North Bethesda Primary Care

06/16/2025

There will be blood.

It’s not just the name of a highly acclaimed movie. It’s also what transpired (now past tense) at the first-ever NBPC Blood Drive today.

Thank you to EVERYONE who showed up, including those who had to be excluded for one medical reason or another. In all, 44 people went out of their way — sacrificed some of their time and comfort — for the purpose of benefiting the well-being of complete strangers. For several folks it was the first time they had donated in years, if not ever.

To put it another way, there were all different blood types at the blood drive today, but only one person type: E…for “Extraordinary.”

Check out these photos for a glimpse of the fun we had. And if you couldn’t join us, don’t despair. There will be a 2nd Annual NBPC Blood Drive — we guarantee it!

05/12/2025

Definitely not named after Dr. Zeki or Dr. Possner, but delicious nonetheless.

05/07/2025

Blood. You don’t have to be a doctor to know it’s kinda important. It’s a resource that, as of now at least, cannot be manufactured and for which there is no substitute. We need it to survive and if we don’t have enough in our own body — either due to loss or insufficient production — we need to get it from somebody else.

According to the American Red Cross, which provides about 40% of our nation’s blood and blood components, approximately 29,000 units of red blood cells are needed every day in the U.S. And yet only about 32,000 units are donated per day on average from all sources. That’s not a lot of margin.

Maybe you know someone who benefitted from a blood transfusion. Maybe that person had a GI bleed from a stomach ulcer. Maybe that person underwent surgery, or maybe that person was getting chemotherapy for cancer. Maybe that person was you. Every few months, at least one person in our practice needs a blood transfusion for one reason or another.

We here at NBPC pose the following challenge: For those among us who are in decent health, let’s do our part to support those who are struggling with their health.

In order to host a blood drive for the American Red Cross in our building (11300 Rockville Pike), we must demonstrate that we have at least 35 people seriously interested in donating.

IF YOU ARE INTERESTED IN DONATING, please complete this very brief, 5-question survey, https://forms.gle/7HphRVt6QSp8D9VS9.

If you have any concerns about whether or not you meet criteria to donate, check out the link below.

Let's do this!

Find out how often you can donate blood and answers to more frequently asked questions about the blood donation process with American Red Cross blood services.

04/26/2025

Yenifer completes the 5K PurpleStride walk against pancreatic cancer.

So important that it had to be done in slow-mo and posted on its own. (See the other post about PurpleStride.)

04/26/2025

Today was the Pancreatic Cancer Action Network (PanCAN) PurpleStride fundraiser walk/run in D.C.

Thanks to Evelyn Morton for organizing Team “Honoring Wayne” in tribute to her partner and our former patient Wayne Kliman. Yenifer, Mel, and I represented NBPC; Dr. Zeki, you were missed!

I also brought one of my sons. He and I walked not only for Wayne but also for my father-in-law, Jerry Paskowitz, who passed from pancreatic cancer in 2022.

And thanks to all the NBPC patients who donated!

02/14/2025

In case you think we here at NBPC don't know how to party, check out this glimpse of today's pre-birthday celebration for Mel. Happy Birthday tomorrow, Mel!

Those are ACTUAL cupcakes, not impostures concocted from tofu and vegetables. Like I said, we know how to party. Everything in moderation....

01/31/2025

This week our very own Dr. Zeki is away at a POCUS conference in San Antonio, Texas.

Now before you assume that Dr. Zeki is an aspiring wizard, let us assure you it's not that kind of POCUS, although she does use dictation software called Dragon.... Here we mean POCUS as in Point Of Care UltraSound -- ultrasound used to augment the traditional physical exam real-time. A few months back we purchased a handheld device and Dr. Zeki has taken it upon herself to become our resident expert in the use thereof.

The conference is intense; full days of lectures followed by practicing on volunteer patients. We're happy to report Dr. Zeki won an award for answering the most questions correctly during a rapid-fire quiz of three blocks of ultrasound cases. We can't say we're surprised!

POCUS that is not hocus pocus. Just one of the many ways we here at NBPC strive to provide the very best care for our patients!

01/16/2025

Folks, check out this depressing piece of news, will you?

If you ask me, lack of exposure to primary care in medical school is just one of the reasons why so few medical students pursue primary care. The main reason is an insurance-based system that doesn’t value cognitive work.

At NBPC, we have cracked the code by distancing ourselves from said system, which allows us to keep patients at the center of what we do…and not lose our sanity in the process!

——————

Many Young People Choosing Not to Become Primary Care Physicians After Leaving Medical School

KFF Health News (1/13, Freyer) reports many young people choose not to become primary care physicians after leaving medical school. Last year, “252 of the nation’s 3,139 pediatric residency slots went unfilled and family medicine programs faced 636 vacant residencies out of 5,231 as students chased higher-paying specialties.” KFF Health News says, “Could...medical schools do more to promote primary care? The question could not be more urgent.” The Association of American Medical Colleges predicts “a shortage of 20,200 to 40,400 primary care doctors by 2036.” Medical students frequently “start out expressing interest in primary care,” but “then they end up at schools based in academic medical centers, where students become enthralled by complex cases in hospitals, while witnessing little primary care.”

01/05/2025

Ever wonder what a primary care powerhouse of 4 looks like celebrating the 4-year anniversary of their practice?

Wonder no more.

Here's to 4 years of North Bethesda Primary Care (b. 1/4/21) and, more importantly, to the patients who make it possible. We love ya!

12/12/2024

Nocturnal leg cramps do***ng you?

If so, check out this study in JAMA Internal Medicine, https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2825457?&utm_source=BulletinHealthCare&utm_medium=email&utm_term=110824&utm_content=NON-MEMBER&utm_campaign=article_alert-morning_rounds_daily&utm_uid=3442614&utm_effort=DAMR01. Assuming you are not on warfarin (Coumadin), you may want to try vitamin K2 (menaquinone 7), 180 μg daily. Ask your doctor.

And if your doctor is not us, give us a ring at 301-941-4414 to set up a complimentary meet-and-greet today!

10/26/2024

Day #6

Let me begin by saying that Dr. Zeki and I, along with Yenifer and Mel, have the best jobs in the world. We get paid for helping people and we get to learn everyday. In fact, the more we learn, the more we can help — and the more we help, the more we learn. Deep, right?

I learned a ton at this conference. See below for my latest, and last, report of pearls gleaned from Santa Fe. Although I’m sad it’s over, I miss my family — both my actual family and my family of patients. And I’m really not used to sitting for so long.

Since today was a truncated day like Wednesday, after the conference I headed north to check out Los Alamos. Years ago, before the creation story of the nuclear bomb became hip, my best friend and I made a pilgrimage to Alamogordo, site of the Trinity test. Now that I’ve seen Oppenheimer’s house and the complex where the bomb was devised, the circle is complete.

From Los Alamos I drove to just outside Jemez Springs and hiked 7.5 miles to Jemez Falls, passing some natural springs along the way. With 1,500 feet of elevation change, I’m beat. Tonight I sojourn in Jemez Springs. Tomorrow, it’s another hike for a few hours starting at sunrise, a rejuvenating steep in the hot springs, and then to the Albuquerque airport.

I hope you’ve found these daily summaries of the conference educational and at least mildly entertaining. Please share with your friends!

Until next year’s conference, this is Dr. P, signing off.

—————-

ASTHMA/COPD
- Mild asthma management has shifted away from beta-2-agonist-only use as-needed to combined steroid/beta-2 agonist (such as Symbicort) as needed.
- Omalizumab for IgE 30-700. Dupilumab (anti-IL4 and anti-IL13) is for people with an absolute eosinophil count of 150-1500.
- COPD can present as chronic bronchitis and/or emphysema (permanently dilated airspaces).
- For COPD, add an inhaled corticosteroid if the blood eos>300. May give an inhaled corticosteroid if eos at least 100. Can use roflumilast if FEV1

10/25/2024

Day #5

As if I’m being punished for doing something other than lecture yesterday (in addition to disrespecting Akron, Ohio), I don’t have any interesting photos for you today. Well, that’s not entirely true…. On my lunch break I did go to the local market off the main square to seek out some presents for the wife and kids (shh, don’t tell) and snagged a picture.

The first and last time I was in Santa Fe was 24 years ago, on a cross country trip after graduating from college. One of my few memories from passing through is of visiting this same market in the square. Never could I imagine that I would return a quarter of a century later — married with two kids, cured of acne, with my own medical practice — shopping for presents, maybe even from one of the same vendors I saw back then.

The longer I live, the more convinced I am that we can never leave a place knowing for sure it’s our last visit until our visit on earth ends. And some would say, not even then….

———————-

EYE
- Ocular coherence tomography is like ultrasound, but uses light.
- Age-Related Macular Degeneration (ARMD): Biggest risk factor is age. Leading cause of blindness in those 65 years old and older. The macula is a very metabolically active area. Starts with a decline in the choroid, which supports the macular cells. Drusen (waste products) starts to build up. Starts with dry phase; 90% stay dry. Most vision loss occurs with wet form. Anti-VEGF injections claw back some visual acuity, but mostly prevent further loss.
- Diabetic retinopathy: Non-proliferative and proliferative. Starts with yellow and red spots. When vision loss occurs, due to macular edema. Laser treatments are designed to damage the peripheral retina to reduce the oxygen demand and prevent new blood vessel formation, which protects the central vision.
- Glaucoma: Damage to the optic nerve. Rest of the eye is often healthy. Primary open angle is the most common and is usually asymptomatic other than vision loss.
- Dry eyes: Use eye drops that have oil in them. Flaxseed or fish oil orally can help. Brands of OTC eye drops: Restorative, Soothe XP, Systane Balance, Systane Complete, Refresh Optive Advance.

RHEUM
- "Diagnostic tests" in Rheum more frequently provide more prognostic than diagnostic information. For instance, in rheumatoid arthritis a higher RF is associated with a worse outcome.
- ESR is driven by globulin and fibrinogen.
- CRP tends not to rise in lupus.
- CRP not affected by age, gender, pregnancy, or smoking.
- For rheumatoid arthritis, RF can be a false positive.
- It would be very unusual to have lupus with a negative ANA.
- Start colchicine for a gout flare within 36 hours, if possible.
- Check HLA-B*801 before starting allopurinol in someone from African or Asian descent.
- In rheumatoid arthritis, extra-articular disease can indicate cervical spine disease. Can get subluxation at C1-C2.
- Of people with psoriasis, 15-30% can have psoriatic arthritis.
- Parvovirus B19 (erythema infectiosum, aka Fifth Disease) is an important mimic of rheumatoid arthritis. Kids may have a "slapped cheek" rash. Resolves within 4-6 weeks.
- The muscle enzyme aldolase may rise before CK. Aldolase can be a tip-off for connective tissue-associated interstitial lung disease and eosinophilic fasciitis.
- Hydroxychloroquine should be started in all patients with lupus to reduce the risk of major organ damage.
- Rheumatoid arthritis: Start with methotrexate monotherapy.

DERM
- Steroids for the eyelids: hydrocortisone 2.5%, alclometasone 0.05%, tacrolimus 0.03%, and -- if really bad -- triamcinolone 0.1% for a few weeks.
- Fluocinolone 0.1% oil safe for face and body.
- Mometasone 0.1% or fluocinonide 0.05% for "hot spots," where the skin is thicker.
- Imiquimod: Less effective, reaction is unpredictable, and can be severe. Instead use fluorouracil 5%. Twice a day for 2 weeks. If use with calcipotriene, reduce duration to 1 week.
- The vast majority of melanomas are flat.
- Melanonychia