Sunday, September 27, 2015

Rheumatoid Arthritis

What is Rheumatoid Arthritis?  There are many different types of arthritis. Certainly one of the most serious ones is rheumatoid arthritis. This is a chronic , systemic (thru the whole body), inflammatory (red, hot, tender joints) disorder of unclear cause. This arthritis is symmetrical. If the disease is not controlled, the joints may be destroyed  and/or become disfigured which leads to disability.

How is it diagnosed?  Here is a summary of the characteristic features used to make the diagnosis: morning stiffness for at least one hour and present for at least six weeks; swelling of three or more joints for at least six weeks; swelling of the wrist or hand joints for at least six weeks; hand x-rays that show erosions in a joint; nodules under the skin; or blood tests that are positive for rheumatoid factor or other markers of inflammation.

A real key is morning stiffness associated with fatigue, weight loss, low grade fever and depression. These are very common presentations. It can also be a cause of carpal tunnel syndrome.

What does it affect?  At presentation, one joint (such as hand) or many may be involved.  Key is how the arthritis has affected daily activities such as walking, doing stairs, dressing, use of the toilet, getting up from a chair, opening jars, opening doors, typing, or performing on the job. The feet may also be involved. A very potential and serious involvement would be the upper cervical neck. If you have been diagnosed with rheumatoid arthritis (RA), ask your doctor about getting x-rays of your upper neck.
It is important to know that rheumatoid arthritis may affect other systems outside of the joints. Anemia, skin, heart, nerves( neuropathy), eyes, spleen, blood vessels(vasculitis) may all be involved. These other systems almost always occur with the joints.
Most patients show a fluctuation of disease activity (changes in symptoms) over a period of months. The goal is remission (symptoms of disease subside) which is very rare without the use medication called disease modifying anti rheumatic drugs( DMARDS). We do see some remissions here in the clinic.


Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
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Tuesday, October 25, 2011


For those who have ever had a case of food poisoning you know what a terrible thing it is! Especially when it occurs after a meal that you have spent money on! It is a complicated thing, like most things in medicine. This is a medical review of how your doctor approaches the problem.

Food poisoning is an illness that can cause nausea, vomiting, or diarrhea. The food can be contaminated with bacteria, viruses, or parasites.

Food can be infected by several means. One way would be by people who work with food who are sick and do not wash their hands. Another way is that the infected food is not washed properly or cooked enough. Another way is for one food product infects another food item.

Symptoms can happen right after a meal, days or even weeks later. Common symptoms include nausea, vomiting, abdominal pain, diarrhea that can be watery or bloody, and fever. 
Other symptoms can include blurry vision or dizziness.

If this should happen to you, be sure to drink plenty of water. Eat small meals that do not include a lot of fat in it. See your doctor for abdominal pain, if you cannot eat or drink, vomiting blood or having blood in the bowel movements, or if you have fever more than 100 degrees.
If you are younger (child) or an older adult, see your doctor sooner as kidney involvement may occur sooner.

Here are some helpful recommendations
  • Do not drink unpasteurized milk or any unpasteurized products
  • Wash raw fruits and vegetables
  • Keep the refrigerator temperature at 40 degrees or colder
  • Use precooked or perishable or ready to eat food as soon as possible
  • Keep raw meat, fish, or poultry separated from each other
  • Wash hands, knives or cutting boards after handling uncooked food
  • Cook chicken eggs thoroughly until yolk is firm
  • Never leave cooked food at room temp for more than two hours
For pregnant women
  • Do not eat hot dogs, lunch meats or other delicatessen meats unless they are reheated until steaming hot. Microwave ovens may give uneven cooking
  • Avoid spilling fluids from raw meat and hot dog packages onto utensils or other surfaces that you will come in contact with
  • Do not eat refrigerated smoked seafood unless it has been cooked.
For more information, consult your health care provider.


Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
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Thursday, September 15, 2011

Men's Health Issue - PSA

What is PSA? PSA stands for prostate specific antigen, which is a protein produced by both normal and cancerous cells of the prostate gland. It is used as a screening test for prostate cancer; although this is met with controversy. It is also used to assess response to the treatment of prostate cancer.

The PSA value increases with increasing age because the prostate gland size increases. As a result, the normal reference range may be appropriate based upon a man’s age. This may help understand what a true normal or abnormal number may be and help avoid needless biopsies in older men.

It is also known that different races have different PSA values; black men in particular tend to have higher PSA values than white men without cancer. As a result, there is discussion that the PSA value should be race dependent. This is still unclear, but you can see the issues surrounding PSA values.

It is interesting that the higher the BMI (obesity) the lower the PSA values tend to be. This may be due to higher plasma volume. If that is the case, consider the importance of the rectal exam (o joy!).

There are some medications that lower the PSA value (5-apha reductase inhibitors). When on such meds (i.e. finasteride) the PSA interpretation need be adjusted. Some say any increase in PSA value while on these meds need to be evaluated.

Other medications such as the cholesterol lowering statins (ex: Lipitor) also appear to be able to lower PSA values. So maybe a two-fer? Lower cholesterol AND lower PSA? It appears promising, if you like statins.

What are other causes for elevated values? There are several major causes of elevated PSA values: BPH (benign prostatic hypertrophy (enlarged prostate)); prostate cancer; inflammation and trauma.

Of these, BPH is the most common especially for men over 50 years old. Simply put, bigger prostates produce more enzymes. Unfortunately, it is not that simple, as bigger prostates may also have pockets of cancer as well. In addition, treatment of BPH may lower PSA values. What to do? Work closely with your doctor.

Prostatitis is another common cause. As a result many physicians will treat an elevated PSA value with antibiotics for presumed infection than repeat the PSA after four weeks or so. This approach is also controversial as to its effectiveness; it is however the usual practice.

In regard to trauma, vigorous bike riding may elevate the PSA value as can a digital rectal exam. Although not proven, the blood test probably should be checked before the exam or after a time of biking abstinence.

Other methods for screening prostate? There is something called PSA density that you may hear about to more accurately predict cancer if you have an elevated PSA value. This is the volume of prostate as measured by ultrasound. The density would be the PSA divided by the volume. This is also controversial as there are different standards regarding the measurements with the ultrasound.

The approach that has gotten the most traction is something called PSA velocity, or the rate of change of the PSA over time and not so much the actual value. This velocity seems more related to the risk of death from prostate cancer.

So, PSA is a valuable tool for prostate cancer but is not specific for cancer. The use of PSA velocity or density has not proven of great use. Thus, the number of biopsies done is still too high. The value of checking PSA seems higher the younger you are (starting age 40-50).