What You Need to Know
About the Zika Virus

By Dr. Sheethal Laxmi

Zika virus is transmitted by infected aedes mosquito. The virus is related to dengue virus, yellow fever virus, and West Nile virus.

Zika virus is named after the Ugandan forest where it was first isolated in a rhesus monkey in 1947. The World Health Organization (WHO) declared Zika virus and its associated complications as Public Health Emergency of International Concern given the current ongoing outbreak.

Transmission:

1. Mosquito bite: Zika virus is transmitted to people after a bite from infected aedes mosquito which lays eggs in and near standing water. They bite during the daytime and evening hours.
2. Mother to child: Zika virus can be transmitted from an infected pregnant woman to her unborn child in the uterus and also during labor.
3. Through Sexual Contact: Zika virus can be spread by an infected man to his sexual partners. The virus is present in Semen longer than Blood.

Symptoms:

Most patients infected with Zika virus may not even realize that they have been infected. Illness presents itself with mild symptoms like fever, joint pain, rashes, conjunctivitis (red eyes). Headaches and muscle pains can also occur, lasting from several days to a week after mosquito bite. Death because of the Zika virus infection is rare, and once a person is infected they are protected from future infections.

Diagnosis:

Patients who develop the symptoms and have recently traveled to Zika virus transmission areas should see their healthcare provider. Infection is usually identified by blood test looking for Zika virus.

Protecting others from getting Zika virus:

If you have Zika virus infection, avoid mosquito bites during first week of illness to prevent spread of infection. Using condoms during sex, helps prevent infection from infected male partner. Avoiding sex is the best way to prevent spread of infection from sexually transmitted Zika virus.

Zika virus and Pregnancy:

1. Avoid traveling if you are pregnant.
2. If travel cannot be postponed, follow mosquito bite prevention all the time.
3. If you are trying to get pregnant or are currently pregnant and have recently traveled, discuss with your healthcare provider even if you have no signs or symptoms.

Treatment:

There is no medicine to treat Zika virus infection or vaccine to prevent it.

Treatment involves supportive therapy
1. Rest
2. Keep hydrated
3. Tylenol as needed for fever/aches and pains
4. Avoid aspirin and other nonsteroidal anti-inflammatory agents until dengue fever is ruled out (to avoid increased risk of bleeding)

Prevention:

CDC recommends:
1. The use of Environmental Protection Agency (EPA) registered insect repellents (DEET and Permethrin use is safe in pregnancy as long as they are used as per label instructions)
2. If sunscreen needs to be used, apply sunscreen prior to insect repellant
3. Always wear long sleeve shirts and pants to cover any exposed parts of your body
4. Wear permethrin treated clothes
5. Stay in rooms with air conditioner or rooms with door and window screens to keep mosquitoes out
6. Mosquito prevention should be followed throughout day and night to prevent the risk of infection.

Dr. Sheethal Laxmi is a new addition to MAOM. She is board certified in Infectious Disease as well as Internal Medicine. After graduating from Gandhi Medical College, she completed her residency in Internal Medicine at Monmouth Medical Center and Fellowship in Infectious Disease at Robert Wood Johnson University Hospital quickly becoming an integral leader of the medical community in New Jersey. Dr. Laxmi practices in our Edison, and Marlboro locations.

Dr. Sheethal Laxmi


Detecting Dementia

By Dr. Prasuna Gourkanti

Do you feel that you or a loved one is experiencing the early signs of dementia and memory loss? Please seek help if you or a loved one is experiencing the following issues:

1. Memory Loss
The changes are often subtle and tend to involve your short-term memory. Your loved one may be able to remember past events; however may not what they did or ate this morning. Other signs may include misplacing certain items, unable to recall why they went into a particular room, and even forgetting what they were supposed to do on any given day.

2. Difficulty Managing Everyday Tasks
A subtle shift in the ability to complete normal tasks may indicate an early sign of dementia. This usually starts with difficulty doing more complex tasks such as balancing a checkbook or playing a game with many rules. You may also notice someone having an issue with trying to learn new skills or follow a new routine.

3. Getting Lost Doing Everyday Things
People may start to become lost while walking or driving around a familiar area. A deteriorating sense of direction and spatial orientation forces many to become unfamiliar with certain landmarks and forgetting regularly used directions.

4. Misplacing Items
Misplacing items in inappropriate places such as, leaving a wallet or keys in the refrigerator or cabinet.

5. Difficulty Finding the Right Words
Words are frequently forgotten or used in the wrong context. It will be common for people to forget or mix up words and making it hard for them to follow a conversation. This is a common and core sign of dementia.

6. Personality Changes
Frequent mood swings and changes can cause depression. One typical personality shift will be a person becoming very outgoing who was once shy, due to affected judgement and brain function.

7. Loss of Interest
Loss of interest in hobbies or activities and not wanting to partake in fun activities will cause people to become emotionally flat. Losing interest in spending time with friends and family will cause the person to become distant and unrelateable.

8. Repetitive Behavior
Repeating daily tasks and asking the same questions in a conversation.

9. Signs of Confusion
Confusion can arise with age but will be exacerbated with dementia. Confusion can arise when someone can no longer remember faces and names. It will also become difficult to make the right decision in certain situations.

10. Difficulty Adapting to Changes
For some people adapting to changes in their environment is very frightening. Since it is a scary experience they might crave a certain routine that they can stick with and not be open to changes and new environments.

Dr. Prasuna Gourkanti


Diabetic Neuropathy

By Dr. Swapna Nair, M.D.

Diabetes mellitus (DM) is a chronic lifelong disease of the pancreas in which there is elevated sugar in the blood. Diabetes Mellitus is due to either the pancreas not producing enough insulin or the body not responding properly to the insulin produced. Symptoms of DM are increased frequency urinating, increased thirst and increased hunger.

In the US, approximately 29.1 million people have DM of whom 8.1 million are undiagnosed.

Uncontrolled DM can cause complications such as cardiovascular disease, stroke, kidney failure, neuropathy (inflammation of the nerve cells) or retinopathy (damage to the eyes).This article will concentrate on Neuropathy. Diabetic neuropathy can affect nerves throughout the body.

There are four main types of diabetic neuropathy:
1) Peripheral neuropathy which is the most common type of diabetic neuropathy causes pain or numbness in toes, feet, legs, hands and arms.

2) Autonomic neuropathy affects nerves of the heart, stomach, intestines, bladder, sex organs, sweat glands, eyes and lungs. Fluctuation of heart rate and blood pressure is seen in such instances. Patients may experience hypoglycemia with a drop in blood sugar but may not experience shakiness, sweating or palpitations due to neuropathy. Patients may also experience decreased sexual response. Some may even have recurrent urinary tract infections due to damage to the bladder nerves.

3) Proximal neuropathy such as severe pain in the thigh, hips or buttocks is common in those with DM especially in the elderly.

4) Focal neuropathy such as carpal tunnel syndrome or paralysis of one side of the face (Bell's palsy) is also a risk due to uncontrolled DM.

DM neuropathy can be diagnosed during a physical exam. Doctors can check for peripheral neuropathy thru a monofilament exam on the patient's feet. Patients may also be sent for nerve conduction study based on symptoms. Ultrasound may be used to check organs for example, the bladder ultrasound can verify emptying after urination.

First step to treat neuropathy is to control blood sugar to prevent further nerve damage. Good control of blood sugar may prevent or delay further problems. Initially tight control of DM may worsen symptoms but it will improve over time. Medications such as antidepressants, anticonvulsants or analgesics been used for symptom relief. For patients with dizziness or labile blood pressure using elastic stocking have been shown to improve symptoms. Other options are increasing salt in diet or physical therapy. Treatment varies depending on the type of neuropathy the patient suffers from.

In conclusion the old adage, "an ounce of prevention is better than a pound of cure", holds true. Regular follow up, compliance with diet, exercise and medicines as well as open communication with one's physician will reduce risk of neuropathy.

Dr. Swapna Nair


Adult Immunizations - The Seasonal Influenza Vaccine

By Dr. Rakesh K. Parikh, M.D.

Flu is an acute illness caused by Influenza viruses affecting upper and lower respiratory tract. According to the CDC, 5-20% of population in U.S. is infected by the flu each year. It is estimated that nearly 200,000 people become hospitalized and 36,000 people even die each year due to influenza. Influenza vaccine can keep you from getting sick, may make your illness milder, and reduces the risk of more serious flu outcomes including hospitalizations and death. The flu vaccination is an important preventive tool for people with chronic health conditions such as congestive heart failure, diabetes, and chronic lung and kidney diseases.

Routine Annual Seasonal Influenza vaccines are recommended for all adults, including healthy adults between ages 19 and 49. For 2014-2015, U.S.-licensed influenza vaccines will contain the same vaccine virus strains as those in the 2013-2014 vaccine. Trivalent influenza vaccines will contain hemagglutinin (HA) derived from an A/California/7/2009 (H1N1)-like virus, an A/Texas/50/2012 (H3N2)-like virus, and a B/Massachusetts/2/2012-like (Yamagata lineage) virus. Quadrivalent influenza vaccines will contain theseantigens, and also a B/Brisbane/60/2008-like (Victoria lineage) virus (9).

Adults between ages 18 and 64 may be given intramuscular IIV (Inactivated Influenza Vaccine), or alternative intradermal IIV product (Fluzone). Adults age 65 and above may be given standard dose (trivalent) IIV or alternative high-dose quadrivalent IIV (Fluzone). LAIV (Live Attenuated Influenza Vaccine) is also available and is given intranasally. This is generally more effective in children and can only be used for healthy, and non-pregnant people under age 49.

The flu vaccine is contraindicated in people with previousanaphylactic reaction or Guillain Barre SyndromeAdults with an egg allergy of any severity may receive RIV or adults who experience only hives with exposure to eggs may receive other IIV with additional safety precautions.Vaccinations are now available at all 8 MAOM locations and will be given throughout influenza season.

Please speak to your Medical Associates of Marlboro physician regarding specific recommendations for other adult immunizations such as pneumococcal vaccine, TDaP, MMR, Varicella and Herpes Zoster vaccines. You can also visit www.immunize.org for more information.

Dr. Rakesh K. Parikh

Dr. Rakesh Parikh is board certified in Internal and practices out of the Marlboro and Edison office locations. He graduated from Baroda Medical College in India. Dr. Parikh completed his residency at Bergen Pines Hospital UMDNJ and has done his fellowship in geriatrics at Newark Beth Israel Medical Center.



Hyperinsulinism

By Dr. Purnima Vallabhaneni

What is Hyperinsulinism?
There are 2 typesof Hyperinsulinism. The first is in infants or children, and is a congenital condition that is caused by a tumor in the pancreas. The second is seen in adults and is called "Secondary Hyperinsulinism". In this condition, the fasting sugar is normal or sometimes below normal and the HbA1c, a measure of sugar present in the body in the last 6 weeks, is borderline or high. This condition is caused because of the resistance of cells to the effect of insulin, which is secreted by the pancreas to bring the sugar level down in the blood. This resistance causes the pancreas to produce more insulin to maintain the glucose level in the blood. The pancreas then ceases to function correctly, at which point the level of sugar in the blood starts to rise and the patient is diagnosed as a Type 2 diabetic. In short, Hyperinsulinism is a precursor for Type 2 Diabetes.

Who should be tested for Secondary Hyperinsulinism?
Patients who are overweight or obese, having difficulty conceiving or whose blood sugar is low should be tested.

Why do you need to be tested for Hyperinsulinism?
If left untreated, Hyperinsulinism can lead to diabetes and heart disease. Insulin resistance is also seen in women with "polycystic ovary syndrome", a conditionwhich can cause infertility. Sometimes, treating this condition can improve the chances of fertility for some women. It can be diagnosed with a simple fasting blood test to check the Insulin level.

Fortunately, Hyperinsulinism is a reversible condition and can be treated with a low carbohydrate diet, exercise and weight loss. It can also be treated with medications such as Metformin and Thioglitazones, which are also used for diabetes.

Dr. Purnima Vallabhaneni


Preventing Falls in the Elderly

By Dr. Prasuna Gourkanti

Falls occur more commonly than people realize, and the risk of falls increases with age. Overall, 1 out of 3 people over the age of 65 falls each year. Significant morbidity and mortality may result from falls. Falls account for 62% of non-fatal injuries leading to US emergency room visits, of which 5% to 10% are fatal. Injuries can range from fractures to brain injuries, which may also lead to death. Treatment of injuries resulting from falls often does not include investigating the cause of the falls. A number of physical conditions and environmental situations that predispose falls are preventable.

Am I at risk of falling?
Your risk of falling increases as you grow older, and effects of falls are more serious in people of the age of 65. If you have fallen in the past, you are at risk of falling again.

How can my doctor help me to avoid falling?
Your doctor can assess your risk of falling based on your medical illnesses, thorough assessment of cardiovascular and neurological status, and vision check. He/she can order physical therapy to improve strength, balance, flexibility and endurance, and also by optimizing medications.

10 tips to prevent falls for the elderly:
1. Make your home safer: to avoid falling at home, get rid of things that make you trip or slip such as area rugs, unstable furniture, electric cords, clutter, etc.

2. Keep your home well lit.

3. Avoid storing things in high places so you do not have to reach or climb.

4. Use grab bars, hand rails, and a sturdy seat for a shower. Avoid wet bathroom floors.

5. Wear sturdy shoes that fit well. Walking around with bare feet or only socks can also increase your risk of falling.

6. Taking calcium and vitamin D helps make bones and muscles stronger. Avoid excessive use of alcohol.

7. Stay active- exercising on a regular basis will help to develop muscle strength and balance.

8. If your doctor recommends safety devices like a cane or walker, make sure they are the right size and know how to use it properly.

9. Alarm buttons that let you call for help if you fall and cannot get up.

10. Avoid going out if there is snow or if weather conditions are bad.

Dr. Prasuna Gourkanti


Year in Review

By Dr. Jayendra Patel, M.D., F.A.C.C.

2013 was an exciting year for MAOM, and we were happy to welcome new physicians into our group. Dr. Ravindra Patel (Cardiology) and Dr. Seema Varma (Hematology/Oncology) were wonderful additions to our practice, and have provided excellent care to our patients in their respective fields.

One of the greatest achievements of our practice in the past year was the continued implementation of the Electronic Medical Records (EMR) system. By continuing to improve our electronic operations, MAOM is one step closer to becoming an entirely paperless private practice. The staff and physicians of the organization have put in many hours of hard work towards this goal, and their efforts are seen every day.

We are proud to announce that MAOM has been one of the few practices to be selected to form a Patient Centered Medical Home (PCMH) program with Blue Cross Blue Shield/Horizon Healthcare, starting January 1st, 2014. Our primary care physicians will continue to offer screening tests and preventive care for many of chronic illnesses and cancers, as per guidelines. Through the PCMH, we now will be able to better monitor and track the progress of our patients. Moving ahead, we look forward to partnering with other major health insurance companies.

With a network of practices covering a large area of Central and South New Jersey, MAOM is well positioned to adapt to oncoming changes in the healthcare industry. We strongly believe we will continue to team up with our patients to provide them superior care.

Dr. Jayendra Patel

Dr. Jayendra Patel is the Founder and Medical Director of MAOM, and practices interventional and non-interventional cardiology in our Bayville, Marlboro, Old Bridge, Edison, and Whiting locations. He is the Vice President of the Department of Medicine and Assistant Director of Cardiology at JFK Medical Center. Dr. Patel also serves on the Medical Executive Committee of Raritan Bay Medical Center.



Atrial Fibrillation

By Dr. Shaukat Chaudhery

Atrial fibrillation (AF or A fib) is an arrhythmia, or a disturbance in the heart's rate or rhythm. Every heartbeat starts in the atria (the heart's upper chambers) and moves into the ventricles (the heart's lower chambers), stimulating them to contract. Normally, the atria and the ventricles contract in this coordinated manner, and a normal heart beats between 60 and 100 times per minute.

In AF, the electrical signal that normally causes the atria to contract in an organized fashion circles through the muscles of the atria in an uncoordinated manner. This causes the atria to quiver, sometimes firing more than 400 times per minute without contracting. At the same time, this might drive the rate of the ventricles, resulting in an irregular fast heart rate. Some of the most common reasons to have AF are advanced age, hypertension, and coronary artery disease. Patients with AF often have no symptoms. However, when symptoms occur they may include dizziness, palpitations, weakness, fatigue, shortness of breath, chest pain, and loss of consciousness.

One significant danger of AF is that blood clots (called thrombi) can form during an episode of AF, enter the bloodstream, and lodge in the brain, causing a stroke. For this reason, patients are often prescribed an anticoagulant such as Coumadin or Predaxa to minimize risk of clotting and stroke. Uncontrolled AF can weaken the heart, which may lead to dilated cardiomyopathy or heart failure.

Patients may require medications to control rapid heart rate. Occasionally patients with a very slow heart rate may require pacemaker implantation to avoid syncope. Some patients whose heart rate cannot be controlled or who cannot tolerate medications may require a special invasive procedure called Radiofrequency ablation.

Patients with AF are required to have very close monitoring to check their heart rate, medications and overall health.

Dr. Shaukat Chaudher

Dr. Shaukat Chaudhery is a cardiologist practicing in the Old Bridge, Iselin, and Perth Amboy office locations. He completed his residency at Long Island Jewish Medical Center and Queens Hospital Center, and his Fellowship at Newark Beth Israel Medical Center. He is described as being an "excellent diagnostician who makes his patients feel comfortable and important."



Lyme Disease is on the Rise

By Dr. Frank Alario

Lyme disease affects thousands of individuals every year in New Jersey, and recent studies have shown an increase of this disease in the Northern United States. Lyme disease is primarily caused by bacteria transmitted through ticks, and is more prevalent during May, June, and July.

The symptoms of Lyme disease include: fever, headache, fatigue, muscle/joint pain, swelling and occasionally a rash. After it is diagnosed by a physician, Lyme disease is usually treated with a short course of antibiotics. If left untreated, it may lead to complications involving the skin, joints, nervous system, and heart.

Ticks need to be attached to the body for at least 24 hours before Lyme disease can be transmitted, which is why it is imperative to find and remove ticks as quickly as possible to reduce the risk of disease transmission. When returning from areas where ticks may live, carefully examine the skin and scalp for ticks - make sure to check pets, too. To safely remove a tick, use fine-pointed tweezers to grasp the tick as close to the skin as possible, and pull it straight out. After removal, wash the area and your hands with plenty of warm water and soap.

The best way to prevent Lyme disease is to prevent tick bites. To do this, the CDC recommends using repellents that contain 20 percent or more DEET, avoiding areas that are wooded or have high grass, and showering soon after returning from the outdoors.

If you are not able to remove the tick effectively or experience flu-like symptoms after removal, see your physician immediately.

Dr. Frank Alario

Dr. Frank Alario has been practicing Internal Medicine for over 20 years and sees patients in the Bayville, Marlboro, and Whiting offices. He is described by his patients as being "extremely knowledgeable and thorough as well as caring and compassionate." Dr. Alario has been the recipient of the Filippo Mazzei Memorial Award in 1993, and both Compassionate Doctor Award and Patients Choice Award in 2009.



Can't Sleep? What to Know About Insomnia

By Dr. Babar Mirza, M.D.

Insomnia is a sleep disorder which is characterized by the inability to fall and remain asleep. Most adults require seven to eight hours of sleep. According to the National Institutes of Health (NIH), 10-15% of adults suffer from insomnia. People with insomnia can feel tired, irritable, depressed, and anxious. Insomnia can affect your health and quality of life.

One of the common causes of insomnia is stress. It could be caused by school, work, or death of a loved one. Insomnia can be related to hormonal changes during menstrual cycle, pregnancy and menopause. Medication, either prescription or over the counter, containing a stimulant can affect your ability to sleep.

There are several things that you should try before you see your doctor. You should remove all distractions from your bedroom including TV, computer, and plants if you have allergies. Sleeping at the same time every night and waking up at the same time every morning is also recommended. Caffeine, nicotine and alcohol can also contribute to sleeplessness. Therefore, avoid them in the late afternoon and evening hours before bedtime. Light exercise, five to six hours before bedtime, is also suggested.

Medical consultation and diagnosis may be required to provide accurate and effective treatment for the disorder. During the evaluation, you will be asked about your medical history and sleeping cycles. There are many prescription medications that are available; however, side effects include dependency. Persistent insomnia requires further investigation and an appointment should be made with your doctor.

Dr. Babar Mirza

Dr. Babar Mirza has been practicing Internal Medicine in our Old Bridge and Perth Amboy office locations since 1994 and is board certified in Internal Medicine. He graduated in 1982 and completed his residency in Anatomic and Clinical Pathology at Brooklyn Caledonian Hospital. Dr. Mirza completed his Internal Medicine Residency at New Rochelle Hospital in 1992.



Cancer Screening and Prevention

By Dr. Seema Varma, M.D.

Cancers responsible for the greatest mortality in the Unites States are lung, colorectal, breast, and prostate cancer. Screening for breast, cervical, or colorectal cancer can decrease cancer mortality, while routine screening for lung and prostate cancer is controversial.

Breast cancer - Breast cancer screening with annual mammography between the ages of 50 and 75 reduces the risk of dying from breast cancer. Screening mammography is recommended to continue up to age 75. Annual breast exams by a clinician are also encouraged.

Cervical cancer - Cervical cancer screening is recommended to begin at age 21 and is done by cytological examination (PAP smears) annually for three years followed by every three years in absence of abnormal findings. In women over age 30, testing for human papillomavirus (HPV) may be used in addition and is useful to guide management in women with borderline findings on cytology. Co-testing with cytology and HPV tests (in women over age 30) also allows the testing interval to be extended to five years.

Colorectal cancer - Screening for colorectal cancer reduces the risk of dying from this disease. Regular screening is initiated at age 50 for patients with an average risk for colorectal cancer and earlier for those with increased risk (risk factors, family history or known genetic syndrome). Several screening strategies are available; screening colonoscopy is most commonly used. Recommended interval between screenings depends on the method used, findings and risk factors for individual patient.

Lung cancer - Until complete results from ongoing clinical trials are available, screening for lung cancer is not routinely recommended, however, should be considered in subset of heavy smokers, especially in presence of symptoms.

Prostate cancer - Screening for prostate cancer remains controversial and is generally discouraged. The benefit of screening in reducing the risk of dying from prostate cancer is small and potentially outweighed by the significant harms of screening that affect many more men. However, screening is considered for men at higher risk (risk factors, African Americans, those with a positive family history) between ages 50-69. Screening is performed with blood test for prostate specific antigen (PSA) levels.

Dr. Seema Varma

Dr. Seema Varma specializes in Hematology and Oncology, and is a new addition to MAOM. Dr. Varma practices in our Edison, Iselin, Marlboro, Old Bridge, and Bayville locations. She has earned numerous awards for her work throughout her career, and is especially interested in breast cancer, bone marrow disorders, and women's health.



Getting Healthy and Staying There!

By Dr. Seema Varma, M.D.

Maintaining good health aimed at prevention of diseases and ailments is the principal key to good health. Avoiding a diagnosis is as important as managing and treating it. Thus, it is imperative that one take the initiative for getting healthy and staying there! Here are few steps one can take for a healthy lifestyle:

1. Healthy diet - Consume a well balanced diet with adequate protein intake. Daily diet should include at least 2 servings of green vegetables, fruits and milk or milk products. Drink at least 8 ounces of water everyday. Avoid high amount saturated fat content in your diet. Avoid excessive calorie intake (recommended 800-2000 kcal per day depending on body habitus).
2. Exercise - Exercise at least three times a week for at least half hour each session. Begin with warm up followed by vigorous exercise for remainder time. Brisk walking for at least half hour each, three times a week, has been shown to reduce the risk of cardiac events.
3. Avoid smoking - Smoking is deleterious for health in any minuscule amount, and so is exposure to second hand smoke. Smoking significantly increases risk of heart disease, stroke, cancers, lung and kidney problems. Say an absolute "no" to smoking.
4. Alcohol - There have been several studies suggesting that small amount of amount of alcohol (1-2 drinks per week) reduces the risk of heart disease and cancer. However, there have been conflicting studies suggesting detrimental effect of even small amount of alcohol. In general, occasional intake is acceptable. However, in excess is harmful and may increase risk of heart disease, stroke and liver failure. Alcohol intake also adds to the amount of calorie intake and attributes to obesity, which in turn can increase the risk of heart disease, diabetes and stroke.
5. Aspirin - Several large studies have indicated the beneficial effect of low dose aspirin intake (75-100 mg per day) in prevention of heart disease, stroke, blood clots, kidney problems and various types of cancers. Unless there is any contraindication to aspirin (possible risk of excessive bleeding or kidney damage), taking low dose aspirin daily is recommended after age of 35. Check with your doctor regarding risks and benefits for individual situation prior to initiation.
6. Vitamin D - Low levels of Vitamin D in our body can be undetected until a blood level is performed. Symptoms can be non-specific such as feeling tired, dizzy, dry skin, friable hair. Obtaining blood levels of Vitamin D and correcting for low levels has recently gained attention after studies correlated Vitamin D deficiency with increased risk of different kinds of cancers. Ask your physician about testing for Vitamin D level. For those with normal levels, daily Vitamin D supplementation in the range of 400-800 units daily for those under the age 60 and 800-1200 units daily for those over the age of 60 is recommended.
7. Other supplements - MVI, omega-3 fatty acid, fish oil have had conflicting results in various studies regarding potential cardiovascular benefits. However, no significant side effects have been observed.
8. Preventive medicine visits/regular health check ups - Lastly, regular health checkups are as important as maintaining a healthy lifestyle. Follow up with your regular physician visits and annual routine bloodwork evaluations and immunizations. Follow with age appropriate screening tests including cancer screening for breast cancer, cervical cancer, lung cancer and prostate cancer. Discuss with your physician at every visit regarding the need for appropriate blood tests, immunizations, screening tests and cancer screenings.

Dr. Seema Varma

Dr. Seema Varma specializes in Hematology and Oncology, and is a new addition to MAOM. Dr. Varma practices in our Edison, Iselin, Marlboro, Old Bridge, and Bayville locations. She has earned numerous awards for her work throughout her career, and is especially interested in breast cancer, bone marrow disorders, and women's health.



Controlling Your Risk Factors

By Dr. Jayendra Patel, M.D., F.A.C.C.

It is widely known that cardiovascular disease is the number one cause of death of men and women in the United States, but few know that the majority of these diseases can be prevented.

Smoking, high blood pressure, high blood cholesterol, diabetes, obesity, and physical inactivity are all risk factors for heart disease. We recommend that our patients maintain a healthy lifestyle by discussing their dietary habits with their physicians and engage in physical activity for at least 30 minutes per day, 3 times per week. The CDC estimates that about 80% of heart disease, stroke, and Type 2 diabetes can be prevented if Americans stopped smoking, ate a better diet and exercised more.

Hereditary factors also contribute to heart disease, and patients who have family members with heart disease should be screened on a regular basis.

A blood test which includes cholesterol testing should be done every year for patients age 25 and above, and every 3-6 months for patients with high risk factors. Your total cholesterol level should be less than 200 mg/dL, HDL level greater than 40 mg/DL for men and 50 mg/dL for women, LDL level less than 129 mg/dL and Triglyceride level less than 150 mg/dL.

Your blood pressure will also be taken every time you visit your doctor, and should be below 130/80 mm Hg for an adult age 20 and over. If there is a high reading of your blood pressure, your doctor may ask you to monitor your blood pressure at home and take several readings over time before diagnosing you with high blood pressure.

Regular monitoring will ensure that you and your doctor are taking active measures to prevent and treat cardiovascular diseases.

Dr. Jayendra Patel

Dr. Jayendra Patel is the Founder and Medical Director of MAOM, and practices interventional and non-interventional cardiology in our Bayville, Marlboro, Old Bridge, Edison, and Whiting locations. He is the Vice President of the Department of Medicine and Assistant Director of Cardiology at JFK Medical Center. Dr. Patel also serves on the Medical Executive Committee of Raritan Bay Medical Center.

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