Internal Medicine and Primary Care Specialist

Tests and Services

Internal Medicine and Primary Care Specialists performs various tests in our office. The following list comprises the tests that are performed on site and the necessary preparations when needed.

Allergy Testing

Allergy tests are used to determine the specific substances that cause an allergic reaction in an individual. They may also be used to determine if a group of symptoms is a true allergic reaction, which involves antibodies and histamine release.

Before any allergy testing, the health care provider will ask for a very detailed medical history. This may include questions about such things as illnesses, emotional and social conditions, work, entertainment, lifestyle, foods, and eating habits.

If skin testing will be performed, it is essential that you not take antihistamines and decongestants including over-the-counter products prior to the test. This may lead to a false-negative result, falsely reassuring you that a substance is unlikely to cause a severe allergic reaction. The antihistamines and decongestants will need to be stopped 48 hours prior to skin testing. Your doctor will tell you which other medicines to avoid and when to stop taking them before the testing

Blood and Urine Analysis

Blood tests and urine test are performed to act as an aid in diagnosing a suspected disease or condition. They are also used to monitor existing conditions such as diabetes, hypertension and other illnesses. We also do Coumadin monitoring using the latest techniques via finger stick in our office.

For some blood tests it is necessary for the patient to fast for a minimum of ten hours prior to the venipuncture or blood draw. These include full lipid analysis and cholesterol testing.

Bone Density

A bone density test, or scan, is designed to check for osteoporosis, a disease that occurs when the bones become thin and weak. A bone density test measures the strength and density of bones at various sites in the body. It can detect osteoporosis before a fracture occurs, predict your chances of fractures and determine the rate of bone loss. This test also can monitor the effects of treatment if the test is conducted at intervals of a year or more. Osteoporosis happens when the bones lose calcium and other minerals that keep them strong. Osteoporosis begins after menopause in many women, and worsens after age 65, often resulting in serious fractures. These fractures may not only bring disability, but may affect longevity. As many as one-fourth of women who fracture their hip after age 50 die within one year. Other conditions should be screened for osteoporosis including steroid use, thyroid disease and others

No preparation is necessary prior to taking this test.

CT Scan

Computed tomography (CT) an imaging method that uses x-rays to create cross-sectional pictures of the body. CT scans differ from conventional x ray by collecting x rays that have passed through the body (those not absorbed by tissue) with an electronic detector mounted on a rotating frame rather than on film.

Certain exams require a special dye, called contrast, to be delivered into the body before the test starts. Contrast can highlight specific areas inside the body, which creates a clearer image.

Contrast may be delivered using an intravenous line (IV) that is placed in a vein in your hand or forearm. Contrast may also be given as a liquid that you drink before the scan. (When you actually drink the contrast depends on the type of exam being done.) The contrast liquid may taste chalky, although some are flavored to make it taste a little better. The contrast eventually passes out of your body through your stools. Some tests require taking a medicine to slow your heart rate or pulse to improve the images. With the “64 slice” latest technology, we can view coronary arteries of the heart often substituting more invasive testing.

EKG

Electromyography is a test that assesses the health of the muscles and the nerves controlling the muscles.

An electrocardiogram (ECG) is a test that records the electrical activity of the heart. ECG is used to measure the rate and regularity of heartbeats as well as the size and position of the chambers, the presence of any damage to the heart, and the effects of drugs or devices used to regulate the heart (such as a pacemaker).

There are no restrictions for food or fluids. However, ingestion of cold water immediately before an ECG may produce changes in one of the waveforms recorded (the T wave). Exercise (such as climbing stairs) immediately before an ECG may significantly increase your heart rate. We do request that you use no body lotions, oil or powder on the day of the test.

EMG

Electromyography (EMG) is an electrical recording of muscle activity that aids in the diagnosis of neuromuscular disease, which affects muscle and peripheral nerves. EMG results can help determine whether symptoms are due to a muscle disease or a neurological disorder, and, when combined with clinical findings, usually allow a confident diagnosis. Symptoms for which EMG may be useful include atrophy, stiffness, weakness, numbness, cramping and pain and diabetic neuropathy screening.

No special preparation is necessary prior to having this test.

Flexible Sigmoidoscope

Sigmoidoscopy is an internal examination of the lower large bowel (colon), using an instrument called a sigmoidoscope. The sigmoidoscope is a small camera attached to a flexible tube. It is inserted into the colon to examine the rectum, and the sigmoid and descending portions of the colon. Flexible sigmoidoscopies are commonly used to evaluate gastrointestinal symptoms, such as abdominal pain, rectal bleeding, or changes in bowel habits. They are also performed to screen people over age 40 for colon and rectal cancer.

Have only clear liquids for dinner and after, the night before your procedure. Your bowel must be cleansed in order for sigmoidoscopy to be successful. You will receive 2 enemas before the procedure since the rectum and lower intestine must be empty so that the intestinal walls can be seen. One should be before bed the night before the procedure and the second one should be the morning when you awaken. You will need to try to hold the enema solution for at least 5 minutes before releasing it.

Glaucoma Screening

Glaucoma is a disease of the eye in which damage is caused by elevated pressure within the eye. The incidence in persons over the age of 40 is about 0.5%, making glaucoma one of the most common and serious eye disorders

A screening test is used to determine if pressure within the eye has begun to develop in order to be able to treat the condition at an early stage.

There is no special preparation needed for this test.

Hearing Test

An audiology exam tests your ability to hear sounds. Sounds vary according to the intensity (volume or loudness) and the tone (the speed of sound wave vibrations).

Hearing occurs when sound waves are conducted to the nerves of the inner ear and from there to the brain. Sound waves can travel to the inner ear by air conduction (through the ear canal, eardrum, and bones of the middle ear) or bone conduction (through the bones around and behind the ear). Hearing tests are indicated after hear injury, noise trauma, ringing or tinnitus, dizziness or hearing loss.

There is no special preparation needed for this test.

Holter and Event Monitor

A Holter monitor is a small piece of equipment worn by the patient that continuously records the heart's rhythms. The monitor is usually worn for 24 hours during normal activity. An Event Monitor records the same information but is worn for a period of three weeks to a month. In both tests, the patient should note when there are periods of increased stress or activity and will be asked to keep a diary. Indications include dizziness, palpitations, chest pain or blackouts.

There is no special preparation for the test. Your doctor will start the monitor. You'll be told how to replace the electrodes, should they fall off or become loose.

Mammogram

A mammogram is an x-ray picture of the breasts. It is used to find tumors and to help tell the difference between non-cancerous (benign) and cancerous (malignant) growth. Mammography is performed to screen healthy women for signs of breast cancer. It is also used to evaluate a woman who has symptoms of a breast disease, such as a lump, nipple discharge, breast pain, dimpling of the skin on the breast, or retraction of the nipple.

Do not wear deodorant, perfume, powders, or ointments under the arms or on the breasts on the day of the mammogram. These substances may obscure the images. Remove all jewelry from your neck. Notify your health care provider and/or mammography technician if you are pregnant or breast-feeding.

Pulmonary Function

A Pulmonary Function Test is the measurement of lung function, specifically the measurement of the amount (volume) and speed (flow) of air that can be inhaled and exhaled. This test is an important tool used for assessing lung diseases such as asthma, cystic fibrosis, emphysema, and COPD.

There is no special preparation necessary for this test to be performed.

Stress Test

An exercise stress test is a screening tool to test the effect of exercise on your heart. The test gives a general sense of how healthy your heart is. .It is graded test to measure an individual's heart rate and oxygen intake while undergoing strenuous physical exercise, as on a treadmill.

The patient walks on an exercise machine while the electrical activity of their heart is measured with an electrocardiogram (ECG), and blood pressure readings are taken. This will measure the heart's reaction to your body's increased need for oxygen. The test is often done in conjunction with a nuclear scan of the heart which requires an injection and time under the camera before and after exercise. Occasionally a medication is injected for those who cannot adequately walk on the treadmill. This can give some patients a headache. Let the technician know if this occurs so that it can readily be treated.

On the day of the exam prior to the test, the patient may not drink anything that contains caffeine and they may not smoke. No bath oils, powder or lotion should be worn and the patient should wear comfortable clothes and walking shoes. It is also important to bring a list of all medications that are being taken.

Ultrasound

An ultrasound uses high-frequency sound waves. Ultrasound waves can be bounced off of tissues using special devices. The echoes are then converted into a picture called a sonogram. Ultrasound imaging, referred to as ultrasonography, allows physicians and patients to get an inside view of soft tissues and body cavities, without using invasive techniques.

Preparation for kidney, thyroid, breast, extremities, aorta or carotid ultrasound is not necessary.

Abdomen: Nothing to eat or drink 8 hours prior to exam. You can drink water and take your normal medications.
Pelvic: Drink 32 ounces of liquid. Complete drinking the liquid 1 hour prior to exam. DO NOT URINATE UNTIL AFTER THE EXAM IS COMPLETE.
Abdomen & Pelvic: Do not eat 8 hours prior to the exam and you MUST finish drinking 32 ounces of water prior to the exam.

Xray

An X-ray examination uses electromagnetic radiation to make images of your bones and internal organs. An X-ray machine sends individual x-ray particles, called photons. These particles pass through the body. A computer or special film is used to record the images that are created. Simply put, an X-ray allows your doctor to take pictures of the inside of your body.

One of the oldest forms of medical imaging, X-ray is a painless medical test that can help your doctor in diagnosis and treatment — even in emergency situations. It's a fast, easy and safe way for your doctor to view and assess conditions ranging from broken bones to pneumonia to cancer. Many different types of X-rays, such as bone or chest X-rays, exist. The type your doctor uses depends on what part of your body is being examined and for what purpose

There is no special preparation necessary for this test to be performed.

Ancillary Services

Acupuncture

Acupuncture is a Chinese medical practice where body is pierced by fine needles at specific anatomic points (called acupoints or acupuncture points) for therapeutic purposes, to relieve pain or stress or produce regional anesthesia. Acupuncture stimulates the nervous system, blood circulation, blood pressure, secretion of gastric acids, rhythm and stroke volume of heart, and production of red and white blood cells. It is also shown to stimulate the release of a variety of hormones in body to that help overcome stress and injuries. Acupuncture is best known for the control of pain. However, acupuncture can treat a wide variety of common and uncommon disorders.

Bruce Stein, D.O.M. is a certified Acupuncturist with our practice.

Nutritional Counseling

Nutritional deficiencies rob the body of its own natural resources and can manifest as symptoms such as fatigue, mood swings and insomnia. Many times, these symptoms are taken for granted as a natural sign of aging. When left unchecked, however, these same deficiencies can contribute to diseases such as arteriosclerosis, high blood pressure, diabetes and arthritis.

Nutrition-related conditions we address include diabetes, blood lipids (cholesterol and triglycerides), hypertension, kidney disease before dialysis, polycystic ovarian syndrome, hypoglycemia, gluten intolerance (celiac disease), irritable bowel syndrome, gastro esophageal reflux disease, and obesity.

Medical nutrition therapy is provided by appointment only,

Suboxone (Substance Abuse)

SUBOXONE is the first opioid medication approved under DATA 2000 for the treatment of opioid dependence in an office-based setting. SUBOXONE also can be dispensed for take-home use, just as any other medicine for other medical conditions.

SUBOXONE at the appropriate dose may be used to:

Suppress symptoms of opioid withdrawal
Decrease cravings for opioids
Reduce illicit opioid use
Block the effects of other opioids
Help patients stay in treatment

Vaccinations and Immunizations

The Center for Communicable Diseases has strongly advised that all adults become aware of the various vaccinations that are available and when they should be considered. To help you with the information needed, we are providing you with the following list. All vaccinations are available in our office by appointment.

Vaccine	For whom vaccination is recommended	Schedule for vaccine administration (any vaccine can be given with another)
Influenza	Persons age 50yrs and older. Persons with medical problems (e.g., heart disease, lung disease, diabetes, renal dysfunction, hemoglobinopathy, immunosuppression) and/or people living in chronic-care facilities. Persons with any condition that compromises respiratory function or the handling of respiratory secretions or that can increase the risk of aspiration (e.g., cognitive dysfunction, spinal cord injury, seizure disorder, or other neuromuscular disorder). Persons working or living with at-risk people. Women who will be pregnant during the influenza season (December–March). All healthcare workers and other persons who provide direct care to at-risk people. Household contacts and out-of-home caregivers of children ages 0–59m. Travelers at risk for complications of influenza who go to areas where influenza activity exists or who may be among people from areas of the world where there is current influenza activity (e.g., on organized tours). Persons who provide essential community services. Students or other persons in institutional settings (e.g., dormitory residents). Anyone wishing to reduce the likelihood of becoming ill with influenza.	Given every year in the fall or winter. October and November are the ideal months to give the flu vaccine.. Continue to give through the influenza season from December through March (including when influenza activity is present in the community) and at other times when the risk of influenza exists.
Pneumococcal	Persons age 65yrs and older. Persons who have chronic illness or other risk factors, including chronic cardiac or pulmonary disease, chronic liver disease, alcoholism, diabetes, CSF leak, as well as people living in special environments or social settings (including Alaska Natives and certain American Indian populations). Those at highest risk of fatal pneumococcal infection are persons with anatomic asplenia, functional asplenia, or sickle cell disease; immunocompromised persons including those with HIV infection, leukemia, lymphoma, Hodgkin’s disease, multiple myeloma, generalized malignancy, chronic renal failure, or nephrotic syndrome; persons receiving immunosuppressive chemotherapy (including corticosteroids); those who received an organ or bone marrow transplant; and candidates for or recipients of cochlear implants.	Routinely given as a one-time dose; administer if previous vaccination history is unknown. One-time revaccination is recommended 5yrs later for persons at highest risk of fatal pneumococcal infection or rapid antibody loss (e.g., renal disease) and for persons age 65yrs and older if the 1st dose was given prior to age 65 and 5yrs or more have elapsed since the prior dose.
Hepatitis B (Hep B)	All adolescents; any adult wishing to obtain immunity. High-risk persons, including household contacts and sex partners of HBsAg-positive persons; injecting drug users; heterosexuals with more than one sex partner in 6 months; men who have sex with men; persons with recently diagnosed STDs; patients receiving hemodialysis and patients with renal disease that may result in dialysis; recipients of certain blood products; healthcare workers and public safety workers who are exposed to blood; clients and staff of institutions for the developmentally disabled; inmates of long-term correctional facilities; and certain international travelers. Persons with chronic liver disease.	Three doses are needed on a 0, 1, 6m schedule. Alternative timing options for vaccination include 0, 2, 4m and 0, 1, 4m. There must be 4wks between doses #1 and #2, and 8wks between doses #2 and #3. Overall, there must be at least 16wks between doses #1 and #3. Schedule for those who have fallen behind: If the series is delayed between doses, DO NOT start the series over. Continue from where you left off.
Hepatitis A (Hep A)	Persons who travel or work anywhere except the U.S., Western Europe, New Zealand, Australia, Canada, and Japan. Persons with chronic liver disease, including persons with hepatitis B and C; injecting and non-injecting drug users; men who have sex with men; people with clotting-factor disorders; persons who work with hepatitis A virus in experimental lab settings (not routine medical laboratories); and food handlers when health authorities or private employers determine vaccination to be cost effective. Anyone wishing to obtain immunity to hepatitis A. Note: Prevaccination testing is likely to be cost effective for persons older than age 40yrs, as well as for younger persons in certain groups with a high prevalence of hepatitis A virus infection.	Two doses are needed. The minimum interval between doses #1 and #2 is 6m. If dose #2 is delayed, do not repeat dose #1. Just give dose #2.
Tetanus, diphtheria, pertussis	All adults who lack a history of a primary series consisting of at least 3 doses of tetanus- and diphtheria-containing vaccine. A booster dose of tetanus- and diphtheria-containing toxoid may be needed for wound management as early as 5yrs after receiving a previous dose, so consult ACIP recommendations.* Using tetanus toxoid (TT) instead of Td or Tdap is not recommended. In pregnancy, when indicated, give Td or Tdap in 2nd or 3rd trimester. If not administered during pregnancy, give Tdap in immediate postpartum period. For Tdap (tetanus- and diphtheria-toxoids with acellular pertussis vaccine) only: All adults younger than age 65yrs who have not received Tdap. Healthcare workers who work in hospitals or ambulatory care settings and have direct patient contact and who have not received Tdap. Adults in contact with infants younger than age 12m (e.g., parents, grandparents younger than age 65yrs, childcare providers, healthcare workers) who have not received a dose of Tdap.	For persons who are unvaccinated or behind, complete the primary series with Td (spaced at 0, 1–2m, 6–12m intervals). One dose of Tdap may be used for any dose if ages 19–64yrs. Give Td booster every 10yrs after the primary series has been completed. For adults ages 19–64yrs, a 1-time dose of Tdap is recommended to replace the next Td. Intervals of 2yrs or less between Td and Tdap may be used if needed. Note: The 2 Tdap products are licensed for different age groups: Adacel (sanofi) for use in persons ages 11–64yrs and Boostrix (GSK) for use in persons ages 10–18yrs.
Polio	Not routinely recommended for persons age 18yrs and older. Note: Adults living in the U.S. who never received or completed a primary series of polio vaccine need not be vaccinated unless they intend to travel to areas where exposure to wild-type virus is likely (i.e., India, Pakistan, Afghanistan, and certain countries in Africa). Previously vaccinated adults can receive one booster dose if traveling to polio endemic areas.	Refer to ACIP recommendations* regarding unique situations, schedules, and dosing information.
Varicella (Chickenpox)	All adults without evidence of immunity. Immunity is defined as any one of the following: a history of two doses of Var born in the U.S. before 1980 history of varicella disease or herpes zoster based on healthcare provider diagnosis laboratory evidence of immunity or laboratory confirmation of disease.	Two doses are needed. Dose #2 is given 4–8wks after dose #1. If Var and either MMR, LAIV, and/or yellow fever vaccine are not given on the same day, space them at least 28d apart. If the second dose is delayed, do not repeat dose #1. Just give dose #2.
Meningococcal	College freshmen living in dormitories. Adolescents and adults with anatomic or functional asplenia or with terminal complement component deficiencies. Persons who travel to or reside in countries in which meningococcal disease is hyperendemic or epidemic (e.g., the “meningitis belt” of Sub-Saharan Africa). Microbiologists who are routinely exposed to isolates of N. meningitidis.	One dose is needed. If previous vaccine was MPSV4, revaccinate after 5yrs if risk continues. Revaccination after MCV4 is not recommended. MCV4 is preferred over MPSV4 for persons age 55yrs and younger, although MPSV4 is an acceptable alternative.
MMR (Measles, mumps, rubella)	Persons born in 1957 or later (especially those born outside the U.S.) should receive at least one dose of MMR if there is no serologic proof of immunity or documentation of a dose given on or after the first birthday. Persons in high-risk groups, such as healthcare workers, students entering college and other post–high school educational institutions, and international travelers, should receive a total of two doses. Persons born before 1957 are usually considered immune, but proof of immunity (serology or vaccination) may be desirable for healthcare workers. Women of childbearing age who do not have acceptable evidence of rubella immunity or vaccination.	One or two doses are needed. If dose #2 is recommended, give it no sooner than 4wks after dose #1. If MMR and either Var, LAIV, and/or yellow fever vaccine are not given on the same day, space them at least 28d apart. If a pregnant woman is found to be rubella susceptible, administer MMR postpartum.
Human-papillomavirus (HPV)	All previously unvaccinated women through age 26yrs.	Three doses are needed. Dose #2 is given 4–8wks after dose #1, and dose #3 is given 6m after dose #1 (at least 12wks after dose #2).
Zoster (shingles)	A herpes zoster (shingles) vaccine was licensed in May 2006 for use in persons age 60yrs and older. ACIP recommendations for its use are pending. Refer to the package insert for details on its use.