Cardiology

Electrocardiography (EKG)

An electrocardiogram (also called EKG or ECG) is a test that records the electrical activity of your heart through small electrode patches attached to the skin of your chest, arms, and legs. An EKG may be part of a routine physical exam or it may be used as a test for heart disease. EKGs are quick, safe and painless and are routinely performed if a heart condition is suspected. An EKG can be used to further investigate symptoms related to heart problems.

Your doctor uses the EKG to:

  • Assess your heart rhythm.
  • Diagnose poor blood flow to the heart muscle (ischemia).
  • Diagnose a heart attack.
  • Evaluate certain abnormalities of your heart, such as an enlarged heart.

Stress Testing

A stress echo test is a sophisticated test that will allow us to better understand your heart. Initially, you will be asked to lie on your left side, and ultrasound images of your heart will be obtained by applying a probe to your chest. You will then be asked to walk on a treadmill, which will gradually increase in speed and grade. Your doctor will be present throughout the entire procedure, and you will be able to communicate with him as you exercise. Immediately after exercising, you will be asked to lie down in order to obtain additional ultrasound images. After reviewing the exercise traces and ultrasound images, your doctor will discuss his findings with you.

The following steps will help ensure your test is properly performed.

Preparation:

  • Do not eat or drink for 2 hours before the test.
  • Wear loose, comfortable clothing.
  • Wear comfortable shoes with flat rubber soles, such as sneakers.
  • Male patients should note that it may be necessary to have a small portion of their chest shaved.
  • Male patients must avoid taking Viagra within 72 hours of the test.
  • Take all medications as you usually do, up to and including the day of your test, unless instructed otherwise.
  • Please refrain from wearing any body lotions, perfumes, or powders on the day of this test.

Please feel free to call our office if you should have any additional questions. We look forward to seeing you.

For additional information please contact the office at (516) 222-0404.

Nuclear Stress Testing

For nuclear studies, a small amount of radioactive material (known as a tracer) is given through a vein in your arm. A camera scans the tracer as it flows through your heart. Areas of the heart muscle that have good blood flow pick up the tracer material quickly, while areas with poor blood flow do not. The test takes approximately 3 hours. This test will help the doctor determine if there are any blockages in the blood vessels that supply blood to your heart. The radioactive material does not usually cause any reaction and is easily eliminated through your urine.

Echocardiography

An echocardiogram uses sound waves to see images of your heart muscle, its valves, and the pumping function of your heart. A special instrument called a transducer is held on the chest by a technologist. The transducer picks up sound waves and uses them to create and project a picture of your heart on a screen. This test takes approximately 20 minutes, is painless, and requires no preparation.

Vascular Studies

CAROTID DOPPLER ultrasound is a non-invasive test that uses sound waves to measure the flow of blood through the large carotid arteries that supply blood to the brain. These arteries can become narrowed due to arteriosclerosis or other causes, and this can lead to transient ischemic attack (mini-stroke) or cerebral vascular accident (stroke). The carotid doppler test can help doctors determine stroke risk and the need for preventative measures.

ABDOMINAL AORTIC ANEURYSM (AAA) is a condition in which the lining of the blood vessel called the aorta is enlarged within the abdomen. Because abdominal aortic aneurysms are likely to tear if they reach 5 centimeters in diameter, monitoring is important for preventing a rupture. A ruptured AAA can cause blood loss, shock, and death. Ultrasound technology is used to measure the size of your abdominal aorta. The process is painless. You lie on your back on an exam table while a technologist applies gel to your abdomen. The technologist then takes images and measurements of your aorta by moving an instrument called a transducer across your abdomen.

ARTERIAL AND VENOUS DOPPLERS A Doppler ultrasound test uses reflected sound waves to see how blood flows through a blood vessel. It helps doctors evaluate blood flow through major arteries and veins in your legs. It can show blocked or reduced blood flow through narrowing in the major arteries. It also can reveal blood clots in leg veins (deep vein thrombosis, or DVT) that could break loose and block blood flow to the lungs (pulmonary embolism).

During Doppler ultrasound, a handheld instrument (transducer) is passed lightly over the skin above a blood vessel. The transducer sends and receives sound waves that are amplified through a microphone. The sound waves bounce off solid objects, including blood cells. The movement of blood cells causes a change in pitch of the reflected sound waves (called the Doppler effect). If there is no blood flow, the pitch does not change. Information from the reflected sound waves can be processed by a computer to provide graphs or pictures that represent the flow of blood through the blood vessels.

Holter Monitoring

A small electronic recorder is used to record your heart’s rhythm while you continue your normal activities. The monitoring usually lasts for 24 hours, during which time you will be asked to keep a diary of your activities and symptoms. The monitor is used to detect irregularities in your heart’s rhythm and evaluate palpitations and dizziness.

Gastroenterology

Endoscopy

What is upper gastrointestinal endoscopy?

The endoscope is a highly sensitive video camera. The endoscope is gently passed through the mouth, esophagus, stomach, and small intestine to examine their linings. During endoscopy, the physician can inspect these organs and take tissue samples.

Why am I having an endoscopy?

People have endoscopy for a variety of reasons. These include evaluating the cause of digestive problems such as heartburn and upper abdominal pain, diagnosing ulcers, and determining the cause of blood loss from the digestive tract. Endoscopy is superior to alternative diagnostic methods such as upper GI series because endoscopy is both more accurate and better tolerated by patients.

What happens during the exam?

The examination is performed with an anesthesiologist administering deep sedation. Therefore, you will feel nothing, know nothing, and remember nothing. First, we will spray the back of your throat with a local anesthetic. Then, the anesthesiologist will sedate you. Once you are asleep, the doctor will gently pass the instrument through your mouth into your stomach.

How long does it take?

This is variable from patient to patient, but generally the exam takes 10-15 minutes.

How will I feel afterward?

You will recover full consciousness within a few minutes, but you will feel a little groggy. This passes quickly. Your throat may be a little sore for as long as a few days. Also, you may feel bloated for a few minutes right after the procedure because of air that was introduced into our stomach.

When can I eat again?

We will give you full written instructions as to how and when to resume eating; generally you can eat about an hour after the exam.

Is endoscopy dangerous?

The incidence of complications is extremely low, generally less than 1 out of every thousand procedures in most studies. Potential complications can include adverse reaction to the sedative drug, bleeding, perforation of the digestive tract, or aspiration of stomach contents into the lungs. Most complications are mild and require no treatment. However, blood transfusion, hospitalization, or surgery are sometimes necessary. Death is extremely rare. Our gastroenterologist has performed thousands of endoscopies with a superb safety record. Although there can be no guarantees, the doctors will do everything possible to maximize your safety and comfort.

What preparation is necessary?

For the best possible examination, the stomach must be empty. Therefore, you should have nothing to eat or drink, including water, for at least 6 hours before the procedure. If your examination is scheduled for the morning, please do not eat or drink after midnight the night before. If you are to be examined in the afternoon, you may have a breakfast of apple juice, Jell-O, or coffee or tea without milk or cream. (If your mouth is dry, you may suck on an ice cube up to 2 hours before the examination).

Do I need to take antibiotics before endoscopy?

Some people with abnormal heart valves or with artificial joints must take antibiotics before dental procedures. This is generally not necessary with endoscopy.

Should I take my usual medications?

You should take no oral medications for 8 hours before the procedure. Coumadin should be stopped 4 days before the exam. Aspirin and other non-steroidal anti-inflammatories (Advil, Motrin, Voltaren, etc.) should be stopped I week beforehand. Anti-platelet agents (Plavix, Persantine) should also be stopped 1 week before endoscopy

Colonoscopy

What is colonoscopy?

The colonoscope is a highly sensitive video camera which is passed through the colon (large intestine) to examine its lining. During colonoscopy, the physician can examine the colon and also sample tissue and remove polyps (usually benign growths).

Why am I having colonoscopy?

People have colonoscopy for a variety of reasons. These include diagnosing digestive problems, evaluating rectal bleeding, and screening for colon cancer. Colonoscopy is superior to alternative methods of evaluating the colon, including barium enema and flexible sigmoidoscopy.

How long does it take?

This is variable from patient to patient and depends on how long your colon is and how many twists and turns it has. Generally the exam takes about 20 minutes but may require more time if the colon is long or if there are polyps to removed.

Does it hurt?

Your procedure will be performed under deep sedation administered by an anesthesiologist. You will experience no discomfort and remember nothing afterward.

How will I feel afterward?

Within a few minutes after the procedure, you will be completely awake and alert, though you may feel a little “out of it” for a few hours. Although you will feel fine, your reflexes will be impaired, which is why you must not drive for at least 12 hours after you leave the office. You may feel a little gassy and bloated from air which is introduced into the colon during the examination. As you pass this air out over the course of a few hours, you will feel better.

When can I eat again?

We will give you full written instructions as to how and when to resume eating.

Is colonoscopy dangerous?

The incidence of complications is extremely low, generally less than I out of every thousand procedures in most studies. Potential complication can include adverse reaction to the anesthesia, bleeding, or perforation of the colon. Most complications are mild and require no treatment. However, blood transfusions, hospitalization, or surgery are sometimes necessary; death is extremely rare. Our gastroenterologist has performed thousands of colonoscopies with a superb safety record. Although there can be no guarantees, the doctors will do everything possible to maximize your safety and comfort.

What preparation is necessary?

For a thorough examination, the colon must be completely cleansed of waste material. Feces remaining in the colon slow the examination and limit the accuracy of the exam. When you make your appointment, we will give you or mail you instructions regarding preparation, If you do not receive preparation instructions, please contact the office at least 3 days prior to your examination.

Do I need to take antibiotics before colonoscopy?

Some people with abnormal heart valves (such as a “floppy” mitral valve) or with artificial joints must take antibiotics before dental procedures. This is generally not necessary with colonoscopy.

Should I take my usual medications?

Except for diabetes medications and anticoagulants (Coumadin), you should take your regular medications with a small amount of water on the day of your procedure. Coumadin should be stopped 4 days before the exam. Aspirin and other nonsteroidal anti-inflammatories (Advil, Motrin, Voltaren, etc.) should be stopped 1 week before colonoscopy. If you take oral medication for diabetes, skip your morning dose and resume your regular schedule when you get home. If you take insulin, please contact the office for instruction.

Lactose Intolerance Testing

You have been scheduled to undergo a simple, non-invasive breath test – the most reliable method of testing for lactose malabsorbtion. This test takes up to 3 hours to perform, and requires you, the patient, to arrive prepared. Please read the following instructions carefully and call us with any questions you may have.

Preparation for the Test

  • Make sure you have not taken antibiotics for at least two weeks before testing for lactose malabsorption.
  • Do not eat beans, bran or other high-fiber cereal for 24 hours prior to the test.
  • FAST for at least 10 hours prior to the test (usually this means no food after midnight, and skip breakfast on the morning of the exam).
  • You may drink water right up until the testing is performed.
  • You may take your prescribed medications (as long as none are antibiotics) on the morning of the exam.
  • Do not smoke, sleep or exercise vigorously for at least 30 minutes before the test, or at any time during the test.

Preventive Medicine

Preventing illness is one of our major concerns and there is a lot you can do to lower your risk of serious illness. Aside from such common-sense measures as proper diet and exercise, there are a number of diagnostic tests and procedures which can detect illness early or even prevent it entirely.

Please check the recommendations below. If you are not up-to-date on any of these preventative measures, please discuss them with your physician during your next visit.

Complete physical examination (yearly)
This comprehensive visit includes a detailed history, thorough physical examination, lung function testing, electrocardiogram, and extensive blood work. We regard this as the most important step you can take for preventative maintenance.

Blood Tests
Cholesterol profile yearly (every 3 months if on cholesterol medication)
Red and white blood cell count yearly (more often if history of anemia)
Complete metabolic profile yearly (more often if you have diabetes, high blood pressure)

Colonoscopy

Colon cancer is a preventable illness, and colonoscopy represents the gold standard in colon cancer prevention. The examination is quick (20 minutes) and completely painless. It should be done every 3-5 years, depending on your individual circumstances. Our gastroenterologist performs this examination painlessly with state-of-the-art equipment.

Women

  • Bone density testing
  • Pap smear (done by your gynecologist)
  • Mammogram

Men

Prostate cancer screening
We recommend a digital rectal examination and PSA blood test yearly for men over 40. We can perform these examinations for you either as part of your yearly physical or as a dedicated visit.

Vaccinations

ZOSTAVAX (Shingles Vaccine)
The Zostavax vaccine is now available in our office. This vaccine is recommended for patients 60 years of age and older. The vaccine is a live virus vaccine, used against the Zoster virus, which causes shingles. Because this is a live virus vaccine please check with your doctor to see if you can take the vaccine.

INFLUENZA VACCINE
No appointment necessary!

Given as one injection in the upper arm, the flu shot contains killed flu viruses that will not cause you to get the flu, but will cause your body to fight off infection by the live flu virus. Getting a shot of the killed virus causes you to become protected against that particular type of live flu virus if you come into contact with it.

Even if you may have gotten the vaccine last year, that won’t protect you from getting the flu this year because the protection wears off and flu viruses constantly change. That’s why the vaccine is updated each year to include the most current strains of the virus.

The flu vaccine reduces the average person’s chances of catching the flu by up to 80% during the season. But because the flu vaccine prevents infection with only a few of the viruses that can cause flu-like symptoms, getting the vaccine isn’t a guarantee that you won’t get sick during the season. But even if someone who’s gotten the shot gets the flu, symptoms will usually be fewer and milder.

Are There Side Effects?

Most people do not experience any side effects from the flu shot. According to the CDC, the flu shot rarely causes serious harm and less than one third of people vaccinated have soreness or swelling at the site of the shot or mild side effects, such as headache or low-grade fever.

Although these side effects may last for a day, the flu can knock you off your feet for 2 to 3 weeks and can have life-threatening complications, such as pneumonia, ear infections, sinus infections, and other respiratory complications.

A common myth about the flu shot is that it can actually cause the flu. But the flu shot used in the United States is made from killed influenza viruses, which means that it’s impossible to catch the flu by getting this vaccine.

WHO SHOULD NOT GET A FLU SHOT?

  • ANYONE who’s severely allergic to eggs and egg products (because the ingredients for flu shots are actually grown inside eggs)
  • ANYONE who’s ever had a severe reaction to a flu vaccination (although most people do not experience any side effects from the flu shot)
  • ANYONE who has Guillain-BarrĂ© syndrome (GBS), a rare medical condition that affects the immune system and nerves
  • ANYONE who’s sick with a fever

Pneumonia Vaccine

The pneumococcal bacterium (also called Streptococcus pneumoniae) is responsible for many respiratory infections in the upper and lower airways. This bacterium is dangerous for people with serious underlying chronic medical conditions and illnesses. Its most serious infection is pneumonia. Community-acquired pneumonia is the most common type and develops outside of the hospital. Each year between two and four million people in the US develop community-acquired pneumonia, and 600,000 people are hospitalized because of it. Although the majority of pneumonias respond well to treatment, the infection can still be a very serious problem. Together with influenza, pneumonia is the sixth leading cause of death in the US and is the leading cause of deaths from infection.

Of particular concern is the increasing prevalence of pneumococcal bacteria that are resistant to many standard antibiotics. This has created a great sense of urgency in the medical community to find effective measures for preventing infection.

Vaccine Description

Pneumococcal vaccines contain material derived from the most common strains of pneumococci bacteria. (There are no living bacteria in the vaccine). The vaccine is effective and becoming very important, particularly in light of the increase in antibiotic-resistant bacteria.

Candidates for Pneumonia Vaccine

Many experts now recommend the vaccine for the following older children or adults:

  • All people over 65 years old (anyone vaccinated more than five years previously should be revaccinated). According to a 2001 survey, over half of older people have now received a pneumococcal vaccination.
  • Individuals with immune deficiencies (e.g., HIV) or those who are undergoing treatments to suppress the immune system.
  • Patients with kidney disease or kidney transplants. Older people who have had transplant operations or those with kidney disease may require a revaccination after six years.
  • Patients who have problems with their spleen.
  • Alcoholics (especially those with cirrhosis).

Adults with any condition that increases the risk for pneumonia should be vaccinated. Protection lasts for over six years in most people, although the protective value may be lost at a faster rate in elderly people than in younger adults (anyone at risk for serious pneumonia should be revaccinated six years after the first dose).

Side Effects of the Pneumococcal Pneumonia Vaccine

Side effects include pain and redness at the injection site, fever, and joint aches. Rarely, such local reactions can be severe. Even if a person is mistakenly re-vaccinated before the effects of the first vaccination have worn off, the risk for severe side effects is very low. Allergic reactions are very rare. Because the vaccine is inactive, it is safe for pregnant women and people with immune deficiencies.

Bone Density

A bone mineral density test measures the density of minerals, such as calcium, in your bones using a special scanner. This information is used to estimate the strength of your bones. Our DEXA scanner is the most accurate way to measure bone density in your spine and hip. It is fast, painless and uses very low doses of radiation. If your bone density is lower than normal, your doctor may take steps to increase your bone strength and reduce your chances of having a fracture.

Complete Physical Examination and Surgical Consultations

A comprehensive physical examination includes blood work, urinalysis, EKG, pulmonary function (breathing) test, and hearing evaluation. These tests require approximately 30 minutes to complete. Your physician will perform a comprehensive history and physical examination and then discuss the results of your examination and testing.

A member of our staff will attempt to contact you 24 hours prior to your appointment to confirm it with you and discuss any questions that you may have. Since a large block of the physician’s time has been set aside for your visit, we request that you notify us at least 48 hours prior to your scheduled appointment if you need to cancel.

To ensure the accuracy of the tests being performed, please follow these instructions:

Fasting Instructions

  • Have nothing to eat for at least 6 hours before your scheduled appointment.
  • You may drink any of the following: Black coffee, plain tea, diet soda or water. You may use artificial sweetener, but no milk, cream or sugar.
  • Take all medications except diabetes medications or medications with sugar in a syrup base.

Insurance Coverage

  • You must present your current insurance card when you arrive at our office.
  • Your insurance card must show the correct primary care physician.
  • Your co-pay, if applicable, must be paid when you arrive at our office.

Sleep Apnea Screening

Sleep apnea is a serious sleep disorder that occurs when a person’s breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep. This means that the brain and the rest of the body may not get enough oxygen. This can lead to a number of health problems. Your doctor will ask you a series of questions to screen for the possibility that you may be suffering from sleep apnea.

Pulmonary Function Testing

Pulmonary function tests measure how well the lungs take in and release air and how well they move oxygen from the atmosphere into the body’s circulation. By measuring how much air you exhale, and how quickly, spirometry can evaluate a broad range of lung diseases.