Pine Street Doctor Hot Topic 


The providers at Pine Street will be posting a topic that is “HOT”. Something that you, our patients, have been asking about or topics we feel you should know more about. We hope you will visit our website often and at least monthly to see “what’s hot!” Enjoy your reading.

Hot Topic Spring 2018

Melt Away the Winter Fat     Get Ready for Summer

Now Available at Pine Street Family Practice


As we move from our warm and cozy homes and bulky clothing of this cold winter it is time to think about warming up and moving into the spring season. What comes next? It is the fun and sun of summer and removing those layers. Many of us can’t wait for the pool and shore months, but this means we need to start to get ready for bathing suit season. Some of you have made New Year’s resolutions and have started your new eating and exercise routines to shed those extra pounds in anticipation of shedding the layers of clothing.  Many of us have continued our year round health mantra and would still like to see those few extra inches melt away to complement our hard work and dedication at the gym and eating right. So whether you are on a new mission or continuing on your trek to looking and feeling better Pine Street Family Practice has a way to compliment your goals.

is a safe and in office non-invasive procedure that will help you melt away those annoying inches that just don’t want to budge with the diet and exercise program you have implemented. Coolsculpting works by delivering a controlled cooling to gently and effectively target fat cells to crystallize and then die off and be reabsorbed by your body, while leaving the surface skin unaffected. As the targeted fat cells die and become reabsorbed that specific area of fat then flattens and those inches become reduced to help you achieve the sculpted inch reduction you desire. This process will take 8-12 weeks to see the full improvement you want and will be reassessed in our office at that time. Areas of the body with best results are the abdomen, triceps, front of chest arm fat near the arm pits, back fat, under the chin, outer and inner thighs and the buttocks (banana roll) areas. I know we all have one of these areas that could use some inch reduction!

Pine Street Family Practice has fully trained staff that will do a free in office consultation to evaluate which body areas you are interested in sculpting and help you identify other areas that will be improved with this procedure. Not all fat is “freezeable” fat and not all areas you may want inch reduction will have good results, so a consultation is necessary for you to understand the process and achieve the desired outcome. We have financing options also available to help you make this process more attainable for you.

Go to our Facebook page and see my pictures of the procedure from February 2018 and the progress I have made. Call our office to schedule a free consultation now and continue the process to a healthier and more sculpted you.

Dr. Lee Ann



Do you know someone who has had Shingles? Chances are you have heard of it but do you really know much about the virus. We are Pine Street Family Practice think it’s important for you to know a little bit about the virus and how you can help protect yourself.


  Shingles is a viral infection that can cause a very painful rash. This blistery rash can appear almost anywhere on the body which shows up on one side. The virus’ name is varicella-zoster which is the same virus that causes chicken-pox. After you have chicken pox this virus can lie dormant in the nervous system, until it rears its ugly painful head, at what age – not known, where on the body – can be anywhere, how long does it last – undetermined.


Some signs and symptoms include fluid filled blisters either in a linear pattern or a group that can be red, itchy, tingly, and painful. This rash can be very sensitive to the touch. Although this virus is not life threatening if the rash develops near the eyes this can be very serious and the pain can be debilitating. Some people have complained of fever, fatigue, headaches, and becoming sensitive to light. This virus can be contagious if you come in contact with an open blister.


The shingles virus does not discriminate, male or female, young or old, healthy individuals or people who have compromised immune systems.  Complications associated with this virus are vision problems, post herpetic nerve pain, and possible neurological problems, like inflammation of the brain or hearing problems.


There are 2 vaccines that were developed, Zostavax and Shingrix.

*Zostavax was approved for use in 2006, it’s a one dose vaccine recommended for people over the age of 60 with an 65% effective rate.

*Shingrix was approved for use in 2017 and is the preferred alternative. This is a two dose vaccine for people ages 50 and older, with the second dose given anywhere from two to six months after the first dose has been administered. And if you’ve received the Zostavax vaccine already you can also receive the Shingrix vaccine. The most common side effects of the vaccine is a headache, redness, itching and soreness at the injection site.


-Who can get the Shingrix vaccine? Anyone over the age of 50, it’s a 2 dose series.

-Can I get the Shingrix vaccine if I receive the Zostavax already? Yes you can.

-How can I get the vaccine? Call the office we ask that you call your insurance company and give them code 9750 and see if the vaccine is covered. Then call our office and schedule a convenient time.

-Why should I get the Shingrix vaccine? In people ages 50-69 the vaccine was 95% effective in preventing shingles and over 90% effective in preventing the pain associated with the rash. In ages 70 and over the vaccine was almost 90% effective.

As we get older our risk of getting shingles increases.

So why get ShingRix-it will help prevent the after-shingles pain that can last for six weeks to six months and in some people, it can last a lifetime.

Protect yourself today!  Call the office for an appointment.


OVER 70? Four Test to Avoid

If you're over 70, regular screening tests — especially when it comes to cancer — may be a big waste of time, say a growing number of health experts worried about the over testing of those who are in their 70s, 80s and even older. These experts' concern is that unnecessary screenings could lead to invasive procedures or treatments that leave patients worse off than before, especially among those with serious health problems such as heart disease.


Having a colonoscopy past age 75 may do little to protect you against cancer, reports a new Harvard study of more than 1.3 million Medicare patients ages 70 to 79. Researchers found the cancer risk dropped from about 3 percent to a little more than 2 percent over a span of eight years. At the same time, other studies have shown, the risk of complications from the test increases with age, especially for those in their 80s. The U.S. Preventive Services Task Force (USPSTF), an independent advisory board of medical experts, recommends that screening for colorectal cancer in adults 76 to 85 "be an individual decision," based on overall health and careful consideration of potential benefits and risks. Obviously, if you've had a polyp removed or have a family history of colon cancer, your risk is higher and you should probably be screened. If not, you may be able to finally skip all that lovely laxative prep.


The experts pretty much agree that women should get a mammogram every one to two years until age 75. After 75, however, the evidence for continuing the exams is murky. The USPSTF says there is "insufficient evidence" to conclude yay or nay to mammograms past 74. A large European study of women 70 to 75 showed that screening mammograms may have limited benefits and could lead to overtreatment, putting some women at risk from harmful side effects. For women with several chronic conditions that could affect their life expectancy, the benefits of routine mammograms after 75 are questionable. Those women should discuss with their doctors whether continuing the exams is really necessary.

PSA Test

No medical group recommends a PSA screening for prostate cancer past age 75, yet recent research published in the Journal of the American Medical Association found that 41 percent of men in this age group still have the test, many at the recommendation of their physician. Talk with your doctor, but many men age 76-plus can skip this.

Pap Smear

After age 65, most women with no previous cancer or precancerous lesions are good to go if they've had three negative Pap smears to check for cervical cancer in the previous 10 years. Unfortunately, most women have become so accustomed to having an annual Pap smear that they have them even after undergoing a hysterectomy, according to a study. So, ladies, assuming your physician agrees, you can cross this test off your annual to-do list.

Two Test You Should Get

Bone Density Scan

While women should be getting routine bone density scans beginning at 65 (or earlier, depending on their risk factors), men 70 and older also need to get a bone mineral density test to check for osteoporosis. This weakening of the bones is often considered a "silent disease," because its symptoms can develop unnoticed until a bone fracture occurs. In men, osteoporosis begins later than in women, and progresses more slowly, but the problem is growing among men who are 70-plus, notes the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Indeed, by age 65 or 70, men and women are losing bone mass at about the same rate, making this screening test critical for everyone — men as well as women — over age 70.

Abdominal Aortic Aneurysm Screening

Men 65 to 75 who have been smokers anytime during their lifetimes should have a onetime ultrasound to screen for an abdominal aortic aneurysm (AAA). The aorta, the main artery supplying blood to the body, extends from the chest to the abdomen. Men who have smoked are at higher risk for the aorta to rupture, which is usually fatal, but if an aneurysm is caught before rupturing, it can be successfully repaired by surgery. The evidence is unclear whether routine screening would benefit women ages 65 to 75 who have been smokers in the past, notes the USPSTF, but the panel recommends against AAA screening for women who have never smoked.



Mosquito Fever Is Among Us

It is spring, it’s wet and the mosquitoes are on their way. As the weather gets warmer and we plan more outdoor activities, it’s important to remember that we are not the only ones becoming more active. Mosquitoes are vectors for disease. This means they can transmit disease from one human or animal to another. Typically, the diseases are caused by viruses or tiny parasites. The virus and mosquito coexist together without harming each other. The virus reproduces itself within the mosquito, and then is passed along when the mosquito bites another person.

The big story in the news lately has been the Zika virus. The most common symptoms of the Zika virus are fever, aches, rash and red eyes. Most of the time the illness is not severe enough for people to seek medical treatment. For this reason, people may not even realize they are infected. The worry with the Zika virus is mainly for pregnant women. The Zika virus can cause a serious birth defect called microcephaly or other fetal brain defects. The most recent increase in outbreaks has been in South America, specifically Brazil. Also reports from Central America and Puerto Rico have occurred. No local mosquitoes have been found to have the Zika virus in the United States. Cases that have been diagnosed in the U.S. were all related to travel exposure. The Zika virus can be detected by a blood test, but the availability is limited. Tests need to be approved by the state CDC.  Treatment is all symptomatic; it is aimed at preventing dehydration, controlling fever and aches.

Prevention of transmission is also important. Transmission has been found to occur through sexual contact. Males who have traveled to areas endemic with Zika virus and have a pregnant partner are recommended to use condoms with any sexual activity throughout the entire pregnancy. Men who have traveled to endemic areas should avoid attempting to impregnate their partner for 3 months post exposure. Women who become pregnant after recent travel to endemic areas should consult their physician for testing. So as you can see it’s a good news story but not something most of us in the state of New Jersey will have much exposure to.

What we do need to be more concerned about is West Nile virus, which does occur in the northeast. Again symptoms are flu like in nature, fever, aches, chills, and diarrhea. In less than 1% of the cases people develop encephalitis or meningitis. These patients suffer from severe headache, neck pain, fever and seizures. Treatment usually entails supportive treatment in a hospital setting.

The true goal with any mosquito borne illness is prevention. Avoiding mosquito bites by using repellants that contain DEET is the mainstay. When weather permits, wearing long sleeves and pants when outdoors at night is beneficial. Mosquito proof your home by fixing screens and keeping doors closed. Reduce the # of mosquitoes in your yard by removing standing water. Also notify the state of any issues with dead birds in your area, which can be a sign of West Nile virus. Some local municipalities may participate in applying insecticides.

All in all mosquito borne illnesses are not that common in our area. A little prevention will go a long way. If you are planning on traveling to areas endemic with mosquitoes check the CDC website to see what specific precautions should be taken.



The thyroid gland is a butterfly-shaped endocrine gland that is normally located in the lower front of the neck.

The thyroid gland can be described as a butterfly-shaped endocrine gland that is normally located in the lower front of the neck. The thyroid’s job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. Thyroid hormone helps the body use energy, stay warm and keep the brain, heart, muscles, and other organs working properly.

Prevalence and Impact of Thyroid Disease
Here are a few statistics about thyroid disease from the American Thyroid Association.

  • More than 12% of the U.S. population will develop a thyroid condition during their lifetime.
  • An estimated 20 million Americans have some form of thyroid disease.
  • Up to 60% of those with thyroid disease are unaware of their condition.
  • Women are 5 to 8 times more likely than men to have thyroid problems.
  • One woman in 8 will develop a thyroid disorder during her lifetime.
  • Most thyroid cancers respond to treatment, although a small percentage can be very aggressive.
  • The causes of thyroid problems are largely unknown.
  • Undiagnosed thyroid disease may put patients at risk for certain serious conditions, such as cardiovascular diseases, osteoporosis, and infertility.
  • Pregnant women with undiagnosed or inadequately treated hypothyroidism have an increased risk of miscarriage, preterm delivery, and severe developmental problems in their children.
  • Most thyroid diseases are life-long conditions that can be managed with medical attention.

Facts about the Thyroid Gland and Thyroid Disease
According to the ATA, the thyroid is a hormone-producing gland that regulates the body’s metabolism—the rate at which the body produces energy from nutrients and oxygen—and affects critical body functions, such as energy level and heart rate.

  • The thyroid gland is located in the middle of the lower neck.
  • Although the thyroid gland is relatively small, it produces a hormone that influences every cell, tissue and organ in the body.
  • Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormone.
  • Symptoms include extreme fatigue, depression, forgetfulness, and some weight gain.
  • Hyperthyroidism, another form of thyroid disease, is a condition causing the gland to produce too much thyroid hormone. Symptoms include irritability, nervousness, muscle weakness, unexplained weight loss, sleep disturbances, vision problems and eye irritation.
  • Graves’ disease is a type of hyperthyroidism; it is an autoimmune disorder that is genetic and estimated to affect 1% of the population.

Research Advancements in Thyroid Disease
Research funded by the ATA over the past 40 years has accomplished the following:

  • Mandatory screening of newborns for congenital hypothyroidism, and early treatment that has prevented mental retardation.
  • Cost-effective methods to detect thyroid cancer by screening the 250,000 thyroid nodules developed in Americans each year.
  • Groundbreaking work in brain development and thyroid hormone function.
  • Promising Graves’ disease genetic research that may lead to improved prognosis and new preventive treatments.
  • An experimental drug that may prove useful for treatment and prevention of eye problems associated with Graves’ disease.

For more information, contact the American Thyroid Association.


Six Things That Raise Your Blood Pressure

American Heart Association News, 02/26/2016

·  Salt. The American Heart Association recommends people aim to eat no more than 1,500 mg of sodium per day. That level is associated with lower blood pressure, which reduces the risk of heart disease and stroke. Because the average American’s sodium intake is so excessive, even cutting back to 2,400 mg per day can improve blood pressure and heart health.

·  Decongestants. People with high blood pressure should be aware that the use of decongestants may raise blood pressure. Many over–the–counter (OTC) cold and flu preparations contain decongestants. Always read the labels on all OTC medications. Look for warnings for those with high blood pressure and who take blood pressure medications.

·  Alcohol. Drinking too much alcohol can raise your blood pressure. Your doctor may advise you to reduce the amount of alcohol you drink. If cutting back on alcohol is hard for you to do on your own, ask your healthcare provider about getting help. The AHA recommends that if you drink, limit it to no more than two drinks per day for men and no more than one drink per day for women.

·  Hot Tubs & Saunas. People with high blood pressure should not move back and forth between cold water and hot tubs or saunas. This could cause an increase in blood pressure.

·  Weight gain. Maintaining a healthy weight has many health benefits. People who are slowly gaining weight can either gradually increase their level of physical activity (toward the equivalent of 300 minutes a week of moderate–intensity aerobic activity), reduce caloric intake, or both, until their weight is stable. If you are overweight, losing as little as five to 10 pounds may help lower your blood pressure.

·  Sitting. New research shows that just a few minutes of light activity for people who sit most of the day can lower blood pressure in those with type 2 diabetes. Taking three–minute walk breaks during an eight–hour day was linked to a 10–point drop in systolic blood pressure.


Is it the Flu or a Cold?

When you wake up sneezing, coughing, achy and feverish how do you know if it is a cold or the flu? It’s important to know the difference between the two because treatments are different. Also secondary health issues can be more serious with one versus the other. For the most part a cold is a milder respiratory illness then the flu. Length of symptoms also varies greatly from a cold to the flu.

Cold symptoms can begin with a sore throat that lasts a couple days. This is often followed by nasal symptoms that can be either runny or congestion. Nonproductive cough is not uncommon. Fever is rare in adults but can be low grade. Children are more likely to have a fever.

Flu symptoms are usually much more severe and come on very quickly. Symptoms can include sore throat, headache, cough and runny nose. Fever is usually high causing body and joint aches.

SYMPTOMS                                         COLD                                       FLU

Fever                                                   Seldom, mild                           Usual, 101-102

Headaches                                          Occasional                              Common

Body aches                                          Slight                                       Usual, often severe

Fatigue                                                            Sometimes                              Usual, up to 2weeks

Congestion                                          Usual                                       Sometimes

Sore throat                                          Common                                 Sometimes

Cough                                                  Mild                                         Moderate/ severe

Complications                                                 Sinus HA, Ear Infection           Bronchitis/Pneumonia


The best treatment for either is prevention. Good hand washing techniques is the most important prevention, along with avoiding touching your face and staying away from those who are visibly sick. For the flu getting an annual vaccine is important. Cold treatments include decongestants, pain/ fever relievers and cough meds. Flu treatments pain/ fever relievers, decongestants, cough meds and antiviral meds.

Cold symptoms can last for up to a week no matter what you do. The first 2-3 days are the worst and when you are the most contagious. Flu symptoms are much more severe and can last 10-14 days. A not uncommon complication of the flu is pneumonia, which can last for 3-4 weeks after the flu. This is much more common in the young, elderly or people with lung problems.

If you have a cold or the flu and symptoms worsen after a few days, it’s time to call the doctor. Other worrisome symptoms include persistent fever for more than 4 days, chest pain, persistent cough, ongoing sore throat or shortness of breath. Seek the advise of a physician if any of the above symptoms occur.

FALL 2015

We thought our patients would find this article helpful:

5 Important (But Rarely Explained) Medical Terms, and What They Mean

By Jeanne Faulkner

No one wants to seem ignorant when they see their doctor, but no one should be expected to be bilingual either. If your doctor's medical jargon is incomprehensible, you're not getting your money's worth. In fact, not knowing what your doctor is talking about can be downright dangerous.

Here are five common terms that patients hear frequently—but often don't understand.


1. Blood Pressure. When your doctor says your blood pressure is something over something, what is she talking about? She's referring to the pressure of the blood in the arteries, the result of the heart muscle's contractions. Let's say your blood pressure is 120 over 80, which is read as 120/80. The two numbers reflect the first and last heartbeats heard with a stethoscope after a blood pressure cuff (a sphygmometer) is pumped up to restrict blood flow, then slowly released.

  • The first number (120) is called systolic pressure and it measures the highest pressure as the heart contracts.
  • The second number (80) is called diastolic pressure and it measures the lowest pressure as the heart relaxes.

What should your blood pressure be? If your systolic number is below 120, and your diastolic number is below 80, you have normal blood pressure. Higher numbers can indicate pre-hypertension, or hypertension (high blood pressure).


2. Cholesterol. What if your doctor says you have high cholesterol? Cholesterol is a natural chemical compound produced by the body, a combination of lipid (fat) and steroid. Cholesterol is a building block for cell membranes and hormones like estrogen and testosterone. The liver produces about 80 percent of the body's cholesterol; the rest comes from diet. When your doctor gives you your cholesterol lab results, you'll hear three numbers, which are expressed in terms of milligrams (thousandths of a gram) per deciliter (tenths of a liter) of blood (mg/dL).

  • LDL (low-density lipoprotein) cholesterol is known as "bad cholesterol," because high levels are associated with heart disease. LDL levels lower than 100 md/dL are great; levels from about 130 to 160 mg/dL are borderline, and higher levels boost your risk of heart disease.
  • HDL (high-density lipoprotein) cholesterol is considered "good cholesterol," because it prevents the hardening of the arteries (atherosclerosis) by taking cholesterol out of the arteries and depositing it in the liver. An HDL level of 60 mg/dL or more is good. For men, levels below 40 mg/dL and for women, below 50/dL, raise your risk of heart disease.
  • Total Cholesterol is the sum total of all cholesterol components in your blood stream. A good total cholesterol level is under 200 mg/dL.

3. Biopsy. If your doctor says you need a biopsy, she wants to remove and examine a tissue sample. Biopsies often help diagnose or rule out cancers, but are also used to identify other conditions. Biopsies may be performed with a needle or a scalpel; they might be minor procedures or require general anesthesia. After a biopsy, your tissue sample will be sent to a laboratory, examined under a microscope, and subjected to any tests your doctor has ordered.


4. CBC and BMP. Your doctor may order these blood tests to help determine your health status. CBC stands for Complete Blood Count, and it measures the amount of several different types of blood cells, including white blood cells (WBCs), red blood cells (RBCs), hemoglobin (HGB), hematocrit (HCT), and platelets in your body.

  • WBC: The normal range is between 4,500 and 10,000 cells/mcL, or cells per microliter (millionth of a liter). A higher count usually indicates infection.
  • RBC, Hgb and Hct values indicate the presence or absence of anemia (a lack of red blood cells). Normal RBC range for men is 4.7 to 6.1 million cells/mcL; for women, normal range is between 4.2 to 5.4 million cells/mcL. Normal Hgb is between 13.8 to 17.2 gm/dL (grams per deciliter, or tenth of a liter) for men, and between 12.1 and 15.1 gm/dL for women. Normal Hct ranges from 40.7 to 50.3% (in men), and from 36.1 to 44.3% (in women).
  • Platelets indicate your blood's ability to clot. The normal platelet count range is between150,000 - 400,000 platelets per microliter (millionths of a liter).
  • BMP stands for Basic Metabolic Panel, a test for sodium, potassium, calcium, and glucose levels, and measurements of kidney function. Your doctor may order this if you’ve had vomiting or diarrhea, or to screen for other types of diseases, including heart and kidney disease.

5. Body Mass Index (BMI). Your BMI is a measure of your weight in comparison to your height. It's calculated by plugging your height and weight into a formula.

  • Normal BMI for adults is between 20 and 25.
  • Overweight is 25 to 30.
  • Obese is 30 to 35.
  • Morbidly obese is 35 to 40 or above.

Don't hesitate to speak up when your doctor speaks medical-ese. Excellent health care is all about communication and getting the information you need.



Get in Shape for Summer and Just Do It!

Summer is just around the corner and there aren’t too many of us who don’t have the urge to shed our winter coats. Weight loss for many of us is a full time job. At Pine Street we have a saying “Work Smarter not Harder”.  So this is what I would suggest to all of you for the next few months.  Weight loss is not rocket science, but the logic of calories in vs. calories out.  One pound of weight is equal to 3500 calories. So this means to just lose a pound a week you need to process 500 calories different a day.  Eat 500 less, exercise 500 more or do a combination of both. But you need to do it!


For the most part weight loss is 85 % eating and 15 % exercise. So this means change the 500 calories a day in eating and let the exercise be a bonus for your weight loss goal.  You need to look at portion sizes and read labels.  Remember the portion size and calories listed are all you should eat for the meal or snack. You should not eat from the bag or container.  Take the portion size and this is your allowable amount. To be successful at weight loss you also need to keep a diet diary. This helps hold your accountable to yourself for what you put in your mouth. With technology today keeping an eating diary is not as challenging as it has been in the past.  Weight Watchers even has an “APP” that you can scan the products bar code and it will tell you the amount of points allowed for that food.  My Fitness Pal is another great “APP” to utilize as you are trying to get into shape. Use the notes section on your phone to keep track of your daily intake. Again, you just need to do it!


Your plate should be at least half salad or vegetables and then 1/4 ¼ protein and 1/4¼ grain or starch if you must.  In my exam rooms I have a poster “Carbs are killing you “.  This poster discusses the breakdown process of starchy carbohydrates and how they are broken down and your body stores the metabolites as fat due to insulin production.  So eating less Bread, Pasta, Rice and Potatoes will dramatically improve your ability to lose weight. If you feel the need to eat a starch, try to eat a portion of protein first to get your metabolism started and then10 minutes later have your potion sized treat.  Another helpful calorie burning effort is to eat 4-5 smaller meals per day instead of two or three larger meals. Again your body is able to process these calories more efficiently and helps in your weight loss goals.  Water is the next piece of the puzzle.  If possible you should try to drink 4-6, 8 ounce glasses of water per day to hydrate and help keep you full.  Drinking a glass 30 minutes prior to each meal is also very helpful.


Did you know it takes 20 minutes for your brain to realize that your belly is full? We all eat too fast. Our lives are busy and eating does not take priority. Try to eat slower and use that 20 minutes for the portion size allowed for that meal. If you are still hungry drink another glass of water at the end of the meal. If you are really still feeling hungry have a 100 calorie snack. Eating only at the kitchen table or lunch room table should also become a habit. Eating in front of your computer or the TV allows you to mindlessly continue to eat past the full signal.  Eat slower- Just do it!


Finally, you need to make time to exercise.  No one will say to you, stop what you are doing and take a walk or go to the gym.  You must schedule time to exercise just like you know your work day schedule.  Ideally, 20-30 minutes daily is the goal.  But be realistic and stick to your exercise routine. I have never asked anyone to exercise who have come back and told me they felt so horrible after I asked them to exercise. You will feel better.  SO JUST DO IT!

Happy Summer----- Dr. Lee Ann


Spring 2015

Coping With the Loss of a Loved One

Dealing with the loss of a loved one can be one of the most difficult times in a person’s life. How o get through this time is something we all look for at some point. We have all heard about the different stages of grief Denial, Pain, Anger, Depression and Acceptance. Getting to the last one is not always easy. We talk about taking things one day at a time and working our way from one step to the next. The truth is the path is not always a straight one. More often it is filled with taking 2 steps forward and 1 or 2 steps backward. Sometimes it can feel like we are in two stages at once, even on the same day.

What we have to realize is the grieving process is different for every individual. There is no one blueprint that works for everyone. There is no time line as to when someone should move from one step to the next. Each individual is different, each relationship is different and hence forth the process will be different each time. Realizing there is no normal should actually be the first step.

Having family and friends around to help us through the process can be a great comfort. Using them when you need to is perfectly normal. You shouldn’t feel guilty for asking for help when you need it. Family is often more than happy to help in any way that they can.

If you do not have that kind of relationship with your family there are other sources of help out there. Churches and communities often have support groups that you can attend. There are different types of groups to attend, ones for spouses, young or old, ones for loss of a child, or ones for loss of parent. Individual counseling can also be of benefit for some people. Whatever you feel most comfortable with to help you through this journey.

At times your grief can seem so overwhelming that you need more help then what has already been mentioned. Sometimes we need the help of medications to get us through the process, this is completely normal. No one should feel guilty or embarrassed by the need for medication. It is not a sign of weakness, it is just another option for treatment on the journey. Even when medication is needed it does not mean that it will be forever. Often medication is used to help get over the hump and stopped when no longer needed.

The stages of grief are a process that is different for each of us. No one can tell you what is the timeline or normal for you. It’s an unfortunate journey that we all have to go through at some point. When we get to the last stage acceptance, it does not mean we have forgotten our loved one or that we aren’t sad that they are gone. It means we are able to think about our lost loved one without the pain, are able to anticipate good times to come and find enjoyment in the experience of living.

For those currently dealing with the loss of a loved one, our thoughts and prayers are with you.


Married to your Doctor

February 2015


     This month’s Hot Topic will review the Health Screenings that you and your family should make a part of your wellness fitness plan.  As your physician at Pine Street Family Practice, our relationship is like a marriage, “In Sickness and in Health”.  Our contribution to the marriage is to prevent and fix the “Sickness” and your role is to actively participate in “Staying Healthy”.  Listed below are the health screenings and testing you and your family should have now or schedule in the future. We want to celebrate and look forward to our 50th Anniversary together!!!

Men’s Health

Here's how often you should have a complete physical by your doctor.



19 to 21 years

One visit every 2 to 3 years; every year if you choose

22 years to 64 and older

One visit every 2 years; every year if you choose

65 and older

One visit every year

Vaccinations for men



Hepatitis A

2 doses for men at high risk

Hepatitis B

3 doses for men at high risk

Herpes zoster (shingles)

1 dose at age 60 and older

Influenza (flu)

1 dose every year

Measles, mumps, rubella (MMR)

1 to 2 doses for men who have no history of MMR vaccination or the disease; can be given to men age 40 and older if at high risk.

Meningococcal (meningitis)

1 dose at ages 19 to 24 if not previously vaccinated; can also be given at age 40 and older if at high risk

Pneumococcal (pneumonia

1 dose before age 65 followed by a booster after age 65 for men who have a history of asthma or smoking; 1 dose after age 65 for all others

Tetanus, diptheria and pertussis (Td/Tdap)

1 dose of Tdap for men who have not received a pertussis booster, regardless of the date of the last tetanus vaccination; after that, 1 Td every 10 years.

Varicella (chicken pox)

2-dose series for men with no history of varicella vaccination or the disease


Screenings and tests recommended for men


Assessments, screenings, and counseling


Abdominal aortic aneurysm screening

1 screening between ages 65 and 75 for men who smoke or have smoked in the past

Alcohol misuse screening

At physical exams

Blood pressure screening

At physical exams

Chlamydia, gonorrhea, syphilis and HIV screenings

[How often?] for all sexually active men

Colorectal cancer screening

1 of the following screening options beginning at age 50:

Colonoscopy every 10 years

Flexible sigmoidoscopy every 5 years

Fecal occult blood test annually

For men with a family history (first-degree relative) of colorectal cancer or adenomatous polyps: Begin colonoscopies every 5 years either at age 40 or 10 years before the youngest case in the immediate family. Consider stopping screening at age 75. Screening is not recommended for after age 85.

Depression screening

At physical exams

Diabetes screening: Fasting plasma glucose test (Type 2)

Every 3 years for men with ongoing blood pressure greater than 135/80, treated or untreated

Diet counseling

At physical exams, if at higher risk for chronic disease

Family and intimate partner violence

Anticipatory guidance, at physician discretion

Height, weight and body mass index (BMI)

At physical exams

Lipoprotein profile, fasting (total cholesterol, LDL, HDL and triglycerides)

1 every 5 years

Medical history

At physical exams

Obesity screening, counseling and behavioral interventions

At physical exams

Safety, falls and injury prevention

Anticipatory guidance at physician discretion

Sexually transmitted infection (STI) prevention counseling

At physical exams, for those at high risk

Tobacco use screening and cessation counseling

At each visit; includes intervention for tobacco users

Tuberculosis testing

For those at high risk


Drugs men may need for preventive care

Preventive care drugs may be provided to you at no charge if your plan is not "grandfathered" under the Affordable Health Care Act of 2010. If your plan is "grandfathered," these prescriptions will be covered according to your prescription plan.



Low-dose aspirin

For men ages 45 to 79 years and others with risk factors for heart disease. Consult your doctor before beginning aspirin therapy.



Women’s Health

Here's how often you should have a complete physical by your doctor.


19 to 21 years

1 visit every 2 to 3 years; every year if you choose

22 years to 64 and older

1 visit every 2 years; every year if you choose

65 and older

1 visit every year

Vaccinations for women



Hepatitis A

2 doses for women at high risk

Hepatitis B

3 doses for women at high risk

Herpes zoster (shingles)

1 dose for women age 60 and older

Human papillomavirus (HPV)

A 3-dose series for women ages 19 to 26. Requirements: Second dose given at least 4 weeks and preferably 2 months after the first; third dose given at least 12 weeks and preferably 6 months after the second; at least 24 weeks required between the first and third dose

Influenza (flu)

1 dose every year

Measles, mumps, rubella (MMR)

1 to 2 doses for women who have no history of MMR vaccination or the disease

Can be given to women age 40 and older if at high risk

Meningococcal (meningitis)

1 dose for women ages 19 to 24 with no history of meningococcal vaccination

Can be given to women age 40 and older if at high risk

Pneumococcal (pneumonia)

1 dose followed by a booster every 5 years for women age 19 or older who have a history of asthma or smoking; 1 dose for all other women age 65 or older

Tetanus, diptheria and pertussis (Td/Tdap)

1 dose of Tdap for women who have not received a pertussis vaccine previously, regardless of date of the last tetanus vaccination; after that, 1 dose of Td every 10 years

Recommended especially for women who have contact with children under age 1

Varicella (chicken pox)

2-dose series for women with no history of varicella vaccination or the disease


Screenings, tests & counseling for women


Assessments, screenings, and counseling


Alcohol misuse screening

At physical exams

Blood pressure screening

At physical exams

Breast cancer gene (BRCA1 and 2) screening counseling

For women at high risk

Breast cancer screening (mammogram)

For ages 40 and older, mammograms once every 2 years

Breast cancer chemoprevention counseling

For women at high risk for breast cancer who might benefit from chemoprevention: Discuss benefits and potential harms

Breast self-exam guidance

At physician discretion

Cervical dysplasia/cancer screening (Pap tests)

Annually starting when a woman becomes sexually active or at age 21, whichever is first, up to age 30; every two to three years after age 30. Suggest stopping at 70 if: 3 or more normal Pap tests in a row, no abnormal Pap test in previous 10 years and not at high risk.

Chlamydia infection, gonorrhea and syphilis screenings

At physical exams, for all sexually active women

Colorectal cancer screening

One of the following screening options beginning at age 50:

Colonoscopy every 10 years (recommended because it's the most complete)

Flexible sigmoidoscopy every 5 years

Fecal occult blood test annually

For women with a family history (first-degree relative) of colorectal cancer or adenomatous polyps: Begin colonoscopies every 5 years at age 40 or 10 years before the youngest case in the immediate family. Consider stopping screening at age 75. Screening is not recommended for individuals older than 85.

Contraceptive counseling and contraceptive methods*

Access to FDA-approved contraceptive methods, sterilization procedures and patient education and counseling when needed.
Services don't include prescribing drugs that induce abortion.

Depression screening

At physical exams

Diabetes screening: Fasting plasma glucose test
(Type 2)

Every 3 years for women with ongoing treated or untreated blood pressure greater than 135/80

Diet counseling

For women at higher risk for chronic disease

Domestic violence screening and counseling*


Height, weight and body mass index (BMI)

At physical exams

Human immune-deficiency virus (HIV)counseling and screening*

Annually for sexually active women

Human papillomavirus testing*

Every 3 years beginning at age 30, regardless of Pap test results

Lipoprotein profile (fasting, for total cholesterol, LDL, HDL and triglycerides)

Once every 5 years

Does not include metabolic panel

Medical history

At physical exams

Menopause counseling

At physician discretion

Obesity screening and counseling

Includes counseling and behavioral interventions

Osteoporosis screening

For women ages 40 and older, a screening without bone density test once every 2 years during physical exam

Beginning at age 50, a bone mineral density test every 2 years for post-menopausal women with risk factors. If no risk factors, every 2 years beginning at age 65.

Safety, falls & injury prevention guidance

At physician discretion

Sexually transmitted infection (STI) prevention counseling

At physician discretion, for women at high risk

Sexually transmitted infection (STI) screening and counseling*

Annually for sexually active women

Tobacco use screening and counseling

At each visit; includes cessation counseling and intervention for tobacco users. Expanded counseling for pregnant women.

Tuberculosis testing

At physician discretion, for women at high risk

Prescription drugs for women's preventive care

These drugs may be provided to you at no charge if your plan is not "grandfathered" under the Affordable Health Care Act of 2010. If your plan is "grandfathered," these prescriptions will be covered according to your prescription plan.



Folic acid supplements

0.4 to 0.8 mg of folic acid for women of childbearing age

Low-dose aspirin therapy for the prevention of cardiovascular disease

Women age 55 to 79 years, and others with risk factors for heart disease. Consult your doctor before beginning aspirin therapy.




Benefit level


Female condoms
Contraceptive sponge

Generic contraceptive methods for women are covered at 100% (free).

You will pay your prescription copayment for brand-name contraceptives.


Oral contraceptives ("the pill")
Injectable contraceptives




Next Choice®
Next Choice® One Dose

Covered at 100% (free) as a preventive service, not covered by your prescription drug plan.


Tubal ligation ("tubes tied")

Covered at 100% (free) when performed at outpatient facilities.

If received during an impatient stay, only the services related to the tubal ligation are covered in full.



Children’s Health

Here's how often you should have a complete physical by your doctor.



2 to 3 days after discharge

Under 3 years

Well-child visits at 2, 4, 6, 9, 12, 15, 18, 24 and 30 months

3 to 6 years

1 visit every 12 months

7 to 10 years

1 visit every 12 to 24 months

11 to 18 years

1 visit each year

19 to 21 years

1 visit every 2 to 3 years; every year if desired

22 years and older

1 visit every 2 years; every year if desired

Vaccinations recommended for children



Diphtheria, tetanus, pertussis (DTaP, Tdap, and Td)

5 doses of DTaP: 1 each at 2, 4 and 6 months, between 15 and 18 months and between 4 and 6 years

1 dose of Tdap between ages 11 and 12

1 Td booster every 10 years after the dose of Tdap

"Make-up" doses:

1 dose of Tdap between ages 7 and 10 if the child missed any of the 5 DTaP doses listed above

1 dose of Tdap for anyone 18 or younger who has not already received it, regardless of when the last Td was given

Haemophilus influenza type b (Hib)

4 doses, 1 each at ages 2, 4, 6 and 15 to 18 months

At the doctor's discretion, dose 4 may be given as early as 12 months if 6 months have elapsed since dose 3

Hepatitis A

2 doses at least 6 months apart at ages 12 to 23 months

2 doses at least 6 months apart from age 2 to 18 years, if not vaccinated previously and at high risk, at the doctor's discretion

2 doses at least 6 months apart for all adolescents up to age 18

Hepatitis B

3-dose series for infants: First dose before leaving the hospital, second dose between 1 and 2 months, third dose between 6 and 18 months

May begin 3-dose series at age 2 to 18 years if not vaccinated in infancy

Human papillomavirus (HPV)

3-dose series of either Gardasil® (boys and girls) or Cervarix® (girls only) between ages 9 and 26 years, best given between 11 and 12 years.

Requirements: Second dose given at least 4 weeks and preferably 2 months after the first; third dose given at least 12 weeks and preferably 6 months after the second; 24 weeks required between the first and third dose

Inactivated poliovirus (polio)

4 doses, 1 each at ages 2, 4 and 6 to 18 months, and between ages 4 and 6 years

Influenza (flu)

1 dose annually for healthy children between ages 6 months and 8 years

2 doses separated by 4 weeks if receiving for the first time or if vaccinated during the previous flu season but only received 1 dose

1 dose annually for children 2 years and older

Measles, mumps, rubella (MMR)

2 doses: The first at ages 12 to 15 months, the second between ages 4 and 6; doses should never be less than 1 month apart

After age 7, 2 doses if not previously vaccinated or no history of disease; doses should never be less than 1 month apart

Meningococcal (meningitis)

1 dose between ages 11 and 12 years with a booster at age 16

2 doses 2 months apart between ages 2 and 18 if high risk (HIV, non-functional spleen, etc.)

Catch-up all adolescents 13 and older who have not had Tdap

Pneumococcal (pneumonia)

4 doses at 23 months and younger: 1 each at 2, 4, 6, and 12 to 15 months


3 doses, 1 each at 2, 4 and 6 months

Varicella (chicken pox)

2 doses: 1 between ages 12 and 15 months and 1 between 4 to 6 years

1 dose between ages 12 months and 12 years if the child has no history of varicella

2 doses between 7 and 18 years if the child has no history of varicella and no previous vaccination

Screenings and tests recommended for children

Assessments, screenings and counseling


Alcohol and drug use assessments

During each visit between ages 11 to 18 years

Anticipatory guidelines as defined by Bright Futures

Throughout a child's development, at physician discretion

Autism screening

Once between ages 18 and 24 months

Blood pressure

Every year beginning at 3

Cervical dysplasia/cancer screening

For all sexually active females

Congenital hypothyroidism screening

Once at birth

Depression screening and behavioral assessments

At physician discretion

Developmental screening

3 screenings, 1 each at 9, 18, and 30 months

Dyslipidemia screening

Assessments at 2, 4, 6, 8 and 10 years old, then once a year through age 18. Routine lab testing not recommended, but may be done for children identified as high risk.

Gonorrhea preventive medication

1 dose at birth

Hearing loss screening

At birth and at ages 3, 4, 5, 6, 8, 10, 12, 15 and 18 years

Height, weight and body mass index/percentile measurements

At each visit; all measures up to age 2 years, then starting at 2 years, BMI/percentile only

Hematocrit or hemoglobin screening

Once at 12 months, once between ages 11 and 18, and once annually for menstruating adolescents

Lead screening

A blood test at 12 and 24 months for children at high risk.

Risk assessments for lead exposure between ages 6 and 12 months, at 24 months, and between ages 2 and 6.

Medical history

At each well-child visit and physical exam

Newborn screenings as identified by the federal Health Resources and Services Administration, including but not limited to phenylketonuria (PKU) and sickle cell disease

Once at birth

Obesity screening and physical activity and nutrition counseling

Beginning at age 6

Oral health risk assessment

At 12, 18, 24 and 30 months, 3 years and 6 years

Sexually transmitted infection prevention counseling and screenings for chlamydia, gonorrhea, syphilis and HIV

Counseling for sexually active adolescents

Screenings for sexually active females, and for males at high risk

Tobacco-use screening and counseling

At each visit. Includes cessation intervention for tobacco users and expanded counseling for pregnant tobacco users.

Tuberculin testing

For children at high risk

Vision screening

At ages 3, 4, 5, 6, 8, 10, 12, 15 and 18

Prescription drugs children may need for preventive care

These drugs may be provided to your child at no charge if your plan is not "grandfathered" under the Affordable Health Care Act of 2010. If your plan is "grandfathered," these prescriptions will be covered according to your prescription plan.



Oral fluoride supplements

Children 6 months of age and older without fluoride in their water source to prevent dental caries

Iron supplements

Children ages 6 to 12 months at risk for iron-deficiency


Please help us celebrate our Golden Wedding Anniversary and stay Healthy!!


Dr. Lee Ann


 January 2015

Warning:  Drinking Is Hazardous to Your Health


Consuming alcohol, like any other beverage, is a choice.  But is it your smartest choice?  For years alcohol has been touted to be cardio protective. The notion of alcohol’s protective effect on the heart depends on consistent light to moderate drinking, without episodic heavy or “binge” drinking. The daily low to moderate alcohol intake with your evening meal is associated with the strongest reduction in harmful cardiovascular outcomes.  Unfortunately heavy alcohol consumption can result in hypertension, atrial fibrillation, stroke, cardiomyopathy and liver damage.  More alarming is the risk associated with cancer.


Alcohol consumption is viewed as a modifiable behavioral risk factor for cancer.  There are direct correlations between alcohol consumption and the development of oral-pharyngeal, esophageal and breast cancer. A link is also being found to pancreatic cancer.  Alcohol contains at least 15 carcinogenic compounds including but not limited to acetaldehyde, arsenic, benzene, ethanol, formaldehyde, and lead. Ethanol is the most significant carcinogen and it is partially due to the fact that its metabolism is genetically controlled.


So why might this happen?  For one, these carcinogens come in direct contact with the mucosal cell surface and create cell damage and mutation.  Alcohol directly antagonizes folic acid which is needed for metabolism and cell growth and DNA function.  Alcohol also can increase estrogen levels and the activity of insulin-like growth factor receptors which can stimulate mammary cell growth increasing breast cancer cell changes.  Finally, drinking alcohol is also associated for many people with simultaneously smoking cigarettes. So now we have two dangerous cancer causing agents amplifying their negative effects. Of note… Hard alcohol is more directly associated with esophageal cancers than any other type of cancer.


Should alcohol now also have a warning label for its risk for cancer? The public opinion is surely mixed.  Most people do not even know or think about this risk. But knowledge is power, so it is “Your Choice” on whether to consume alcohol and exactly how much and how often. For heavy alcohol consumers, the good news if cutting back definitely lessens your risk for cancer. So, less is better. 


Strategies to Reduce the Personal and Public Costs of Alcohol


Personal health behaviors:

  • Monitor your alcohol intake ("know your number"). This is similar to knowing your blood pressure, cholesterol level, or calorie intake.
  • Limit consumption to 20 g daily for men and 15 g daily for women (1.5 drinks for men and 1 drink for women, by US standards).
  • Less is more: Lower alcohol consumption leads to greater health and longevity.
  • Take a day off. Not drinking for 1-2 days each week can help the liver recover from the effects of alcohol and reduce the risk for liver complications.

Government intervention:

  • Apply a minimum pricing policy to alcohol to reduce consumption of cheap alcohol, especially by young people.
  • Label the amount of alcohol in grams (like food labeling) to allow consumers to track the exact amount of alcohol they are consuming.
  • Limit the times and places alcohol can be purchased to reduce impulse buying, and avoid contact with alcohol in shops and supermarkets.
  • Provide treatment to benefit individuals and society; offer to all people with an alcohol dependence problem.
  • Invest in research to develop new approaches to addiction.
  • Develop alternatives to alcohol -- investigate new drugs that mimic the milder effects of alcohol; simulate relaxation without the negative side effects of alcohol.


So when my staff asks you “on average how many alcohol beverages do you have in an average week”?  Please be honest so that we can help lessen your health risks and educate you on the risk vs. benefits of consuming alcohol.

Here is to a Happy and Health 2015

Dr. Lee Ann

October 2014


LIVING WILLS, Who should have one? EVERYONE!

What is a Living Will?

A Living Will is a legal document that a person uses to make their wishes known regarding medical treatments to prolong life.  Other names used for a Living Will are Advanced Directive or Healthcare Directive.  A Living Will does not have anything to do with an individual’s personal assets.


Why have a Living Will?

A Living Will gives you a voice at a time when you may not be able to speak.  It gives you the final say in your healthcare treatments.  It directs healthcare professional as to what therapies a patient wants and does not want.  A Living Will also makes a crisis situation much easier for your family members.  It will take the hardship of making medical decisions off family members because they will be able to follow the blueprint set forth by you the patient.  At times of crisis it is very difficult for family members to be able to recall or determine what you would have wanted. 

As part of a Living Will you should also designate a Healthcare Power of Attorney.  This is the person that you would want to be making decisions for you should the need arise.  This person would be responsible only for your healthcare decisions, not your financial decisions.


Who needs a Living Will?

Pretty much all adults need a Living Will.  Unfortunately accidents do happen and we maybe in a situation where it is necessary.


What is in a Living Will?

A Living Will discusses certain life prolonging treatments such as Resuscitation, Mechanical Ventilation, Nutritional Assistance, Dialysis and Life Support.  These are a few extraordinary measures that can be performed in an emergency situation.  Living Wills discuss not only to implement these treatments but also for what length of time.  Stipulations can be made that if not improving your condition they can be stopped.  You may specify in your Living Will if you would like to be an organ donor or donate your body to scientific research.


Where do I keep my Living Will?

You should keep your original Living Will in a safe place with your important documents.  A copy of your Living Will should be on file at your doctor’s office and a copy should be given to your Healthcare Power of Attorney.


Lastly it is important to share your wishes with your doctor and your family.  At your next office visit you can discuss the specifics of your Living Will.  Discuss your wishes with your family, let them know you have a Living Will and who you designated as your Healthcare Power of Attorney. Under the Patient Forms tab on our website you can find samples of a Living Will and Healthcare Power of Attorney.


Dr. Steve

JULY 2014


What you don't know may hurt you.

Here are some statements that doctors often hear from patients and why we think these are answers you should know.
1. "I don't know if I took my medication today."
It is important to take medications regularly. Some ways to remind yourself is to use a pill box.  Then you can tell if you took each day's dose.
Another option is to set an alarm on your cell phone. Taking medications at the same time of day you always do something else, like brushing your teeth, helps to make it a habit.
2. "I don't know what medications I take; my significant other handles all that."
They are your medications. It is important for you to know what they are and what condition you take them for. If you cannot remember the names, then keep a list in your wallet so you have it at all times.
It helps all of your doctors to know what medications someone else may be prescribing. This helps to prevent prescription interactions.
3. "I know I am allergic to something, but I don't know what it is."
It is also important to know any medications you may be allergic to and what type of reaction you had to it. Once again, if you find it hard to remember, write it down and keep that in your wallet as well.
4. "I don't know what health problems run in my family."
As many of you are aware, we are updating family history in our office now. Since many conditions can be hereditary, it is important for you to know your family medical history so we can discuss what screening tests may be helpful for you.
5. "I don't know what to eat for a snack that is healthy."
Try popping your own popcorn, 6 cups of AIR-POPPED  popcorn has only 100 CALORIES. (Avoid the salt, especially if blood pressure is an issue for you.)
6. "I don't know what the best thing to do to live longer is."
If you currently smoke, quit. While we know this is not an easy thing to do, it is one of the best things you can do for your health. If you would like to discuss some options to help you quit, please ask us.
7. "I don't know what types of food to avoid to help my cholesterol level."
Fried foods, red meat, pork products, shellfish, whole milk and whole milk cheeses and yogurts, ice cream, many salad dressings and egg yolks are some of the foods highest in cholesterol.
 8. "I don't know why I need a colonoscopy; colon cancer does not run in my family and I do not have any symptoms."
In general, for healthy adults without a family history of colon cancer, screening with a colonoscopy should begin at age 50. Individuals with a family history of colon cancer should begin screening ten years before a first-degree relative (sibling, parent or child) was diagnosed. Individuals with certain symptoms: changes in bowels habits, blood in bowel movements, anemia, etc, should also have a colonoscopy, even if they are younger than age 50. Most individuals who are diagnosed with colon cancer have no symptoms and no family history of the disease. That is why screening for small polyps that can be easily removed is essential.

JUNE 2014


Another Way to Save a Life


When you apply or renew your New Jersey Driver’s license one important question that you have to answer is “Do you want to be an organ donor?”  This question is being asked of the 17 year old as well as the senior citizen. It’s a question that I am not unfamiliar with as a family physician. You have all been asked this question as I have prodded you to complete your living will as well.


Many seniors say “who would want these old organs?” My standard reply is “If you are willing to potentially help save another person’s life, then let the organ donation team make that decision.”


Arming yourself with the right information can ease some of the fears you as our patients have about organ donation.  Did you know that in South Jersey in 2011 392 patients donated organs and 1,114 patients received the gift of a lifesaving organ transplant?  Just one organ and tissue donor can save or enhance the lives of more than 50 individuals.  There are vital bone grafts to repair fractures to prevent amputation, skin grafts for burn patients, heart valve replacements, tendons to repair knee injuries and corneal transplants to prevent blindness just to name a few.  The list goes on and on.  The number or patients waiting in our area for organ transplants now exceeds 6,500.  Organs are allocated on the following criteria:  match with a donor, medical urgency and time on the waiting list.  There is no cost to the family for organ donation and donation does not interfere with the customary funeral plans.


The Gift of Life Donor Program is an organization that is notified when there is a potential organ donor from a hospital ER or ICU.  Contact should be thought of before formal brain death examination or having the discussion with the family about the withdrawal of life-sustaining therapies.  Notifying Gift of Life is the first step to ensuring that a family’s donation opportunity is preserved.  The Gift of Life service region includes Pennsylvania, southern New Jersey and Delaware and it is part of the 58 nonprofit organ procurement organizations in the nationwide network run by the United Network for Organ Sharing (UNOS). 


UNOS and its success rely on us, so please consider organ donation with your next driver’s license renewal and living will.  Visit for more information.


Thank you for trying to help Save a Life!



Dr. Lee Ann

MAY 2014

To PSA or Not To PSA

The two common screenings for prostate cancer are either a blood test called a PSA, that calculates a secretion from the prostate gland, or the digital rectal exam (a healthcare professional uses a gloved finger inserted into the rectum to check for lumps on the prostrate).  When the blood test is done, high levels of PSA for men indicate a high risk for prostate cancer.  Other factors such as age and race, medications, infections and enlarged prostate can also affect the PSA level causing high results.

So what is the controversy?  A US Task Force made the following recommendations in 2012. The standard guideline for screening in non-symptomatic males has no benefit and that the harm outweighs the benefit.  This sent shock waves through the Urologic Community. The question is whether we are saving lives with this test or causing harm through unnecessary testing.

Benefit-The obvious benefit is early detection of prostate cancer and saving lives.

Harm-The blood test causes very little if any risk for harm.  Abnormal PSA may result in a biopsy which can cause bleeding or infection.  What we do next is the big step.  About 25% of all biopsies are positive for prostate cancer.  Once diagnosed with cancer, treatment options are watchful monitoring of your prostate, hormone treatments, or reduction type surgery.  Most men opt for treatment which is very successful.  Yet treatment can come with the risk of incontinence or impotence.

So now what?  The recommendation of some physicians is to still have the PSA testing done.  Then have a frank discussion with your physician as to what to do with the results.  Knowledge is power.  The more informed you are the better the decision you can make. 

If you have any questions about PSA testing or Prostate Cancer, please set up an appointment so we can discuss your risk factors.

Dr. Steve



April 2014

Over the Counter Medications Fact vs. Fiction

Just because a medication is over the counter (OTC), and not a prescription medication, does not mean that it is safe for everyone or that it can be combined with all other medications. It is important to read the entire label to see all of the ingredients in the medication and to see what other conditions that you have that the medication may interfere with. It is important to let your doctor and pharmacist know what OTC medications you may be taking. Here are some facts about OTC medications to help prevent complications. This is certainly not a comprehensive analysis of all OTC meds and their possible risks or interactions, but rather, serves as a general guideline.

1.  Tylenol is safe for everyone.  FALSE

While Tylenol (Acetaminophen) is a great medication for headaches, other pains, and to reduce fevers, it is NOT for everyone. Individuals with liver disease should avoid Tylenol. Also, Acetaminophen is found in many cold remedies, so be sure to read the label of all cold medications to make sure you are not already taking this. Acetaminophen is also in many prescription pain medications such as Percocet, so make sure you read any prescription medications or ask your doctor or the pharmacist before adding Tylenol (acetaminophen.)


2.  Aleve is better than Advil on my stomach since it is just twice a day. FALSE

Both Aleve (Naprosyn) and Advil/Motrin (Ibuprofen) are in the class of medications called NSAIDs (Non-steroidal- Anti-inflammatory drugs.) While these do work well for fevers and aches, they can irritate the stomach or cause serious stomach problems in some patients. Patients with kidney disease or impaired kidney function should avoid these medications. They can also increase blood pressure.


3.  Avoid Aspirin in children and teens. TRUE

Children and teens should NEVER take aspirin if they have a cold, flu, or chicken pox. They can develop a rare condition called Reye’s syndrome that can cause serious long term complications or be fatal.


4.  All cold medications are the same. FALSE

Decongestants can help with nasal congestion, but can elevate blood pressure and cause side effects in patients with prostate problems.

Decongestant nasal sprays should not be used for more than three days.

Guaifenesin can help loosen mucous; drink plenty of water to help this work.

Dextromethorphan helps to suppress a cough.

Many of these medications are found alone but often times are found in combinations. Make sure to just take a cold medication that treats the symptoms you have and does not interfere with other medications or health conditions that you have.


5.  There is a difference among over the counter allergy medications. TRUE

Medications with Diphenhydramine (Benadryl) can be effective for allergy symptoms, but can cause drowsiness. They can interfere with your ability to work and drive safely.

Other antihistamines with less sedation include: Loratadine (Claritin, Alavert), Fexofenadine (Allegra), and cetirizine (Zyrtec).



Always read the label before taking an over the counter medication. If you are not sure what you can safely take for your symptoms, please ask. Remember to always let your doctor know what medications and supplements you are taking, both prescription and over the counter.

February 2014

Patient Health Portal


The office now has a Patient Health Portal.  The portal is a web-based system that allows for secure communication and transfer of information between Pine Street Family Practice and the patient.

The portal will give you direct access into your electronic health records (EHR).  You will be able to access the Patient Health Portal at your convenience. Patients are able to update demographics, insurance information on the portal.  You can view a Clinical Summary from your office visit. Request refills, referrals, future appointments, and ask questions to the office. 

The portal is not to be used for emergent medical problems, and the response on the Patient Health Portal may take up to 48 hours.  If you require a sooner response please contact the office by phone at 856-629-7436.

At this time the portal does not give the patient access to their diagnostic or laboratory results, but we are hoping to add that feature in the near future.

The staff is available to assist with any questions you may have for registering and participation in the Patient Health Portal.  Please contact the office to request an “Invitation to join the Patient Health Portal” and we will send the link to join directly to your email.  It is that simple.

We hope you take advantage of our Patient Health Portal.  Pine Street Family Practice always trying to provide you with excellent patient care and now the technology to participate in the future of your medical care.

Our Family Caring For Your Family