Board Certification: Family Practice

Recently, we have noticed an increasing number of sports related injuries at our clinic, most of which happened to teenagers active in different team sports, such as basketball, baseball and football.  An increase in pediatric sporting events has been attributed to the increase in pediatric sporting injuries that we witness. There are nearly 3 million emergency department visits annually for pediatric-related sports injuries and that number is still on the rise.

One of the major challenges that we face in the diagnosis of acute fractures in kids is the presence of growth plates, which can mimic subtle hairline fractures.  Salter Harris fractures refer to the acute fractures that involve the growth plates in skeletally young patients.  Salter-Harris fractures are classified into five different types. Type I fractures are fractures through the growth plate. On radiographs, a fracture usually will not be seen. It is common to see some widening of the affected bone. Type II fractures involve one side of the growth plate. Type III fractures involve the other side of the growth plate. Type IV fractures involve both sides of the growth plate.  Type V fractures are due to a compression injury of the gap between the growth plates. There will often be an absence of the normal gap of the growth plates on radiographs for Type V fractures.

The goal in treating Salter-Harris fractures is to realign the anatomic growth plate so the bone can keep growing. The risk of bone growth failure increases with Salter-Harris classification. Types I and II fractures usually can be treated with immobilization (placing a cast or brace). In instances where the fracture is displaced, closed reduction (manipulation) may be necessary, followed by immobilization with a cast or brace. Rarely is open surgery needed. Types III, IV, and V fractures usually require orthopedic intervention to avoid growth problems. These patients must be followed long-term to assess for growth problems. It is important in all sport injuries where a potential fracture has occurred to see a medical professional and consider X rays.

By Dr. Lu

Board Certification: Internal Medicine

The other day I had a patient with a vague onset of worsening shoulder pain. She had no complaints of any injuries, but for some unknown reason her shoulder was gradually becoming so tense and uncomfortable that it was difficult for her to do the smallest tasks with her dominant right arm. The pain even began to interrupt her sleep, and it forced her to take notice and do something about it.

One of the most satisfying things about being a physician is the ability to help patients help themselves. With a careful history of her daily activities at work and at home, it soon became apparent that some of her activities were new and coincided with the onset of her vague discomfort months ago. She had an “aha” moment, and could not believe that such small tasks that seemed so effortless when she began the new activities were now unbearably difficult to complete at the same pace and frequency.

We discovered together that she had a Repetitive Motion Injury, and that she would need to modify her daily activities to allow that shoulder to heal. I educated her on how the healing process simply took time as the slightly torn or inflamed muscles, tendons and ligaments in the area slowly mended the fibers by themselves. The amazing human body! If she just took care not to further injure her shoulder for the next 6 weeks or so, then she would regain her full function and the pain would resolve.

I reviewed some simple range of motion exercises for her to start right away that did not stress the shoulder and would keep it fluid. I prescribed anti inflammatory medications for pain, and scaled back her offending activities at work and at home. We planned regular physical therapy sessions 3 times a week for an initial trial of 2 weeks. I explained to her that the physical therapist would aid the healing process by teaching her the postural mechanics of the shoulder and how she can modify her activity to avoid hurting the injured areas in the future when she returned to full activity levels. The 45 minute physical therapy sessions would also include many different modalities such as heat to warm up before beginning the therapy, electric stimulation and/or ultrasound to aid circulation, massage to address any scar tissue buildup, very careful and specific light strengthening exercises, and finally ice to decrease inflammation.

I also reviewed some radiographs of her shoulder, and explained that although these pictures showed that the bony aspects of her joint were fine, it did not rule out other more serious injuries to the tendons, ligaments, cartilage, and muscles. If the shoulder became more painful and not less painful with physical therapy, then we would need to perform an MRI of her shoulder to rule out soft tissue injuries that might not heal by themselves, and might require surgery. I assured her that her exam indicated that this was not likely, but that pain was her guide, and she should monitor herself carefully.

Repetitive Motion Injuries are so subtle, and yet so debilitating. They can affect any body part that is used repetitively for long periods of time. I often see repetitive injuries and they can occur in any joints such as the wrist/elbow in tennis, the hand/wrist in computer keyboard use, the shoulder/neck in computer mouse use, the hips/knees/ankles/feet in running or operating heavy vehicles, and the back in any labor intensive activities. Cross training and strengthening throughout our lives minimizes the risk of any repetitive injuries, and as always, the level of prevention is a direct result of your level of preparation. An ounce of prevention is worth a pound of cure.

This case illustrates very well that the most important part of any doctor visit is the history. It takes time to take a complete history, and listening carefully is my priority. Being a good listener builds a strong foundation for diagnosing and treating any injury or illness properly. Communication is especially key in discovering the cause of a Repetitive Motion Injury and then implementing a treatment plan suitable to the patient’s needs. I never forget that injuries that limit our physical world are also very mentally draining and depressing to anyone. I address the patient’s disappointments and sadness, and aim to elevate their outlook with enlightening education and guidance through the difficult rehabilitation period.

My patient ended our first visit with the most gratifying “doorknob” comment. As I was leaving the room, she asked me if she could address one more thing. I turned around, closed the door again, and replied of course! She then told me that she had had the most pleasant experience at Marque Urgent Care, and that she wanted me to know that every single person she encountered at our facility had been “genuine” and “kind” and she really felt welcome here even on her first visit. She reported that it was the only time in an urgent care walk-in setting where she had experienced complete and undivided attention at all points of her care. She thanked me and our entire staff for our excellent listening skills, and obvious compassion. I thanked her so much for the positive feedback. Once again, I was reminded that I was blessed to be a part of the staff at Marque Urgent Care and that our care was making a difference in our community.

Board Certification: Family Practice

We have had a few patients test positive for the influenza (flu) virus this past week. The flu is a virus in the nose, throat and lungs. The flu is stronger than a common cold and comes on real quick. Chills, fever, headache, sore throat, runny and stuffy nose, body aches, muscle aches, weakness and fatigue are common symptoms. The flu usually resolves in a few days and we support the symptoms (Tylenol or ibuprofen for fever, clear fluids, rest). Sometimes the flu can precipitate infections such as bronchitis, pneumonia, ear infections and dehydration which may require medical treatment. The flu can be worse in young or older people, and those with other medical conditions such as asthma or diabetes. The flu is contagious so stay away from others, wash your hands often, don’t touch your eyes, nose or mouth, and get some rest. Sometimes a medicine called Tamiflu (prescribed by a healthcare professional) can help shorten the duration of symptoms. If you want to be tested for the flu, see your doctor.

Board Certification: Family Practice

Within the past several weeks, we have noticed increased number of patients coming to our clinic with acute gastroenteritis, which is also commonly known as “stomach flu” or “stomach bug”.   Some of the most common symptoms include diarrhea, nausea, vomiting, generalized weakness and stomach pain.  Acute gastroenteritis is especially common among children, though it is certainly possible for adults to suffer from it as well. While most cases of gastroenteritis last a few days, acute gastroenteritis can last for weeks and months if the underlying causes are not treated properly.

Bacteria and Viruses remain the top two likely causes of acute gastroenteritis.  There are other pathogens, such as parasites, that can cause acute gastroenteritis, but not typically seen within the US.  If you have recently traveled outside the US, you should definitely disclose the relevant information to your doctor. 

The initial treatment for acute gastroenteritis is always FLUID, FLUID and more FLUID.  With the frequent diarrhea, you can lose a lot of fluid, and result in dehydration, which is especially true for children.  When you do not improve from stomach flu symptoms within two to three days from the onset of symptoms, it is a good idea to check in with your doctor. Some types of acute gastroenteritis may not resolve without antibiotic treatment, especially when bacteria or exposure to parasites are the cause.  The diagnosis of the specific cause for the acute gastroenteritis is typically made via the analysis of analyzing a stool sample.

Board Certification: Family Practice

Because of the Santa Ana winds a few weeks ago I have seen a lot of patients come to the urgent care with sinus infections. Sinus infections are one of the most common reasons people seek medical care. Each year in the United States sinusitis affects 1 in 7 adults.

A sinus infection is the swelling of the interlining of your sinuses most likely caused by a virus like a common cold. When you get a cold, mucus in your sinuses becomes thick and sticky and is more difficult to drain. Bacteria can grow in the mucus and lead to an infection. Sinus infections are most commonly caused from allergies, deviated septum or change in pressure (flying). Symptoms include pressure or pain in your face or forehead, congestion, cough (often worse at night), sore throat, headache, and fever. Usually sinus infections resolve on their own and we treat the symptoms. Netty pots or nasal saline rinses help loosen the mucus so it drains better. Drinking lots of water and taking mucinex helps thin the mucus. Over the counter decongestions and pain medicines may alleviate the congestion. Avoid allergy medicines which may cause mucus to become thicker. If your sinus symptoms last more than 7 days or are getting worse you may need an antibiotic or a prescription for a nasal steroid. Go see your doctor if you have a fever above 101, if you have a bad headache, vision changes or swelling around your eyes.

Board Certification: Family Practice

Nearly 26 million Americans are living with diabetes, and another 79 million are at high risk for developing type 2 diabetes. However, most Americans don’t consider diabetes a serious matter. Recent numbers by the Centers for Disease Control and Prevention paint a desperate situation of where we are at, and where we are headed:

• Every 17 seconds, someone is diagnosed with diabetes.
• Diabetes kills more people each year than breast cancer and AIDS combined.
• Recent estimates project that as many as 1 in 3 American adults will have diabetes in 2050 unless we take steps to Stop Diabetes.

What is Diabetes?

Diabetes occurs when a person’s body doesn’t make enough of the hormone insulin or can’t use insulin properly. Type 1 diabetes occurs when your body’s pancreas doesn’t produce any insulin. Type 2 diabetes occurs when the pancreas either doesn’t produce enough insulin or your body’s cells ignore the insulin. About 95% of people who are diagnosed with diabetes have type 2 diabetes.

What are the symptoms of diabetes?

Most people have very few symptoms during the early stages of diabetes, so you may not know you have the disease. Damage may already be happening to your eyes, kidneys and cardiovascular system even before you notice symptoms. Common symptoms include:

• Extreme thirst
• Frequent urination
• Unexplained weight loss
• Fatigue or drowsiness
• Blurry vision
• Slow-healing wounds, sores or bruises
• Dry, itchy skin
• Tingling or numbness in the hands or feet
• Frequent or recurring skin, gum, bladder or vaginal yeast infections

Call your doctor if:

• You start feeling very thirsty and are urinating more often than usual.
• You lose a significant amount of weight.
• You start breathing deeper and faster.
• Your breath smells like nail polish remover.
• You start to tremble, feel weak and drowsy, and then feel confused or dizzy, or your vision becomes blurred.
• You feel uncoordinated.
• You have a sore, blister or wound that won’t heal.

Why is it important to prevent, diagnose, and treat diabetes?Untreated diabetes causes blood sugar levels to rise. This can lead to a number of serious problems, including:

• Eye damage that can cause blindness
• Kidney failure
• Heart attacks
• Nerve and blood vessel damage that can lead to the loss of toes or feet
• Problems with gums, including tooth loss

The longer the body is exposed to high blood sugar levels, the greater the risk that problems will occur. That’s why diagnosing diabetes as early as possible is important. Treating diabetes can minimize, delay and, in some cases, even prevent the problems that diabetes can cause.

How is diabetes diagnosed?

Your doctor may test for diabetes if he or she suspects you are at risk. To check for diabetes, your doctor may request the following tests:

• Random blood sugar test. This test measures the level of glucose in your blood at any time of day, regardless of when you last ate.
• Fasting blood sugar test. This test is usually done in the morning, after an 8-hour fast.
• Oral glucose tolerance test. During this test, you will drink a beverage containing 75 grams of glucose dissolved in water.

If you think you have diabetes or would like to be tested for diabetes, call or visit your doctor.

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Our staff of established, Board Certified Physicians are available to see you during extended hours morning, afternoon or evening.  As a Better Business Bureau Accredited Business, we strive to be the best urgent care facility in the area.

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