 I'm Dr. Arman Wushtak. I'm the program director for Entomal Medicine Residency, Derishur Hospital, and I'm also the medical director for G&H Booker Family Health Center. And as I said, an important topic to review today, and we'll start. Can you go to the next slide? OK, so for the blood pressure, I just want to give an overview of what exactly a blood pressure means. When we check a blood pressure, we get two readings. One is the upper number, one is the lower number. So the recommendations and definitions have changed recently, and now it has become more and more strict in terms of blood pressure readings. So the normal is your upper number should be less than 120, and your lower number should be less than 80. Then we go into elevated blood pressure readings. If something is about 120 or 121, 229, the upper number, and the lower number is still less than 80, you fall into the category of elevated blood pressure. Then comes hypertension itself that is from above 130. So above 130 to 139 is stage one hypertension, and lower number from 80 to 89. If your lower number is higher than that, and if your upper number is higher than that, or either one of those is higher than that, then you do go into stage one hypertension. Stage two is more than 140, and lower number more than 90. These are the numbers you need to remember. Next. Yes, so why hypertension is important? Hypertension does give symptoms, but most of the times it may remain silent. You will not feel anything if you are in elevated blood pressure range, or if you're in stage one blood pressure range. You may stay like that for a long time, and you may not feel anything before. It starts to give you some devastating symptoms, and start to damage your vital organs. So high blood pressure can cause stroke, long-standing high blood pressure, and sudden high blood pressure, and can also cause vision loss related to stroke. And otherwise, for chronic long-standing high blood pressure can cause heart attack, can cause heart failure, because your vessels are so strong and stiff, and the heart has to push hard to have your blood reaching your brain and all those vital organs. So the heart gets tired and fatigued, and goes into heart failure. Kidney disease. When the blood goes so very rushed into the kidneys, it can damage the kidneys, and can cause kidney failure. It's common. It's completely silent. You may not feel anything, unless your kidneys are failing, and you start feeling fluid overload, swelling, fatigue, and tiredness, and stuff. Sexual dysfunction in males and females, both. Next. OK, so what to do? This is something that I would like to emphasize, that we can treat things. We can diagnose things with medications and all that stuff. But this is something that each and every one of us can do on their own, and has a significant impact. These are recommendations for lifestyle modification. So whenever someone has high blood pressure, elevated blood pressure, stage one blood pressure, stage two blood pressure, the first recommendation is to act on lifestyle modifications. In lifestyle modifications, just focus on the numbers, and you will see that even if you are stage two hypertension, by adopting the lifestyle, which we are going to mention here, you can go back into your normal blood pressure category, just by adopting the lifestyle. So if you see reducing your weight, the first on this table, if you go into your BMI, that you can achieve the BMI less than 25, or if you achieve 10 kgs or 22 pounds weight loss. So every 10 kgs weight loss, you can reduce your blood pressure from 5 to 10 millimeters of mercury. So suppose your blood pressure was 140, and you were above 140, you were in stage two hypertension. You lose 10 kgs. You can bring down your blood pressure, the upper number and the lower number, both up to 10 millimeters. So from 142 to 132. So you will be now stage one hypertension. You lose 22 more pounds. You can go into elevated blood pressure, a range. So that's how significant the impact is. The next lifestyle modification is dietary sodium restriction. Yes, in the next slide on the table, dietary sodium restriction. If you cut down your sodium, that is your salt in your food, that is cooked food, and especially the added salt at the end. If you cut it down to 2 grams, 1,502 grams, then you reduce it to 8 millimeters on top of what you reduced it with your weight. Then if you consume this dash diet, dashes, it says dietary approach to stop hypertension. If you eat more vegetables, fruits, low fat dairy, whole grains, legumes and all that, eat more a hypotasium diet, magnesium diet and calcium, then you reduce it up to 8 to 14 millimeters. So you can imagine starting from 140 and above with weight, 10 millimeters of mercury, with cutting down salt, 8 more, with doing this dietary approach, 14 more. So you can even get out of the medications, get off the medications and go from stage 2 hypertension to normal blood pressure. Other things, a hypotasium intake, if you eat more bananas and all that stuff, moderate alcohol consumption has also less than 2 drinks per man and less than one drink per day for a woman. Exercise 30 minutes per day or 45 minutes five times a day. If you do that, 9 millimeters of mercury reduction in your blood pressure. If you do all these just lifestyle modification, whichever is easier for you, you can go back to normal blood pressure, even without medications. So that's the most important message I would like to give to all team members. This is in your hands, and you can make the difference in your life by yourself. Next. OK, so blood pressure treatment, very simple. Just one slide. It's called ACT. It's just an acronym for that, ACT. So there are three classes of medications. You may have heard of these. One is ACE and ARBs. They usually act on the vessels and also on the kidney. Listen up your low salt on the common ones. Calcium channel rockers, they dilate your blood vessels and diuretics, thyroid diuretics, they kind of take away the water out of your body. So these three medications, most of the times, can control your blood pressure. So if one is not acting, we increase the dose, and then we add the second one, and then we add the third one. So most of the times, more than 90% of the times, with these three medications, the most difficult blood pressure we can treat. There are many more. There are many more classes, but these three are the most common ones. Next. So let's go to diabetes now. So what is diabetes by the readings? We'll talk about what is pre-diabetes with the readings and how to diagnose. And what are the symptoms? Well, the symptoms of diabetes is early thirst, feeling more hungry than usual, increase urination, weight loss, numbness and tingling, and feeling more fatigued. So very vague symptoms. But if you feel any of those, go to your doctor and talk about these things. If at any time you go to a doctor, you have taken your breakfast or lunch, and your blood sugar is checked, and if it is more than 200, then you get the diagnosis of diabetes with these symptoms. If you do not have symptoms, then these are a few values I have mentioned here, that fasting, FPG, is fasting blood glucose measurement. Less than 100 is normal, and the fasting should be around 12 hours of fasting. If you have not eaten anything in the last 12 hours, in the morning, you check your blood sugar, it should be less than 100. 126 is pre-diabetes, more than 126 is diabetes. Then another number that we check is A1C. So A1C is the average amount of blood sugar in your blood and in your body, spanning over three months. So this gives us an average, this number. So if it is checked at any time, less than 5.7 is normal, 5.7 to 6.5 is pre-diabetes, and more than 6.5 is diabetes. Then oral glucose tolerance test is usually done in pregnant females, or who are trying to conceive and all that, that maybe Dr. Muriel will have more on that. Or sometimes if we do not get good readings, we also can do oral glucose tolerance test, and we give some glucose to you and then check the readings. So these numbers you need to remember and you need to talk to your provider regarding these. Next. Two types, type one is mainly hereditary, come in early life and treatment is only insulin, type two is most common, later in life and influenced by family history, but more related to lifestyle, a sedentary lifestyle, unhealthy eating, and can be treated with oral medications. Next. So these things you need to remember regarding diabetes that you, again, almost the same things, almost the same things as hypertension. Be physically active and eat more vegetables, fruits, olive oil, beans, legumes, fish and seafood, eat more of it, poultry, egg, cheese and yogurt, again, more of it, and less often is meats and sweets. So sweets should all completely be avoided and meats should also be avoided. So more is fish and seafood and poultry that you should be consuming with diabetes. Next. So now going into cholesterol. Few numbers that you need to remember and few types that you need to remember is LDL. LDL is low density lipoproteins. This is the dangerous cholesterol, right? So that cholesterol should be less than 100 for you. If you see the picture, the yellow one and the LDL, small, small particles, they deposit into the vessels and make a plaque like this and it narrows your vessels and that can be, that narrowing can be in the brain, in the kidneys, in the heart, can lead to heart attack and stroke and all that. The HDL is high density lipoprotein. That's a good one. So because we have to eat cholesterol, right? We have to consume cholesterol in our diet. So HDL, high diets are good because it does not get deposited into the vessels and takes away the bad cholesterol also out of the vessels. Total cholesterol should be less than 200. So these numbers you need to remember in your reports. So again, same thing. Lifestyle changes, no fast food, stop smoking, avoid frying your food, exercise regularly, more vegetables, more fruits. Salmon is good in high density lipoproteins, good cholesterol, plant proteins are good, whole grains are good, beans are good. So you'll see that red meat is kind of not mentioned. So cut down red meat as much as you can, pork and goat and lamb and all that. Next. So cholesterol, this number you need to remember, whenever there is a cholesterol check and you go to your provider, ask your provider about your 10 years risk of having a stroke or a heart attack. It is called ASCVD, that is atherosclerotic cardiovascular disease risk score. It's a calculated score that your physician, your doctor should put in your numbers, your age, your cholesterol, your blood pressure and few other things and should come up with a number. And that number you should review with your doctor. There it is from two to five and five to seven and above seven. So above seven is always in a ring that you need treatment and your risk is higher. So what I would like you to take away from today in this cholesterol thing is your ASCVD risk score. Always discuss this with your doctor. Always look up for the answer so that you are aware that what is your risk and what are your options to get treatment or you do not require treatment. Statins are the most common medications. One pill if you take that can nicely take care of your blood cholesterol. Most common side effect is muscle aches but there are tons of statins out there and you can easily change one to another and then get yourself treated and avoid the side effect. So don't get afraid of the muscle aches and side effects but there will be a lot of options for you to manage the side effects. Next. So now let's go on to the screenings that you need to address with your physician. These are the most important ones that we will discuss for women ages 50 to 74 you are required to get every other year your screening mammogram and based upon the results it can go through every year and it can go to even earlier than that. So 50 to 74 is the age. For 40 to 50 years you should talk to your doctor regarding getting a mammogram. It is recommended that you can get it and what you have to discuss it with your doctor about your recommendation in that. Actually women of any age should talk to their doctor because talking with your doctor regarding the breast cancer screening is important in terms of your family members, history, male or female anyone who had breast cancer then your age can drastically change your screening age can change. So always review this with your doctor. Next. Lung cancer screening it is interesting if you see here at the bottom of the slide if someone is currently smoking or quit within 15 years and 20 back years if you have been smoking if anyone has been smoking 20 years one pack a day or something like that above the age of 50 should get a lung cancer screening. It is smoking causes these are the numbers 68,000 or 69,000 death in men and around 61,000 death in women. And the number of lung cancer actually is increasing in females than in males. So this is the age range that you need to know 50 to 80 and it's once a year low dose CT scan of your lungs that you should be getting. If anyone is currently smoking has quit smoking in 15 years they are in this range and they are recommended to get this. Next. Colon cancer screening. So this is the age recently changed from 50 to 45 the age range is 45 years to 75 in both males and females. So now colonoscopy invasive test have some side effects, but is the gold standard? Similarly, all of these tests that I have listed are kind of gold standard. So if someone does not want to get an invasive test or get some sedation to get the colonoscopy so someone does not want to get sedation someone does not want colonoscopy. In colonoscopy they put a camera and they look into all of the GI track and in the colon. So if someone wants to avoid that there's stool tests available. So just give a stool sample and rest assured the test will tell you something about and then further recommendations can definitely come in. So stool tests of different types. So one test is on top that is stool test. There are two types just to detect the blood in your stool. And from blood, if something is positive then you will need the colonoscopy that reflect that there is something going on in your GI tract. Then there's a DNA test. It's called cologuard. So cologuard is done every three years. It detects cancer cells, small, small, small you know, microscopic level cancer cells and the blood also. So with that it's more sensitive. So then we can take three years with regular simple stool test for the blood. It's every year. Then flexible sigmoidoscopy. It does not go throughout the colon. Just a part of colon is visualized again invasive. And then there is a CT colonography. There are some different time intervals in between that but bottom line is any one of these you choose you will be benefited. You will get something that will be detrimental for your health and longevity. Any stool test, colonoscopy or CT. Okay, next. PAP test is well known. So woman ages 21 to 65 years are recommended. That is for cervical cancer screening and get it done every three years with cytology. Talk to your GYN and talk to your family provider. Also the interval can be lengthened also after a few tests or after combining one or two tests. So I will remain simple but this is something for cervical cancer screening you should talk to your physician also and get it done starting from 21 years of age. Next. One time hepatitis C screening. So that's rarely discussed. So I want to put it here so that we are more educated about this. Anyone who was born between 1945 to 65 needs to get one time of hepatitis C screening or any individual who received a blood transfusion before 1992, it's 92, two is missing. I'm sorry about that. So anyone who received blood transfusion before this 1992 or anyone who was born between 1945 to 65 needs to get one time hepatitis C screening and the rationale behind that is that screenings and for the blood transfusions, needles, sterilization techniques were not that advanced at that time. So there are chances that someone may be carrying hepatitis C and that's again a silent killer. So it is recommended to get it done once. So talk to your doctor if you fall into these categories. Next. Abdominal aortic aneurysm screening. We do it in Hope Tower. There's a program regarding this also and it's a very interesting recommendation if you see for all men ages 65 to 75 who have ever smoked. So it's an interesting number. We have only smoked 10 cigarettes ever, not 10 packs, 10 cigarettes ever, ever. So it is recommended to get this abdominal aortic aneurysm screening, aorta, the big vessel, taking blood from your heart to the whole body. It gets swollen, it gets dilated like you can see in the picture. So because of smoking, there's a relationship with that. It is recommended to get an ultrasound. It is screened with a simple ultrasound. They will measure the diameter of aorta and further recommendations will be given either to keep monitoring it or to get some intervention. If the aorta, this big vessel burst, it's a sudden death. So please keep this in mind and review it with your doctor. You should be getting it at the age of 65 till 75. It's every, it's once and if it is normal, then it's normal and afterwards it depends upon, you know, your risk factors and all. Next. Bone density, I think this is the last one for females and also for males, but mainly for females, all women ages 65 and older should get it or even younger women who have risk factors, mainly steroids, hormonal therapy, you know, lifestyle, all of these risk factors, if they are there, then they are also justified to get this testing done. You can see their healthy bone and osteoporotic bone. This is, you know, a bone which is weak and easy and easy prone to fractures actually. So you should get it done. And I think it's every two years. And then depending upon if you're getting the treatment, the duration is different. So that's for women, for men also it is there, but for risk factors, if they were on long-term steroids or, you know, compromise or something like that. So not a bad idea for, you know, males also to review it with their physician. Next. PSA test is for prostate cancer screening. This is called PSA, prostate-specific antigen. This is for the ages of 50 to 69 only for males. However, review this with your doctor. There are some other, you know, delicate, mutual decision-making recommendations because the test can be false negative. There could be something in the prostate and it does not show up and test can be false positive. It shows up and then you go up to the biopsy and something like that, but there was nothing actually there. So you have to review it, but it is recommended to at least review it and get it done with your physician. Next. These are my references. Thank you very much, everyone. And I think from here, we are going on to Family Health Center, Kelly. Yes, thank you so much, Dr. Mushtalk. That was very informative. So now, Dr. Mushtalk will transition to talking about the Jane H. Booker Family Health Center. Okay, so this is our center. This is our home. We will live. And, you know, it's for our patients, of course, we live there and, you know, it's very close to each and every one of us and our hearts. We truly feel proud to serve in this center. So it is located at 1828 Westlake Avenue, Neptune. And we offer a wide range of outpatient healthcare services to meet the need of every member of your family. We'll go through the services that we provide here and you will see that each and every one of your family can be taken care of at this center. We have a team of specialists that work in the center and then also work into a journey-sure hospital. And it's a well-coordinated care that anyone will receive. Electronic medical record system is the same. And, you know, the doctors work in hospital and in the center, coordination is great. So you get a very comprehensive care coming to this hospital. We have social workers available for assistance and assessing community resources and we have financial assistance is also available on site. Having social workers on site is, you know, a huge, huge plus. So any need of the patients we can take care of. Next. These are the services which are included. Primary care is the largest one. We see each and every, any patient that comes to us. I think with the only one or two exceptions in terms of some insurances other than that, we see almost everyone. Dentistry, Dr. Song is there. He will further, you know, tell us about cardiology. Every Friday we have a clinic endocrinology and specialized endocrinology, also diabetes, thyroid, you know, and gastroenterology, getting the colonoscopies, getting other tests, you know, and treatment of any gastroenterology issues and, you know, diseases, prenatal, postpartum, obstetrics, hypertension clinic that I would like to highlight here because they are not many out there. There are very few actually nationwide and especially the statewide. So we are, you know, we're lucky to have three hypertension specialists in our hospital. One is our chair, Dr. Asif. One is Dr. David Coons, a big name. He's a hypertension specialist and one is Dr. Masood, nephrologist and hypertension specialist. There's a special training actually for hypertension that you have to get and get board certified. So they are hypertension board certified. So it's a great facility, you know, opportunity to have your help regarding hypertension taken care of. Infectious disease, HIV, STD, care and counseling. We have lab every day. We have changed this thanks to Renita and New Leadership and AmeriCatronia. We have made so many changes. We have lab every day. So you come in, you get your script, you can go downstairs and get your labs done. Your frictional counseling, psychiatry, a huge, huge service, a big plus for the center. The huge shortage out there getting into a psychiatrist is difficult, but we have this facility, pulmonology, rheumatology, nephrology and urology. Pediatrics, of course, with dentistry, pediatrics. So subspecialty care, primary care, everything is available. Next. Okay, so I have a question here, Kelly, if I can. Answer. Of course. I think we're done. So after 65, it depends upon the risk factors for the PAP, Jennifer Alton has asked. So after 65, PAP smears can be done, but, you know, if you have negative tests consistently along with, you know, cytology and, you know, viral testing, then the benefit of getting a positive test and then going into the treatments and longevity of life is something that with the recommendations they consider. So every test will have kind of end date, like, you know, conoscopy at 74, mammogram at 74. So the reason to stop the testing is that the incidence of detecting the cancers or detecting anything that will, you know, help the patient in terms of lifestyle, in terms of, you know, longevity of the life, treatment options, how the treatment will impact you. That all, according to the research, changes after certain ages. So that's why, you know, CDC and, you know, these task forces come up with these ages. So that's the rationale behind almost every test. Oh, you're welcome. Thank you. Any other questions? Anything else that I can answer? I can always take more questions in the chat and we can also answer those at the end as well. So thank you so much, Dr. Mushtalk. That was a wonderful overview of the Family Health Center. It's certainly a great offering to the community. So now, what I will do is... Thank you very much for having me here. Oh, you're very welcome. So now we'll turn it over to our meet and greet and we will start with Dr. Morialli. Dr. Morialli, please tell us a little bit about yourself and the services that you provide at the Family Health Center. Okay, good morning all. My name is Dr. Ginger Morialli. I'm actually a native of Neptune. I matriculated through Neptune schools from first grade all the way through 12th grade. And then I went to do all my schooling down in North Carolina. I did my residency and internship at Duke University Medical Center and I'm specializing in gynecology. Then I moved back home to New Jersey in 2007. And this is my first job actually out of my... I've been with memorandum health systems since 2007, my first job out of residency. I was in private practice for 12 years before joining the Family Health Center as the medical director of the OBGYN resident clinic where I oversee the resident doctors in training taking care of doing comprehensive women's health care. And I am also on faculty and staff at the hospital in the OBGYN department. I am also the cook, ship director for the new medical school that's affiliated with Hackensack Meridian Health System and the Hackensack Meridian School of Medicine. And so I'm in charge of the medical students who actually rotate in OBGYN through our hospital here and at Hackensack University Medical Center. And I'm happy to be here. Thanks Dr. Morialli. Thanks for being here. And I can take any questions. Oh, absolutely. Yes, if there are any questions that are OBGYN related please feel free to enter them in the chat and we'll get to them at the end. All right, well, next we welcome Dr. Shire. Dr. Shire is a pediatrician at the Family Health Center. So welcome Dr. Shire, please tell us a little bit about yourself and the services that you provide. Hello everybody. Great to be here. I am originally from South Jersey. I did my medical school training in Philadelphia at MCP Hanuman Natural School of Medicine and did my residency here. And then I did a one-year fellowship after and then I came back here at home. And now I am the Pediatrics at Clarkship Director for our medical students from SGU and HMH as well as run our clinic for pediatrics. And we provide well care from the time baby's discharged from the hospital through the age of 21 including standard developmental screenings and weight and growth checks as well as standard blood work screening such as cholesterol and fasting lipid panels and sugars when needed. We also have an obesity clinic to help further assist kids with that issue who need it as well as an asthma clinic. And I'm happy to be here today. Thanks Dr. Shire. If anybody has pediatrics related questions, feel free to enter them in the chat and we'll address them at the end. And last but not least, I would like to introduce Dr. Song. He's a dentist at the Family Health Center. So Dr. Song, please introduce yourself. Hi, I've been here working for 23 years. So I'm kind of like long in the tooth if you will. There are three things that I do and that's going to be served as an introduction for the dental service that we provide here. First is that we have a full service dental clinic and we have a five resident and one hygienist and then dedicated staff and general dentist attending and several specialists to support the resident. So rather than orthodontics, we provide full service including implant, dental implant. And my day job would be dental A team. And dental A team is for the HIV positive population and I've been doing the work for 22 years. And the third one is not directly related to Family Health Center, but I'm on call for six months a year in the Judicial Medical Center and a lot of patients is either referred to here or coming for the post-op care. So that's how it's related and that's all I can say for today. Thank you. Thank you, Dr. Song. If anybody has a dental related questions, please feel free to enter them into the chat. So we did get a couple of questions ahead of time. So I'm gonna just start with those and then if there are any others, again, please enter them into the chat. So this first question is about insurance and I'm not sure who can answer this one. Renita, I don't know if you're on or we can always follow up about it. Oh, perfect. Thanks, Renita. So I think you'll be able to answer this question. So can patients who have Medicaid, who are connected to a primary care physician, see one of the specialists at the Family Health Center? Yes, that is correct. So at the Family Health Center, so as long as the patient has a referral to come to our specialist, we can certainly see them. The only insurance that we do not accept in the center is, I just look to my mind, AmeriCorps. I'm sorry, AmeriCorps is the only insurance that we do not accept, but we accept Medicare and all managed care to include the brand new one that we have, which is WellCare. Yep, you're welcome. Okay, thank you. And this other question, I think this would be good for Dr. Mush talk. So is there a less busy month in the summer to schedule routine health screening? Can you repeat? I could not hear it well. Oh, of course. Is there a less busy month in the summer to schedule routine health screening? Ah, that's an interesting question. I think we kind of haven't seen any barriers in terms of scheduling for health screenings. So the only difficult one to get in is the colonoscopy, but if you go for the stool testing and other any screening modalities that we discussed, including all of your, you know, birth pressure diabetes and all that, I think in summer we are all good, except for I would say the month of July, first couple of weeks when we have new incoming residents coming in, maybe our schedule is not completely open. Other than that, but even then the attendings are available and people are available there. So I would broadly say that any time is good, any time is good, but someone is good because you know, you can get things done easily. There are no barriers in there. And I would like to also add, and we also have nurse practitioners in every specialty within the center. So we have a nurse practitioner in the medical clinic and the OBGYN clinic and the pediatric clinic and in the AIDS ambulatory, I'm sorry, the infectious disease clinic as well. So in the event that the resident or attending is not available, we always have our nurse practitioners here ready and waiting to see patients. So everybody, long story short, schedule your screenings, don't delay them. Any other questions about hypertension, cholesterol, you know, pediatric care, dentistry, anything before we wrap up with our presenters? Don't be shy. All right, if there's nothing else at this time, then we will go ahead and wrap up. Before we end the presentation, I would just like to encourage everyone to keep an eye out for the feedback survey that we'll be sending out. So you can let us know your thoughts on the presentation. And then you can also request an appointment with any of our presenting physicians through the survey. So any appointment requests that come in, we'll go ahead and send them to the team and the team will be in contact with you. And in addition, this recording will be sent out to everybody. So I just wanted to, again, thank all of our doctors for participating in the presentation today. Thank Renita and the entire team for their help with getting this together. And thank you to all of our attendees who joined today. We really appreciate having you. And we really hope that you found this information helpful. So thank you again and have a wonderful day. You too, thank you everyone. Thank you very much. Thank you. Thank you everyone. Bye-bye. Here. Bye-bye.