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Do I need a Primary Care Physician?

Many people think that now they are adults, they don’t need a primary care physician; when, in actuality, the important role that this doctor plays can’t be overstated. 

Besides doing your yearly physical, your primary care physician is often your first stop in identifying autoimmune disorders such as chronic fatigue syndrome, psoriasis, lupus, thyroid disease, rheumatoid arthritis and more.

Think again if you feel that only children need regular check-ups. Adults need them, too. They need regular visits to their primary care physician or to Los Gatos Doc’s primary care physicians. These visits result in better health care management because during them, you get to know your doctor and vice versa. They also result in better health care management because of the chronicity of autoimmune diseases. Your primary care physician can give you ideas which will result in a better quality of life!

A relationship with your primary care physician often gives both patient and doctor a chance to get to know each other. The relationship becomes special and built on a foundation of trust. Nurture the relationship now because it might be much easier to discuss possibly uncomfortable health issues later if you have developed a bond with your primary care physician. 

Research has shown that people who visit their primary care physicians regularly experience the benefits of better overall health, lower health care costs and have more satisfaction with their health care and lives. It is especially important to discuss how lifestyle changes can have a major effect on autoimmune disorders.

A major benefit of your relationship with a primary care physician is that it’s so much like having your own ‘health care hub’. Other physicians in the practice can access, provide vital information and coordinate all of your care in one place.

Some of the services provided by your primary care physicians can include:

  • Autoimmune disease management
  • Preventative care; disease prevention and screening
  • Checking for hypertension (high blood pressure)
  • Checking for hypoglycemia (low blood sugar/diabetes)
  • High cholesterol
  • Checking for cancer
  • Depression
  • STD’s
  • Help manage your chronic conditions
  • Give recommendations
  • Discuss sensitive and private concerns
  • Make referrals to specialists
  • Inoculations
  • Physicals

Your primary care physician is quite knowledgable in all of these areas and many more. Discussing preventative measures and developing strategies for dealing with health issues is one of the biggest reasons for making regular visits to Los Gatos Doc’s family clinic  or to your primary care physician. When we know who you are what your baseline is, we can easier detect changes or patterns which make diagnosing more accurate.

A major advantage of having a primary care physician is in having a team organizer, the hub of a health care wheel. The primary care physician has the ability to identify a patient’s need for a specialist. If you need an allergist and/or a pulmonologist, your primary care physician will point you in the right direction and assist you in understanding what your part might be as you  work together to achieve your health goals. Your primary care physician might also point you towards a rheumatologist who he/she has worked with before, if you need this specialty.

When you go to Los Gatos Doc’s primary care physicians, we treat you as a person and not a disease. If you want to live longer and have better health we are here to advocate for you, to treat you with compassion and to help guide you through your individual health care journey.

About the Author: Arun Villivalam, MD is a concerned and caring family physician and primary care doctor serving the community of Los Gatos, CA. Dr. Villivalam attended Thomas Jefferson University, where he received his medical degree, and completed his residency in family medicine at Cook County Hospital. Dr. Villivalam provides a variety of services to ensure the health and wellbeing of his patients, including physicals for all ages, chronic care management, stress management, urgent care, medicare wellness visits, school physicals and more.

 

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Celiac Disease for caregivers of the elderly

Celiac Disease and Aging

Olivia Jones is psychologist and entrepreneur from Brisbane. Mother of two beautiful children and proud owner of two silly boxer dogs, Teo and Mia. She is passionate about writing and always inspiring her readers to be clever in their lives. Her motto is “Be the change you want to see in the world”.

Some autoimmune diseases aren’t accurately diagnosed until the ‘golden years;’ Celiac Disease is one of these. People may have had symptoms for years, but the symptoms may have been too vague to make a definitive diagnosis.

Caregivers of Celiac patients need to recognize many of it’s nearly 200 symptoms, reporting them to the doctor. If you are the caregiver or if you are new to Celiac Disease in older adults, read on to find out ways to help older adults manage this disease.

Know the symptoms

As people age, Celiac’s gastrointestinal symptoms (bloating, diarrhea and cramps, amongst others) are often attributed to normal aging or an upset stomach, so they may have received sub-optimal treatment. Also, since many medication can cause an inability to absorb nutrients properly, the Celiac patient’s health may decline.

Throughout the years, this mis-management may have led to unnecessary medications being added. Studies have shown that many subtle and not-so-subtle symptoms go unnoticed, disregarded or poorly managed for 17 years on average.

Diet changes

The most significant dietary change involves gluten: it just became a ‘no-no-.’ What is gluten? Gluten is a protein found in many grains. As the caregiver who is likely to be doing the marketing you’ll need to be very careful when reading food labels, ensuring that every ingredient on the menu is truly labeled as “gluten-free”. Seeing a professional nutritionist is mandatory.

Elderly patients often take nutritional supplements because they may have osteoporosis and nutrient deficiencies and they usually benefit from these. However, the shopper must be aware that supplements can also contain trace or ‘hidden’ gluten. Condiments, iced cream and processed foods can also be sources of hidden gluten.

There may come a time when family members need help managing this disease; your loved ones might benefit from in-home care services which offer quality meals with all their limitations. Any family gatherings may be a challenge because gatherings tend to involve food. Even though hostesses may make a gluten-free menu, seniors still want to eat their like their old family recipes. So this diet transition can be hard on them, hard on you! Please have patience with them.

Budget concerns

Another issue with the gluten-free diet is expense; especially  while seniors are still learning what to eat, what not to eat and discovering which foods they like. They may be wondering, “how am I going to afford this?

One way to lower the cost is to purchase goods online! Many websites like GlutenFreeSaver.com offer discounts and less-expensive alternatives to store-bought items. Or purchase an Amazon Prime ® membership and order from their Pantry. Some very good gluten-free bargains can be had there! Most Celiac diets revolve around plenty of vegetables and fruits, but canned (gluten-free, of course) can be just as healthy, and much more affordable.

But, seniors don’t need to stick to pre-packed and processed gluten-free products. Instead, caregivers can help find natural gluten-free foods, find proper substitutions, and help manage their budget with new dietary restrictions. They’ll really need your help as they transition to a diet with NO wheat or wheat products!
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Immune-Suppression

Virus in blood – Scanning Electron Microscopy stylised

Finally, the combination of methotrexate, prednisone and Plaquenil™ had been titrated for my Rheumatoid Arthritis and worked ‘like a charm.’ But, after about 8 consecutive months on this ‘cocktail,’ I developed pneumonia. Strange thing; I had also been on these same meds a year ago, when another type of pneumonia was diagnosed.

In both peumonias, the ‘culprit’ was determined to be methotrexate. Methotrexate causes pneumonia? Not directly but when the immune system is suppressed by methotrexate, the body is susceptible to other germs. Not only is this true of methotrexate, but of prednisone, Humira™, Rituxan™ and other medications used in the treatment of autoimmune diseases. This supression of the immune system: immune-suppression.

These meds really stop inflammation, but at an expense. That expense? They can leave your immune system unable to mount a defense against foreign invaders. That’s why you see this admonishment in advertisements for the above meds: “make sure that you tell your doctor about any infections you have and avoid going to large public places.” My solution: have an intimate dinner at home and invite a few friends-who don’t have colds! Continue reading

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Steroids-“when they’re good, they’re very, very good; but when they’re bad, they’re horrid”

 

I used to be skinny, so skinny, that jokes followed me around. Yep, people said, “she’s like a McDonald’s hamburger; so skinny, she only has one side;” that sort of thing. Then I was diagnosed with lupus and all that changed Why?

Meds commonly used for autoimmune symptoms are often non-steroidal anti-inflammatories drugs or NSAIDs. While they don’t pack on the pounds, if symptoms worsen and other meds which include  prednisone, Decadron™ or Solu-Medrol™ are used, watch the scales for weight gain which can increase the problems one has with ‘carting around’ extra weight.

It is known that steroids cause fluid retention and an increased appetite; both of which will increase weight rapidly. All of a sudden eating that second piece of pie is completely normal behavior! Another way is theorized: interference with fat metabolism and a redistribution of body fat.

But, steroid medications do have a good effect, one so good that having the moon face and other side effects of steroids is sometimes worth the side effects. Steroids are so good at relieving the inflammation which causes the discomfort and some of the life-threatening side effects from autoimmune disease (for example, the joint pain from RA) or the inflammation of the lung lining: pleurisy. Without them there would be more pain and aches.

Steroids also play a huge role in the treatment of asthma. The asthmatic would also have to make the choice to suffer the side effects of steroids or to breathe. Kind of an untenable choice, don’t you think? But there is an increased risk of osteoporosis due to their effects on the bones. 

Also, because there is redistributing of fat, you don’t have to take steroids for autoimmunity. Ashley Judd took high dose of steroids for a sinus infection and as beautiful as she is, you can see the impact of steroids on her face.

But there are ‘new kids on the block’ which don’t have the risk/side effects of steroids; Rituxan™, methotrexate™, Benlysta™ and a host of others.

 

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Autoimmunity took my teeth and mouth hostage!

 

How Autoimmune Disease Impacts Oral Health

Did you know that people who suffer from immune diseases have an increased risk of developing oral health conditions and gum diseases? Numbered below are common immune diseases and how oral health is impacted by them:

  1. LUPUS ERYTHEMATOSUS

The inflammation caused by lupus affects the mouth and tongue. This inflammation, can cause sores on the lips, palate and inside the cheeks. In extreme cases patients may also experience burning of the mouth and lack of saliva. Since saliva normally washes away food, sugars and bacteria, a lack of it can result in dry mouth and an increase in dental caries. Dry mouth increases the risk of decay and yeast/fungal infections of the mouth. Tooth decay can incrase the need for fillings, the need to extract teeth, dentures to replace missing teeth or ineffective chewing which can result in stomach and digestive problems

     2 RHEUMATOID ARTHRITIS

Rheumatoid arthritis causes inflammation of the joints, and Rheumatoid Arthritis patients can experience inflammation of the temporomandibular joint (TMJ). TMJ patients experience extreme discomfort while performing any activity using their mouths: chewing and talking, opening their mouth at the dentist, eating. They may also experience facial pain, headaches, earaches, locking of the jaw, worn teeth and ringing in the ears. In a few cases, TMJ is caused by misalignment of joint and often expensive orthodontic treatment is needed to lessen or prevent the symptoms.

People suffering from Rheumatoid Arthritis can also have Sjögren’s Syndrome, an autoimmune disease of the salivary and tear glands. Sjogren’s causes severe dryness of the mouth; thus creating problems with chewing and swallowing  and dryness. Because of this dryness there can result in heavy plaque deposits on the teeth. This in turn increases the chances of tooth decay and periodontal gum disease. Because of oral dryness and food not being completely digested when it leaves the mouth and difficulty swallowing,Sjogren’s patients also experience pneumonia because they choked on food. .

     3.SCLEORDERMA (Progressive Systemic Sclerosis)

Scleroderma is known for it’s hardening of the skin; often the lips and tongue are involved. As the effects of this increases, the mouth becomes narrower and the lips and tongue grow more rigid. A tightened mouth makes it difficult to open or move the jaw, thus causing difficulties cleaning the mouth. This increases the risk of developing tooth and gum infections, including periodontal disease or tooth caries.

     4.THYMIC HYPOPLASIA 

Thymic hypoplasia, (DiGeorge’s syndrome) causes abnormal growth of the thymus and parathyroid glands, leading to a white blood cell deficiency. Therefore, people with thymic hypoplasia are prone to viral and fungal infections, especially in the mouth. Oral Candidiasis, thrush, and herpes are some of most common fungal infections that affect those suffering from Thymic hypoplasia. In extreme cases, Thymic Hypoplasia affects the mouth and jaw, resulting in improper development of the palate resulting often in a cleft palate, a split uvula, a receding chin, or a shorter-than-normal distance between the nose and the upper lip.

     5 DERMATOMYOSITIS

Dermatomyositis is an inflammatory muscle disease that causes unusual skin rashes. It affects women more than men and can affect people at any age. Muscle weakness in the head and neck are the more common signs of dermatomyositis. This is especially concerning as it can also lead to difficulty in swallowing and chewing, and those suffering from Dermatomyositis may have hard bumps inside their face and tongue.

As you can see, each of the above mentioned diseases can have adverse impacts on the health of your mouth. Since the condition of your mouth directly impacts the functioning of your mouth and digestive system, the above mentioned diseases can drastically affect your overall health. If you have been diagnosed with any of the diseases mentioned above,  I can’t stress enough the necessity of meeting with your dentist, explain the concerns you have about your mouth and find out what you need to do to avoid the chances of complications due to oral dryness.

 

Author Bio:

Emily found the perfect fit for herself as the Online Marketing Manager at Thurman Orthodontics in Fresno CA. She believes that a great smile does more than just make a person look great – it makes them feel great as well. The power of a smile has always been a mystery to Emily that she solves by researching and writing about. She loves to write about everything to do with a healthy bite and a beautiful smile – whether is it ways to achieve it or the importance of it in the various aspects of life. What brings a big smile on Emily’s face is her family and surfing. She also likes to bake and her children and co-workers call her the cookie fairy!

 

 

 

 

 

 

 

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Rituxan #3

Tuesday: was my third Rituxan® infusion. Walloped with IV steroids and IV Benadryl™ (both as pre-meds to prevent a reaction to infusion), the appropriate labs had been drawn.The premeds are given to prevent a reaction to the infusion.

Reaction to infusion? Essentially, the administration of any foreign drug is likely to elicit some response from the immune system. How and why could I react to this infusion? Well, think of this just like the immune system in lupus. There is a foreign invader (antigen and in this case, Rituxan®) and the body can mount an immune response with antibodies. The antibodies which attack foreign cells are called auto-antibodies.
If the body does mount a response, it usually is diminished with the body’s own antihistamines. The administration of IV steroids and IV Benadryl, an antihistamine usually prevents this reaction from occurring and treats it it it does. Symptoms of a reaction might be itchiness, hives, throat tightening, airway obstruction and distress and respiratory arrest.

 

I find the following video an easy way of remembering the definition of antibodies and antigens and auto-antibodies and their difference.

An hour after the infusion began, the nurse increased the rate as she had done 2 times before, but shortly therafter, I got a very intense itch on my back. I didn’t consider an infusion reaction; rather, I thought of dry skin on my back: because I forgot to lotion!
Just as quickly as the nurse stopped the infusion, she looked at my very itchy back. It was reddened and raised and blotchy red. My face was reddened and so was my neck, I was having a reaction. The infusion was turned off for an hour and when she resumed the infusion, she started it at a much slower rate and I was fine.

 

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Rituxan #1

Apprehensive, that was me; you know how they say that nurses make the worst patients? Well. it’s true! Today was day one of Rituxan/Rituximab infusions and you’d think I’d never had an IV before! But, symptoms of lupus and Sjogren’s Syndrome had gotten too great to be controlled any longer with the Prednisone and Plaquenil I take.

My rheumatologist and neurologist decided that Rituxan® was the treatment that would benefit me the most and have the fewest side effects. Before starting the medication, the nurse drew blood, sent the results to my doctor and gave me two medications: Benadryl™ and a steroid. Both were intended to decrease the chances of a reaction:  So, that was the reason for increased restless leg syndrome twitching. IV benadryl was the culprit!

The first treatment was pretty smooth with only one disruption: the nurse needed to stop the infusion because my tongue became ‘tingly.’ That was an early sign of potential life-threatening reaction, so we decided to err on the side of caution and stop the infusion for a while. She resumed the infusion after about 20 minutes, but more slowly this time.

I spent the rest of the time; well, I had lots of things to do, but I slept-after I ate lunch at the infusion center. Yes, they delivered sandwiches to each large cubicle (@5′ x 10′), I sat in a reclining chair complete with television and heated blanket! I had brought books on tape, movies, Facebook, and twitter; but did I do any of those things? NO! I slept.

The next day, my skin was a little flushed, my doc said to observe it, but the flushing was gone by evening. So, all in all, day #1, no problems. I’m scheduled to have the infusions weekly x 4 then the doctor will reevaluate and determine how often in the future I’ll need them.

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