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Integrative Weight Loss SolutionsIntegrative Weight Loss Solutions Launched On April 21. Our first group of participants have lost an average 24 pounds over twelve weeks while eating regular foods, without supplements or gimmicks, learning how to eat healthy, get moving, and having fun in the process!

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Program Participants

Author Nutritionist Rick Weissinger RD, MS, CPT

Psychotherapist Andrea Lopes LCSW-C

Yoga Instructor & Personal Trainer Kathi Doan

Washingtonian Top Doctor Edward Taubman, M.D.

Local Chef Debbie Amster Recently Featured On Local TV

Our Ten Week Program Meets Weekly From 7:00 to 8:30PM At The Olney Counseling Center at 3430 North High Street

Topics Covered Include

Re-Engineering Your Food Intake – What Should We Be Eating?

Emotional Eating – Identify Your Triggers And Develop Strategies To Manage Them

Get Moving And Relax – Yoga Techniques to Help You Win The Battle

 

Learn To Cook And Eat Healthy With Cooking Demos And Trips To The Grocery Store

At The Olney Counseling Center 3430 N High Street, Olney MD

Participation Is Limited To approx 25 people.

The present cost for the initial ten week program is $599 (patients of Dr Edward Taubman and Members of OlneyMyWellness receive a $100 discount).

Those who wish to can then join our weekly maintenance program

Call 301-774-5400 for More Information or Fill Out the Form Below

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Are Annual Pelvic Exams Still Warranted?

ovarian-cancer-pelvic-examinationFor most women routine pelvic examinations by their internist, family doctor, or gynecologist have become annual rituals.  However, some recent recommendations have raised questions about the value of these exams and in the process confused many patients and physicians alike.  Much of the confusion has to do with the terms “Well Woman Exam, PAP test, and “pelvic examination”.  For most women these terms are synonymous.  However, in the medical field they can be three separate things.

A PAP test, for instance, is a swab taken from the entrance to the uterus or womb.  The purpose of the PAP test is to check for either early changes that could lead to cervical cancer, or the detection of the Human Papillomatous Virus (HPV) that causes the vast majority of cervical cancer.  A PAP test requires a woman to be on an exam table, legs up in stirrups, with the insertion of a device known as a speculum which opens the vagina so that the cervix can be seen and the PAP smear of the cervix done.

A “Pelvic Exam” (sometimes called an “Internal”) starts out also with a woman up in stirrups. However, instead of inserting a speculum to visualize the cervix, this procedure involves the insertion of one gloved hand in the vagina and the other on the abdomen to feel if anything in between seems abnormally enlarged such as the uterus or ovaries.

A “Well Woman Exam” literally means an otherwise well woman visiting the doctor, discussing important issues such as heart health, diabetic tendency, osteoporosis screening, blood pressure checking, having a breast exam, and otherwise being appropriately examined which may or may not include a PAP smear being obtained or a pelvic exam.

The recent brouhaha which has caused all the confusion is really only about the value of that second element – the “Pelvic Exam” in otherwise healthy, non pregnant, asymptomatic women.  Turns out that poking around with one hand in the vagina and the other on the abdomen rarely finds anything serious and occasionally results in surgery that in retrospect might not have been necessary.

That’s not to say that a pelvic exam couldn’t disclose factors of interest or importance to the patient or doctor such as the presence of non – cancerous “fibroids” or bladder “prolapse” – which might contribute to incontinence.  Trying to catch early ovarian cancer is often cited as a reason to do routine pelvic exams.  Unfortunately, repeated studies have shown that ovarian cancer is rarely detected on routine pelvic examination; for that matter there does not exist any reliable test for detecting early ovarian cancer in women who have no symptoms.

So, what does this mean for the average woman?  The most important thing to understand is that women who are feeling well should still see the doctor from time to time to check their blood pressure, cholesterol, breasts, skin, and thyroid; and have referrals for preventative health measures as may be appropriate based on their family history and age, such as mammograms, bone density tests, and colonoscopies.

Women, between the ages of 21 and 65 still should have periodic PAP tests which still involves getting up on the exam table with legs up in stirrups.  Current guidelines for women without symptoms and previously normal PAP tests support PAP testing every three years – though as newer technology to test for HPV is introduced, the recommended frequency for some women may decline.

So, in summary, should women give up going to the doctor for a well woman exam?  Absolutely not.

Should women younger than 65 give up on PAP smears? Absolutely not.

Should all women regardless of age have an annual pelvic exam/”Internal”??  Not necessarily.  However, keep in mind that part of the debate in medical circles revolves around the question as to how often doing the exam results in finding something significant in people who otherwise feel well.  Part of the debate also revolves around cost effectiveness.  The same argument could be made for not listening to people’s hearts with a stethoscope, or not listening to their lungs as that might result in further testing such as echocardiograms, chest xrays or CT scans without proof that doing so results in longer lives.

Importantly, none of this applies to women who have symptoms that could be warning signs such as abnormal bleeding, unexplained bloating or pains.  If these persist, they require a complete exam regardless of age.

 

by Dr Ed Taubman Primary Care Physician Olney MD 301-774-5400

Once Again Voted Top Doctor “Washingtonian Magazine”

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New Directions In Cholesterol Testing & Treatment

good-versus-evilThe balance between HDL – the so – called “Good or Happy” cholesterol and LDL – the so – called “Lousy” cholesterol is often used as a way to evaluate one’s risk of developing clogged arteries.  However, some people still have heart attacks or strokes despite seemingly ideal levels of of these fats in their blood, while others with low HDL and high LDL levels seem to do just fine.

So researchers have been searching for different kinds of blood tests to better define one’s risk of getting clogged arteries and better treatments for those at risk.  One potential way to better define one’s risk for heart attack or stroke is the use of blood tests that look at more than just HDL, LDL, and triglycerides.  In our practice we also are integrating newer tests with names such as LDL particle number, HDL Map, and LDL pattern, just to name a few.

The mainstay of cholesterol drug treatment, the class of drugs known as statins, while safe and effective for most, can be difficult for some people to tolerate because of muscle pains or even weakness.  Niacin, which has been around for a long time and can increase the good HDL, has yet to show that it is beneficial when it comes to lowering one’s risk of arteriosclerosis.  Similarly, drugs known as fibrates (tricor, lopid) have struggled to show they reduce arteriosclerosis.  Ditto for Zetia.  New drugs that raise HDL have not come to market because of safety concerns.

The one class of drugs that may soon reach the market are the PCSK9 inhibitor drugs.  These drugs work on something called LDL Receptor Metabolism and can lower “lousy” cholesterol levels dramatically.  They have the potential to be game changers in the treatment of high cholesterol and to manage those who already have clogged arteries by dropping LDL levels to previously unimaginably low levels.  One drawback: they would need to be given by injection, but perhaps once a month would be sufficient.

Is lowering one’s cholesterol so low safe?  The PCSK9 inhibitor drugs are modeled on the fact that a few people have been discovered with genetic variations in their PCSK9 genes that naturally lower their LDL levels from a typical 130 or so to only 15!  These people seem to be otherwise healthy and without any signs of arteriosclerosis.  With cholesterol levels pushed down that low, it is is conceivable that this class of drugs might not only slow down arteriosclerosis, as do present statin drugs, but might actually reverse it.  Nonetheless, if approved by the FDA, it may well take years of experience to know for sure that the drugs don’t have unintended consequences.  More than three decades after approval, we are still learning about the pros and some of the cons of statins.  In the meantime lifestyle changes such as weight loss and increased exercise as taught in our multidisciplinary weight loss program can make a big difference for many people in both their cholesterol numbers and their cardiovascular risks, and statins will remain an important treatment for some time to come.

 

by Dr Ed Taubman Primary Care Physician Olney MD 301-774-5400

Once Again Voted Top Doctor Washingtonian Magazine

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Medicare Accountable Care Organizations and You

Savings AheadACO AfraidDespite the fact that as a country we spend much more on health care than anyone else in the world, we lag in health care measures when compared to others.  Medicare spends over a half trillion dollars each year, and you can’t blame them for trying to figure out how to lower costs and make sure that the care they are paying for is actually promoting health.  One such attempt is the advent of accountable care organizations or ACOs.  In Maryland there are presently over a dozen of these groups which have formed, and almost every physician or hospital will soon be part of one of them.  We are members of a Medicare certified ACO known as Maryland Collaborative Care which was originally formed by the Maryland State Medical Society.  We have researched them and so far are very pleased to partner with Maryland Collaborative Care.  Some of you may have received a letter from Medicare about our participation in Maryland Collaborative Care, giving you the choice to allow this ACO to view where your health care dollars are being sent.  Once Maryland Collaborative Care ACO has that information, it can share it with us; and we can work together to help you stay healthy.

The theory behind ACOs is that by their promoting information sharing among physicians and hospitals and providing targeted extra resources, you can receive more efficient care with fewer unnecessary tests without duplication of services; and in the end your care will be of better quality.  Like motherhood and apple pie – Who could argue with that?  Or should we be suspicious?  Of course “the devil is in the details.”  For instance what is quality care, how do we measure it, and how do we improve it?  Medicare has created over twenty “quality care measures” to judge us by and the list (and administrative burden) is growing.  There are many ironies here.  For instance one Medicare quality measure is to see if we are providing a depression checklist for patients to fill out.  Yet if we wish to refer someone to a psychiatrist  (good luck finding one),  many mental health care providers in our area don’t accept Medicare because the reimbursements are so low and the paperwork too great.  Further checklists are for risk of falls and all other manner of things, including seeing if we are in compliance with what are now outdated cholesterol guidelines.

The truth is that Medicare’s struggle to contain costs and improve communication with one’s primary care physician is in part due to our collective glamorization of specialty care.  Case in point, we refer you to a cardiologist to make sure your heart is healthy and your tests are thankfully negative.  Nonetheless, when you find yourself going back every six months to get your blood pressure checked by their nurse practitioner with yearly expensive tests that don’t change your care,  should we be asking Medicare to create an organization to reign in those expensive tests and force the cardiology practice to keep Dr T informed?  Might it not be a better choice to have Dr T manage your blood pressure in the first place and let him direct your further care as appropriate?

Repeat that scenario over and over for routine diabetes care, thyroid care, annual prostate checks, etc.; and you can start to see why Medicare finds itself in the position it presently is in: lots of dollars being spent with little to show for it.  If nothing else, remember your time is valuable.  As a board certified internist surrounded by superb staff, Dr T is well equipped to attend to the majority of your care.

ACOs will likely be with us for a long time to come.  We do recommend sharing your health information among all your health care providers.  Your participation in the ACO information sharing is voluntary and can be revoked at any time.  We are happy to answer any questions about these new and evolving Medicare organizations and how they may impact you.

 

by Dr Ed Taubman Primary Care Physician Olney MD 301-774-5400

Voted Top Doctor Washingtonian Magazine

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Colon Cancer Is Declining – Is It Time To Celebrate??

coloncancerrates

Recently Released Data show that new cases of colon cancer and deaths from colon cancer have declined significantly in the past decade.  During this period 30% less people have developed colon cancer than in the prior decade.  The largest decline has been in those over the age of 65.  This coincides with a tripling of the number of seniors undergoing colonoscopy in the same period.  Because colon cancers often originate in small non cancerous polyps periodic colonoscopy offers an opportunity to remove polyps before they become cancerous and to find colon cancers at an early stage when they are more easily treated and cured.

Despite these encouraging statistics many people avoid colonoscopy for a variety of reasons.  Many people fret over the prep which for the vast majority is no big deal.  Others erroneously believe that that since nobody in their family has had colon cancer that they are not at risk.  And while it is is true that an important minority of colon cancer has a hereditary basis (listen to Doctor Taubman’s Podcast On the Subject)- the vast majority of patients diagnosed with colon cancer do not have anybody in their family with colon cancer.

While the present data is encouraging two areas of concern are emerging.  First, while colon cancer screening usually begins at age 50 (or 10 years before the earliest case in the family), the incidence of colon cancer prior to age 50 appears to be slowly increasing for unclear reasons.  Our western diet, sedentary lifestyle and associated weight gain may be contributing.  Also colon cancer screening often stops when patients get into their mid seventies though many people nowadays are living a good bit longer.  Certainly for those who have never had a colonoscopy and are otherwise healthy a one time colonoscopy at age 75 or beyond is reasonable and supported by the literature.

Colon cancer remains the third most common cancer and cancer related deaths.  The progress of the last decade is truly remarkable and a rare example of health care dollars well spent.  However 23 million Americans between the ages of 50 and 75 have not been screened for this preventable cancer.  Rather than rest on our laurels and celebrating a coalition co-founded by the American Cancer Society and the CDC has set its sights on increasing colon cancer screening from the present reported 55% of those aged 50 to 75 to 80% in the next decade.  With colonoscopy becoming more accepted by the population, and insurance coverage becoming more universal that laudable goal should be within reach.