• Disease Management
  
  • Asthma
    
  • Diabetes mellitus
    
  • Hypertension (high blood pressure)
    
  • Hypercholesterolemia (high cholesterol)
    
• Weight reduction program
  
• Smoking cessation program
  
• Traveler's immunization / services program

Disease Management:

Disease management can be defined as the use of information systems, clinical practice guidelines, and case management to improve a patient's health status and quality of life.

At no time in our history have we known as much as we know today concerning what the true risks are as they relate to specific diseases and the best ways to reduce or eliminate these risks. Out of managed care's concern regarding reducing costs of health care, most of which come from the "sickest patients", came significant research into what we now call "evidence based" medicine. Evidence based medicine is the result of research that has given us the ability to identify those patients that are at greatest risk, and through proven treatment protocols, significantly alter their otherwise eventual outcome.

For a disease management program to succeed, it must have and utilize:

A technologically advanced information management system, in other words a sophisticated computer system and programs, that allows a practice to identify high risk patients with high risk diseases, follow their compliance with recommended treatment protocols, and objectively measure their outcomes.

"Evidence based" clinical guidelines, now available for most of the high risk disease states, allow a provider to give the patient "true quality care", treatment and recommendations based upon research and facts.

Case management, a process whereby patients with specific health care needs are identified and an individualized plan is developed that uses all available health care resources to achieve the optimum patient outcome, in the most efficient, cost effective manner. It typically integrates care provided by all the players, the payer, the provider, the patient, and the family; in an effort to find the most appropriate treatment and care for that patient.

Other important elements necessary for any disease management program to realize its ultimate potential are patient education and patient compliance. There is no disputing that the more a patient knows and understands about their disease, the better they are able to manage it, and therefore end up with much better outcomes. A good disease management program makes a wide range of educational opportunities and resources available to patients.

Of course, the best disease management program in the world will have little or no chance for success if it does not have patient compliance. The critical importance of patient compliance is something that must be reinforced over and over again to patients. Human nature seems to, more often than not, create a pattern of patient compliance that is highest immediately after a chronic disease is diagnosed, and for short periods of time following a complication or worsening of the disease process. The degree of patient compliance between these major events is usually to some degree, far from ideal. Strict periodic follow-up visits are an important element of any disease management program for many reasons, not the least important of which is to reinforce patient compliance with the overall care plan.

At Verdugo Hills Medical Associates, we offer disease management programs for asthma, adult onset diabetes mellitus, hypertension, and hypercholesterolemia. Disease management programs are by their nature and complexity an evolving phenomena. We are constantly striving to improve and expand upon our programs and their components, based upon the true "outcome" results we get.

A. Asthma:

What is it?
Asthma is a chronic (long-standing) disease in which the linings of the air passages of the lung are inflamed. This causes the air passages to be over-reactive to a variety of things. When the air passages react (an asthma attack), more inflammation occurs. The muscles around the air passages tighten. The airways swell and fill with mucus. Both of these effects cause the air passages to become narrower for a time. This can make it difficult to breathe.

What causes it?
Asthma is often inherited, but may be caused by other problems. The inflammation that exists in your air passages causes your lungs to be more sensitive to certain irritations ("triggers") that can cause an asthma attack. Triggers may include allergies to pollens or dust mites, exercise, breathing cold air, air pollution, and cigarette smoke. Catching a cold is a common trigger of asthma. Emotional upset can make asthma worse.

What are the symptoms?
Symptoms of asthma include wheezing, a chronic cough or nighttime cough, shortness of breath and chest tightness.

How is it treated?
Like with most other chronic diseases, asthma is a disease that in most instances we can "not cure", but we can help you "manage" it very well. The more you learn and understand about asthma, the better you will be able to control it. Treatment includes avoiding things that make asthma worse, and depending upon the severity of your asthma, you may need to use inhaled medication. When your asthma is mild, you may need to use an inhaled medication only when you have symptoms. This is called a "rescue medication" because it can help you feel better immediately. When your asthma is worse, you may need to be on two different types of medications. One type would be a "rescue medication" that you would use only if you were experiencing asthma symptoms. The other would be a preventative or "maintenance medication" that will not help with an asthma attack, but it will help prevent them. The "maintenance medicines" work over a period of time to help control the inflammation and the over-responsiveness of the airways that the inflammation causes. They should not be used as the first medication reached for during an acute attack. The "rescue medicines" work more rapidly (faster onset of action) to more quickly help open the narrowed airways and make breathing easier. The "rescue medicines" should not be used on a daily basis if not needed.

With a good management (control) plan devised by both you and your provider, a patient with asthma can lead a normal life. Your commitment to working closely with your provider, and following your management plan, can help you better attend school or work daily, participate in sports just like anyone else, and avoid unplanned visits to the hospital emergency department or your provider's office.

B. Diabetes mellitus:

What is it?
Diabetes mellitus is a condition in which the blood contains too much glucose, a sugar. Over time, this damages blood vessels. The most common organs and areas of the body affected by diabetes are the heart, brain, eyes, kidneys, hands, and feet. Careful treatment of diabetes can help prevent these problems.

There are two types of diabetes:
Insulin dependent (type 1):
What causes it?
In insulin dependent diabetes, the blood sugar is high primarily because the body does not make enough insulin. Insulin is a hormone that allows the body to utilize glucose (sugar) for energy. Insulin dependent diabetes may be caused by antibodies damaging the pancreas, which makes insulin. The cause of this is not known.

What are the symptoms?
When insulin dependent diabetes is first discovered your blood sugar may be very high. The usual symptoms that result from this include: --feeling thirsty and hungry --frequent urination --weight loss --weakness and fatigue --blurry vision --wounds that will not heal --vaginal infections that return after being treated.

How is it treated?
There is no cure for insulin dependent diabetes, but with the proper treatment and a good management plan you can lead a healthy and active life. The goal of treatment is to keep your blood sugar levels as close to normal as possible. You do this by eating correctly, getting the right kind of exercise, and using insulin.

Non-insulin dependent (type 2):
What is it?
In non-insulin dependent diabetes, the blood sugar is high primarily because the body is not able to use the insulin it makes. Insulin is a hormone that allows the body to utilize glucose (sugar) for energy.

What causes it?
Non-insulin dependent diabetes occurs more often in certain families. The exact cause is not known. Even if you inherit the problem, you may not become diabetic. This type of diabetes does not appear until adulthood. Being overweight, eating poorly and not getting enough exercise can add to the risk to developing the disease.

What are the symptoms?
Non-insulin dependent diabetes usually develops slowly. The usual symptoms may be so mild that you have not noticed them. We often discover non-insulin dependent diabetes during a routine medical examination. The most common symptoms are increased thirst and a need to urinate frequently. Other less common symptoms include infections of the skin, gums, vagina or bladder; blurred vision, fatigue, and dry, itchy skin.

How is it treated?
There is no cure for non-insulin dependent diabetes, but with the proper treatment and a good management plan you can lead a healthy and active life. The goal of treatment is to keep your blood sugar levels as close to normal as possible. You do this by eating correctly, getting the right kind of exercise, and perhaps using medicines.

C. Hypertension (high blood pressure):

What is it?
Hypertension, also called high blood pressure, occurs when the pressure inside the body's arteries is too high. A person's blood pressure is generally considered too high if either the systolic pressure (upper number) is greater than 140, or the diastolic pressure (lower number) is greater than 90. It is normal for blood pressure to increase temporarily with exercise. With hypertension, blood pressure is elevated even at rest. If left untreated, overtime hypertension can cause damage to your body. The most common organs and areas of the body affected by uncontrolled hypertension are the blood vessels, heart, brain, eyes, and kidneys. With good control, many problems related to hypertension can be avoided.

What causes it?
For most people the cause of their hypertension is unknown. Often there is a family history of high blood pressure. Even though the disease is called hypertension, being nervous or stressed usually does not cause long term blood pressure elevation.

What are the symptoms?
Most people do not notice high blood pressure. Even though you cannot feel it, hypertension will damage your body if not treated. If your blood pressure is very high, you may have a headache, shortness of breath, chest pain, numbness or tingling in your hands and feet, or a nosebleed.

How is it treated?
The first step in treating hypertension is making some changes in your lifestyle. Losing weight, reducing salt and alcohol, and increasing your exercise may all help lower your blood pressure. You may also need to take medicines. Medicines cannot cure hypertension, but they can control it. You will need to monitor your blood pressure by taking it at home or by having it taken periodically. If you are prescribed medicines to control you blood pressure, continue to take your medication even if you blood pressure is normal. Your blood pressure is normal because of the medication. Do not make any changes in your medications without talking it over with your provider first.

D. Hypercholesterolemia (high cholesterol):

What is it?
Cholesterol is a fat made by the liver. The body uses cholesterol to make some vitamins and hormones. Too much cholesterol can be harmful. The body stores extra cholesterol as a coating inside your arteries. Too much cholesterol can block these blood vessels.

What causes it?
A common cause of high cholesterol is eating a diet high in fat. Cholesterol is found in food that comes from animals such as meat, eggs and dairy products. Other kinds of fat can raise your cholesterol levels because the liver turns these fats into cholesterol. A family history of having high cholesterol, heart disease or stroke can increase the chances of you having high cholesterol. Some diseases, such as diabetes, can increase your risk of high cholesterol. Some medications, such as estrogen, may also raise cholesterol.

What are the symptoms?
Having a high cholesterol level will not make you feel any different. Cholesterol gradually builds up inside the arteries making the arteries more and more narrow. This progressive narrowing of arteries does increase the risk of stroke and heart attack. If the artery which becomes narrowed supplies blood to your heart, you may have a heart attack. If the artery supplies blood to your brain, you may have a stroke.

How is it treated?
There are three main approaches to lowering your cholesterol: diet, exercise, and medication. You should eat a diet that is low in fat, avoiding foods such as fried foods, meats, pastries, eggs and bacon. You should eat more low fat foods such as fish, lean meats, vegetables and grains. We can help you plan a diet that allows you to eat many of your favorite foods but perhaps in smaller amounts. If you are overweight, you should lose weight. Exercise will help you do this and improve the health of your heart. Smoking and drinking alcohol can raise your cholesterol. We can help you stop smoking. If drinking is a problem, you need to deal with it. We can help.

If diet and exercise do not bring down your cholesterol to acceptable levels, there are medications that can help. In the last few years, many excellent research studies have proven these cholesterol lowering medications to be extremely safe when compared to the tremendous benefits that we now know their use results in. You will need to have your cholesterol checked regularly. It may take some time to bring it down to target levels. Once it is decided that you would benefit from medication to lower your cholesterol, you will probably need to take it for the rest of your life.

Weight reduction program:

Weight reduction programs are meant to help patients that suffer from "obesity" to lose weight.

Obesity :

What is it?
Obesity is considered to be a weight of 20% more than normal for a person, based on his or her height. Obesity is not just feeling fat or overweight. It is weighing more than is healthy for your body. It is the result of having too much fat on the body. Being obese can bring about other health problems and cause an earlier than normal death.

What causes it?
Food contains energy called calories. Your body needs calories to live. The main cause of obesity is taking in more calories than your body uses. The extra calories are stored in your body as fat. Many things can add to obesity. If other members of your family are obese, you also may tend to be obese. An inactive lifestyle can add to obesity. Eating a poor diet such as to many foods high in fat also contribute. Friends and family may pressure you to eat more than you should. Some people eat when they are lonely or sad.

What are the symptoms?
You may feel heavier than you should. You may have a difficult time getting around or you might get tired quickly when you exercise. You may not feel good about yourself and you may have difficulty sleeping. Other health problems such as high blood pressure, arthritis or diabetes may be affecting you.

How is it treated?
A comprehensive history, physical examination, laboratory tests and body measurements will help us decide on the best treatment for you. Dietary and lifestyle changes are the main treatment. You will be given guidelines about what and when to eat. Exercise will be needed to help you lose weight. A personalized exercise program will be designed to meet what you are able and like to do.

It is important to avoid fad diets. Skipping meals does not help either. If you skip meals, your body reacts by thinking it is being starved. This causes your body to slow down the amount of calories it uses, and may make you feel more hungry.

New and specific medications are now available to help patients lose weight. These medications are not meant or indicated for everyone. We will discuss the specific indications, benefits and risks of using these medications with you.

Obesity can bring about other health problems such as heart attacks, diabetes, high blood pressure, gall bladder disease, arthritis and gout. We will help you reduce the risk of developing these problems and/or treat them as well. Obesity also can cause social embarrassment and work discrimination.

Long term weight maintenance is the goal. Gaining and losing weight over and over is worse for your body than being slightly overweight. Your progress depends on maintaining your motivation. With the support from the people around you, and if you follow a healthy diet and exercise properly, you can live a healthy, productive life.

Smoking cessation program: (stop smoking)

What is it?
You may have been asked to quit smoking or you may have wanted to quit for some time. Smoking has been proven conclusively to have many adverse effects on your health, and the health of those around you. Lung disease, lung cancer, heart disease, stroke, ulcers, osteoporosis, premature skin wrinkling, yellowing of teeth, and many other conditions are strongly related to smoking. Many people delay quitting thinking it may be too hard, or they may quit and then go back to smoking. It is hard for most people to quit because smoking cigarettes is truly addictive. The nicotine in cigarettes causes a chemical addiction, and having gotten used to smoking in social, pleasurable, and relaxed situations causes a psychological addiction as well.

The addictive affect of nicotine occurs after you have had a cigarette. When you smoke, the nicotine is absorbed into your blood stream and your body develops an amount or level of nicotine that it becomes used to. Without a cigarette for a few hours, the nicotine level drops, causing the person to feel nervous and edgy, like they need a smoke. Having another smoke brings up the level of nicotine, relieving this nervousness. Smoking will not relieve a nervous feeling caused by real day-to-day problems.

What causes it?
Many smokers begin early in life, some before age 18. Smoking has been socially acceptable for some time. Advertisements show young, healthy people playing sports, enjoying the outdoors and entertainment while they smoke. Teenagers often begin smoking with friends. A high percentage of teen smokers come from homes where one or both parents smoke. Education about the health affects of smoking do not usually prevent teens from beginning.

What are the symptoms?
Due to nicotine's chemical addiction, you may have withdrawal symptoms for 3 to 10 days after quitting. You may feel edgy and nervous. These symptoms will fade with time depending on how strong your addiction is. You may notice an increase in your cough. This is how your body begins to rid itself of the nicotine and carbon monoxide. The healing begins the first day you quit.

Due to nicotine's psychological addiction, there may be times after the initial withdrawal that you feel like lighting up a cigarette. Social situations or times that you normally would have smoked can feel unnatural without a cigarette. The first week can be the hardest and is most often when a relapse can occur. Relapses occur because of the strength of the addictions and a possible weakness in the patient's motivation to quit and/or in the smoke-ending program.

How is it treated?
Trying to quit on your own, or quitting secretly, has in most studies proven to not work very well. You will benefit greatly from the support of friends, family, and us. There are also many classes and groups to help you quit smoking. The most important thing to help you quit is your motivation and commitment.

For any attempt to quit smoking, you will find the following general advice helpful:

• List your reasons for quitting. Write them down so you can frequently refer to the list during your attempt/program.
• Pick a date to quit.
• Let family, friends, and co-workers know you are quitting.
• Take quitting a day at a time. Stay focused on not smoking each day.
• You will need to change some of your habits.
• Times that you normally smoked or places that you usually had a cigarette may be more difficult for you.
• If you smoked after eating, get up from the table as soon as you finish you meal.
• You may want to take a walk in place of smoking.
• Change anything commonly connected with smoking for you, such as removing all ashtrays and sitting in a different chair.
• Choose activities that make it difficult to smoke and perform at the same time, such as gardening, swimming, or washing a car.
• Think positively about your new lifestyle and believe that you can make it.
• When the urge to smoke strikes, know that you can make it through that urge. Urges usually only last a few minutes.

Our smoking cessation program has proven very effective because it is individualized to each patient's needs. Mentally and physically preparing you to quit is a very important part of our program. Periodic follow-up visits are instrumental in helping us help you sustain your motivation, as well as insuring that our individualized plan for you is working. Smoking cessation aides are available to help you. Nicotine replacement therapies, like patches or gum, are available to help reduce the withdrawal symptoms that can result from the chemical addiction. The oral medication bupropion, brand named Zyban, is available to reduce the "cravings" that can result from the psychological addiction. The use of these aides are individually considered, recommended and properly taken advantage of to maximize your chance for success.

Traveler's immunization / services program:

What is it?
As the world becomes a smaller place, the chances of our coming into contact with a contagious disease, to which we have not previously been exposed, increase. Catching malaria or meningitis can really mess up your day, not to mention your long awaited and hard earned travel plans. Many parts of the world have their unique organisms, and the respective diseases that they cause, just waiting for the unsuspecting and unprotected. Verdugo Hills Medical Associates is a licensed travel immunization and yellow fever vaccination administration site.

What do we offer?
We offer an extensive line of travel services including:

1. Travel consultation: a provider will review your present and past travel and medical history, as well as your specific itinerary, with you. Your provider will then look up, via our on-line CDC access, the most current health related information and recommendations as they relate to your specific travel plans. This allows us to offer you the best chance of a more pleasant travel experience .

2. Travel immunizations: travel immunizations can be classified as those that are recommended and those that are required.

A. Recommended immunizations are for diseases that the Center for Disease Control, or we, know you will be sufficiently exposed to during your specific travel route, but that are not required to get in or out of the countries you are visiting.

B. Required immunizations are for diseases that the Center for Disease Control tells us you are required to have in order to either get in or out of one or more of the countries you will be visiting.

C. Our comprehensive supply of travel immunizations consists of such vaccines as: yellow fever, cholera, typhoid, meningitis, Japanese encephalitis, hepatitis A and B, tetanus, diphtheria, polio.

D. You will receive an official international traveler's vaccination certificate as proof of your having received your vaccinations.

3. Prescribed medications for the prevention of specific diseases such as malaria, traveler's diarrhea etc.

4. Printed copy of CDC approved recommendations for anyone traveling to the countries you will be visiting.

How can I access it?
We offer our travel services by appointment, in our primary care suite, or on a walk-in basis in our urgent care suite. Special arrangements can be made for providing travel immunization services off-site for large groups.

When should I start?
We strongly recommend that you make arrangements to come in for a traveler's consultation as soon as you know when and where you are going. Any immunization requires some time between administration and when the patient is actually protected. Many immunizations require an initial dose followed up by a booster, necessitating a minimum period of time between them. The sooner you get started, and the more time we have to adequately protect you, the better are your chances for desirable results.