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Internal Medicine Doctors of
Mill Basin & Bergen Beach, Brooklyn

6301 Mill Lane (Corner of East 63rd) in Mill Basin (11234)

718-942-4600

Dr. Bella Zimilevich

Dr. Bella Zimilevich, MD
Primary Care Doctor

Dr. Bella Zimilevich

Dr. Anatoly Pisman, M.D
Physical Medicine & Rehabilitation

Dr. Bella Zimilevich

Dr. Alexander Shapsis, M.D
Gastroenterologist

Geriatric Care

 

Why See A Doctor For Alzheimer’s Disease?

Posted by on August 19th, 2013

Dr. Bella Zimilevich, MD

“Many people mistakenly believe that Alzheimer’s disease is a “natural” outcome of aging- this is simply not true. Although advanced age is a risk factor for the disease, it is not an expected outcome of aging. If you are worried that you might be showing signs of Alzheimer’s disease, or you are reading this because you are concerned about someone you care about, it’s important to know that early diagnosis can help slow progression of the disease. It’s important to get an early diagnosis so that treatment can start early”.

-Dr. Bella Zimilevich, MD

What is Alzheimer’s disease?

Alzheimer’s is the most common form of dementia. Dementia is a condition that causes memory loss and a decline in cognitive functioning. Alzheimer’s disease is the most common form of dementia, accounting for somewhere between 50 to 80% of cases of dementia.

What are the risk factors for Alzheimer’s disease?

Age is the single greatest risk factor for the development of Alzheimer’s. Notice that I did not say that aging causes Alzheimer’s (younger people are sometimes diagnosed with Alzheimer’s, but far less often than older individuals), but  Alzheimer’s does become more common as age advances. Most people diagnosed with Alzheimer’s are 65 years of age or older.

Heredity is known to be a factor in Alzheimer’s disease. If you have a close family relative (parent, sibling or child) with the disease, your risk is higher than someone who has no family history of the disease. Scientists have identified genes that are implicated in Alzheimer’s disease. Some genes raise your risk of of developing Alzheimer’s, while others almost guarantee that you will develop Alzheimer’s. However, it’s important to know that the type of Alzheimer’s that is passed down through generations of the same family is rare, accounting for only about 5% of all cases of Alzheimer’s disease.

Most experts believe that there is no single “cause” of Alzheimer’s. Rather, it is thought that Alzheimer’s develops from a combination of genetic factors and other risk factors. You can’t change your age or your genes, but scientists believe there are other factors that may come in to play that you may have some control over, such as:

  • traumatic brain injury- there is some evidence to suggest that patients who have experienced trauma to the brain are at higher risk of developing Alzheimer’s later in life. It’s not a good idea for anyone, regardless of age and risk of dementia,  to expose their brain to trauma, so wear a helmet while participating in sports and wear your seatbelt while driving or riding as a passenger.
  • heart, lung and cardiovascular health- we know that the brain is nourished with oxygen and other nutrients, so it stands to reason that anyone with an issue affecting blood supply and blood oxygenation may be at higher risk of developing dementia. Control your weight, blood pressure, cholesterol level and blood glucose levels and avoid excessive alcohol use and smoking. In addition, eat a heart healthy diet and try to exercise regularly. All of these can help to keep your heart and lungs (and thus your brain) healthy.

What signs and symptoms might signal the development of Alzheimer’s disease?

The following are some symptoms/signs associated with Alzheimer’s:

  • frequent problems finding the right word when writing or speaking
  • misplacing things
  • showing poor judgement
  • withdrawal from people, social activities or work
  • personality/mood changes
  • memory loss that affects ability to function
  • difficulty in performing tasks that were once easy
  • memory loss
  • difficulty with problem solving/planning
  • confusion regarding time and place
  • difficulty interpreting visual images or spatial relationships

We may all have difficulty with an item on this list from time to time. People with Alzheimer’s may have difficulties with many of the items on this list on a regular basis, and these difficulties tend to get worse over time. There are seven stages of Alzheimer’s, ranging from stage 1 (no impairment) to stage 7 (very severe decline).

What can I expect if I come to see you (or I bring my loved one to see you)?

You can expect that I will treat you (or your loved one) with respect and dignity. I am an internal medicine physician and I specialize in geriatrics, which means I have specialized training in caring for older individuals. Most importantly, I care and I want to help you or your loved one if you are concerned about Alzheimer’s, as I know just how scary the symptoms can be, and what a diagnosis of Alzheimer’s disease means.

First of all, I will want to take a detailed medical history. I will want to know about past and present medical problems, past surgeries, current medications and allergies. I will also want to perform a thorough physical exam, which means that you will be asked to change into a gown. I will assess you completely from head to toe. I will also do a neurological examination to see if there are balance and/or gait problems, visual problems or other neurological issues. I may also perform mental status testing, which involves testing of memory, recall and other cognitive functions. Lastly, I may order blood work, brain imaging exams or other diagnostic tests if I feel that symptoms are consistent with Alzheimer’s disease. If I order tests, I will tell you why I think the test is necessary and what I think the test will rule out or tell me. It’s important to know that other diseases and conditions can cause some of the symptoms of Alzheimer’s, and that these conditions may be completely reversible, so it is important to rule them out.

Once I have all of the information I need, we’ll discuss the results and decide on a plan of care. If you, or your loved one, have Alzheimer’s disease it is important to know that, although the condition can’t be cured, there is treatment available that can slow disease progression. Medications can help with memory, sleep disturbances and other symptoms of the disease. It’s also important to know that there is a lot of research going on regarding Alzheimer’s disease, and new knowledge is coming forward all the time.

If you are concerned that you may have Alzheimer’s disease, or you worry that a loved one is showing signs, make an appointment to see me. The sooner you come in, the sooner you will have an answer. If Alzheimer’s is the reality, treatment can begin immediately, which can help to slow disease progression and symptoms.

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What My New Patients Should Know About Osteoporosis (Weak and Brittle Bones)

Posted by on July 29th, 2013

Dr. Bella Zimilevich, MD

“Osteoporosis causes bones to become weak and brittle, making them more prone to fracture. Osteoporosis is a serious disease that can result in serious disability. As you get older, your bones also age, losing mass, especially in women after menopause. Osteoporosis can be halted, and sometimes prevented, by diet and exercise. If you have been told that your bones are weak, we can work together to prevent disease progression and protect you from breaking bones”.

Dr. Bella Zimilevich, MD

What is osteoporosis?

Osteoporosis is a disease of the bones. It is characterized by low bone mass. Bone tissue deteriorates over a long period of time, resulting in bones that are brittle and weak. Because the bones are brittle and weak, they can break easily. Osteoporosis rarely causes symptoms until the disease is well under way, earning it the nickname of “the silent thief”, because it steals bone mass without you knowing it. The spine, hip, wrist and shoulder are the bones that break most commonly in osteoporosis.

What causes osteoporosis?

There is no one single cause of osteoporosis. It can strike men and women of any age, although the condition is more common among older patients. Risk factors for osteoporosis include:

  • age– osteoporosis is more common in older individuals
  • sex– osteoporosis is more common in women
  • menopause– all of us begin to lose bone in our 30s; after menopause, women lose bone at an accelerated rate (up to 2 to 3% per year)
  • glucocorticoid drugs– steroid use for longer than 3 months increases the risk of osteoporosis
  • malabsorption– medical conditions that inhibit the absorption of nutrients such as calcium and vitamin D can lead to osteoporosis
  • medical conditions/medications- these may contribute to, or speed up, bone loss (i.e. thyroid disease, parathyroid or adrenal gland disorders)
  • race– Caucasian and Asian women are more prone to developing osteoporosis
  • size– individuals who start out with a small frame are more likely to develop osteoporosis (i.e., someone who is 110 pounds with a tiny frame may be at higher risk than someone who is 200 pounds with a large frame)
  • lifestyle– a sedentary lifestyle, drinking too much alcohol, cigarette smoking and poor diet may all contribute to the development of osteoporosis

If you parents suffered a hip fracture or a compression fracture of the vertebra, you may be at higher risk for osteoporosis. Loss of height may be an indication of osteoporosis.

 What are the symptoms of osteoporosis?

As mentioned, there are often no symptoms of osteoporosis until a fracture occurs. If your osteoporosis is fairly advanced you may experience:

  • loss of height over time/stooped posture
  • back pain
  • bone fracture that occurs after an inconsequential event, such as bending over or sneezing, or a fall that normally would not cause a bone to break

How is osteoporosis diagnosed?

Bone densitometry is a special type of x-ray that can measure the density of bones. Usually only a few bones are checked, such as your wrist, spine and hip. With this test, the density of your bones is compared to others of the same height, weight and age. Sometimes regular x-rays will raise the suspicion that your bones are thinning, which may prompt me to order a bone density test.

What can I expect when I come in for my appointment?

When you come in to see me and you are concerned about osteoporosis, I will start by asking about your past medical history and that of your family, as a family history of osteoporosis is important. I’ll ask you about medications you are taking or have taken in the past (such as steroids) that may have a bearing on the condition. I’ll ask about diet and lifestyle factors that may be of concern. I’ll measure your height to see if it has changed or remained stable. If you are a woman, I’ll determine if you are premenopausal or postmenopausal, as this may put you at higher risk. If you have back pain or have already suffered a fracture, I may want to see old x-rays, and I may order new x-rays for comparison. I will order a bone density test if needed.

We can discuss your personal risk factors for osteoporosis and what you can do to decrease your risk of developing osteoporosis, or prevent it from getting worse and protect you from fractures if you already have it. Exercise, diet, supplementation with calcium and vitamin D, quitting smoking and reducing alcohol intake can all help to arrest the disease. There are medications that can be prescribed if you have osteoporosis to help slow bone loss.

If you have or suspect you may have osteoporosis, you should come in and see me as soon as possible. The sooner we reduce your risk factors, the sooner we can stop the process of bone loss and protect you from suffering a fracture.

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How I Diagnose and Treat Arthritis (Joint Pain, Osteoarthritis)

Posted by on July 6th, 2013

Dr. Bella Zimilevich, MDArthritis can be a disabling and painful condition that can limit your ability to be independent and enjoy your usual activities. Osteoarthritis is common as we age, but just because it’s common doesn’t mean that it can’t be treated. If joint pain is making it difficult for you to engage in your usual activities, make an appointment to come in to see me. If arthritis is causing your pain, treatment is available”.

-Dr. Zimilevich, MD

About Arthritis

Did you know that arthritis is actually a large family of conditions affecting the body’s  joints, bones, cartilage and muscles? There are more than 100 distinct arthritic conditions! They all have pain and limited mobility in common.

Osteoarthritis is one of the most common types of arthritis. In osteoarthritis, the cartilage that acts as a cushion between the joints, allowing them to glide and move easily without coming in contact, becomes thinner. When this cartilage breaks down as a result of wear and tear over the years, the joints are no longer cushioned and essentially rub together (‘bone on bone’), which causes pain, loss of mobility and stiffness in the affected joint(s). Over time, bone spurs and other bony abnormalities appear.

osteoarthritis diagnosis

Unfortunately, there is no cure for this form of arthritis. The cause is not completely understood, although we do know that aging plays a role. It is estimated that almost 30 million Americans are living with osteoarthritis.

What are the risk factors for arthritis?

Although arthritis is more common in older people due to joint wear and tear, aging is not the only factor implicated in the development of arthritis. Other factors also play a role:

  • Genetics/Heredity- if arthritis “runs in the family”, you might be more likely to develop arthritis, especially arthritis affecting the hands. This does not mean that you are guaranteed to get it, but it does mean that I will watch you more closely for signs and symptoms of the disease.
  • Obesity- Being overweight increases your risk of developing arthritis. For every pound of weight you gain, you put four extra pounds of pressure on your knees and six extra pounds of pressure on your hips! Your knees and hips bear the brunt of your weight when you are upright. Losing even a small amount of weight can improve arthritis symptoms.
  • Muscle weakness- Muscles surround your joints and help to hold them in proper alignment. When your muscles are weak, more stress is placed on your joints. Studies have shown that weak thigh muscles can predispose to the development of arthritis of the knees.
  • Overuse/Injury- years of using joints to excess at work or in sports can predispose you to develop arthritis, as can injury to a joint.

What are the symptoms of arthritis?

Osteoarthritis usually begins gradually over a long period of time. In the beginning, one or more joints may be occasionally stiff and sore. As the disease progresses and the damage worsens, affected joints become painful after periods of inactivity or overuse. Typically, you may experience pain upon awakening that improves as you move around, only to return at night after a full day’s activity. Walking may become difficult as the disease progresses. It is important to note that some people develop mild symptoms that never get worse.

What joints are typically affected?

The weight-bearing joints are commonly affected (hips, knees and back). The base of the big toe, small finger joints, base of the thumb and the neck may also be affected.

How is arthritis diagnosed?

Arthritis can usually be diagnosed on the basis of medical history, physical exam and x-rays of the affected joint(s). I will examine the affected joint(s), looking for swelling, redness and decreased range of motion. If fluid has gathered in the joint space, I may withdraw some of the fluid with a needle for analysis. Your description of your symptoms often tells me a lot about the likelihood of arthritis as the cause of your symptoms, and x-rays showing decreased joint space due to erosion of the cartilage between your joints can confirm the diagnosis.

What treatment options are available?

Arthritis can be managed using several different strategies:

  • Pain relief- anti-inflammatory medications can help with pain relief by decreasing inflammation. Steroids (orally or by injection into the affected joint) can also improve pain
  • Exercise- believe it or not, exercise can help to prevent worsening of arthritis by strengthening the muscles that support the affected joint(s). Walking is one form of exercise that can help to strengthen weak muscles and keep you mobile. Swimming is another option because there is no stress on the joints when you are immersed in water.
  • Physiotherapy- physiotherapy can help you maintain and even improve mobility and strengthen muscles, which can improve your ability to walk with less discomfort. Physiotherapy can also improve balance and coordination.
  • Weight control- if you are overweight, losing even a small amount of weight can decrease wear and tear on your joints.

If you have severe arthritis with constant pain and limited mobility, surgery may be an option. Surgery is generally not considered unless and until all other options have been tried. If you have severe arthritis, I can refer you to an orthopedic surgeon who can evaluate you to see if surgery is warranted.

If you are suffering from joint pain, don’t assume that arthritis is an inevitable part of aging that you just have to live with. Make an appointment to come into the clinic and see me- together we can ensure that your symptoms are caused by arthritis and determine the best course of action to improve your symptoms and keep you active and independent.

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My Geriatric Care Services (Arthritis, Heart Health, Skin Conditions, etc.)

Posted by on June 14th, 2013

Dr. Bella Zimilevich, MDAging effects virtually every body system. As a geriatrician, I have been trained to identify these changes and to anticipate how these changes might effect you individually. My training allows me to anticipate what problems associated with aging you might experience and to help you manage them. I chose geriatric care because I truly enjoy interacting with older individuals, who have so much to offer in terms of wisdom and experience. Let me help you to maintain your health so that you can continue to share these qualities with others”.

-Dr. Zimilevich, MD

What is geriatric care?

Geriatric care is the care of older adults. A geriatrician is someone who specializes in caring for aged individuals. I completed a fellowship in geriatric medicine, which is a form of specialization. This means that I am well qualified to care for older adults and their complex health issues.

What changes in the body occur with aging?

There is no body system left unaffected by aging.

  • Eyes-you may notice that you have trouble focusing on objects that are close to you. Your eyes may become more sensitive to glare and you may have trouble adapting to changes in lighting (i.e., going from a light room to a darker room). Glaucoma (increased pressure in the eye) and cataracts (clouding of the vision) are more common in older individuals.
  • Ears– you may become hard of hearing as you age, particularly in crowded or noisy environments, where you may find it difficult to distinguish voices from background noise.
  •  Mouth and teeth– your mouth may become drier, especially if you are taking certain medications. Your gums may start to pull back from your teeth. Tooth loss or decay may result in the need for dentures.
  • The skin– skin becomes thinner and more fragile, leaving you more susceptible to bruising, skin tears or cuts. Your skin will be drier and you may notice the appearance of age spots, skin tags and wrinkles. You will be more prone to infection, so any breaks in the skin should be tended to immediatly and watched closely for signs of infection.
  • Weight– as you age, your muscle mass will slowly be replaced by fat. You will require less calories to maintain your weight. If you have health problems such as arthritis, exercise becomes more of a challenge and you may find that you gain weight more easily due to a more sedentary lifestyle and a slower metabolism.
  • Heart and lungs– arteries become less elastic (stiffer) as we age, which can lead to high blood pressure because the heart must work harder to pump blood through stiffened arteries. Your heart rate may slow slightly. The blood vessels in your feet and legs become less efficient at returning blood to the heart. You may develop varicose veins or hemorrhoids as a result of blood pooling in the veins. As for the lungs, the alveoli (air sacs) can become “baggy”, trapping air and making breathing a little more difficult. The muscles and bones supporting the chest may weaken, altering the contour of your chest. This can also contribute to breathing difficulties.
  • Cognition/Mood– memory loss, increased difficulty in concentration and other changes in mental functioning may occur. It may be harder for you to learn and remember new things. Depression is not uncommon among older individuals; loss of a spouse, retirement and moving from a home into a care facility may exacerbate depression.
  • Bones and muscles– the bones become weaker and lose density- you may even find that you lose a little in height. Bones become more brittle and more prone to fractures. Your muscles become weaker, which can cause changes in coordination and balance and cause you to be at higher risk of falling. Arthritis is common, as are other joint problems.
  • Stomach and intestines– the entire digestive system can slow, making constipation an issue. Medications and lack of exercise can contribute to this problem. The valve that lies between the stomach and esophagus may become less efficient, resulting in symptoms of heartburn and indigestion. You may find that your appetite decreases and foods are a little less flavorful.
  • Urinary tract– as the bladder and the pelvic floor muscles that help to control urination  weaken with age, incontinence (inability to hold your urine) may become an issue. You may be more prone to urinary tract infections. In men, the prostate enlarges and may lead to urination problems.
  • Sexuality– libido decreases in both men and women as a consequence of aging, often due to health changes such as arthritis or heart disease, although sexual intercourse can be just as satisfying. It may take longer for both men and women to achieve orgasm. Men may experience erectile dysfunction, while women may experience vaginal dryness and discomfort after menopause.
  • Immunity– as you age, your immune system becomes less efficient at fighting off infections, leaving you more vulnerable to serious infections such as pneumonia and influenza.

If reading the above is frightening, it doesn’t have to be. These days, people are living longer than ever. They are also more savvy about caring for themselves. If you are an older individual, it is important for you to form a relationship with a physician whom you trust. You will need to work hand in hand with this person to manage your health. As a geriatric specialist, I would love to be your aging support person. Together, we will manage any conditions arising from the aging process to keep you feeling young and vibrant. If you need a physician who understands the aging process and passionately believes that older individuals deserve to feel well and function independently, you’ve come to the right place- make an appointment today and discover the Mill Basin difference.

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Our Location

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6301 Mill Lane, Brooklyn, NY 11234.

718-942-4600

We are not a hospital/urgent care facility. Our urgent care services are offered during normal business hours only.
Mill Basin Clinic Location

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