Hepatitis C And You

chronic_hepatitis_cThe past three decades have seen many incremental advances in the diagnosis and treatments for viral hepatitis.  When I started practice, the only commonly identified causes of viral hepatitis were types A, which typically is short-lived and without long term ill effect, and hepatitis B, which can cause chronic liver problems and liver cancer.  Hepatitis B cases in this country have been steadily dropping since the introduction of an effective vaccination series which is now started at birth.  Unlike hepatitis A and B there are no vaccinations to prevent hepatitis C.  For a number of years now, we have had a test to identify hepatitis C.  The initial benefit of having a test to identify hepatitis C was to protect the blood supply which prevented transmission from blood transfusions thereby starting a slow decline in the number of new cases.  However, as more and more people have been tested, we now know that as many as 3 million Americans, predominantly baby boomers, may be carrying the virus; and most people who carry the virus are not aware of it.

Though most people with hepatitis C never develop serious complications, an important minority develop cirrhosis, liver failure, or liver cancer.  Until late stage complications arise, the infection is usually asymptomatic; and usual liver blood tests are either normal or show low grade abnormalities that may be falsely attributed to medications that the person is taking.  Though progress in the treatment of hepatitis C up to now has been remarkable, many of the treatments have been less than optimal.  They can take almost a year, require a weekly injection plus as many as 18 pills per day for treatment of the infection and the side effects from the medications, and be accompanied by unpleasant side effects – with cure rates between 40 and 80% depending on the strain with which one is infected.

With the recent advent of two new medications, Olysio (simeprevir) and Sovaldi (sofosbuvir), we appear to be quickly entering a new era in the treatment of this potentially serious condition.  In some cases treatment can now be as short as 12 weeks with pills only and with significantly fewer side effects and cure rates of over 90%.

An analysis of recent trends published in the Annals of Internal Medicine suggests that in the United States alone, with the adoption of universal hepatitis C screening, almost a million new candidates for treatment could be identified. With the wide- scale adoption of the newer treatments, the disease could become a rarity in the next twenty years, preventing over a quarter million liver-related deaths.

The new drugs, though, come with a steep price; $1000 per pill with an average estimated cost of $84,000 per treatment and a growing debate over a fair price for breakthrough drugs that are the culmination of decades of research that can prevent costly medical complications in years to come.  Plus, in a time of strained health care budgets, who will pay the many billions of dollars for the treatments in this country and in poorer developing countries?

Wish to know your hepatitis C status?  The easiest way is to donate blood – since 1992 all donated blood is screened and you would be notified if infected.  Haven’t donated blood or ever been tested?  Let us know at the time of your physical and we can include a hepatitis C blood test with your complete blood work and cholesterol tests.

By Dr Ed Taubman Olney Maryland 301-774-5400

Looking for a high quality primary care practice? We are now accepting new patients

Yoga While Sitting In Your Chair! Click To Watch Our Video – YOU Can Do This!

IntegrativeWeightLossSlim

Integrative Weight Loss Solutions Launched On April 21. Our first group of 25 participants 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!

Thanks to all who attended our open house on September 8 and to our program participants who spoke including Restauranteur Barry Schwartz who told how he has lost forty pounds and counting through our program and Debbie Butler and Husband Rick who have lost together 60 pounds and counting.  Our next 10 week session will begin on Monday September 29.  There are still a few slots available – you can reserve your spot by filling out the form below.

“Thank you for the Time and effort you all have put in to make a miracle happen in my life. While over 20 pounds in 7 weeks may not sound a lot to some, To me, who has never lost weight on a diet, this was a life changing event. Thanks for the help with cooking, yoga and mental discipline.” Shiela Hanson Cloverly MD

Program Participants

Author Nutritionist Rick Weissinger RD, MS, CPT

Yoga Instructor & Personal Trainer Kathi Doan (giving Yoga Instructions above)

Psychotherapist Andrea Lopes LCSW-C (demonstrating chair yoga above)

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).

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

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The Controversy About PSA Screening Explodes

psatestingOnce again prostate cancer screening has been in the news – fueled by a provocative book written by Dr. RJ Ablin entitled “The Great Prostate Hoax: How Big Medicine Hijacked the PSA Test and Caused a Public Health Disaster”.  Dr. Albin’s claims are not easily dismissed as he is the person who discovered PSA in the 1970s.  Dr. Albin’s discovery of PSA, and its initial FDA approval, was for the purpose of following men who were seemingly cured of prostate cancer, and to alert doctors that the cancer might be coming back and thus require additional treatment.

However, ultimately the test started to be used for the early detection of prostate cancer in men who had no symptoms.  Unfortunately, when used for that purpose, the PSA is a very imperfect test.  According to Dr. Albin, in a recent interview with Medscape, the test is wrong 80% of the time as a predictor to see if an otherwise healthy appearing man has prostate cancer.  This is similar to the situation in ovarian cancer where the CA-125 blood test is used by cancer specialists to follow and treat women who have ovarian cancer; unfortunately it has failed to be an effective test in catching early ovarian cancer.

Dr. Albin highlights some of the issues of using the test for widespread screening: “A man can have a PSA of 0.5 ng/mL and have cancer, or a PSA of 11 ng/mL and not have cancer…..Furthermore prostate cancer is an age-related disease. If you get, for example, 100 men — black or white — between the ages of 60 and 69 years and do biopsies, you will find that 65% of these men have prostate cancer because it’s age-related.”

Importantly the Achilles heel of the test is that it is unable to make the important distinction as to which men have a slow moving cancer that they will outlive and would be best ignored, and which men are destined to have a much more aggressive and ultimately life – threatening cancer.

Dr. Albin argues that, as a result of the misuse of his test, an unstoppable multi-billion dollar industry has developed where men are tested routinely, many are found to have elevated PSA results, countless have prostate biopsies, and many have removal of their prostates with not infrequent side effects such as sexual impotence and loss of urinary control; all at the cost of billions of health care dollars with few if any lives saved to show for it.  He calls robotic surgery “a train that is ready to come off the tracks;” and that when the FDA approved robotic surgery for the prostate, its approval was not based on any human studies.

Supporters of routine PSA testing point to a long term European study with a 20% decrease in deaths due to PSA screening.  Detractors point to the largest ongoing US study which find few, if any, lives saved.

So where does that leave us presently in 2014?

The PSA test is clearly a far from perfect test for the detection of early prostate cancer. There can be real harms to testing but possibly a small benefit in lives saved.  However, the benefits of testing are not as clear as, say, mammography for early breast cancer detection in women, or as noted in my recent post the benefits of universal colonoscopies for the prevention of colon cancer.  Unfortunately, when it comes to prostate cancer, there is no better test on the horizon.  According to Albin that may in part be due to the fact that we spend over 3 billion dollars a year on PSA screening, but the National Cancer Institute spends just one tenth that on urological research.

Tips for Finding the Right Doctor

Finding the right doctor isn’t easy—and it shouldn’t be. You are putting your life, and health, in someone else’s hands. You need to feel confident that this person is skilled and qualified enough to give you the care you deserve. You should “shop” for a doctor the same you would a lawyer or even a good mechanic. Your relationship with your primary care doctor is one of the most important professional relationships you will develop.

What to Consider When Finding a New Doctor

People spend more time shopping for a new car than they do “shopping” for the right primary doctor. A primary care doctor helps keep you healthy and provides a “home base” for all of your medical needs. Knowing what to look for when selecting a new doctor is critical. Here are a few things to remember when searching for a new doctor in Olney, Maryland.

What to Remember When Searching for a New Doctor

Call around to several different doctors’ offices. Don’t stop at the very first doctor you find on Google. Consider your choices.  Is the phone answered by a live, friendly, caring person?  Remember you need a friendly and competent staff to help you wind your way through the complicated web of medical care to get appointments, schedule tests, fill prescriptions, and handle insurance properly.  The quality of the staff you encounter tells you a lot about the quality of the doctor and the medical services you will receive.

Ask for references!  Talk to family, friends, and co-workers and see what primary doctor they chose.  Is the doctor rated Top Doctor?  When checking references on the internet, ask yourself are there enough reviews to accurately reflect on the doctor.  Look for ratings that have over fifty reviews.

Ask about the doctor’s credentials.  You should always make sure your doctor has credentials and is properly licensed.  A Board Certified Internist is an expert in the field of adult medicine.  Did you know that cardiologists, endocrinologists, gastroenterologists, and cancer specialists have to become board certified internists first?  Did you know that internists are known for being excellent diagnosticians and are commonly known as the doctors that other doctors go to?  And don’t forget about the credentials of their staff; more and more primary care practices have replaced experienced seasoned registered nurses with years of training with medical assistants who have had  just a few weeks of training.

Talk to your doctor about insurance plans.  Does the doctor accept Medicare?  If you use out of network benefits, are they discounted through a service such as PHCS or Multiplan which can save you a lot of out- of- pocket money?  It is more and more common for doctors to charge an extra fee to keep their practices smaller and manageable and to retain experienced staff.  Having a doctor who doesn’t see as many patients gives you the ability to receive same day appointments and for him to spend more time taking care of you.

Look for a doctor who has good bedside manner.  You don’t want a doctor who just comes into the room, tells you that you have something wrong, gives you a prescription and then walks out. You also don’t want to be the one always telling your doctor what to do.  You want to look for a doctor who will take the time to sit down with you and discuss all of your health concerns and all of the possible treatments.  Good medical care is a partnership.

Make sure your doctor’s approach to healing is consistent with your views and philosophies and that he is an expert in his field.  Does your doctor have a holistic approach to your health?  Your doctor should share the same beliefs you have on the body and healing.  Does your doctor write a medical blog or conduct “Grand Rounds” at local hospitals to educate other doctors?

Do you get to see your doctor?  In many practices, particularly those run by large entities such as hospitals, you may be seen most of the time by a physician assistant or nurse practitioner.  Be mindful that these non-physicians have a fraction of the training and experience of a Board Certified Internist.  This can result in important diagnoses being missed or delayed, or the reverse – unnecessary testing.

Top Doctor in Olney, Maryland

It is important to consider the kind of care you are looking for and where you are looking to get that care. Everyone should spend time “shopping around” for a primary care doctor to find the right fit.  Making the right, lasting relationship with your doctor is important for long-term quality health care.

If you are in the Olney, Maryland area, schedule a time to visit with Dr. Edward Taubman.  Dr. Taubman will spend time with you discussing your health history and take the time to get to know you.  Dr. Taubman has repeatedly been rated “Top Doc” by “Washingtonian” and “Checkbook” magazines.  Go to zocdoc.com to read over 200 reviews on Dr Taubman who has a rating of 4.9 out of 5.0  Dr. Taubman has been repeatedly invited to lecture at local area hospitals including Medstar Montgomery General, Holy Cross, Shady Grove, Mercy Baltimore, and Medstar Franklin Square.  Schedule an appointment online, or call Dr. Taubman today at 301-774-5400

Hereditary Breast Cancer – The Role Of PALB2 Testing

Cancer RiskMost cases of breast cancer can not be attributed to a specific cause.  It is theorized that the majority of breast cancer is due to incompletely understood interactions between environmental exposures and relatively weak genetic influences and one’s lifestyle; such as exercise and the foods we eat.  However, in an important minority of patients a strong genetic influence can sometimes be found.  The best known such strongly inherited influences are genetic changes in the BRCA1 and BRCA2 genes.  The role of these genes in the development of breast, and ovarian cancers, has been known since the 1990s.  However, there remain many families who have strong family histories in which BRCA testing has been uninformative.  This had led to speculation that a “BRCA3″ gene may yet be discovered.  Though a search for a so called BRCA3 gene has been underway for many years a new study reported in the New England Journal of Medicine indicates that a gene called PALB2 may play a more prominent role in causing breast cancers in some families than had previously been appreciated.

Testing for PALB2 is now more readily available.  For those families where multiple family members have had breast cancer, and previous BRCA testing has been uninformative, PALB2 testing may in some cases provide an answer.  Knowing the genetic cause in a breast cancer prone family can help women better understand who in a family may be at particularly high risk and need to take special precautions; and who is at more average risk.  Dr Taubman is a graduate of the National Cancer Institute funded program in cancer genetics at the City of Hope and is able to help patients make informed decisions about the role of cancer genetic testing, help obtain insurance coverage as appropriate, and offer advice on preventative strategies.