Hemoglobin A1C, Why Would You Like To Know It?

Persons with a fasting blood sugar level of 126 mg/dL on two separate occasions, are considered to have diabetes. Diabetes type II is by far the most common form of the disease.

Hemoglobin A1c (or HbA1c) is a measure of the ever-fluctuating blood sugar level over a fairly long period of time, usually about three months. The blood level HbA1c is used to monitor the disease progress or disease control, and in many cases also to identify people suspected to have diabetes.

An HbA1c level of less than or equal to 6.0% is considered normal, whereas a level above 6.5% represents diabetes.

Depending on whether one follows the recommendation of the American College of Endocrinology or the American Diabetes Association, the target HbA_1c should be between 6.5% and 7%.

The most common complications of uncontrolled type II diabetes are cardiovascular, renal (relating to the kidneys), and ophthamological (retinopathy).

If you have diabetes, reaching an acceptable level of HbA1c is extremely important. This may require lifestyle changes (making appropriate diet modifications, increasing exercise, and reaching an optimal body weight), and medications where necessary. In our office, we can determine your HbA1c with blood from a finger stick; it takes 8 minutes to get the results.

So, when in your doctor's office, don't forget to inquire about your blood sugar levels; early detection is very important, and will save potential complications.

Pain Awareness Month

The following appeared in the PainEDU.com earlier this month. 

"September is Pain Awareness Month. This busy month is marked by a variety of different initiatives and activities, all with the goal of promoting education, advocacy and awareness about chronic pain in order to break down the barriers to effective pain management.

Under-treatment of pain is a significant public health issue with far-reaching impact. With over 100 million people in the U.S. affected by chronic pain, it is no surprise that the societal burden of chronic pain is simply staggering. The Institute of Medicine in 2012 reported that the economic burden of pain exceeds $500 billion per year in the U.S., including health care utilization costs and lost workforce productivity."

I'll be attending the annual meeting of the American Academy of Pain Management later this month, for three days, for continuing medical education. Learning is a life-long experience, and I to get as much out of this meeting as possible.

Credentialed by the American Academy of Pain Management

The following appeared in the Summer 2013 edition of The Pain Practitioner, a publication of the American Academy of Pain Management, under the title Newly Credentialed Members: 

"Open to all pain practitioners, the Academy's credential demonstrates that a clinician is knowledgeable about interdisciplinary/integrative pain management; has practiced in the field of pain management for at least two years; remains in good standing with federal and state regulatory agencies; has passed a rigorous exam; and is committed to ongoing education in the field of pain. The Academy welcomes the following credentialed pain practitioners who have met the Academy's requirements and demonstrated proficiency in the management of pain."

Bruce Coplin, M.D., Toms River, NJ
Joseph A. Locke, DO, Germantown, Wisconsin
Mary Mcneill, MD, Buford, Georgia
Richard Randovich, DO, Boise, Idaho, and
Yours truly, with the following "bio"

Igal Staw, PhD, MD, has been in private practice for over 30 years. His introduction into the life sciences started at Columbia University, where he was the first student to graduate with a PhD in Biomedical Engineering, in 1968. He then continued to do biomedical research work at Columbia University and joined the faculty of the Polytechnic Institute of Brooklyn (now part of NYU). Dr. Staw graduated from the Medical University of South Carolina in 1974, and preceded with a pulmonary fellowship at a Yale affiliated Connecticut hospital, where he also ran the respiratory intensive care unit for over 10 years. During that time he also held a chaired professorship at the University of Bridgeport, CT, teaching biomedical engineering and directing special student projects.
Dr Staw developed a particular interest in health risk reduction, and in doing so developed computerized algorithms for early detection and prevention of chronic and other diseases. Recently, Dr. Staw has been focusing on pain management, which had been neglected for many years, but which is becoming an increasingly important part of medical care, especially at a time of opioid use and abuse.  

It's the lifestyle

“Civilization” takes a toll

(copied from bellybillbord.com)

It’s what we eat and don’t eat

It’s the cigarettes we smoke

It’s the exercise we don’t do

It’s the weight we didn't lose

It’s the extra alcohol we drink

More than 40% of premature deaths in the US occur because of faulty lifestyles.

I believe that almost 50% of the cost of today’s medical care can be eliminated by changing our lifestyles, so that we need less medical care.

The decision is yours...

Pain: Are Narcotics the Answer?

Just back fro the annual meeting of the American Academy of Pain Management in Phoenix, AZ. It was a meeting well worth attending, with many experts from a variety of related fields sharing their knowledge and experience. Here is a very brief overview of some of the current issues in pain management.

Approximately 110 million Americans suffer from acute or chronic pain; of these 100 million suffer from chronic pain, which generally lasts more than 6 months. Examples of pain which can become chronic include sciatica, neck strain, myofascial pain, osteoarthritis, knee and hip arthritis, fibromyalgia and migraine headaches. The cost to the economy of chronic pain alone is more than 600 billion dollars a year, almost equally divided between actual medical cost and the cost of loss of productivity. According to an article in The Journal of Pain this is more than the yearly costs for cancer, heart disease and diabetes.

Many people have felt that the mainstay of treating chronic pain is narcotics. Some of the better known ones include Percocet, Vicodin, oxycodone and Oxycontin. But many others exist, Opana, Dilaudid, Duragesic (fentanyl), tramadol, Nucynta, and Butrans, to name just a few.

While the use of opioids is sometimes necessary, this should hardly ever remain the only mode of treatment (an exception to the rule might be the terminal cancer patient). Long term use of opioid medication frequently leads to opioid-tolerance and addiction, and sometimes to dreadful medical and legal consequences. Furthermore, long term use of opioids can, by itself, lead to an increased awareness of pain, where a person begins to have more pain without actually having a worsening of his/her physical condition.

Occasionally, pain becomes chronic because it was not immediately treated. There are numerous cases where pain was inadequately treated just because of a law suit, or just because an insurer refused to allow, delayed, or limited the treatment. Or maybe someone just decided to “drag the case.”

The answer to the treatment of chronic pain is simple in principle. It involves a multidisciplinary approach. There is no one treatment that fits all. Each patient must be individually evaluated, and a course of treatment designed. Treatment may involve one or more elements of physical therapy, massage therapy, acupuncture, chiropractic, yoga, nutrition and special diet design, psychologic/psychiatric support, drug counseling, and the use of non-narcotic medications.

And, yes, as the pain subsides, the use of opioids has to be adjusted. And if tolerance and addiction interfere, then these have to be carefully handled in order to help prevent relapses and uncomfortable narcotic withdrawal.

One great way to treat the opioid addiction is the use of Suboxone. Prescription of Suboxone is by special license. To my knowledge, I am the only internist between Darien and Bridgeport who is licensed to do so. For information about Suboxone click here.