delayed. Why is that?

A. The most common reasons your doctor might be running late for your appointment are patient tardiness, complicated problems and emergencies. Feel free to ask the check-in staff if your provider is running on time.

Q. What does my doctor need to know about my medications?

A: Your doctor will need to know 1) what medications you take, 2) why you take them, 3) the dose for each one, and 4) how often you take them. We encourage all patients to create a list of all medications, supplements, and vitamins you take. Include any drugs a specialist or urgent care center added to your regimen. Some patients bring the actual pill bottles to avoid confusion.

Your doctor can print a list at checkout of all the active medications we are aware of you taking. Once your provider has a full picture of what you take, they can help you avoid drug-drug interactions or be alert to medication-induced illness.

Q. Is it okay to ask questions?
A. It’s your doctor’s job to make sure you understand and follow through on care, so don’t be afraid to ask questions.

If you don’t understand what your doctor tells you, say so. Repeat back what you hear to confirm you have it right. Take notes. If you still aren’t clear after you leave the appointment, call back and ask for clarification.

Q: What health records should I keep?
A. It’s a good idea to keep a folder with copies of these health records:

  • Recent test results
  • Your current medication list
  • Your insurer’s list of covered medications
  • A list of your providers with contact information
  • Pending referrals
  • Lists of your questions
  • Blood sugar or blood pressure diaries
  • Vaccine dates

Take notes at your office visits to help you remember important points about your care, and keep them in your folder so you can review them when necessary. Bring your folder on any visit to a healthcare provider, an urgent care center or hospital to help reduce gaps in your care.

Q: What happens after my appointment?

A: MPCP uses its online Patient Portal to communicate test results, or you doctor may call you. But if you don’t get test results in a timely fashion, be sure to ask for them.

Take prescribed medication as directed, and talk to your provider if you have side effects and need to make adjustments. If your doctor schedules a follow-up appointment, be sure to keep it so your doctor can check on your progress and make any needed changes to your care.


Dr. Rafeena Bacchus sees patients at MPCP’s Columbia office. She received her medical degree from SUNY at the Buffalo School of Medicine and completed her residency program in Internal Medicine at the University of Maryland. She is certified by the American Board of Internal Medicine.

Health Effects of Live Music Go Beyond ‘Feeling Good’

A Q&A by Daniel J. Konick, M.D.

Q: Listening to music can make you feel good. What else is there to know?

A: For the first time, a study has demonstrated that live music can produce beneficial physical effects in listeners ─ it reduces the level of the hormone that causes stress.

Q: How was this discovered?

A: Investigators from the Centre for Performance Science in London used volunteers attending concerts featuring the music of composer Eric Whitacre. Over the course of two concerts, the researchers took saliva samples from the participants before the performance and then during intermission. Laboratory testing found significant reductions in the hormone cortisol.

Cortisol is called the “stress hormone.” When the body is under duress, cortisol spikes. It prepares the fight-or-flight reaction by raising sugar levels in the blood. These activities are designed to keep you safe and ready for action. However, if cortisol levels remain high for long periods, the resulting stress can be physically dangerous.

Q: Why is this research important?

A: Ongoing high levels of stress can lead to serious health issues, such as high blood pressure, heart disease, obesity and diabetes ─ not to mention making you feel bad. The research found that live music reduces cortisol levels, so it follows that live music can reduce stress and contribute to relaxation and a feeling of well-being.

Q: What can we take away from this study?

A: Go to a concert. Enjoy the music and the health benefits of relaxation. Just one thing: if you’re going to hear loud music, make sure you wear ear protection. Your ears are important too.



Daniel Konick, M.D.Dr. Daniel J. Konick is an MPCP partner and is certified by the American Board of Internal Medicine. He sees patients in the Queenstown office. He is also part of a musical family: he plays piano and clarinet, his wife plays violin, his older son teaches music and voice and plays piano and violin, and his younger son is studying for his Masters in Music Composition and plays multiple percussion instruments, including the marimba and hammered dulcimer.

Is Zika coming to Maryland?

A Q & A by: Jerry Levine, M.D., FACP, MPCP Medical Director

Q: What is Zika?

A: Zika is a virus spread mainly by Aedes aegypti mosquitoes, a species found in Maryland and many other states. These mosquitoes, when they bite people infected with Zika virus, become disease carriers and spread the virus by biting other people. In some cases, Zika can also be transmitted between sexual partners.

Q: Where does Zika come from?

A: Before 2015, Zika virus outbreaks occurred in areas of Africa, Southeast Asia, and the Pacific Islands. Since then, Zika has spread to parts of South and Central America, Mexico and the Caribbean.

See which countries have reported Zika: http://1.usa.gov/1Qq5Iow

Q: Is Zika in Maryland?

A: At the time this article was written, there were dozens of confirmed cases of Zika virus in Maryland, but all of those people were infected while traveling overseas. So far, no one has gotten Zika in Maryland, but the imported cases may result in local spread of the virus.

See Zika cases in the U.S.:  http://1.usa.gov/1PiUIcc

Q: Are people with Zika contagious?

A: At this time, the Zika virus is not believed to be airborne and is not primarily spread from person to person, which means there’s little to no risk of becoming infected with the virus from simply being near an infected person. However, Zika can be transmitted sexually.

Q: How dangerous is Zika?

A: Most people infected with Zika virus won’t experience any symptoms or will only have mild symptoms. Common symptoms include fever, rash, joint pain, muscle pain, headache or conjunctivitis (red eyes). The illness is usually mild with symptoms lasting for several days to a week. Hospitalization is rarely needed, and so far there have been only two deaths from Zika reported in the U.S. – an elderly man with other health issues and a baby born infected with the virus.

The main danger from Zika is that pregnant women can pass it to their unborn children. The CDC has confirmed that the virus can cause severe defects in unborn children, including microcephaly, which leaves babies with abnormally small heads and often with brains that do not develop properly. The CDC strongly advises that women who are pregnant or plan to become pregnant soon don’t travel to Zika-infected areas.

Q: If Zika comes to Maryland, what can I do?

A: There is no medicine or vaccine to prevent or treat Zika virus disease, so prevention is key. If Zika is reported in Maryland, take these steps to protect yourself and your family:

  • Use insect repellents containing DEET, picaridin, IR3535, para-menthane-diol, and lemon eucalyptus oil.
  • When weather permits, wear long-sleeved shirts and long pants.
  • Use air conditioning or window/door screens to keep mosquitoes outside.
  • Aedes mosquitoes typically lay eggs in standing water, so empty water from containers outside your home such as buckets, bowls, bird baths, flower pots, old tires and vases.
Q: What should I do if I think I have Zika?

A: The risk of getting Zika is presently very low in Maryland. However, if you travel to an area with Zika and develop a fever, rash, joint pain, or red eyes within two weeks of returning, see your doctor. Be sure to tell your doctor where you traveled. Zika can’t be cured, but your symptoms can be treated to make you more comfortable.



Jerry Levine, M.D., FACPDr. Levine is an MPCP partner and sees patients in the Columbia office.  He received his medical degree from New York Medical College, completed his residency program in Internal Medicine at University of Maryland Medical Center, and is certified by the American Board of Internal Medicine. Dr. Levine currently serves as MPCP’s Medical Director and Vice President.