Montes Medical Group

"Diabetes cases will nearly double in the U.S. in the next 25 years, and the cost of treating the disease will almost triple,” according to a University of Chicago study published in the journal Diabetes Care this month.

Diabetes affects every part of your body—vision, circulation, nerves, heart, kidneys, and brain. That’s why it’s vital to keep the condition under control. Discuss with your doctor which tests and interventions you may need.

Get blood tests
• A1C. This blood test indicates how well your blood-sugar levels are controlled. Your A1C, sometimes called your “diabetes number,” should be tested every three to six months. Ideally, your score should be less than 7.
• Cholesterol. People with diabetes often have higher rates of heart disease, so make it a priority to keep your cholesterol low. Have it checked at least once a year. Your LDL, the so-called bad cholesterol, should be less than 100. Ask your doctor whether you should be taking a cholesterol-lowering drug.
• Creatinine. This chemical, found in the blood or urine, is measured to estimate kidney function, as diabetes can wreak havoc on the kidneys. Check it yearly.

Protect your immune system
• Flu shot. Diabetes affects your ability to recover from infections, so make sure you get vaccinated every fall.
• Pneumonia vaccine. Everyone with diabetes should receive a one-time immunization.

Maintain good habits
• Diet. Nutrition is vital in managing diabetes. Ask to talk to a nutritionist to figure out what works best for you.
• Exercise. Fitness is as important as taking medications to control, and sometimes even reverse, diabetes.

Having diabetes can be overwhelming. Creating a diabetes health record will help you keep track of all the recommended tests. Use this list as a start. Know your numbers. And keep the lines of communication open with your doctor.

by Dr. Ranit Mishori

published: 12/20/2009 in Parade Magazine

“The stress at work is sending my blood pressure through the roof,” a patient told me. His instinct was good, because experts who study stress are increasingly seeing how it connects to illness. Stress affects your heart, weight, and skin. It’s also linked with “poorer wound healing, an increased risk for developing depression, the common cold, and influenza, as well as associated with increased symptoms among those with chronic illnesses,” says Dr. Sheldon Cohen, a professor of psychology at Carnegie Mellon University in Pittsburgh.

Confronted by sudden danger, the human body instantly pumps the bloodstream full of adrenaline. This hormone, along with cortisol, raises your blood pressure, heart rate, and blood sugar, temporarily giving you additional strength, speed, and stamina. In emergency situations, stress can save your life.

But ongoing stress—the kind you might face when you’re experiencing marital, financial, or work-related problems or are caring for a sick relative—influences your ability to function and may lower your immunity. Even your genes can be affected, says Dr. Elissa Epel, a health psychologist at UC, San Francisco, because stress changes “the protein output of our DNA.” That’s like saying it affects the core of what we are made of.

Here’s what else we know about stress and sickness.

Heart. “There is overwhelming evidence that stress creates an environment where heart attacks and even sudden death become more likely,” says Dr. Joel Dimsdale of UC, San Diego, in the Journal of the American College of Cardiology. Job stress has been found to increase cardiovascular risk by up to 50%. In addition, stress lowers estrogen production, which reduces protections against heart disease in women, explains Dr. Stephen Manuck, a professor of psychology at the University of Pittsburgh.

Headaches. Stress appears to change the balance of chemicals in the brain in a way that may contribute to the narrowing of blood vessels—one theory for why we get migraines. Stress also is a factor in tension headaches. And physical reactions to stress—such as tensing the neck and shoulders, grinding teeth, or clenching the jaw—may make headaches worse.

Skin. Stress can exacerbate many common skin conditions, such as acne, psoriasis, hives, and rosacea. It may lead to hair loss, brittle nails, herpes outbreaks, and shingles.

Cancer. The evidence linking stress to cancer is limited, but we do know that chronic stress can weaken a person’s immune system, which may make him or her more susceptible to certain cancers associated with viruses.

Obviously, you need to address stress that wreaks this sort of havoc. Start by recognizing what stress looks like—it’s not always obvious. You might feel tense, have headaches, sweaty palms, a racing heart, or an upset stomach. General aches and pains can be stress-related. The same goes for constant worrying, difficulty focusing, and trouble making decisions.

The good news is that there are various ways to cope with stress, ranging from medications to exercise to calming techniques like meditation and biofeedback. Taking these routes to “chilling out” is well worth the effort.

by Dr. Ranit Mishori
published: 10/25/2009 in Parade Magazine

Tips on Managing the Heat

The risk of heat exhaustion and heat stroke rises along with the temperature and humidity. Heat illnesses occur when the body's cooling mechanism becomes overloaded. When the heat starts to rise - slow down. Regardless of your activity level, drink more fluids - your body needs water to prevent dehydration during warm summer days. Stay away from liquids that contain caffeine, alcohol, or large amounts of sugar. Stay indoors or in shaded locations; wear lightweight, light-colored, loose-fitting clothing; and limit your outdoor activity to morning or evening hours when it is cooler outside.

Signals of Heat Emergencies

Heat exhaustion is a milder form of heat-related illness that can develop well after dehydration occurs. Those most prone to heat exhaustion include the elderly, those with high blood pressure, and children. Some symptoms of heat exhaustion include: cool, moist, pale or flushed skin; muscle cramps; heavy perspiring; nausea and sometimes vomiting; weakness; dizziness; dry mouth; and a headache.

Heat stroke is a life-threatening situation. It occurs when the body is unable to regulate its temperature. Heat stroke can occur within 10-15 minutes of the first symptoms. Signs of heat stroke include: very high body temperature (above 103 degrees); hot, dry, red skin; no sweating; nausea; dizziness; confusion, disorientation, hallucinations; or loss of consciousness.

Treatment of Heat Emergencies

If you feel you are suffering from heat exhaustion, it is important to get out of the sun and into a cool place; loosen clothing; drink water/fluids (be sure to avoid caffeine and alcoholic beverages); take a cool shower, bath or sponge bath; and rest.

Heat Stroke is a medical emergency - have someone call for immediate medical assistance while you begin cooling the victim. Get the person to a shaded area; cool him/her rapidly using whatever methods you can (immerse in a tub of cool water, place in a cold shower, spray with cool water from a garden hose); do not give fluids; if convulsions occur, keep the victim from injuring himself; call the hospital emergency room for further instructions if medical assistance is delayed in responding.

Healthy Swimming

Summer time means fun in the sun, and plenty of fun and games in the water - but did you know that germs could contaminate swimming water? Recreational water illnesses (RWIs) are spread by swimming in contaminated recreational waters such as: pools, water parks, lakes, and the ocean. Germs causing RWIs can be killed by chlorine, but it doesn't work right away. It takes time to kill germs, and some are resistant to chlorine and can live in pools for days. Here are some tips on how to protect yourself and your family from RWIs.

Swimmer's Ear

"Swimmer's Ear" is an infection of the ear and/or outer ear canal, which can cause the ear to itch or become red and inflamed. More common in children and young adults, movement or touching the ear can be extremely painful. Reduce your risk of getting Swimmer's Ear:

Dry your ears after swimming.
Check with the pool staff about the chlorine and pH-testing program at the pool. Those with good control are unlikely to spread Swimmer's Ear.
Avoid swimming in locations that may have been closed because of pollution.
Avoid putting objects (e.g. fingers, cotton swabs) in your ear that may scratch the ear canal and provide a site for infection.

Swimmer's Ear can be treated with antibiotic eardrops - contact your doctor if you think you might have Swimmer's Ear.

Swimmer's Itch

"Swimmer's Itch" is a skin rash caused by an allergic reaction to infection caused by certain parasites found in contaminated salt or fresh water. You may experience tingling, burning, or itching of the skin. Small reddish pimples may later occur and could develop into blisters. Swimmer's itch cannot be spread from person-to-person, and most cases do not require medical attention. If you have a rash - try not to scratch as this may cause the rash to become infected. You may try the following for relief:

Cool compresses
Anti-itch lotion; calamine lotion
Corticosteroid cream
Apply a baking soda paste to the rash

Children are more likely to be affected because they swim, wade, and play in the shallow water (where the parasites are most often found) more than adults, and they do not towel dry themselves when leaving the water. To reduce the risk of swimmer's itch:

Avoid swimming in areas where swimmer's itch is a known problem.
Do not attract birds by feeding them in areas where people are swimming.
Avoid swimming near or wading in marshy areas where snails are commonly found.
Towel dry or shower immediately after leaving the water.

Cooking Outdoors

No matter what time of the year, more and more people are cooking outdoors. But outdoor cooking during the summer seems to pose a few extra challenges - leaving food out for just a short period of time under the hot sun can result in harmful bacteria rapidly multiplying and it increases the chance of getting foodborne illness. Here are some basic guidelines for safe food handling during the hot summer months:

From Store to Home

Purchase refrigerated or frozen items after you have selected all your non-perishables.
Put raw meat/poultry in a plastic bag so juices won't cross-contaminate your fruits or vegetables.
Immediately refrigerate all perishable items when you get home.
Completely defrost meat/poultry, so that it cooks more evenly and doesn't leave raw or poorly cooked places.

Transporting

When transporting food to another location, whether on a long family trip or just a short distance to the park, it is important to keep it cold to minimize bacterial growth.

Keep meats refrigerated until ready to use.
Pack perishable food from the refrigerator to the cooler just before leaving and keep on ice until ready to use.
Keep cooler out of direct sunlight and avoid opening it too often.

Hint: Pack beverages in one cooler and foods in another.

Keep it Clean!

Whether preparing food in your kitchen for the backyard grill or putting it all together at the campground, be sure to keep food surfaces clean. And with so many "cooks in the kitchen", or at the grill, make sure to have plenty of clean utensils and platters on hand. To prevent foodborne illness, don't use the same utensils or platters for raw and cooked meats. If you are headed to the park or campgrounds, find out if there is a source of clean water. If not, bring water for preparing and cleaning. Or pack both dry and wet cloths for cleaning surfaces and hands.

When I ripped a ligament in my knee on a ski slope last winter, I had no idea that I was joining a limping sisterhood. A torn ACL (anterior cruciate ligament) ranks among the most common sports-related knee injuries. But women are five to seven times as likely as men to sustain this kind of athletic damage. And a torn ACL is just one of a number of injuries to which women are more vulnerable: We're also more susceptible to stress fractures, shoulder instability, a painful condition called patellofemoral pain syndrome (a.k.a. runner's knee), sprained ankles, arthritis in the knee and thumb, and a condition called frozen shoulder syndrome. Ouch!

The good news is that new research has shed light on what can be done to prevent and treat the damage.

Protect Your Knees

It's obvious that women and men are built from a different set of blueprints. "Our wider pelvis is part of the problem," says Dr. Laura Tosi, director of the bone-health program at Children's National Medical Center in Washington, D.C. "It's why women's knees tend to go into a knock-kneed position, and the feet tend to roll into a little flat-footedness." On top of that, women tend to have looser ligaments than men, probably because of the influence of estrogen. The combination, says Dr. Tosi, means the muscles aren't able to pull in a straight line, which puts stress on the kneecap.

Studies show that girls tend to run, jump, and turn with straighter legs and less bending at the knees and hips than boys. These differences are visible from a young age, says Dr. Letha Griffin, an orthopedic surgeon in Atlanta. "Little boys stay low to the ground. The girls are running more upright."

But plenty can be done to teach girls to move safely. One program, called PEP (Prevent injury, Enhance performanc), is a 20-minute training session for high school and college students. It uses a series of exercises designed to strengthen critical muscle groups and promote proper alignment during running, jumping, and turning. A recent study of 1435 female soccer players found that PEP reduced non-contact ACL injuries by 70%.

Diversify Your Workout

Mix it up, advises Dr. Kim Templeton, an orthopedic surgeon at the University of Kansas Medical Center. If you run, lift weights. If you enjoy tennis, try the StairMaster. Cross-training will help prevent overuse injuries like stress fractures while also improving performance in your favorite activities. "Strong muscles help cushion the bones and joints," says Dr. Templeton.

Women should pay special attention to strengthening the hamstring muscles in the back of the thighs. In men, the hamstring and quadriceps (or front thigh) tend to be equally strong, while in women the quads tend to dominate, raising the risk of injury. We often make this imbalance worse at the gym. "The thigh-presser machines have lines, but the hamstring machines are lonely and off in the corner," Dr. Templeton observes. Her advice to women: Stop fretting about the front of your thighs and strengthen the underside, too.

If the Shoe Fits...

Another smart strategy: Use good judgment at the shoe store. "Many athletic shoes aren't designed for women," warns Dr. Templeton. Women's feet are wider at the front, narrower at the heel. Yet some women's shoes are simply scaled-down men's shoes. Templeton suggests researching shoes that are specifically designed to support and fit a woman's foot.

Another common misstep is using the same shoe for many sports. "A lot of women think shoes called cross-trainers are good for all types of sports, but they really are designed for working out at a gym," says Dr. Templeton. It may cost more up front, but you save in medical bills with sports-specific footwear.

Give Pain a Cold Shoulder

Three years ago, Connecticut attorney Betsy Goff developed a mysterious pain in her left shoulder. "I couldn't hook my brassiere," she says. "Sleeping was impossible." As for her beloved golf, forget it.

Goff, now 60, had developed adhesive capsulitis, often called frozen shoulder syndrome because this painful inflammation can lead the shoulder to lock up. The cause is unknown, but about 70% of patients are women--usually aged 40 to 60.

The key is to treat frozen shoulder early, before scar tissue forms. A new approach uses X-ray guided shots of cortisone to speed healing. But wait too long, and the shots won't work.

Goff has had it both ways. Her left shoulder responded to cortisone. But when she developed pain in her right shoulder, she was slow to get help, and shots didn't work. An operation to remove scar tissue followed. That plus a follow-up shot of cortisone got Goff back in the swing. "Though I'm still a lousy golfer," she says.

By Claudia Wallis
Published: 10/19/2008 in Parade Magazine

By Dr. Ranit Mishori
Published: September 30, 2007 in Parade Magazine

Fifteen minutes. Except for unusual or complicated cases, that’s about how much time I, and most doctors, get to spend with patients during an average appointment. The upside is that I can actually see, treat and help many people in a typical day. But it also means that both doctor and patient need to be as efficient as possible to get the most out of that precious quarter-hour.

You can help me. If you come prepared for the visit, we can both do a better job. Here’s how:

Before Your Doctor’s Visit: Gather the Facts
Be ready with the details of your current medications, recent test results and your medical history.

Let’s start with medications.

Make a list of prescription drugs as well as any over-the-counter medicines or herbal medications you may have been taking. Here’s a tip: If it’s too much trouble to write down all the names and dosages, just sweep your whole array of medicine bottles into a plastic bag and bring them with you.

Next, be sure to bring copies of your latest X-ray or MRI reports or any other test results, including reports from specialists you’ve seen. Include the specialists’ contact information— phone numbers, e-mail addresses and so forth. As a doctor treating you, I want to be sure that any treatment I provide works with, and not against, what your other doctors are recommending.

Get your history straight—your medical history and your family’s. Your doctor needs to know about any previous hospitalizations, as well as old or current medical problems, even if they are not the reason you are going to the doctor this time.

Genetics matter too. Gather information on the medical background of every member of your family. (For more on how to create a family tree on medical conditions, see page 6.)

If you have diabetes: Record your daily bloodsugar measurement and bring along your log.

Finally, if you have high blood pressure: Get a series of readings at home during the week prior to your visit so your doctor can gauge whether your numbers have spiked just because you are in a busy medical clinic—a phenomenon known as “white coat hypertension.”

Prior to the Visit: Prepare Yourself
Call your doctor’s office a day or two before your scheduled visit to check whether you should skip breakfast or lunch. Some blood tests require that you show up with an empty stomach. Knowing this beforehand can save you another trip to the lab.

If you have medical insurance, be sure to take any insurance cards you’ll need to present at the office for reimbursement.

If your condition is complicated or you are trying to make serious decisions about your health and can get overwhelmed easily, consider bringing along a family member or friend to your appointment. Your “appointment buddy” can help take notes, ask questions and give you support. Set some rules ahead of time: Do you want him or her to step outside during the physical examination? Can sensitive personal information be openly discussed? How proactive should he or she be?

Then sit down and think about what you want to get out of the visit. This is the time to understand that your 15 minutes cannot address everything. You may have five or six issues on your mind, but realistically you are going to have time to deal with, at most, your top three. Decide what these are before going in. Consider making a second appointment or booking a double appointment if you believe your issues are complicated or so numerous as to require the extra time.

The important point is to set your own priorities for the day you walk into the office.

Seeing the Doctor: Your Time To Be Heard
Show up a few minutes early and be prepared to fill out some forms.

Now is your time to be heard, but you also have a job to do. Start with your most pressing questions right away, the ones you’ve thought about beforehand. This is not the time to be shy. Like many physicians, I often find patients waiting until the very last minute to bring up important matters that are frightening or perhaps embarrassing. “Oh, and by the way, Doc…” is how this part of the conversation often begins, but by then, there’s almost no time left before the next patient needs to see me.

When recounting your symptoms, be as specificas you can. Your doctor will guide you with questions, but try to be accurate: When exactly did the pain start? What part of the body is affected most? How long does the pain last? Be as descriptive as possible: Is the pain sharp? Does it have a burning quality, or is it dull? Try to remember and report colors, smells, intensity. Every bit of information is important in order to get to the bottom of your condition.

While you are talking, your doctor is already forming a list of possible diagnoses in her mind, taking into account your symptoms, personal history and lifestyle, family history and other factors.

You’ve done your job as a patient. Now it’s the doctor’s turn. You should expect to leave your appointment knowing the answers to three questions: What is wrong? Why? What can I do about it? In reality, your doctor may not have the definitive answers yet. Tests may be ordered and follow-ups scheduled. But you should at least be given an idea of what the doctor thinks is going on and what treatments may be possible.

You need to understand what the doctor is saying. If you find things confusing, you are not alone. Some doctors use advanced medical vocabulary. Ask them to make it simple. If you still don’t understand, ask again. You even can ask to have it explained to you with pictures or illustrations. This is your body, your life, and you have aright to know.

After the Visit: Follow Up
If your doctor prescribed medications, get them filled and start taking them right away. If at any point you have questions, you should call the office. And if you want to learn more on your own, make use of the Internet: A few Web sites with good general information are: mayoclinic.com, familydoctor.org and medlineplus.gov.

As you leave the office, be sure you’ve scheduled a follow-up appointment, if necessary. Don’t wait until you get home—you may forget. Finally, use what you’ve learned to take better control of your health and start preparing for the next appointment.