A bone density scan assesses a person’s risk for osteoporosis, a disease that affects approximately 10 million Americans.  Osteoporosis causes a loss of minerals from the bones, leaving them brittle and vulnerable to fractures.  The condition becomes more common with age, and many people don’t know they have osteoporosis until they break a bone.  Old bone breaks down more quickly than new bone can be made.

Osteoporosis can affect both women and men; however, it is a common women’s health issue.  A bone density, or DEXA scan, is the imaging test that is used to diagnose osteoporosis.  The National Institutes of Health recommends women have a bone density scan at age 65.  Then they should be rescreened in 2-3 years, if their results are good.  Some doctors may recommend women aged 64 and under receive a bone density scan after going through menopause, since reduced levels of estrogen is a risk factor for osteoporosis. 

Many physicians don’t recommend a DEXA scan for men until age 70, unless they’ve had a vertebral bone fracture, osteopenia of the spine, other broken bones, or additional risk factors.  The National Osteoporosis Foundation recommends a DEXA scan for anyone over age 50 who breaks a bone.

Risk Factors for Osteoporosis

The most common risk factors for developing osteoporosis are age, post-menopausal female, small body frame, and a family history of the condition.  Some medications pose risk factors including long-term use of cortisone, prednisone, thyroid hormone medications, anti-seizure drugs, and some cancer drugs.  People having primary hyperthyroidism are also at higher risk.

Common Bone Fractures

Those with osteoporosis most commonly fracture a wrist, hip, or spinal vertebrae.  There is no cure for osteoporosis, but medications can help slow down the rate of bone loss.  Periodic bone density scans help doctors monitor the progression of the disease and evaluate how well the osteoporosis medication is working.

Test Preparation

No special preparation is needed before a DEXA scan except to stop taking calcium supplements 24 hours before the test. The scan is a low dose x-ray that is totally painless.  The patient will lie on their back on a padded table while the machine moves over the body.  The entire process takes 15-30 minutes.  The scan will be read by a radiologist, and a report is sent to the referring physician.

Will insurance pay for the test?

Medicare Part B covers a bone density scan for women once every 24 months, and more often if medically necessary.  A person may qualify for more frequent tests if they have any of the following conditions, which could lead to decreased bone density:

• Rheumatoid arthritis
• Chronic kidney disease
• Overactive parathyroid gland or other hormonal imbalance
• Diabetes
• Organ transplant

Medicare will cover the test for men who have had a vertebral fracture or osteopenia of the spine.  Many private health insurance companies also cover DEXA scans.

Next Steps

RMD Primary Care treats many common women’s health issues, such as osteoporosis.  Our physicians can make a referral for a bone density scan.  Contact our office to schedule an appointment.     

May is Skin Cancer Prevention and Awareness Month, a good time to review some basic facts about skin cancer.  Although skin cancer is the most common cancer diagnosis in the U.S., many cases could be prevented with proper skin protection.  When found in the early stages, skin cancer is very treatable.

Common Types of Skin Cancer

• Basal Cell Carcinoma – the most common type of skin cancer.  Often appears as a shiny raised spot that can be mistaken for a pimple, sore, or scar.  The slow growing spot doesn’t heal and sometimes bleeds.  May crust over.  Usually non-life-threatening.
• Squamous Cell Carcinoma – lesions may look like rough, reddish scaly areas or an open sore.  May also resemble a wart or a brown age spot.  Slow growing and usually non-life threatening, but can grow deep and spread to other parts of the body.
• Melanoma – the most dangerous and deadly type of skin cancer.  May resemble a mole that looks asymmetrical and has irregular borders.  May also be a new pigmented growth that may be brown, tan, black, red, or pink in color.  Spots can change as they grow and may itch, bleed, or feel painful.  Melanoma grows quickly and can spread to other organs.

Rare Types of Skin Cancer

• Merkel Cell Carcinoma – More likely in people over age 50.  Is aggressive and can spread.
• Sebaceous Carcinoma – Often begins as a tumor on the eyelid, but can develop in any sebaceous gland.  Is aggressive and may spread.
• Dermatofibrosarcoma Protuberans – May resemble a deep pimple or rough patch.  Begins in the middle layer of skin.  Slow growing and seldom spreads.

Protection and Prevention

Most skin cancer is preventable with proper protection.  When outdoors, wear a broad-spectrum sunscreen with an SPF of 30 or higher.  Reapply every two hours and after swimming or sweating.  This provides protection from the sun’s harmful UVA and UVB rays.  Wear protective clothing including long-sleeved shirts, a wide-brimmed hat, and sunglasses.  Avoid peak sun hours between 10am and 2pm, when the sun’s rays are the strongest.  Use sunscreen even on cloudy days.  Avoid tanning beds, since they use UV light.

Rod MD Primary Care

Your primary care physician may be the first to notice potential skin cancers.  A patient may call a particular spot to the attention of their primary doctor during a routine physical exam.  The primary doctor will often refer the patient to a dermatologist for a follow up and biopsy.

The physicians at RMD Primary Care can perform in-office mole biopsies and excisions and send them to a lab for diagnosis.  We provide continuing and comprehensive medical care and preventive services.  Contact us to schedule an appointment.

According to the CDC, more than 130 million Americans visit emergency rooms each year.  Some of the most common reasons for a trip to the emergency room include chest pain, stomach or abdominal pain, stroke symptoms, difficulty breathing, seizures, falls, concussions, broken bones, and other injuries or traumas.  After being evaluated by a physician, diagnostic tests such as blood work, x-rays, or CT scans may be ordered.  The patient will receive appropriate care based on the evaluation.  If discharged, the person will be advised to follow up with their personal physician.

Why is a follow up with your own doctor important?  The following are some of the primary reasons to follow up a trip to the emergency room with a visit to your primary care physician.

Continuity of Care

Your personal physician has your medical history and a record of your past care.  This physician is equipped to provide continuity of care in treating your medical conditions.  The patient should describe the symptoms that led them to seek emergency care and bring their hospital discharge papers, as well as any new medications, to their follow up doctor visit.

Management of Chronic Medical Conditions

The primary care physician can determine whether the patient may need a referral to a specialist.  The primary care physician should always be apprised of any changes in conditions, to help manage overall healthcare.  They can determine whether any new medications are compatible with existing medications the patient is taking.

Determine Whether Additional Tests are Needed

Some test results from the ER may indicate the need for follow up testing.  This is especially important if a new medication has been prescribed.  The primary care physician will be able to monitor the patient for any complications that may arise.

Risk of Subsequent Hospitalizations Reduced

Studies have shown that patients with chronic diseases are at higher risk of repeat hospitalization, or even death, if they do not see their personal physician or specialist within 30 days after discharge from the ER.  This is especially true of patients suffering from heart disease, diabetes, or chronic lung disease.  A prompt follow up visit with their own physician may be critical to their care management.

Next Steps

Patients should not assume the hospital will notify their personal physician about the emergency room visit.  It’s always appropriate for the patient to call their own doctor within a few days of their trip to the emergency room.  RMD Primary Care physicians are Board Certified in Family Medicine and Internal Medicine.  They are qualified to provide continuing and comprehensive medical care, health maintenance, and preventive services.  Contact us to schedule an appointment.   

The Academy of Nutrition and Dietetics has designated March as National Nutrition Month, an opportunity to highlight the importance of nutrition in our health and wellness.  It’s a time to focus on making healthy food choices and creating better eating habits.  Maintaining a healthy diet is essential as it protects against many chronic illnesses such as heart disease, type 2 diabetes, and some types of cancers.  Healthy eating boosts the immune system, supports healthy pregnancies, and may help us live longer.

Different foods provide the body with key nutrients, so it’s important to select a variety of foods within each food group.  These groups have changed somewhat over the years.  The old food pyramid many people may remember from childhood was replaced over a decade ago with a chart called MyPlate, which shows five food groups and better illustrates the proportion of each group that should be eaten daily.  The five food groups in MyPlate are fruits, vegetables, grains, protein foods, and dairy.  Each group plays a role in a healthy diet.  Based on a recommendation of 2,000 calories per day for women and 2,500 calories per day for men, the following are recommended servings from each group.

Fruits

Two cups per day is recommended and includes fruits and 100% fruit juices.  Fruits may be fresh, frozen, canned, or dried.  Most fruits are low in fat, sodium, and cholesterol.  Adding fruit to the diet may increase the amount of fiber we eat, which aids in the digestion of food.

Vegetables

Adults should eat 2 ½ cups of vegetables each day.  Vegetable choices should be varied and include some from the following subgroups:  dark greens; red and orange; beans, peas, and lentils; and starchy vegetables.  Each subgroup provides different nutrients that are vital for good health.  Most vegetables are naturally low in fat and calories.

Grains

Adults should eat 6 ounces of grains each day, with half the grains being whole grains.  These whole grains contain the bran, germ, and endosperm while refined grains have undergone a process that removes the bran and germ.  Foods in the grain group include breads, pasta, oatmeal, grits, tortillas, and breakfast cereals.

Protein Foods

This group contains seafood, meat, poultry, eggs, soy products, nuts, and seeds.  Beans, peas, and lentils also contain protein, although they are considered part of the vegetable group.  Meat products should be lean or low fat.  Seafood options such as salmon are also rich in omega-3 fatty acids, which have been linked to many health benefits.  The recommended protein serving per day is 5 ½ ounces.

Dairy

Most Americans don’t get enough dairy.  Three cups of low fat or fat-free dairy is recommended.  Milk, yogurt, cheese, and fortified soy milk are good choices.  Avoid high fat dairy such as cream and butter.

RMD Primary Care

If you have questions about how food choices impact your health, contact the providers at RMD Primary Care.

Cardiovascular disease (CVD) is the leading cause of death globally.  CVD includes coronary artery disease, stroke, aortic disease, and peripheral artery disease.  The risk of cardiovascular disease increases with age and is most common in those over age 50.  While genetics is a factor in the risk of developing cardiovascular disease, our lifestyle choices also play a role.  The following are some ways that people can help reduce their risk.

Maintain a Healthy Weight

Being overweight increases the risk for heart disease.  Carrying excess weight increases inflammation and puts added stress on the heart.  Eating a heathy diet and controlling portion size help in maintaining an appropriate weight.  A heart healthy diet includes fruits, vegetables, whole grains, lean meat, low fat or fat free dairy, and healthy fats such as olive oil.

Keep Physically Fit

Strive for 30 minutes of physical activity daily.  Even light to moderate activity is beneficial.  The American Heart Association recommends combining aerobic exercise with resistance training.  Regular exercise lowers blood pressure, helps maintain a healthy body weight, and lowers the risk of developing diabetes.  Being more active has the added benefit of helping people think, feel, and sleep better.

Get Quality Sleep

Many people get less than the recommended seven hours of sleep each night.  Those who don’t get enough sleep are at greater risk of heart attack, high blood pressure, obesity, and diabetes.  People with obstructive sleep apnea tend to have high rates of cardiovascular disease.

Don’t Smoke

The chemicals in tobacco damage the blood vessels by causing them to thicken and narrow.  Smoking tends to make the blood more likely to clot, which can block blood flow.  Cigarette smoke lowers oxygen levels in the blood, raising blood pressure and heart rate.

Manage Medical Conditions

• Monitor cholesterol levels – A complete cholesterol test, or lipid panel, is a blood test that measures cholesterol and triglycerides in the blood.  High cholesterol levels indicate a risk factor for cardiovascular disease.
• Control blood pressure – High blood pressure, or hypertension, is a risk factor for heart disease and stroke.  High blood pressure damages arteries that provide blood flow to the heart.
• Manage diabetes – Diabetes can damage blood vessels and cause circulatory problems.  People with diabetes are twice as likely to have a stroke or heart attack than those who don’t have diabetes.  The most common test for diabetes is a fasting blood test to measure blood sugar levels.

People with these medical conditions should have regular screening tests, eat a healthy diet, and take their medications as directed.

RMD Primary Care

The physicians at RMD Primary Care provide a number of services to support the health and well-being of patients.  Contact our office to schedule an appointment.

Diabetes is a chronic disease in which the body is unable to process sugar as it should.  In type 1 diabetes, the pancreas makes little or no insulin.  In type 2 diabetes, the body is unable to use insulin as it should.  Type 2 diabetes is much more common and often affects people in middle age and older.  People with diabetes must manage their condition and carefully monitor their blood sugar levels to avoid serious complications.

The following are five common complications of diabetes:

Heart Disease (cardiovascular disease)

Heart disease is one of the most common complications of diabetes.  It not only affects the heart but also the blood vessels.  People with type 2 diabetes are twice as likely to develop cardiovascular disease than those without diabetes.  Blood vessels will eventually stiffen and narrow, decreasing blood flow.  Decreased blood flow to the heart can cause a heart attack, and a decrease of blood flow to the brain can cause a stroke.

Kidney Disease

Diabetes that is not well controlled can lead to diabetic nephropathy.  The blood vessels in the kidneys become damaged and do not filter waste as they should.  This can allow fluid to build up in parts of the body, leading to swelling of the arms, legs, feet, and lungs.  End-stage kidney disease may require dialysis or a kidney transplant.

Diabetic Retinopathy

This condition causes vision loss and blindness as the blood vessels in the retina are affected.  The risk increases the longer the person has had diabetes.  Damaged blood vessels in the eye can actually leak fluid or blood.

It’s important for diabetics to get a comprehensive eye exam annually including dilation of the eyes.  There may not be noticeable symptoms in the early stages of the disease, but early detection can help prevent vision loss.

Diabetic Neuropathy

This is a type of nerve damage that can occur with diabetes.  Symptoms can include pain and numbness in the feet, legs, hands, and other parts of the body.  Diabetic neuropathy can be painful and disabling, and the damage cannot be reversed. 

Foot Complications

Diabetes can cause nerve damage and poor circulation.  People may develop serious foot problems including infections, ulcers, bone and joint damage.  Ulcers and infections may be slow to heal.  There may be yellowing of the toenails.  If blood flow is cut off, tissue will die.  This complication can lead to amputations of the toes or foot.

RMD Primary Care

Our physicians at RMD Primary Care help patients manage their diabetes.  We recommend eating a healthy, balanced diet and maintaining a healthy weight.  Following a daily regimen of exercise and healthy physical activity is important.  Medication may be necessary to control the condition and prevent long-term complications.  Contact us to schedule an appointment with one of our providers.

Colds and flu are common this time of year.  Covid cases are also on the rise again.  People are more likely to spread these respiratory illnesses during the colder months because they spend more time indoors.  Viruses tend to spread more easily in smaller spaces with drier air.  Recent studies have shown that the nasal cavity is more sensitive to cold temperatures, and there may be a weaker immune response to respiratory viruses.  During the holiday season, people may find themselves in crowded places such as shopping malls, parties, and special events where they may be exposed to those who are ill.

What causes colds?

The common cold can be caused by over 200 different viruses, with rhinovirus being the most common.  These viruses generally affect the upper respiratory tract, causing inflammation of the membranes that line the nose, throat, and sinuses.  Colds are easily spread through airborne droplets when an infected person sneezes, coughs, or touches a surface that someone else then touches.  Colds generally cause mild illness.

What causes flu?

Flu is caused by influenza viruses.  It can cause mild to severe illness that affects the nose, throat, and sometimes the lungs.  Symptoms of flu come on suddenly and can include sore throat, runny nose, headache, fever, muscle aches, chills, dry cough, and shortness of breath.  Influenza viruses also spread through tiny droplets.  Young children, seniors, and those with weakened immune systems are particularly at risk for serious illness.  The best way to prevent flu is by getting an annual flu vaccine.

What causes covid?

Covid-19 is caused by the SARS-CoV-2 virus, a corona virus.  Covid can attack the respiratory system and lungs.  It is very contagious and spreads quickly.  Symptoms resemble those of the cold, flu, or pneumonia.  Some people suffer only mild illness while others become severely ill.  A Covid-19 test is used to diagnose the illness.  Vaccines are available to help prevent severe complications.

When should I see a doctor?

People with a cold can usually treat their symptoms at home.  People with flu symptoms should be tested for flu.  Antiviral medications can be prescribed to help shorten the flu and prevent complications.  People who test positive for covid but have only mild symptoms may be able to recover at home.  Paxlovid may be prescribed for those who are at higher risk for severe illness.  People who are having difficulty breathing should go to the emergency room.

RMD Primary Care

The physicians at RMD Primary Care recommend that patients get an annual flu shot and stay up to date on covid vaccines.  If you have tested negative for covid but think you may have the flu, contact our office.

Shingles is a painful skin condition that can develop in anyone who has had chickenpox.  More than 95 percent of American adults have had chickenpox.  Shingles causes a blistery rash that can occur anywhere on the body.  Early symptoms of shingles are pain, tingling, burning, and itching in the area where the rash will eventually appear.  The rash may not be visible for several days.  Some people may also have a headache and fever.  According to the CDC, one in three people in the U.S. will develop shingles in their lifetime.

What causes shingles?

The varicella-zoster virus, one of the herpes viruses, causes shingles.  It’s the same virus that causes chickenpox.  The virus can stay dormant for years in the body of anyone who has had chickenpox.  When something triggers the virus to become active again, the person will develop shingles.

Who is most at risk for shingles?

• People over age 50
• Those with weakened immune systems, such as cancer patients
• People who have recently been ill
• Those who are under stress

Is shingles contagious?

Shingles is not contagious.  It doesn’t spread from person to person, although those with shingles can spread chickenpox through the fluid in the blisters.  A person can have shingles more than one time, although the rash usually affects a different place on their body.

Are there complications from shingles?

People over age 60 are more likely to have serious complications.  The pain from the rash may continue long after the blisters have healed.  Serious complications include neurological problems such as facial paralysis and swelling of the brain.  Hearing and balance issues are other complications.  Shingles around the eye can lead to vision problems.

Who should be vaccinated for shingles?

Shingrix has been the recommended shingles vaccine in the U.S. since 2017.  It replaced an earlier vaccine called Zostavax.  Two doses of the Shingrix vaccine is recommended for those age 50 and older who are in good health.  Shingrix vaccine is more than 90 percent effective at preventing shingles, and immunity remains strong for at least seven years.  People can get Shingrix even if they have had the previous vaccine, have already had shingles, or don’t know if they have had chickenpox.

RMD Primary Care

The physicians at RMD Primary Care can treat patients who develop shingles.  If you suspect you may have shingles, you should make an appointment with the doctor as soon as possible.  Patients can get more information about the Shingrix vaccine from their healthcare provider.  Contact our Lawrenceville office today.      

Dense breasts are common.  According to the National Cancer Institute, nearly half of women who are age 40 and over who have mammograms are found to have dense breast tissue.  While not abnormal, it’s not possible to detect dense breast tissue during a physical examination.  However, dense breast tissue does show up on a mammogram.

Dense breasts contain more glandular tissue, the part of the breast that makes milk.  Glandular tissue is more likely to develop cancer, putting women with dense breasts at higher risk.  Dense breasts also make it harder to detect cancer using conventional mammography.  Since dense breast tissue appears white on a mammogram, cancerous lumps may be hidden.

Factors that Influence Breast Density

• May be inherited
• More common in younger, pre-menopausal women
• Having a low body mass index (BMI); having a thin body type
• Using post-menopausal hormone replacement therapy

Breast density can decrease following menopause.

3D Mammography Improves Cancer Detection

Conventional 2D mammography produces flat images.  There will be a top view and a side view of each breast.  Overlapping tissue in these images can make it more difficult to detect cancers.  It’s even more problematic when the breast tissue is dense.

Radiologists are better able to see through dense breast tissue with 3D imaging, or breast tomosynthesis.  This 3D technology produces multiple images, which look like slices.  The radiologist can examine each layer looking for abnormalities.

Abnormal areas are sometimes seen on conventional mammograms.  However, there are also false positives.  This outcome causes anxiety and stress for women who have to return for additional testing, such as an ultrasound.  3D mammography is more precise, so the number of false positives is reduced.

While 3D mammography is becoming more common, it’s not available everywhere.  Women with dense breasts may particularly benefit from 3D mammography, as well as women who are at higher risk for developing breast cancer.  Those women should definitely seek out a facility that offers it.

Schedule Your Annual Breast Cancer Screening

October is Breast Cancer Awareness Month, the perfect time for women to schedule their annual mammogram.  RMD Primary Care encourages women to be proactive in managing their healthcare.  Our physicians offer women’s health appointments as part of our Family Medicine Services.  Fall is a good time of year for women to take care of their health issues, preventative tests, and cancer screenings.  Women’s health also includes menopause and the symptoms that come with it.  Contact us to schedule your annual pap smears, breast exams, and mammogram referrals.

Omega 3 fatty acids have been studied for years.  There are a number of health benefits to adding them to your diet.  Some benefits include lowering the risks of heart disease, improving cognitive function, reducing inflammation, and preventing certain eye diseases.

Omega 3s are found naturally in some fish such as salmon, tuna, herring, mackerel, and   sardines.  Nuts and seeds including walnuts, flaxseed, and chia seeds contain omega 3s.  They are also found in plant oils including soybean oil, flaxseed oil, and canola oil.  In addition, omega 3 fatty acids are available in over-the-counter supplements like fish oil and krill oil.

The following are some of the health benefits of adding omega 3s to the diet:

Heart Health

Studies have shown that omega 3 fatty acids lower triglyceride levels and help protect against some heart problems.  Omega 3s may help lower blood pressure.  They also keep blood platelets from clumping together, which prevents blood clots from forming.  Research suggests omega 3s may raise good (HDL) cholesterol levels.

Cognitive Function

Some research has shown that a diet rich in omega 3 fatty acids may lower the risk of developing dementia, Alzheimer’s disease, and other issues associated with cognitive function.  They may help improve mild memory loss in people with early age-related cognitive decline.  Studies show that people may receive the most benefit when taking omega 3 supplements in the early stages of decline.  However, supplements may have little effect on those with more severe cognitive impairment.  Other research shows that omega 3 supplements may be effective in treating symptoms of depression and anxiety.

Inflammation

Omega 3s have strong anti-inflammatory properties.  They are helpful in reducing chronic inflammation and providing joint lubrication.  They may be effective in relieving joint stiffness and pain for those suffering from different types of arthritis including osteoarthritis, rheumatoid arthritis, and gout.

Eye Disease

Taking omega 3 supplements is effective in treating inflammation and reducing symptoms associated with dry eye disease.  Research suggests that omega 3s lower the risk of developing age-related macular degeneration (AMD), a disease that affects the central vision.  AMD is a common cause of vision loss in seniors.  Omega 3s may help in the prevention of the disease, but do not slow its progression if the disease is already present.

Dietary Notes

Omega 3 fatty acids are not produced naturally in the body, so they must be obtained from food sources or supplements.  Fish oil supplements are generally considered safe when taken as directed.  Possible side effects include nausea, diarrhea, heartburn, and an unpleasant taste in the mouth.  Diabetics should consult their doctor before taking fish oil supplements, as they may increase blood sugar levels.

The physicians at RMD Primary Care are happy to answer questions about maintaining a healthy diet or the benefits of dietary supplements.  Contact us today to schedule an appointment.