Questions to Ask at Your Next Check-Up

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Your annual check-up is an important part of maintaining overall health and well-being.  Many patients, particularly those who are generally healthy, may see their primary care provider only once per year.  The annual check-up is your chance to have a face-to-face and get answers to those nagging health questions you’ve been wondering about all year.  To make sure that you’re getting the most out of your appointment, it makes sense to do a little preparation before the check-up. Here, a list of questions that I recommend asking at your next appointment.

Ask About Your Family History

If your family members have been diagnosed with certain conditions, such as breast cancer or diabetes, you may be more likely to be diagnosed with these as well.  Share your family history at your appointment, and ask how it might impact your personal health.

Ask About Any Unusual Symptoms You’ve Been Experiencing

Not every medical condition is apparent on a physical exam, so make sure to ask about anything unusual that you’ve been experiencing, such as fatigue, weight changes, or other symptoms.

Ask About Any Screening Tests or Treatments that are Recommended

As an equal partner in your own health, it’s important to understand why certain screening tests, medications, or other tests are being recommended for you.  Be sure to ask if there’s anything you’re wondering about or don’t understand.

Ask About Your Lifestyle

Many chronic diseases can be prevented with healthy lifestyle choices, such as eating well, not smoking, and getting enough exercise.  Be honest when sharing your lifestyle choices, so that your healthcare provider can properly evaluate your health risks and make appropriate recommendations for healthier options, if needed.

Ask About Your Medications

Some medications can have interactions when taken together, so it’s important to let your healthcare provider know about any and all medications you’re taking—including those prescribed by other doctors, as well as any supplements or other over-the-counter medications.  If there’s anything you’re not sure regarding your medications (dosing, side effects, whether you still need to be taking it), now is the time to ask.

Ask About Your Next Appointment

You may need to have a follow-up appointment before your next annual check-up, or you may need to schedule an appointment for additional testing or to see a specialist.  Make sure that you have a clear timeline before you leave the office.

Remember, communication is key when it comes to your health.  My office is a judgment-free zone, so don’t be afraid to speak up and ask if you have any questions.  That’s what I’m here for. You can call my office at 310-360-6807 to schedule your check-up. You can also book an appointment online by clicking below.

IBS Treatment Options

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Irritable bowel syndrome — or “IBS” — is a very common disorder and one of the conditions that I see most often in my practice. In fact, researchers believe that about 55 million Americans suffer from IBS.  However, just because IBS is common doesn’t mean that it’s easy to treat.

IBS is actually a very individualized illness, so symptoms can vary widely among patients.  For example, some patients with IBS deal with chronic constipation, while others tend towards diarrhea.  Similarly, treatments that work well for one patient might have no effect (or even make symptoms worse) for someone else.  That’s why important to work with a healthcare professional, rather than trying to manage IBS symptoms on your own.

I prefer to use a patient-centered approach when treating IBS, which means that I work with each patient to formulate a unique treatment plan that addresses your individual symptoms and needs.  However, there are several broad categories of treatments that we can choose from:

Diet and Lifestyle Changes

Dietary changes are often the first-line treatment strategy for IBS symptoms.  This may include keeping a food diary to identify any problematic foods that exacerbate symptoms, meeting with a professional dietician, or restricting certain foods like gluten or dairy.  Additionally, there are diets that have been developed specifically for people with IBS, such as the low FODMAP diet. Other lifestyle modifications, such as increasing exercise and practicing stress management techniques, can also be helpful.

Rifaximin

While researchers still don’t know what causes IBS, one theory is that the disorder is related to an overgrowth of bacteria in the intestines.  An antibiotic called rifaximin has been used to treat IBS, with patients often reporting a reduction in bloating and other symptoms following treatment.  Rifaximin may work by inhibiting the growth of gut bacteria, particularly in patients with diarrhea-predominant IBS.

Other Medications

Other medications may also be prescribed for IBS, such as antidepressants, antispasmodics, and antidiarrheals.  Medications that treat constipation-predominant IBS include lubiprostone, linaclotide, and various laxatives. Remember that everyone is different, so these medications may not be right for every patient.

Probiotics and Other Supplements

The GI tract normally contains trillions of “good bacteria”, which aid in digestion and provide many other health benefits.  Experts are still doing research in this area, but one theory is that IBS symptoms occur or worsen when the balance of “good bacteria” and “bad bacteria” in the gut becomes unbalanced.  Taking probiotics might be one way to restore balance in the gut and reduce symptoms. There are many different types of probiotics, so you should work with your healthcare provider to choose the right one.  Probiotics may not be recommended for all patients with IBS.

Other supplements may sometimes be used to complement these treatment strategies.  These include digestive enzymes, fiber, and peppermint oil. As always, be sure to talk to your doctor before taking any supplements or other over-the-counter treatments. 

If you need anything, I’m here for you. Book an appointment below and let’s talk.

National HIV Testing Day

A day to be responsible and involved.
— Dr. Dale

From National HIV Testing Day  

June 27 is National HIV Testing Day, a day to get the facts, get tested, and get involved!

Around 1.2 million people in the United States are living with HIV, and one in eight people don't know they have it. Nearly 45,000 people find out they have HIV every year.

HIV testing is the gateway to prevention and care.

  • People who test negative have more prevention tools available today than ever before.

  • People who test positive can take HIV medicines that can keep them healthy for many years and greatly reduce their chance of passing HIV to others. Learn more about living with HIV.

More than 90% of new HIV infections in the United States could be prevented by testing and diagnosing people living with HIV and making sure they receive early, ongoing treatment.

Find more information about HIV testing, and who should be tested, on CDC's HIV Testing Basics web page.

What Can You Do?

Get the Facts. Learn about HIV, and share this lifesaving information with your family, friends, and community. Tell them about the importance of making HIV testing a part of their regular health routine.

Get Tested. Knowing your HIV status gives you powerful information to help keep you and your partner healthy.

CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health care. People with certain risk factors should get tested more often. Learn what those risk factors are and how often you should be tested.

To find a testing site near you:

  • visit ActAgainstAIDS,

  • text your ZIP code to KNOWIT (566948), or

  • call 1-800-CDC-INFO (232-4636).

You can also use a home testing kit available in drugstores or online.

Get Involved. CDC offers many resources to help you raise awareness about HIV testing in your community. Doing It is a new national HIV testing and prevention campaign designed to motivate all adults to get tested for HIV and know their status. Join Doing It on FacebookInstagram, and Twitter, share videos of volunteers, community leaders, and celebrities explaining why they're getting tested, and download posters and other materials.

Supporting Liver Health for Hepatitis C

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The liver is one of the most important organs in the human body—it’s responsible for storing nutrients, aiding in the digestive process, and removing waste products, harmful chemicals, and other toxins from the body. The word “hepatitis” means inflammation (swelling) of the liver, which makes it harder for the liver to perform these functions. Put simply, if you have Hepatitis C, your liver may not be working as well as it should.  This can cause symptoms such as fatigue, nausea, and joint and muscle pain.

For this reason, it’s very important to take steps to support your liver after receiving a Hepatitis C diagnosis. While Hepatitis C may be treated with antiviral medications, following some simple health practices can help your liver function without complications for as long as possible.

Eat Well
A healthy diet is important for everyone, but it is absolutely crucial for patients with Hepatitis C to eat well.  In general, appropriate nutrition for Hepatitis C includes monitoring iron intake, replacing saturated fats with unsaturated fats, consuming moderate amounts of protein, and limiting intake of caffeine and high-sodium foods.

Avoid Alcohol
Alcohol can be extremely taxing on the liver, leading to increased inflammation and scarring of the tissue.  While a drink or two is generally fine for most people, patients with Hepatitis C need to take extra precautions to protect their liver.  I strongly recommend that my patients with Hepatitis C avoid alcohol entirely.

Maintain a Healthy Weight
Like alcohol, excess weight can place undue stress on the liver, so patients with Hepatitis C should strive to maintain a healthy weight through diet and exercise.  Incorporating regular physical activity into your routine also has beneficial effects for your overall health in general. If you find that you’re having trouble shedding those extra pounds, don’t hesitate to give the office a call.  I can help you meet your weight loss goals.

Use Caution with Supplements and Over-the-Counter Medications
There are many medications that seem relatively harmless but can actually have negative effects on your liver.  Tylenol is one example, and many herbs and supplements also fall into this category. Therefore, it is extremely important to let me know about any medications you might be taking, including vitamins and supplements.

Regularly Monitor Hepatitis C
This one is crucial—patients with Hepatitis C should come in for a check-up a minimum of twice per year, and more often if needed.  At these appointments, we’ll monitor your liver enzymes, discuss your symptoms, and make any necessary adjustments to your treatment plan.  Patients who follow-up regularly tend to have better liver functioning and overall health, so it’s important to attend your appointments and closely follow any medical or dietary instructions.

If you'd like to sit down and ask any questions about treatment, I'm here for you. You can schedule an appointment online by clicking the link below.

What All Patients Should Know About the HPV Vaccine

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Human papillomavirus, or HPV, is the most common sexually transmitted disease in the United States. There are more than 40 different types of HPV, which together are responsible for about 14 million new infections each year.

In most patients, the body’s immune system is able to clear the HPV infection on its own, over time. However, there are times when the body cannot clear the HPV infection which can lead to cervical cancer, anal cancer, or anogenital warts.

These statistics may sound scary, but the good news is that HPV can be easily prevented with a vaccine called Gardasil. Gardasil protects against the nine types of HPV that are responsible for the vast majority of HPV-related cancers and anogenital warts.

Gardasil has been approved since 2004 for use in younger patients, but the FDA recently announced an expanded approval for the vaccine. The organization now recommends that men and women up to age 45 receive the Gardasil vaccine. This new recommendation is based on research indicating that Gardasil is safe and effective in this age group.

The ideal time to receive Gardasil is during early adolescence (around age 11 or 12), but patients who were not vaccinated as teens now have the opportunity to receive the vaccination as adults. Serious side effects with Gardasil are rare, and you can not get HPV or any HPV-related diseases from the vaccine. However, mild side effects can occur, such as pain or swelling where the injection was given.

The Gardasil vaccine is available from our office by prescription, and is often covered by insurance. It’s typically administered as three separate injections given over the course of six months. To schedule an appointment for Gardasil, you can book an appointment online below, or contact the office at 310-360-6807.

Take an important step in protecting your present and future health.

Why It’s Important to Choose a Primary Care Provider

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In the not-too-recent past, it was common for patients to develop close relationships with their physicians, often seeing the same doctor for decades.  But as healthcare has changed and people have become busier, many patients are now neglecting to choose a primary care provider (PCP). Often, these are younger patients who generally consider themselves to be healthy, and thus may not see the need for a PCP.   

In reality, developing a trusted, ongoing relationship with a personal physician is important for everyone, regardless of age or health status.  When a provider knows you well, they’ll be better equipped to offer medical care that meets your individual needs. In fact, multiple studies have shown that patients who have a PCP experience better health overall.  Choosing a PCP can also offer some specific health benefits, including:

Higher patient satisfaction:  People who have a PCP tend to be happier with their healthcare.  When you work with a doctor who knows you well, communication is easier and you don’t need to repeat your health history at every visit.  He or she is also able to make better referrals when you need to see a specialist, and stress levels are decreased because you don’t need to search for a new doctor every time you need one.

Lower healthcare costs: People who have a PCP save money.  Insurance co-pays for PCP visits tend to be significantly cheaper compared to those for specialists or urgent/emergency care.  Additionally, people who have a PCP tend to experience fewer health conditions that can lead to costly hospital visits.

Better long-term health: People who have a PCP tend to be healthier in the long-run.   When you see your doctor on a regular basis, we can often identify problems early on, before they become major health issues.  We can also work together to manage chronic conditions and prevent long-term complications.

As a PCP, my goal is to serve as your “home base” for all things health-related.  This includes preventative services such as check-ups and immunizations, medical care for acute illnesses or injuries, management of chronic conditions, and appropriate referrals in the event that you need to see a specialist.  I can also assist with things like explaining test results and helping you navigate the (sometimes confusing) healthcare system.

Along with my two nurse practitioners, Emily and Jeanne, I offer a full-range of primary care services in my Beverly Hills office.  You can schedule an appointment online below, or by calling 310-360-6807. We look forward to getting to know you and serving as your healthcare home base.

Managing IBS with Diet

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Hey everyone! Dr. Dale here.

Irritable bowel syndrome, or IBS, is one of the most common conditions that I see in my gastroenterology practice.  In fact, it’s estimated that about 15% of the world’s population struggles with IBS and the unpleasant symptoms that go along with it—including gas, bloating, constipation, and diarrhea.

Patients should know that diet alone may not effectively treat IBS.  Plus, IBS symptoms can sometimes be very similar to those found with more dangerous health conditions, such as colon cancer or Crohn’s disease.  For these reasons, it’s important to call the office and schedule an appointment if you believe you may have IBS. However, many patients do find that they are able to manage their symptoms and find some relief through an IBS-appropriate diet.

There are a number of specialized diets available for patients with IBS and other GI issues.  These include diets that eliminate or restrict common “trigger foods”, such as gluten, dairy, sugar, and high amounts of fiber.  Every patient is unique, so trigger foods may not be the same for everyone, and you may need to trial a few different diets before you find the right fit.

If you’d like to try an IBS diet, the “low FODMAP” diet is a great place to start.  This diet was developed by researchers at Monash University in Australia, specifically for patients with IBS.  FODMAP stands for Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols. While the name may seem long and confusing, the important thing to know is that it refers to specific types of carbohydrates that are difficult for people with IBS to digest.  The low FODMAP diet focuses on eliminating these types of carbohydrates, while including a variety of foods that are easier to digest.

In general, a patient following the low FODMAP diet would avoid cow’s milk, certain types of fruits and veggies, most legumes, gluten-containing grains (wheat, barley, and rye), and high-fructose corn syrup.  Instead, this patient might consume almond milk, low-FODMAP fruits and veggies, animal proteins, rice, and sugars that are lower in fructose. There are hundreds of foods that have been tested at Monash University and certified as safe for people with IBS.

One caveat: the low FODMAP diet is quite specific.  Rather than just avoiding one group of foods, such as meat or fats, the low FODMAP diet restricts certain foods from many different food groups.  For this reason, it can be a little challenging to get the hang of, so please call the office at 310-360-6807 and make an appointment if you think you’d like to give it a try.  We can schedule some time to discuss your IBS symptoms and specific nutrition needs, and give you some pointers on getting started with the diet.

The Monash University website also has some great information on this diet, including recipes and a list of high and low FODMAP foods. You can view these resources at: https://www.monashfodmap.com/about-fodmap-and-ibs/

Achieving Your Weight Loss Goals

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With January and February complete, many of my patients are still working towards achieving their New Year’s resolutions.  Often, this means a renewed focus on health and physical fitness, and particularly on losing weight. In addition to its aesthetic aspects, weight loss has so many positive benefits for health—decreased risk of chronic diseases, increased self-esteem, improved energy levels—but this resolution can certainly be challenging to accomplish.

First and foremost, it’s always a smart idea to meet with your healthcare provider prior to beginning any weight loss program.  I can help you to identify an appropriate target weight and physical activity level, and help you develop a personalized weight loss plan that complements your lifestyle.

Patients sometimes struggle to lose weight through diet and exercise alone.  If this sounds familiar, I may have some strategies that can help you meet or maintain your weight loss goals.  Orbera® is a comprehensive, managed weight loss system that has been shown to help patients lose more than three times the weight of diet and exercise alone.  I’m excited to now offer Orbera at my Beverly Hills office.

For most patients, Orbera is a year-long program.  We begin by placing a temporary gastric balloon in your stomach, which stays in place for about six months.  During these six months, you’ll learn portion control, retraining your brain to understand what it means to eat healthy.  The balloon placement is a simple, outpatient procedure that is done in-office.

After the balloon is removed (again, through a simple, in-office procedure), you’ll continue working through the Orbera program for an additional six months.  During this time, you’ll follow a specialized diet and exercise program, receive personalized support from my office, and further develop your healthy eating habits—making it far more likely that you’ll be able to maintain your weight loss.

CoolSculpting® is another in-office option that can help you achieve your weight loss goals.  Unlike Orbera, which focuses on overall weight loss, CoolSculpting targets fat in specific areas.  It’s great for contouring stubborn areas that may be resistant to diet and exercise, such as the chin, upper arms, or love handles.

Using a specialized applicator, the CoolSculpting system delivers targeted cooling to trouble areas, essentially freezing off the fat cells.  Over the next four to six months, your body will naturally flush out these fat cells, leaving a contoured, sculpted physique. CoolSculpting is a safe procedure with no downtime, so many patients even return to work after their appointment.

Because Orbera and CoolSculpting may not be right for every patient, you’ll need to schedule a consultation to ensure you achieve the best weight loss results.  You can contact my office at 310-360-6807 if you have any questions about these procedures, or to schedule a consultation.

Don’t Skip Your Colonoscopy

The dreaded colonoscopy.

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Hey everyone, Dr. Dale here.

Out of all the procedures I perform, this is the one that patients tend to feel the most apprehensive about, hands down.  And while it’s true that no one really looks forward to having a colonoscopy, there’s one very simple reason that doctors continue to recommend the procedure—it can save your life.

According to the American Cancer Society, there were an estimated 50,630 colorectal cancer-related deaths in 2018.  A staggering 60% of these deaths could have been avoided with appropriate preventative care, namely colonoscopy (research shows that colonoscopy is the most effective preventative tool we have for this disease).

Traditionally, doctors recommended that most patients begin colorectal cancer screening at age 50, and continue to have regular colonoscopies every 10 years.  In May 2018, the American Cancer Society updated their guidelines, and now recommend that most patients begin colorectal cancer screening when they turn 45.  Screening can include colonoscopy, as well as other lab and imaging tests, such as the Fecal Occult Blood Test (FOBT).

Patients who have an increased risk of colorectal cancer may need to start screening sooner.  That includes patients with inflammatory bowel disease, and those with a family history of colorectal cancer or certain types of polyps.  Because every patient is different, I can recommend the screening schedule that’s best for your particular health needs.

It’s normal to feel anxious about having a colonoscopy, particularly if it’s your first one.  But keep in mind that there are a lot of common misconceptions about this procedure, which could be feeding your anxiety.  In fact, after the procedure is over, patients often tell us “that wasn’t nearly as bad as I thought it’d be.”

The night before your colonoscopy, you’ll be asked to prepare for the procedure by drinking a laxative solution.  This will ensure that your bowels are completely cleaned out, so that I can see the lining of your colon and detect any polyps or other abnormalities.

During the procedure, a thin, flexible tube is inserted into the rectum, and slowly guided into the colon. There’s a small camera on the end of the tube, which transmits images onto a video monitor.  If polyps are found, they can be removed during the colonoscopy, and may be sent for biopsy.  You’ll also receive a sedative medication to ensure that you feel comfortable and relaxed.  Many patients are actually asleep during the colonoscopy itself.  And that’s it.  When you awake from the procedure, I’ll discuss your results with you.

So don’t put off your colonoscopy due to fear or anxiety.  I have over 14 years of experience treating patients with colorectal conditions. I use the most current, state-of-the-art colonoscopy equipment, and can meet with you to discuss any questions or concerns you might have about this procedure.

Contact my office at 310-360-6807 or click here to schedule a consultation with me.

- Dr. Dale

Cervical Health Awareness Month

I want to bring to your attention the importance of cervical health.
— Dr. Dale

From Cervical Health Awareness Month

Cervical cancer was once one of the most common causes of cancer death for American women. But over the last 30 years, the cervical cancer death rate has gone down by more than 50%. The main reason for this change is the increased use of screening tests. Screening can find changes in the cervix before cancer develops. It can also find cervical cancer early – when it’s small, has not spread, and is easiest to cure. Another way to help prevent cervical cancer in the future is to have children vaccinated against human papilloma virus (HPV), which causes most cases of cervical cancer. (HPV is linked to a lot of other kinds of cancer, too.)

The American Cancer Society is actively fighting cervical cancer on many fronts. We are helping women get tested for cervical cancer, helping them understand their diagnosis, and helping them get the treatments they need. The American Cancer Society also funds new research to help prevent, find, and treat cervical cancer.