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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

Musculoskeletal Care

musculoskeletal

 

How My Medical Office Can Help With Your Rheumatoid Arthritis (RA)

Posted by on August 22nd, 2013

Dr. Bella Zimilevich, MD

“Rheumatoid arthritis differs from osteoarthritis in that it not only causes joint pain and stiffness, but can also affect other body systems. RA often affects younger adults, which can impair ability to work. If you have joint pain and stiffness, regardless of your age, you should come in and see me- there are treatments that can help”.

Dr. Zimilevich, MD

 What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is an autoimmune disorder in which the body attacks itself- usually the small joints of the hands and feet, although any joint may be affected by RA. It is the most common type of  autoimmune arthritis. Women are affected more often than men (3:1). It is estimated that over 1 million people in the US are living with RA, many of them relatively young. Rheumatoid arthritis most often affects people in their 40s, 50s and 60s, but it can occur at any age (when the disease is diagnosed in children it is called juvenile arthritis)

What are the symptoms of rheumatoid arthritis?

The joint pain of RA is often at its worst in the morning when you first wake up. You may find it difficult to move the affected joints well and without pain when you first wake up. The pain may improve as the day wears on; as the disease progresses, or during acute flares of the disease, pain may be constant.

Because RA is an autoimmune disease, other organs of the body may be affected as well. You may also experience:

  • loss of appetite
  • fever
  • fatigue
  • dry eyes and mouth
  • rheumatoid nodules (firm mobile lumps that grow under the skin in the hands, elbows)
  • lung problems
  • anemia (low number of red blood cells)

What causes rheumatoid arthritis?

While experts understand that RA is an autoimmune disease, no one knows what triggers the immune system to attack the synovial membrane of a joint. The synovial membrane is the tissue that lines the joint. The immune system releases chemicals that attack this lining, as well as the cartilage that cushions the joints and the joints themselves. It is likely that some people are genetically susceptible and the disease is triggered by an unknown event.

What can I expect when I come to see you?

If you suspect that you may have RA, it is best to come see me as soon as possible. Early treatment can help prevent disease progression, and RA requires constant monitoring to prevent destruction of joints.

I will start off by taking a history from you. I’ll need to know about your past medical history, medications you are currently taking and any allergies you may have. I will then ask you to tell me about your symptoms: when did they start, when is the pain at its worst and what makes the pain better or worse. I may also ask whether you have noticed any fever, excessive tiredness or other constitutional symptoms.

Once I have learned more about your symptoms, I will want to examine your joints, particularly the joints of your wrists, hands and feet. I will look at your other joints as well. I will be looking for redness, swelling and warmth, as well as pain with manipulation of the joints.

Unfortunately, there is no single test I can order that can tell me whether or not you have arthritis, but there are blood tests that can provide clues. If I suspect you may have RA, I might order numerous blood tests that may provide supporting evidence to the diagnosis. These blood tests might include:

  • complete blood count- to check for anemia
  • rheumatoid factor- a protein found in the blood of many people with RA (although not all)
  • erythrocyte sedimentation rate- a non-specific marker for inflammation which can be elevated in many conditions including RA
  • anti-CPP- blood test to look for antibodies to certain peptides found in the blood of some people with RA

Although x-rays may not be helpful in the early stages of RA, they can be used to mark the progress of the disease. X-rays in the first months of RA may appear normal, but that does not mean you don’t have RA.

Can you treat me?

I am an internal medicine physician with a specialty in geriatric medicine. I can help you manage your disease. If necessary, I would refer you to a rheumatologist to confirm your diagnosis and make treatment recommendations. Many people see a rheumatologist periodically and depend on their primary care doctor to manage their condition the rest of the time. It can be difficult to get in to see a specialist when needed- for this reason, you will need a physician you can depend on to treat you between visits to a specialist. I would love to partner with your rheumatologist to help you with your condition.

Today, there are many treatment options for RA. Medications can help you live a relatively healthy and normal life and can induce remissions in the active disease process. If you think that you may have RA, it is important that you receive a proper diagnosis and begin treatment to prevent worsening of the disease. Make your appointment today.

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How I Can Help Treat Your Back Pain (Lumbar Pain, Sore Back)

Posted by on August 7th, 2013

“If you are experiencing back pain, you are in good company. Back pain is one of the most common reasons that people visit their doctor. Back pain may be acute or chronic and is treated in a variety of ways, depending on the cause of the back pain. Back pain can affect your ability to work and your ability to enjoy life, particularly if it becomes chronic. If you injure your back or suffer from chronic back pain, come in and see me so that we can assess the problem and determine how best to treat your pain”.

-Dr. Anatoly Pisman, MD

What is back pain?

Back pain can affect virtually any area of the back, including the neck, the upper back, the mid-back, the lower back or the tailbone area (the sacrum). It is caused by a problem with the bones or joints of the spine, the nerves that lead  away from the spine to the rest of the body, or the muscles and ligaments that support the spine.

Back pain may be dull, burning or sharp and may radiate to other areas, including the the hands, the arms, the buttocks, the groin, the legs and the feet. In addition to pain, you may experience numbness or tingling. You may also experience weakness of the extremities.

What causes back pain?

In most cases, no specific cause can be found for back pain. Back pain may be caused by muscle strain. Other potential causes of back pain include:

  • disc herniation– a tiny tear in the outer covering of the intervertebral disc which allows the jelly-like cushion to bulge out
  • degenerative disc disease– degeneration (wearing down) of one (or more than one) of the intervertebral discs of the spine
  • osteoarthritis– wearing down of the discs of the spine caused by wear and tear associated with the aging process
  • spinal stenosis– narrowing of the spinal cord causing compression
  • trauma– accident or acute injury affecting the back
  • inflammatory disease-such as rheumatoid arthritis or ankylosing spondylitis
  • infection
  • fractureosteoporosis, in which the bones become brittle and weak and are prone to fracture, may cause compression fractures of the spine
  • cancer (rarely)

How do I know whether to seek care for my back pain?

Most back pain will subside with time and rest. You may still need to see me to rule out a serious cause of your back pain, especially if the pain is severe or does not get better after a few days. There are some absolute red flags that should prompt you to make an appointment to see me urgently. These include:

  • bowel/bladder problems (inability to urinate, loss of bladder or bowel control)
  • numbness, pins and needles in the genitals, buttocks, inner thigh (what we refer to as the “saddle area”)
  • sexual dysfunction (such as sudden impotence with back pain)
  • back pain associated with fever, weight loss or night sweats
  • history of previous cancer
  • progressively or rapidly worsening weakness, pins and needles, or numbness

What can I expect when I come in to see you?

If you come to see me complaining about back pain, I will need to know if you know what caused your pain (for example, back pain occurred at work while you were lifting a heavy object). I will also need to know how long you have had the pain, what remedies you have tried (and if they have worked) and what makes your pain worse.

If you are a new patient, I will need to know about your past medical history, whether you have had any surgeries and whether you are allergic to any medications. I may also ask you about your family history. I will want to know if you have ever had back pain before and what transpired over the course of your previous back pain. Did it get better on its own? Did you require treatment and, if so, what treatment did you receive?

I will then need to examine you. I may ask you to change into a gown, as it will be easier for me to see your back and watch how you move. I will likely ask you to perform different movements and bend in certain ways so that I can try to determine precisely where your pain is located. If necessary, I may order diagnostic testing, but generally this is not necessary if I suspect you have strained your back. Based on my examination and your history, I may suggest:

  • antiinflammatory medications to reduce pain and swelling
  • ice or heat to relieve pain and reduce inflammation (ice is best for the first 48 hours; after that, a heating pad or hot pack can be used)
  • gentle stretching exercises
  • physiotherapy
  • massage therapy
  • avoidance of certain activities for a period of time

If you need a note for work, I can provide you with one. If I feel that your back problem is something that I cannot manage, I will refer you to other specialists; however, I am a physical medicine and rehabilitation physician and can therefore manage most common back pain issues.

If you are suffering with back pain for longer than 3 to 4 days that is not relieved with home remedies, make an appointment to see me in the clinic so that I can rule out any serious causes of your back pain.

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Tennis Elbow (Lateral Epicondylitis, Elbow Pain) Treatment at Mill Basin Medical

Posted by on August 5th, 2013

Dr. Bella Zimilevich, MD

If you suffer from elbow pain, chances are you have tennis elbow, or lateral epicondylitis. This condition is often caused by overuse of the arm (repetitive stress) and can be acute or chronic. If you have pain in the elbow, it’s best to get it assessed to rule out other causes of elbow pain. If you do indeed have tennis elbows, there are several treatment options, the most important of which is rest”.

-Dr. Zimilevich, MD

What is tennis elbow?

Tennis elbow is pain that occurs on the outside (lateral aspect) of the elbow, close to where the upper arm and elbow come together. The condition is common in tennis players because of the way tennis players swing their rackets (backhand strokes are usually the culprit), but it can occur in anyone who uses their elbow to excess. Constant twisting of the wrist, (as occurs when using a screwdriver, for example) can cause tennis elbow, so painters, construction workers, cooks and other workers who use their forearm muscles a lot are particularly vulnerable to tennis elbow. Tennis elbow can also occur from a one-time activity such as raking the lawn if it is done to excess. Using a mouse and computer keyboard too much can also give rise to inflammation.

Muscles in your forearm attach to the bone via tendons at the outside of the elbow. Excessive use of your elbow results in tiny tears in these tendons (may be one tendon, or more than one tendon affected). These tiny tears lead to inflammation and irritation and give rise to the symptoms of tennis elbow.

What are the symptoms of tennis elbow?

  • pain in the elbow that gets worse gradually (may be worse in the morning upon arising)
  • inability to grasp objects due to a weak grasp
  • pain radiates from the elbow to the forearm, and even the hand, when an object is grasped or turned/twisted
  • redness/swelling over the lateral epicondyle (bony protrusion on the outside of the elbow)
  • increasing pain when the wrist is flexed with the arm in a straight position
  • point tenderness over the area of inflammation

How is tennis elbow diagnosed?

If you come to see me complaining of elbow pain, I will ask you when your symptoms started and what caused them (if you can remember). I will ask what makes the pain better or worse and what you have tried at home to alleviate the pain. I will examine your elbow for redness, swelling and pain on palpation over the outer aspect of your elbow. I will have you perform different maneuvers with your arm to see which movements reproduce the pain.

Tennis elbow can often be diagnosed based on symptoms and examination. If I have any doubt as to what is causing your symptoms, I may order an x-ray of your elbow. The x-ray will rule out other problems, such as a fracture, and will show if you have soft tissue swelling around the elbow joint. You can’t see tendons on an x-ray. X-rays are performed to rule out other concerns, not to diagnose tennis elbow.

Can tennis elbow be treated?

Yes, tennis elbow can be treated. Sometimes it takes a long time, and it requires your cooperation. The most important part of treatment is to rest the elbow. You will need to stop doing whatever activity it was that caused the tennis elbow to occur. If you got tennis elbow from the type of work you do, you may need to take some time off work.

Drugs that reduce inflammation may help with the pain and decrease swelling, so I may prescribe an anti-inflammatory agent, either prescription strength or over-the-counter. You should also ice the area 3 times a day for the first week or so. There are tennis elbow braces that can help to decrease pain when you use your affected arm- these can be purchased in any pharmacy or home health store.

If the above measures don’t help, I can inject a corticosteroid into the elbow, which often relieves symptoms for weeks or even months. We can discuss this option if rest, ice and anti-inflammatories do not help. However, rest is the most important thing you can do to help your tennis elbow heal faster. If you continue to use your elbow, your symptoms may become chronic.

If you have had tennis elbow for longer than 6 months to a year and your symptoms have not improved, it may be time to talk to a surgeon. Surgery does not always help with tennis elbow, but it is an option for some. If you need a referral to a surgeon, I can provide you with one.

If you have tennis elbow, it is important that you make sure that tennis elbow is actually the problem. If you have elbow pain it is best to have your elbow assessed. Make an appointment to see me in the clinic.

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Musculoskeletal Care At Our Medical Office: What You Should Expect

Posted by on August 5th, 2013

“The hallmark features of a musculoskeletal issue are pain and disability. If you have neck pain, back pain or hip pain caused by arthritis or another condition, you are likely to have intermittent or constant pain and a reduced ability to perform certain activities. While some musculoskeletal problems are due to aging or injury, others are due to immunological problems, such as rheumatoid arthritis. If you suffer from pain requiring musculoskeletal care, make an appointment to come in and see me. I can help you to manage your pain and return to your usual routine as quickly as possible”.

-Dr. Anatoly Pisman, MD

What is musculoskeletal care?

The musculoskeletal system is made up of bones, muscles, joints, cartilage, tendons and ligaments. All of these components work together to give us the ability to move our bodies in a variety of ways. A problem with any of these structures can result in pain, limited mobility, swelling, redness and other symptoms. Generally pain is the largest feature of any problem involving the musculoskeletal system and will be the symptom that results in you making an appointment with me! Musculoskeletal care is care of any of these structures or parts.

 How the musculoskeletal system works

It’s important to understand how the different parts of this system work together before we can understand how certain conditions can affect this system.

  •  Bones (adults have 206 bones in total) provide support and shape to our bodies, and they also protect vital organs. In addition, bones produce certain blood components and store important minerals, including calcium and phosphorus.
  • Muscles are attached to bones and are arranged in opposing groups around our joints, which allows us the freedom of movement in different directions at the joints (unless we have joint disease). Our muscles are controlled by nerves, which are in turn controlled by our nervous system.
  • Tendons connect muscles to bones and are composed of tough bands of connective tissue. Tendons are attached to bones ; as we contract our muscles, the tendons transmit this force to the bone and pull on the bone, causing it to move. Tendons are quite stretchy, which allows them to act as a spring during movement, which in turn helps us to save energy. Although tendons are stretchy, they have limits- exceed this limit and the tendon can be damaged.
  • Ligaments act as the connection point between bones- they join bones together to form a joint. Ligaments act to prevent bones from moving too far out of alignment (dislocating) or breaking. Made of a dense elastic tissue, they can stretch substantially- again, if they are stretched too far, they can be damaged, resulting in an “unstable” joint, or one that is prone to partial or total dislocation.
  • Cartilage is a flexible connective tissue found all over our bodies. Cartilage acts as a shock absorber in our spine between the intervertebral discs and between the bones that make up our joints. Cartilage does not contain blood vessels. Because its blood supply is limited, cartilage cannot regenerate easily. Arthritis is a result of a wearing out of the cartilage, resulting in a loss of cushion between the bones of joints such as the hips and knees.
  • Bursa are small fluid-filled sacs that cushion joints and can be found around almost every major joint in our bodies. Sometimes a bursa can become inflamed, causing a condition known as bursitis, which cause pain, swelling and limited movement of the affected joint.

What conditions affecting the musculoskeletal system can you treat?

I am a physical medicine and rehabilitation physician. I am able to manage a large number of musculoskeletal conditions, including:

  • low back pain
  • neck pain
  • tendonitis
  • bursitis
  • arthritis
  • gout
  • fibromyalgia
  • hip and knee pain
  • sprains and strains

What Can I expect when I come to see you?

If you come to see me in the clinic requiring musculoskeletal care, chances are you are experiencing one or more of the following symptoms:

  • pain
  • redness
  • swelling
  • decreased range of motion
  • numbness or tingling
  • muscle weakness
  • stiffness
  • loss of function

First of all, I will want you to tell me about your symptoms, including when they began, what makes them worse or better, what precipitated your symptoms (if you know), what you have tried and whether any self-help measures helped at all. I will also ask about your medical history, your family history, what medications you are taking (including herbal and over-the-counter remedies) and whether you have any allergies.

Once I have a good understanding of your health status and what brought you to see me, I will examine the affected area. I may ask you to change into a gown to allow me to better visualize the affected area, and to allow you to move freely without restriction. I may perform various maneuvers to try to duplicate the pain you are experiencing- do let me know if the pain is severe! I will explain what I am doing and why I am doing it as I go along. I will be looking for reduced movement/stiffness, pain, redness, swelling and other signs and symptoms that may provide clues as to what the problem is.

Once I have examined you and gathered your history, I might order diagnostic tests, such as blood work, x-rays or other tests. If I decide to order any tests, I will tell you what the test is looking for and why I feel it is necessary. Once your test results are available, I will discuss the findings with you. I may prescribe rest, medications such as pain relievers or anti-inflammatories, or other treatments. Again, I will explain any treatments to you and what I hope we can accomplish with treatment. I may also request that you come in again for follow-up. If I think you may have a problem that is beyond the scope of my practice, I will refer you to a specialist.

If you are suffering from musculoskeletal pain or disability, make an appointment to come in and see me. I will ensure you get the right diagnosis and the right treatment.

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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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