Dr. Danny Lee’s Blog

One of the doctors at JHCP Odenton has left for maturnity leave. So leaves the internal medicine dept a doctor short. My schedule has been rather full already is now getting rediculous. What the saying, ‘the cup has floweth over’. Well that is my situation for at least the rest of summer. So if you need to make an appointment please plan ahead. Mondays and Friday are my two most requested days and that will push you out further for an appointment. I have very limited (2-4 slots) for same day appointments and they ususally disappear as soon as the phones turn on at 8 AM. I am working hard trying accomodate as many people as I can but there is a limit to what I can do in a day. So it would help me out a lot if you plan ahead.

This week I will be away on vacation with my family. Refills and reports will be covered by other doctors at the office. I will be back next week.

Fortunately, influenza activity has been low this year.  However, of the patients who have had influenza this year, there is a high percentage of patients with Influenza A H1N1 (78% of influenza cases in the mid-Atlantic region are Influenza A.  Of those subtyped, 83% are H1N1).  Therefore, for empiric treatment, or for treatment of with patients with known Influenza A (H1N1), it is recommended to use combination therapy with oseltamavir and rimantidine, or to use zanamavir.

Vytorin is a branded medication combining Zetia and Zocor. Zocor (simvastatin) is a statin which a type of cholesterol lowering drug. Statin have long been renown for their ability to not only lower cholesterol but to prevent heart disease and stroke. Zetia inhibits a transport enzyme that bring cholesterol from food through the small intestines and into the blood stream. Zetia, when combines with a statin, had demonstated dramatic lower of LDL (bad) cholesterol. Even more dramatic LDL lowering then doubling the dose of a statin. Since it was believed that LDL lowering would lead to lower rated of heart disease and stroke, Vytorin came to market.

The ENHANCE trial was designed to see if that theory was true. In one arm of the study, patients would recieve a statin alone while in the other arm, patients would receive Vytorin. In the latest update of the ENHANCE trial, there was no difference in protection from cardiac events or stroke in the two arms of the study. So the potent cholesterol lowering ability of Zetia in combination with a statin gave no addition carioprotection. This trial does not say the Vytorin or Zetia dangerous or unsafe. Rather, that someone looking for the best protection from atherosclerosis should consider maximizing their statin therapy first.

I’ve changed offices again.  I am still at the same address but I’ve moved into a new office and I have my own entrance. So if you coming to see me in 2009, my entrance is located next to the Wilmer Eye Institute entrance. My office hours are still the same. The new entrance will make it easier to get in and out of my office. Hope to see you soon.

There is no evidence that brand-name drugs given to treat heart and other cardiovascular conditions work any better than their cheaper generic counterparts, U.S. researchers said on Tuesday.

http://www.reuters.com/article/healthNews/idUSTRE4B188Z20081202

I have received several emails asking if I have dropped Aetna. In a word, no. I have not dropped Aetna and Aetna did not drop me. It is an administrative issue and Johns Hopkins is looking into the matter. It is not the first time I’ve had trouble with one of the health insurances (some of you may remember the fiasco with MAMSI/United Healthcare). If you have received a letter from your insurance company that states I no longer participate, I would first call JHCP and confirm that the entire organization is no longer participating. I am not in a solo practice and I pariticipate with all the insurances that Johns Hopkins accepts.

Flu season is going to be here in no time. The flu season is generally from late Dec through Early March. I encourage both young and old to get the flu shot. Its availability is widespread. You can even get one while shopping for groceries. One myth I’d like to dispell is that you cannot get the flu from getting the flu shot. The vaccine contains several dead strains of the flu and is helpful in preventing getting the flu. Some people will feel tired and achy after recieving the vaccination. That is due to our body immune response to the vaccine and building an immune defense to the flu. Taking ibuprofen or Tylenol for the symptoms and usually passes in a day.

Not everyone is eligible to get the flu shot but that is a very small percentage of people. The main contradiction are those individuals who have allergies to eggs. That because some manufacturers still use an old method manufacturing the vaccine that utilizes chicken eggs.

Getting the flu shot is easy and relatively painless. Getting the flu is 1-2 weeks of pain and suffering. The decision is easy. Get the flu shot.

This is a short synopsis of a topic I covered in and interview for the Jumping Monkeys podcast ep. 65.

1. Diets alone never work. I am often amazed at how people will readily fall into the trap of the newest fad diet. Sure they lose weight but it almost always comes back and you put a few more pounds than when you started. So instead of dieting try EXERCISING first. Incorporating even moderate exercise to your daily routine will do more take away the pounds permanently.

2. Don’t weigh yourself. Instead get out a tape measure and measure your shoulders, arms circumference, waist, hips and thighs. When you are trying to lose the pounds it can be frustrating to see your scale show the same number even though your are losing fat. However if you are exercising you will be converting those fat cells into muscles cells and that will be reflected in a tape measure. Remember you are trying to lose FAT not pounds.

3. Keep a calorie count. Weight loss is simple. Calories going out has to be greater than calories going in. Recording what you eat and how many calories can be very illuminiating. Finding out where your short comings can help you stay on track. It will force you to learn to read labels and avoid those foods that are high in calories (and not necessarily filling). Own up to what you are eating. If you cheat on the diary then the only person you are cheating is yourself. This is not a test you will be handing in to your doctor. Be honest.

4. Find a friend. Medical reseach has found that people who start a weight loss program with a friend (or friends) are 3-5 times more likely to achieve significant weight loss. Misery loves company so why not find a companion.

5. Be patient. You did not put all your extra weight overnight so don’t expect to lose overnight either. Weight loss is a long term program. Even when you reach your goals that does NOT mean you go back to your old ways (lest your suffer the curse of the yo-yo). Find exercises you like doing. Find a diet plan containing a well rounded meal plan. This will help aid long term sucess.

Good Luck.