This time we actually beat our previous score, getting 110 out of a possible 110. To be recognized, a practice has to show sugar and blood pressure control, diet and medication reviews, urine and cholesterol checks and pass on a patient questionnaire.

As always, this is a team effort – we succeeded because of Kathy Berkowitz, RD MS CDN CDE, Sondra Goldstein, RN, Pamela Cowles, RN, Elana Eiler, and our lab crew Jean Narod, Catherine DeMaio and Terri Bissonette.

And special thanks to our patients, who did the diets, took the pills and/ or the shots, checked their sugars and came for their visits – and made us look good!

And From Westchester Spotlight: It’s not the same as the ADA/ NCQA, but it’s always nice to be thought well of by your peers. We were pleased to be one of the 6 internists voted "best" by other physicians in Westchester.

Weight Loss Hope? An intriguing report from the Denver Endocrine Society meeting comes from an early trial in Maryland. Drs R C Shoemaker and AR Cobitz found that a combination of an amylose-free diet and rosiglitazone (Avandia) produced a weight loss of 1.5-1.7 lbs per week over a 12 week period in a group of 100 patients. High amylose foods include long-grain rice.

Those of you who’ve been in the office lately have watched us toiling hard to get you into the new computer prescription system. The prescriptions are part of a full electronic record system, Practice Partner, that will eventually be your main "chart." Right now, we’re trying to get all medications into the computers. The prescriptions written on the system will now be much more legible. And we’re giving everyone a list of their meds and how to take them - in English! Soon, we plan to be able to fax them out to your pharmacy. Please bear with us!

RNs Sandy Goldstein & Pam Cowles Enter Prescriptions

Another Winner: The latest winner of 2 Hollywood Video rentals is Alice Rees. She got her colon cancer (guaiac) cards in promptly. Remember: everyone who does this test is a winner in the fight to reduce this preventable cancer!

1) Please do not leave a pharmacy prescription number for your medication – we need the drug’s name in order to okay refills.

2) Messages are removed from the prescription line at the stated times, but if it is a busy day, we won’t get to review your chart and medicines until the lunch hour or when we finish with patients for the day. So if you want to pick up your medication in the morning, please leave your request on the system by noon the previous day.

3) Sometimes drug benefit firms request a change to a similar drug – if you do NOT wish to be switched, please say so when you call.

4) Once again, our dedicated prescription number - available 24 hours a day, 7 days a week is:

(914) 962-3182

Please remember

• Your name & phone
• The medication name, brand or generic, size (mg), how often you take it and how many you need
• Your pharmacy name and number

If you become ill and need an urgent appointment, call – even if the office is closed. Leave your request on our answering machine. We check these messages when we come in and will schedule appointments BEFORE we officially open and start answering the phones. It’s an easy way to "go to the head of the line."

Don’t Pay the Pennies!

As many of you know, we like to help everyone remember when they’re due for various preventive services. We use our billing system for this, and the only way it can do so is if there’s a "charge." So we make it $0.01. This generates your reminders and newsletter label. So to continue getting your newsletter and reminders for mammograms, Pap smears, eye exams etc. PLEASE DON’T PAY THAT PENNY!!!

Diabetes Progress: Exciting developments in diabetes research were detailed at November’s Boston meeting on Diabetes & Endocrinology held by Harvard’s famed Joslin Clinic. Progress on "manufacturing" new insulin-secreting Beta islet cells was reviewed by Joslin’s Dr. Myra Lipes. And islet-cell transplants were reviewed by Joslin’s Dr Gordon Weir. Transplants have been done in Edmonton Canada in 12 type 1 diabetics. Five are completely nor-mal; 4 have impaired glucose tolerance and 3 have mild diabetes. This will not be a long-term solution because each transplant requires 2-4 pancreases, and only 2-5000 become available annually in the U.S. There are about 35,000 new type 1 cases yearly and 350,000 type 2.

Another Winner: Albina Lupinacci wins 2 Hollywood Video rentals. She got her colon cards in promptly -- remember, everyone who does helps prevent colon cancer!

Biowar: Anthrax:

At this writing reports indicate a low, but not zero risk of this deadly ancient bacterial disease. Most patients have had the less dangerous skin infection, and have been exposed to spores sent in the mail. But anthrax lung disease in a NY Eye & Ear worker and in a 94 year old Connecticut woman is unexplained at this time, and preparation for additional patients is prudent.

What is Anthrax? It is a bacterial illness caused by exposure to the naturally occurring spores – either a skin pustule that turns black, or a respiratory illness that mimics influenza. There is also an intestinal form, which hasn’t been seen at this writing.

Who is at Risk? The highest risk appears to be in postal workers near government or major media offices. Next highest risk is in those who work in such offices, particularly those who open the mail.

What are the Symptoms? Cough, fever, chills and muscle aches start 3 days to 6 weeks after exposure to the spores. Patients are sick for about 2-3 days, then appear to be getting better for 1-2 days. Then they "crash" with severe damage to the lungs, "air hunger" and a death rate of 80%+.

What is the Treatment? Ciprofloxin (Cipro) is the only currently licensed antibiotic. Penicillin, doxycycline (Doryx, etc), Avelox and Tequin also work on the strains seen so far. Speed is of the essence in starting treatment!

What Can be Done?

First, get your flu shot! The best way to decide on anthrax vs. flu is to avoid all such symptoms, and since flu is so frequent, and the vaccine so effective, get it!

For serious respiratory illness, we’ll see you right away and assess your risk. We have the ability to test for anthrax and for flu. But the most important test is how you do! We’ll ask you to call us the following days, and we’ll carefully track your progress. We are convinced that the problems seen so far would largely have been avoided with follow-up. IF antibiotics are needed, it’ll be for 60 days.

Is Anthrax Contagious? NO!! It cannot be spread person to person.

Is There a Vaccine? Yes, but it’s not available for civilian use. And none has been made since 1998.

This would be a whole different level of problem. For one thing, it is highly contagious person to person. The attack rate is about 90% just by being in the same room! The disease was last seen in 1977. One of the final patients was in a German hospital; he was promptly isolated, but still infected 11 other people on 3 floors! There’s no known effective treatment - only an untested antiviral medicine, cidofovir (Vistide). Those who were vaccinated over 20 years ago may have immunity, but may NOT. There are some 12-15 million doses of vaccine in the country. They won’t be used unless definite cases are seen, and then they will go to military and public safety people first. If smallpox starts and you have a rash, DO NOT come in! We’ll send someone to you!

Botulism: the toxin of this spore forming germ can cause muscle paralysis, including breathing failure. But the germ is treatable with antibiotics, and there is an antitoxin.

Plague: is another treatable germ; but it CAN be spread from person to person. In the most serious form a pneumonia develops after 2-4 days. A vaccine is being developed.

Tularemia: is another treatable germ that causes a flu-like illness, then pneumonia. It can NOT be carried person to person. Untreated, 35% die, but treatment is generally effective.

1) Blood pressure: Many of our patients have heard the "quiz" – what’s the most important thing you can do to live better and longer with the disease? And you now know the answer: control your blood pressure!!

Goal blood pressure for those with diabetes is 130/80 or less. This goal, from the National Kidney Foundation, is supported by a lot of data, according to Joslin kidney specialist Dr. Richard J. Solomon. At that blood pressure, annual loss of kidney function approaches that of non-diabetics. And the huge United Kingdom Prospective Diabetes Study (UKPDS) showed that achieving a blood pressure of 142/82 instead of 154/87 cut the heart attack and stroke rate by 44% over 9 years. Tighter sugar control also helped, but not nearly as much – those who got a "long-range" sugar Hemoglobin A-1C ("Glyco") test of 7.0% had a 16% lower rate than those who got 7.9%.

And it can take several drugs to get to the goal – 3 drugs were used in the UKPDS and they still didn’t get everyone to the new goal of 130/80! Uncontrolled hypertensives lose 15 times the kidney function of normals annually. If your BP is 140/90, you’ll still have over 3X normal loss!!

Sadly, of 75,000 U.S. patients who go on to dialysis or kidney transplant every year, 75% are diabetic, hypertensive, or both!

2) Cholesterol: What’s the

second most important thing you can do for better diabetic health? Right again, control your cholesterol!!

Goal LDL ("Lousy Darn Cholesterol" or low density lipo-protein) is 100 or less. And the goal "good" HDL is 45 or more.

This is also the goal for people with known heart attack (myocardial infarction or MI) or other blood vessel disease. It turns out that diabetics have a higher risk of heart attack than non-diabetics who have already had an MI! So reports Lahey Clinic cardiologist Dr. Richard W. Nesto. In the East-West study, diabetics had a 20.2% heart attack risk over 7 years, compared to 18.8% in non-diabetics with previous MI. Even those with "prediabetes" or impaired glucose tolerance (some 20 million in the U.S.) are at risk. Diabetics have less warning symptoms of and poorer survival after MI.

3) And, Yes, Sugar Control is Also Important! The UKPDS showed that better sugar control (lower hemoglobin A-1C) reduced all complications: heart attack, eye disease, and kidney damage. A level of 6% or less (which is what half of our type 2 patients achieve) reduced heart attacks and related events to normal in that study. And intensive therapy did decrease the heart attack rate 14%. Better sugar control also reduced kidney damage by as much as 25% in the UKPDS.

• Stop Smoking! That cuts heart events by 50-70%!
• Regular Exercise can drop rates by 45%.
• A Healthy Weight maintaining it reduces rates by 35-55%
• Mild to Moderate Alcohol intake, in those who already drink, can reduce event rates by 20-40%.
• Aspirin: 650 mg daily reduced heart attacks 17% in a group of diabetics who had never had an MI (primary prevention) and 32% in another group who’d already had an event (secondary prevention); in that group stroke was reduced 27% and heart death 15%.
• And Don’t Forget Feet! Check them frequently (and we will, too!). Your feet help tell your overall vascular and nerve health.