Three more conditions your primary care provider sees every week

Board-certified family medicine physician Naveed H. Butt, MD, specializes in preventive care and encourages healthy lifestyle changes to help patients avoid chronic medical conditions. He has been in practice for more than 30 years and sees patients at Inova Primary Care – Purcellville.

In part one of this two-article series, we covered four of the issues that bring patients in to see their primary care providers:

• Enlarged prostate
• Colon cancer screening
• Menopause
• Low back pain

These issues can affect a person’s day-to-day quality of life, and there is often a lot we can do to help. As a primary care physician, my goal is to help my patients achieve positive health outcomes – not only by treating illness, but ideally by preventing it in the first place. I always encourage my patients to come in to see me when something is bothering them:

• As a primary care provider, the first thing I do is listen carefully to the patient
• Then, I focus on patient education, explaining the problem and its likely causes
• I partner with my patients to create a plan that fits their lifestyle and health goals

No matter what the problem is, the first step is always the same:  the patient books an appointment.

Three more of the most common reasons patients schedule a visit with their primary care providers

1. Sleep apnea

What it is: Sleep apnea is a very common problem with symptoms that can be easy to ignore at first. It is a sleep disorder in which a person’s breathing stops and starts during sleep, over and over again. The most common type of sleep apnea is called obstructive sleep apnea, where a person’s airway gets blocked as the muscles in the person’s throat relax during sleep.

When a person with sleep apnea stops breathing, the person’s brain sends a signal that wakes the person up enough to get them breathing again. However, if this is happening repeatedly – sometimes dozens or even hundreds of times per night – it leads to poor quality sleep. And if left untreated, it can increase a person’s risk of heart disease, heart rhythm problems, high blood pressure and stroke.

Symptoms to watch for:

• Daytime sleepiness and fatigue
• Snoring
• Waking up gasping for air or feeling short of breath
• Morning headaches
• Dry mouth when you wake up

Sleep apnea is more likely if you have a large neck circumference (more than 17 inches for men or 16 inches for women) or are obese. It’s more likely in men than in women, although it’s common for all genders.

What to do if you suspect sleep apnea

If you have sleep apnea symptoms, talk to your primary care provider about treatment. Sleep apnea is treatable and can greatly improve your quality of life. After years of fatigue despite a full night’s sleep, my patients have said they finally wake up feeling refreshed and energized. Many say treating their sleep apnea was truly life changing.

The first step is diagnosis. We have options to diagnose sleep apnea that include both home sleep studies and sleep studies on site in our sleep lab. Your primary care provider will work with you to determine the right tool for diagnosis.

Lifestyle modifications for sleep apnea

• Lose excess weight
• Change your sleeping position – avoid lying on your back to sleep
• Avoid alcohol, which can make sleep apnea worse
• Do not use over-the-counter medicines to help you sleep – these are generally sedatives, which will not help the cause of the sleep apnea

Available treatment options for sleep apnea

Continuous positive airway pressure, known as CPAP – the CPAP machine works by delivering a stream of air through a mask, keeping the airway open during sleep. Although some may be reluctant to try the machine at first, for many people, it makes a huge difference in their quality of life. I encourage my patients to try the CPAP for a month, and then come talk with me if they have any problems or challenges with it. We can troubleshoot together and find solutions.

If a patient can’t tolerate CPAP, another treatment is a specialty dental appliance. We can refer patients to dentists to explore that option.

For patients who fail on CPAP, hypoglossal nerve stimulation is also an option. A small device is implanted under the skin in the neck, and it triggers a nerve at the base of the tongue, causing the tongue to move forward and stop blocking the airway. It’s a very effective treatment, and the nerve stimulation corrects the airway blockage without waking the patient up.

2. Adult ADHD (also known as attention deficit/hyperactivity disorder)

Signs of adult ADHD include:

• Executive dysfunction – trouble planning and executing tasks
• Trouble focusing on one thing at a time
• Impulsivity
• Difficulty regulating emotions and moods
• Hyper-restlessness

Sometimes, people assume that symptoms like these indicate a behavioral problem. But actually, the problem arises from the levels of certain chemicals in the brain, especially norepinephrine and dopamine. It’s important for patients to connect with experts who can help them regulate these brain chemicals, so they can find relief from these symptoms.

Once again, I urge people struggling with these issues to come talk with their primary care physician. It does not mean that we’re going to prescribe medication right away. The first step is to connect with an expert who can evaluate what’s going on and make the diagnosis of ADHD, if it’s applicable. Primary care providers can help connect patients with the appropriate resources. Inova has licensed therapists and psychiatrists who are experts in assessing and diagnosing ADHD and other conditions.

Lifestyle modifications for ADHD

• Prioritize sleep – aim for seven to eight hours of sleep
• Exercise – start with a daily walk
• Routine – stick to a routine, where you eat and sleep at the same times each day
• A place for everything – keep your belongings in the same places every day, at home and at work
• Use checklists and reminders – make a habit of using checklists on your phone or in a paper journal, calendar or diary
• Do one thing at one time – reduce the number of things you plan to accomplish each day, to reduce overwhelm
• Always take a break or reward yourself with something after you compete a task
• If you have a big task, break it into smaller tasks that are easier to tackle
• Try turning your desk to face a wall, rather than something stimulating or distracting like a window
• Use headphones to reduce noise distraction and increase focus – you can use them for noise cancelation, or you can listen to guided meditations

When it comes to medications and behavioral therapy, it’s important to understand that they can both play a role in managing adult ADHD. It’s my role to guide patients, to connect them with an expert and to help them find lifestyle modifications that can support executive functioning.

3. Osteoporosis – low bone mass

As people age, decreased bone mass can increase the risk of broken bones (like hips, for example). Osteoporosis (brittle bones) is a common condition that affects women more than men. The risk increases with age. That’s why the U.S. Preventive Services Task Force recommends a DEXA bone density scan for postmenopausal women after age 65, based on the best available scientific evidence. If a person has certain risk factors, like if the person has kidney disease or is on immunosuppression drugs or steroids, we may need to conduct the scan earlier.

The scan reveals a person’s current bone mass and can detect if it is low. With that information, we can make a treatment plan to help stop the bone loss before it reaches the level of osteoporosis.

Recommended treatments and lifestyle modifications to prevent and treat osteoporosis

• Prescription medications
• Calcium and vitamin D supplements – available over the counter
• Dietary changes
• Exercise, particularly weight-bearing exercise, strength training and yoga
• Walking daily
• Quitting smoking
• Drinking less alcohol

A note on vitamin D

Calcium and vitamin D supplementation can be an important part of preventing or treating low bone mass. Your primary care provider can work with you to analyze your diet and determine how much calcium and vitamin D you should take. A general rule of thumb is 1,200 mg of calcium daily and 800 to 2,000 IU (international units) of vitamin D. (“International units” are a unit of measurement. One international unit is equal to .25 micrograms.) Your primary care provider will start by checking your vitamin D levels and develop a plan from there.

What is the difference between vitamin D2 and D3?

When it comes to over-the-counter vitamin D, you’ll see two formulations: vitamin D2 and vitamin D3:

• D2 is plant based – it comes from fungi and other plant sources
• D3 is animal based

If you have no problem with animal products, then D3 is preferable. Our bodies use it more efficiently, and it doesn’t degrade as fast in our bodies, giving our bodies more time to use it to help strengthen our bones. However, the D2 formulation is available for patients who are vegan or who prefer the plant-based vitamin. Some supplementation is better than none for people with low bone mass.

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Across Northern Virginia, Inova offers hundreds of expert primary care providers at dozens of locations. Find an Inova primary care provider near you.