Ask Doctor Josh

Urgent Care Facility in Franklin Square

Hi. I am Dr. Joshua Falk and welcome to my website and Urgent Care Center, Rapid Response Medical Care. Since I set out to offer my neighbors quick, affordable and quality healthcare I have been inundated with multiple medical questions on an almost daily basis. While I encourage you to feel free to stop by the center, I understand that it might be easier for you to simply send me your question and allow me to respond publicly so that others may also learn from your question.

I also want to take this opportunity to introduce myself. I was raised on Long Island not far from Rapid Response where I attended college at New York Institute of Technology, graduating with honors and then attended the New York College of Osteopathic Medicine. After completing medical school, I went on to complete my internship and residency in Internal Medicine at Staten Island University Hospital, which is a member of the North Shore / LIJ system. After that training I became board certified in Internal Medicine. Since finishing my training over seven years ago I have been practicing medicine on Long Island. In the past seven years I have had extensive experience in office medicine, hospital medicine as well as nursing homes and assisted living centers. While my foremost interest remains treating complex hospitalized patients, it is that experience that encouraged me to start this urgent care center as a way to offer care sooner to those patients who would usually not want to wait to see their own doctor or for those who don’t have doctors of their own. By encouraging these patients to come in and see us sooner in the cycle of their illness I hope to limit their need to go to the hospital and avoid a possible costly and lengthy stay.

Please note that the opinions expressed in this section are my own and are not meant to treat any specific ailments. It is impossible for me to correctly diagnose a patient without a thorough medical history and physical exam so please do not expect me to do that over the internet. As always I urge you to seek out a trusting primary care provider and create a close relationship with them. I would suggest using this section of my site as a tool to create a line of communication with them and to better understand some basic medical issues.

Frequently Asked Questions by Topic:

1) General Health
2) Preventive Medicine
3) Name Your Symptoms

General Health

Q: Dr. Josh, I have been getting headaches on a daily basis.  I went to my doctor who told me I have high blood pressure.  What can I do to fix this without taking prescription pills?

A: That is a good question. High blood pressure is known as hypertension. For an adult, hypertension is defined as a systolic blood pressure (upper number) of 140 mm Hg or more, or a diastolic blood pressure (lower number) of 90 mm Hg or more. Generally speaking it is to your benefit to maintain a blood pressure of less than 120/80. The main reason that hypertension is such a problem is that over time an elevated blood pressure will cause destruction of blood vessels in different parts of your body. This destruction of tissue can lead to medical problems that affect multiple systems in your body, but mostly your brain and your heart. Hypertension can be caused by poor diet, obesity, tobacco, stress, or genetics. While hypertension can cause headache, the most common symptom is nothing at all. That’s what makes it such a hard disease to treat, most people don’t even know that they have it.

As I don’t know your medical history and you didn’t tell me your blood pressure I can’t tell you specifically how to treat it. I will say that most doctors will first try treating hypertension with diet, exercise and other life style changes. Smoking cessation is very important and smokers can dramatically drop their blood pressure by quitting. If you drink excessively it is also important to decrease your alcohol use. Last but not least is exercise. You must be doing at least 30 minutes of brisk aerobic exercise at least 5 days a week. If that doesn’t work then we move on to medications. In your case, considering that you were having headaches your doctor might consider starting medications sooner.

I would consider taking the following supplements to help lower your blood pressure as there has been some evidence to support the use of calcium and magnesium to lower blood pressure:

1) Calcium 600 mg daily
2) Magnesium Oxide 400 mg daily
3) Therapeutic multi-vitamin (not to be taken at the same time as Calcium)

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Q: Dr. Josh, I was recently admitted to the hospital for appendicitis. They took out my appendix but I was too embarrassed to say that I didn’t know what appendicitis was. Do I need my appendix? Will I develop any problems without having it?

A: The appendix is a small portion of your large intestine. In some people it might become inflamed and irritated. This inflammation might be due to an infection, inflammatory bowel disease, severe constipation, or possibly (rarely) cancer. People who have appendicitis usually will complain of abdominal pain, mostly in the lower right side of the abdomen and at the area around your belly button (umbilicus). Besides pain, you could have severe nausea, vomiting, fever, chills, and changes in bowel habits. Usually your doctor will have a good idea if you have appendicitis by pushing down on your abdomen and noting tenderness in the lower right side. When I see patients with these symptoms and right lower abdominal tenderness I assume its appendicitis until proven otherwise. I would suggest that this patient should have blood samples sent and imaging studies done as soon as possible. From an urgent care prospective, this is the type of patient that I will send to the emergency room. Usually these patients will need either an abdominal sonogram or Cat Scan of the abdomen. The problems associated with not treating appendicitis quickly enough include possible perforation or sepsis, or both. This is when the tissue develops a tear and gets infected. This can have potentially deadly consciences. Treatment of appendicitis is almost exclusively surgical. These days most of this can be done via a laparoscope which means with a small camera inserted into your abdomen with very small incisions made into the skin. If by chance a perforation does occur then the treatment is more controversial and would likely include the use of antibiotics as well.

I always urge my patients to ask many questions when you are having a procedure done. You should never feel ashamed or embarrassed to ask questions about your health or your body. In fact, prior to operating I would suggest that you ask you surgeon to draw you a picture of the proposed surgery. They should also list for you the risks and benefits of operating verse not operating.

Usually most people recover rather well after having their appendix removed. After a brief recovery period you should be fine and never notice it is even gone.

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Preventative Medicine

Q: Dr. Josh, my older sister was just diagnosed with colon cancer. What can I do to prevent that from happening to me?

A: First off, I am sorry to hear about her misfortune. Please send her my best wishes for a speedy recovery. Colon cancer is one of the most commonly diagnosed cancer in the country. It usually forms very slowly which makes it easier to treat if caught in time. Signs and symptoms of colon cancer might be a change in bowel habits, abdominal discomfort, and blood in your stool or anemia. The easiest way to prevent colon cancer is to be screened for it. It is my own personal belief that you can use your known family genetics in your favor. If you have a family history of ANY form of cancer you should start screening for that cancer ten years prior to when your family member was diagnosed. So if your older sister was diagnosed with colon cancer at age 50, you should be checked out for it starting at least by age 40. Generally though, standard of care is to go for a screening colonoscopy at age 50 if you don’t have a strong family history. A colonoscopy is a camera attached to a long thin cable. Under anesthesia the camera is inserted into your rectum and colon. It is attached to a video camera that is being watched by a gastroenterologist and checked for suspicious area of tissue. The benefits of colonoscopy don’t just include visualizing the tissue but it can be used to remove small polyps. Polyps are small clusters of tissue that might develop into cancer. The doctor also has the ability to take a sample of tissue that looks abnormal. This sampling is called a biopsy.

So if you have a family history of colon cancer I would urge you to go get a colonoscopy sooner than later. Other possible factors that might help prevent colon cancer include a high fiber low fat diet, weight loss, quitting smoking and limiting alcohol intake. For people with a family history of colon cancer I personally suggest the following:

1) Vitamin D 1000 IU a day.
2) Take Psyllium supplements weekly. I suggest taking 1 packet of Metamucil in 1 glass of water at least 3 days a week.
3) Try a pro biotic or eat yogurt daily.
4) Lose your gut. Weight loss in the abdominal region has been shown to lower cancer rates.

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Name Your Symptoms

Q: Dr. Josh, diabetes runs in my family. Is there any test I can do to check and see if I have it too? What symptoms would I have if I did have diabetes?

A: Diabetes is a disorder with multiple sub-types. The most common is type 2 diabetes mellitus which involves the dysfunction of glucose (sugar) control in your body. High glucose is called hyperglycemia and it is caused by either low insulin production or your body’s resistance to insulin, or both. People who suffer from diabetes can’t control their sugar. High blood sugar levels can lead to both short term and long term problems. These issues include destruction of nerve conductivity, cardiovascular disorders, neurologic symptoms, kidney problems, and poor wound healing. Symptoms of high blood sugar include frequent urination, severe thirst, severe hunger and weight loss. Some people report blurry vision and numbness in their hands and feet. Testing for diabetes is rather simple. I would suggest 3 tests that are easy and give you the information you need to start treatment if needed.

1) Random glucose check or fasting glucose check. This test involves drawing a small amount of blood from your finger. A fasting blood glucose of over 125 or a random level over 190 is diagnostic of diabetes.

2) Hemoglobin A1C (HbA1c) level of greater than 7% can be used to diagnose diabetes or a disorder known as pre-diabetes.

3) A random urine analysis will tell you if you are spilling sugar in your urine. That can be a sign of diabetes.

It is very important to ask your doctor to do these tests to screen you for diabetes if you happen to have any of those symptoms above or if you have a strong family history of diabetes.

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