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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

Urgent Care

 

Medical Treatment For Your Sprains and Strains

Posted by on September 13th, 2013

Dr. Bella Zimilevich, MD

“Sprains and strains can be very painful. When treated properly, the swelling and pain should diminish quickly. However, doing too much too soon may result in reinjury. It can be difficult initially to tell the difference between a bad sprain and a fracture, in which case it may be necessary to seek a professional opinion”.

-Dr. Zimilevich, MD

Sprains and strains- what is the difference?

Although the terms sound similar, sprains and strains are not the same. A sprain involves injury to the ligaments that connect bones together at the joint, while a strain is an injury to a tendon or muscle. The most common sprain is the ankle sprain, while back injuries are a common form of muscle strain.

What are the signs and symptoms of sprains and strains?

If you experience a sprain, you will notice bruising, swelling, pain and a limited ability to move the affected joint. You may feel (or even hear) a loud “pop” when the injury occurs.

If you sustain a strain injury, you may notice swelling, pain and a limited ability to move the affected muscle. You may experience painful muscle spasms.

What causes sprains and strains?

A sprain occurs when you overextend your ligament while placing stress on the joint. The tendon may actually tear. A strain occurs when the muscle is stretched beyond its normal capacity. Strains may be acute or chronic. While acute strains occur suddenly, usually as the result of a single event or moment, acute strains may occur when a muscle is strained repetitively.

Who is at risk of suffering a sprain or strain?

If you are in poor condition and stress your ligaments or muscles beyond what they are capable of, you may injure them. If you are in good condition but fail to warm up your muscles adequately before engaging in physical activity, you may experience an injury. Becoming overly fatigued may also result in injury as you are less likely to protect your joints. Sometimes sprains and strains are the result of an accident that can’t be prevented.

How do I know if I need to come see you?

If you are unable to walk without a great deal of pain, or you cannot bear any weight on the affected joint, you need to come in and see me.  If you have numbness in the injured area or you cannot move the affected joint, it is important to have you injury evaluated.

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

When you come in to see me, I will first gather a little history about you, including your past medical history, medications you are taking and any allergies to medications you may have.

Next, I will need you to tell me how the injury occurred. I will need to know what you were doing when the injury occurred (playing a sport, shoveling the sidewalk). How long have you had the pain? Have you ever injured the same area before? Did you hear or feel any noises when the injury occurred? The answers to these questions can provide me with some clues to help make the diagnosis.

I will then examine the affected area, looking for bruising, swelling and pain with gentle manipulation of the joint, as well as range of motion. After I have examined the joint, I will determine whether the area needs to be x-rayed to complete my evaluation.

How do you treat sprains and strains?

Treating a sprain or strain involves RICE:

  • Rest- rest the affected area
  • Ice- apply ice to the area for 10 to 15 minutes 3 times/day
  • Compression- wrap the area with an ace bandage (support bandage), being careful not to wrap the area too tightly
  • E– elevate the affected area if possible above the level of your heart to decrease swelling (i.e. put your ankle up on a chair while you are sitting)

Over-the-counter analgesics such as ibuprofen or Tylenol can be used as directed for pain. Crutches may be necessary for severe ankle or knee sprains.

If you are unable to work due to your injury, I can provide you with a note for work. If you injured yourself on the job and your injury is a Workman’s compensation claim, please let my office staff know prior to your visit so that we can help you complete the appropriate paperwork.

If you have suffered a sprain or a strain and you are unable to walk or bear weight, or you experience numbness in the area, make an appointment to see me urgently. In most cases, you can be seen on an urgent basis. Make your appointment today.

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Incision and Drainage: What is an Abscess? Why Should You See Me?

Posted by on August 28th, 2013

Dr. Bella Zimilevich, MD

“An abscess can be quite painful and may be unlikely to heal on its own. Making a small incision and draining the contents can provide relief of pain and speed healing. If you have a painful abscess, make an appointment to see me urgently”.

-Dr. Bella Zimilevich, MD

What is an abscess?

An abscess is a collection of pus under the skin. It is caused by a bacterial infection and often forms at the base of a hair shaft or around a blocked sweat gland. It may also occur from a small injury to the skin. In an abscess, white blood cells rush to the affected area to fight the bacteria causing the infection. Pus is a conglomeration of damaged tissue debris and white blood cells. An abscess may contain quite a large amount of pus.

What are the symptoms of an abscess?

If you have an abscess, the first thing you might notice is pain. Abscesses can be quite tender. They may appear as a large pimple-like lump with a domed peak. The skin around it may be red and warm. The abscess itself may feel firm. You may notice pus coming from it if it has opened. You may develop fever and chills, depending on the size and location of the abscess. Abscesses can form anywhere.

Does an abscess need to be treated?

If your abscess has burst and is draining on it’s own and you do not have fever, you can watch the abscess for a day or two to see if it is going to resolve on its own. You should never squeeze or milk the pus from an abscess! Keep the area clean and dry.

Most abscesses will not clear up so easily and will require medical care. Left untreated, you may feel quite ill and the pain may cause you to seek care. It’s best to see a doctor for your abscess, as incision and drainage, followed by antibiotics, is often needed.

What can I expect when I come in?

When you come in to see me, I will first need to know a little about you, such as whether you have any chronic health conditions, whether you are taking any medications and whether you have any allergies.

I’ll need to take a look at the affected area. You may be asked to change into a gown, depending on the location of your abscess. I’ll examine the area to make sure that it is an abscess and not another problem. I’ll ask when it appeared, whether you have had one before and whether you have had any fever or chills.

Incision and Drainage

There’s a very good chance that I will need to drain your abscess if it is large and painful. Doing so will relieve pain and speed the healing process. Incision and drainage involves the following:

  • cleansing of the skin over the abscess with an antiseptic agent
  • freezing of the area using a local anesthetic
  • making an incision over the top of the incision from top to bottom
  • expressing the abscess to encourage drainage
  • exploring the abscess to ensure I have gotten all of the infected material out (for larger abscesses)
  • packing the abscess to prevent the wound edges from healing together (for larger abscesses)
  • applying a dressing to the area to soak up any further drainage

The entire procedure lasts only about 10 minutes for an uncomplicated abscess. The abscess is left open to allow it to drain and heal. Suturing it closed may result in further infection. You may be asked to return the next day if I packed your abscess- when you return I will remove the packing and recheck the wound.

I may prescribe antibiotics  depending on how large the abscess was, whether you have fever and what I believe the causative agent is. Most simple abscesses are caused by Staphylococcus or Streptococcus, common organisms that live on your skin and only cause infection when they manage to make their way under the skin through a small break. If I prescribe antibiotics, it is important that you take them as directed and finish the entire course.

In some cases, I may elect not to drain your abscess and send you to a specialist. This may occur if your abscess is very large or in an area that I feel is particularly delicate (such as near the genitals or rectum). If this happens, I will explain why it is best that you go elsewhere for care.

If you have an abscess that is reddened, swollen and painful, make an appointment to come in and see me. In most cases, an abscess will not heal without medical care. Medical care can ease the pain and speed healing. In most cases, I will be able to get you in quickly, so call today to make your appointment.

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Suture Removal (Removal of Stitches and Staples)

Posted by on August 15th, 2013

Dr. Bella Zimilevich, MD

“Suture removal is a simple procedure that can be performed quickly in my office. Although it is an easy procedure, trying to remove sutures yourself is never a good idea, as pieces of stitches can be left behind and infection may occur. If the idea of having your sutures removed makes you nervous, don’t worry- the procedure is not painful and will be over before you know it!”

-Dr. Zimilevich, MD

Repair of the skin is generally achieved by either stitching (suturing) the skin closed or by using staples. If you have sutures or staples, you might be dreading having them taken out. I’m here to assure you that the procedure is quick and virtually painless in experienced hands.

Types of skin closure materials

There are two types of sutures, absorbable and non-absorbable. Absorbable sutures break down eventually (usually within a month or two) and do not have to be removed. Non-absorbable sutures, on the other hand, are used to close external wounds in the skin and must be removed after a period of time.

Staples look just like office staples. They are easy to put in and pose less risk of infection. They may be used to close scalp wounds or operative wounds, but can sometimes leave scarring.

Skin closure tapes are also sometimes used, but it can be difficult to perfectly align the wound edges using skin closure tape, and tape might not adhere very well to areas with lots of body hair or areas that are prone to sweating.

Adhesive agents (skin glue), similar to crazy glue, can also be used to close a wound, especially in children because there is no need to anesthetize the skin prior to gluing. However, skin glue cannot be used on any area of the body where the skin is required to move, such as knees and elbows.

Prior to suture or staple removal

If you have sutures or staples in place, you will have received instructions on how to care for the affected area, such as keeping the area clean and dry for the first couple of days, covering the area with a band-aid if there is bleeding or discharge,  watching for signs/symptoms of infection and when to return for removal of your sutures or staples. You will need to make an appointment to come in and have your sutures or staples removed. In general, removal time for specific areas of the body are as follows (you may be given a different timeline):

  • arms/legs- 10 to 14 days
  • trunk- 7 to 10 days
  • joints- 14 days
  • scalp- 7 to 10 days
  • face- varies from 3 to 7 days, depending on the area of the face

Using sterile forceps and suture scissors for suture removal.

What can I expect during the suture removal procedure?

You will be positioned comfortably so that the area with sutures or staples is easily accessible. The affected area will be cleansed to remove debris and loosen any scar tissue forming. Using sterile forceps, I will carefully pick up the knot of each suture and, using a blade or sterile scissors, I will cut the suture. I will then use the forceps to pull the suture gently to remove it fully intact. You may feel a slight tugging sensation, but it will not hurt. I will continue with each individual suture until all of them have been removed. If you have staples, I will use a special tool that resembles a wire cutter to grasp each individual staple in the center. By squeezing the handles of the tool together, the staple’s edges are bent upwards and the staple can be gently pulled straight up and out. Again, you won’t feel any pain.

Following, I will clean the wound again. I may apply adhesive strips to help hold the wound edges together for a few more days until the wound has strengthened again, or I may apply a bandage to cover and protect the wound. It depends on the size and location of the wound.

After suture/staple removal

Just because your sutures or staples are out does not mean you are off the hook as far as wound care goes! You still need to:

  • leave the adhesive strips in place for approximately 5 days, or until they fall off naturally
  • keep your wound dry and clean
  • protect your wound from trauma for about a month, as your wound will be fragile and prone to splitting open should you suffer an injury in the same area
  • protect the area from too much sun

If you need to come in for suture removal, don’t worry- the procedure is quick and painless. Be sure to call and make an appointment to come in for your suture removal well before the due date to ensure that your sutures are not left in too long, as this can make it more difficult to remove them.

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Do You Need A Doctor’s Appointment For Burns (First Degree Burns, Second Degree Burns)?

Posted by on July 30th, 2013

Dr. Bella Zimilevich, MD

Even minor burns can be quite painful. Although most minor burns can be managed at home, a large second degree burn often needs medical attention. Third degree burns should be seen in the emergency room, but all other burns can be managed here in the clinic. If you have suffered a burn and are experiencing pain, or the burn is deep and has blistered, make an appointment to have your burn evaluated.

-Dr. Zimilevich, MD

 The Skin

In order to discuss burns, it’s helpful to have an understanding of how the skin is layered. This makes it easier to understand how burns are classified.

The top layer of the skin is called the epidermis. It consists of three layers and contains melanocytes, which are the cells that produce skin pigment (melanin). Just under the epidermis is the dermis, a thicker layer containing sweat glands, hair follicles, nerves and blood vessels, all held together by collagen. The dermis is what gives our skin its strength and stretchiness. Touch and pain receptors are also found in the dermis. Under the dermis is the subcutaneous layer, or hypodermis, which is formed from a network of fat cells and collagen. It acts as a sort of shock absorber  and helps us to stay warm. Under theses layers are the muscles, bones, ligaments, cartilage and joints.

Our skin serves many functions. It acts as a barrier, protecting us from injury, infection and dehydration. It is also a sensory organ- without skin we could not feel. Your skin is your largest organ. It is thickest on the soles of your feet and thinnest on your eyelids.

What is a burn?

A burn is simply an injury to the skin caused by heat (thermal burns), chemicals, electricity, radiation or friction. Burns can be further classified according to source i.e. heat, or thermal burns, may be caused by fire or hot water (scalds). All burns, no matter their source, cause some degree of damage to the skin.

Degrees of burns

You have probably heard of burns described in terms of degrees. Here is what the terms first, second and third degree burn means:

  • First degree burns affect only the epidermis. The skin is reddened, dry, painful or tender to touch and may be slightly edemetous (swollen). A sunburn is a good example of a first degree burn. These mild burns generally heal in a week or so.
  • Second degree burns affect the epidermis and the dermis. They are sometimes subdivided into superficial second degree burns or deep second degree burns, depending on how much of the dermis is damaged. Obviously, the deeper the burn the greater the severity. Second degree burns are moist or dry (depending on depth) and usually painful because nerves are affected (remember that the dermis houses nerve endings). There will be swelling and blister formation. Second degree burns take longer to heal (anywhere from a few weeks to 2 months) and may cause permanent scarring. Severe second degree burns may require skin grafting.
  • Third degree burns involve all the layers of the skin. The skin may appear white and leathery or charred. Pain may be less because nerves are destroyed (but this doesn’t mean there will be no pain because burns are often “mixed” with areas of second and third degree burns in close proximity). These burns are life-threatening because the loss of skin puts the victim at risk of massive fluid loss and infection. Skin grafting is necessary. Amputation may also be necessary. Healing may take many months and there is always scarring.

Burns are also sometimes described as partial-thickness or full-thickness, depending on the depth of the burn and layers affected.

First aid at home

For first degree burns or second degree burns that are no larger than 3 inches in diameter:

  • cool the burn- run the affected area under cool running water for several minutes or apply a cloth or towel soaked in cool water to the affected area
  • cover the burn with a dry, clean dressing to prevent infection and reduce pain (don’t use any material such as cotton batting that may leave material in the wound)
  • use an over-the-counter pain reliever for pain (do not give aspirin to children under 12 years of age)

Do not apply butter or other greasy agents to the burn- this may cause infection. If blisters are present, do not break the blisters- allow them to break on their own. Lastly, do not apply ice to the area as this may further damage the skin.

If you have a second degree burn that is larger than 3 inches in diameter or a third degree burn, you should seek medical attention right away. If someone you know has been burned over a large part of their body call an ambulance so that they can be transported to the nearest emergency room.

What can I expect if I need to come in because I have burned myself?

If you have burned yourself, you need to come in as soon as possible after being injured. I will ask about your medical history, any medications you are taking and whether you are allergic to any medications. You will need to tell me how you were burned and how long it has been since the injury occurred. I will examine the burned area to determine the severity of the burn. Depending on the extent of the burn, I may prescribe an antibiotic ointment or oral antibiotic if I am concerned about infection. You may need daily dressing changes- if this is the case, I will instruct you on how to perform the dressing change or make arrangements for daily dressing changes. In some cases, you may also need a tetanus shot if you have not had one for a while. If necessary, I may refer you to a specialist (plastic surgeon).

If you have suffered a burn, call to make an appointment as soon as possible. In most cases, we can see you very quickly. Doing so may prevent infection and other complications.

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Medical Attention For Heat Exhaustion (Heat Cramps, Heat Stroke, Dehydration)

Posted by on July 28th, 2013

Dr. Bella Zimilevich, MD

“With the temperatures outside extremely hot and with humidity soaring, you should know how to protect yourself against heat exhaustion. Heat exhaustion can lead to heat stroke, which can be life-threatening, particularly for people who are elderly or those who have heart and lung conditions. If you think you, or someone you know, has heat stroke it’s important to get out of the heat and seek immediate care”.

-Dr. Zimilevich, MD

About Heat Exhaustion/Heat Stroke

Simply put, heat exhaustion occurs when your body becomes overheated. Normally, your body cools itself by sweating. Body temperature is controlled by a part of your brain known as the hypothalamus, which maintains the body’s temperature within a fairly narrow range. When you are outside in very hot weather and don’t replace the fluids your body loses through sweating, the hypothalamus is overwhelmed and begins to produce more heat than the body can handle by sweating. Heat exhaustion is a form of dehydration caused by exposure to excessive heat for prolonged periods, or from drinking fluids that don’t contain enough sodium (salt).

Heat stroke is a more serious form of heat exhaustion and can lead to coma and even death if not treated. People with heat stroke may be confused with dry skin. Heat stroke occurs when heat exhaustion is not treated.

Symptoms of Heat Stroke/Heat Exhaustion

If you have heat exhaustion, you may experience:

  • dizziness/weakness/fainting
  • rapid heart rate (tachycardia)
  • thirst
  • excessive sweating
  • nausea vomiting
  • muscle cramping (heat cramps)
  • pale, cool and clammy skin
  • fatigue
  • headache
  • elevation in temperature (most often a mild rise)

In heat stroke, the body temperature exceeds 40 degrees Celsius (104 degrees Fahrenheit)  and coma or seizure may follow. Heart attack and death may also occur. Heat stroke is an extremely serious condition.

Who is Most at Risk?

Certain people may be at higher risk of suffering from heat exhaustion. If you fall into one of the following groups, you should be especially cautious when outdoors in hot weather:

  • you are already dehydrated (i.e., have had vomiting or diarrhea, or have been unable to drink enough fluids)
  • you are drinking beverages containing alcohol
  • you are elderly
  • you have chronic respiratory disease
  • you are obese or overweight
  • you have hypertension (high blood pressure)
  • you are pregnant
  • you have chronic heart disease
  • you are working outdoors performing physical labor
  • you are taking medications that may interfere with your body’s ability to cool itself (i.e., beta-blockers, tranquilizers, antihistamines)

How to Prevent Heat Stroke

  • The best offense is a good defense- try to avoid the sun during the hottest part of the day whenever possible. If you must be outdoors:
  • drink more fluids than normal, and ensure that you are not drinking fluids that don’t contain any sodium at all
  • check on elderly friends and neighbors and those who may be vulnerable to the heat regularly to ensure they are staying cool and are not victims of the heat
  • avoid drinking alcohol if you must be out in the sun
  • if you must do chores outdoors, wait until it is cooler out before venturing outdoors (i.e., early morning or evening hours)
  • dress appropriately in cool clothing
  • if exercising outdoors, drink 2 glasses of water prior to exercising and a glass of water every 20 to 30 minutes thereafter
  • take cool baths if you are feeling overheated
  • use fans indoors if you don’t have air conditioning
  • remember never to leave anyone who is vulnerable (babies, the elderly, small children or disabled individuals) in vehicles in the heat

What to do if you think you have heat exhaustion:

If you think you, or someone else, may have heat exhaustion, get to a cool place out of the heat. Remove any excessive clothing. You can place ice packs on the back of the neck and head and in the armpits and groins-this will cool the body quickly. You can also use fans or a cool bath to lower body temperature (do not put someone who is not fully conscious in the tub and leave them unattended). Replenish fluid loss by drinking water, naturally sweetened fruit juices or sports drinks.

If you or the person you are treating do not feel better after 20 minutes, you should be seen by a medical professional. If the person is semi-conscious or fully unconscious call an ambulance for immediate assistance.

If you come to see me in the clinic with symptoms of heat exhaustion, I will assess your temperature, pulse, respirations and blood pressure. I will examine you for signs and symptoms of dehydration. I may order diagnostic tests such as blood work or a urine test to assess the extent of dehydration. I may also use cooling measures to bring your body temperature down.

The best way to avoid heat exhaustion and heat stroke is to avoid the heat as much as possible. If you or someone you know are experiencing symptoms of heat exhaustion, call for an immediate appointment.

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Tetanus Vaccination: Do I Need A Tetanus Shot?

Posted by on May 22nd, 2013

Dr. Bella Zimilevich, MD “Most people associate tetanus shots with stepping on a rusty nail. While this situation would certainly call for a tetanus vaccination, there is a wide variety of injuries for which a tetanus shot is justified”.

– Dr. Bella Zimilevich, MD

Do you know when you received your last tetanus vaccination? As adults, few people think about their tetanus status until they are injured and are asked about it. Then they are forced to try to recall when they had their last tetanus shot. If they can’t remember, and there is no way to find out, they may be given a vaccination that they don’t need. This scenario can be avoided by writing the date of your last tetanus vaccination and putting it in your wallet.

What is tetanus?

Tetanus, commonly referred to as lockjaw, is caused by bacteria (Clostridium tetani) that are commonly found in the soil, dust and manure. It can also be transmitted through bites from animals. The term lockjaw came about because tetanus causes extreme muscle spasms and paralysis that often affects the jaw first, causing the jaw to become ‘locked’. The bacteria enter the body through a break in the skin and produce a toxin that travels along the nerves from the muscles. The condition is very painful and can affect the muscles that control breathing. Tetanus can be fatal. Fortunately, a vaccine is available to prevent tetanus.

What types of wounds require a tetanus shot?

Puncture wounds, such as the tiny but deep wounds that occur from stepping on a dirty or rusty nail, are most often associated with tetanus, but virtually any break in the skin can become a portal for the bacteria that cause tetanus. A common myth is that a wound that bleeds heavily prevents tetanus by washing away the bacteria that cause the condition, but this is simply not true. Even a simple scratch that breaks the skin can result in tetanus. The following accidental (and purposeful) wounds can put you at risk for tetanus:

  • burns
  • foreign bodies
  • puncture wounds
  • tattoos and body piercings
  • crush injuries
  • surgical wounds
  • dog bites
  • compound fractures (in which the broken bone pierces the skin)

How often do I need a tetanus shot?

As a child you were probably vaccinated against tetanus with a series of shots during childhood. However, the immunity you gain from being immunized as a child does not last a lifetime. You should be immunized against tetanus every ten years in adulthood.

If you have suffered a wound and it has been more than 5 years since your last tetanus booster, I will generally recommend that you have a tetanus shot. In addition, I will thoroughly clean the wound. I may prescribe antibiotics depending on the injury circumstances, the location and the nature of the wound.

If you work in agriculture, construction, emergency services or another area where the risk of injury is high, it’s a good idea to keep track of when you received your last tetanus shot. This can be of help if you find yourself in an emergency situation where you may be asked about your tetanus status. If you are injured and are unsure of your tetanus status, or whether your wound warrants a tetanus booster, make an appointment and come in to see me so that I can evaluate your wound and determine your need for a tetanus vaccine.

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Dog Bites (and Human Bites)

Posted by on May 16th, 2013

Dr. Bella Zimilevich, MD
“Dog bites are extremely traumatic events, both physically and emotionally. If you suffer a dog bite you deserve care that takes both into account”.

– Dr. Bella Zimilevich, MD

Are dog bites dangerous?

Yes, dog bite injuries can be extremely dangerous. A dog’s teeth are extremely sharp and are designed to tear. Dog bites usually result in either a puncture wound or a laceration (tear) in the skin. The wound may not look serious from the outside, but underneath the skin a lot of damage can be done to the underlying muscles, tendons, ligaments and blood vessels. Apart from the wound itself, infection is always a possibility.

 

Do I need to be seen if I have been bit by a dog?

I need to examine the wound as soon as possible if your skin has been broken (punctured) as the result of a dog bite. Because of the high risk of infection, the sooner you come in so that I can assess your wound, the better the outcome.

What should I expect during my visit?

When you come in to see me, I will assess the wound to determine how serious it is and what (if any) underlying structures have been affected. I will thoroughly clean the wound. If the wound requires stitches, I will freeze the skin first so that you don’t feel pain while I am suturing. After the wound has been stitched, I will dress the wound to keep it clean and dry.

In some cases, I may decide to leave the wound open to heal, as suturing a wound closed can sometimes increase the risk of infection. Whether the wound is left open or is sutured closed depends on several factors, including the location of the wound. Dog bites to the face are usually sutured to reduce scarring, but a small wound on a relatively “hidden” area of the body may be left open to heal. This is a decision that we can make together based on the severity of the wound, your risk of infection, the location of the wound and your personal preference.

Will I need to see a plastic surgeon?

I have extensive experience in treating wounds of this nature and can suture your wound to minimize scarring. If your injury is severe, or if a tendon or ligament has been injured, I may need to refer you to a plastic surgeon or another specialist. If this is the case, we can decide where to send you based on your preference.

Will I need to see you again after the initial treatment?

Because dog bites often result in infection, I may ask that you come to see me again so that I can assess how well your injury is healing and look for signs of infection. At your initial visit, I will provide wound care instructions and we will discuss when you should return for a follow-up appointment. If you receive stitches, you will need to return to the clinic to have them removed.

Will I need antibiotics?

I may decide to prescribe an antibiotic during your first visit if I feel that there is a strong likelihood that an infection will develop in your wound. If the wound is very minor, we may take a “wait and see” approach, closely monitoring your wound for signs of infection.

A Word about Human Bites

Human bites may be intentional (i.e., inflicted during the course of a fight) or accidental (i.e., your head comes in contact with someone else’s tooth, breaking the skin). If your skin has been broken by coming into contact with someone else’s mouth, you should seek medical attention. The human mouth carries many pathogens (germs) that can cause infection. You may also require a tetanus shot, just as in dog bites.

What about rabies?

It is very important that we know whether the dog that bit you has been vaccinated against rabies. If it was your dog that bit you, this is an easy matter to determine. If you were bitten by a stray dog, local authorities may be contacted. The decision to vaccinate you for rabies will be based on several factors which we can discuss during your initial visit. You may also require a tetanus shot if it has been some time since your last one.

Will my insurance cover a dog bite?

Your home owners insurance may cover any medical expenses if you are bitten by your own dog. If you are bitten by someone else’s dog, their insurance may cover the costs of medical care. Some policies exclude certain breeds such as pit bulls.

The emotional toll

Apart from the physical damage, dog bites inflict emotional trauma. Whether you have been bitten by your own or someone else’s dog, the experience can leave you shaken. I understand how upsetting such an event can be and realize that the emotional trauma can be just as bad (or worse) than the physical trauma. Some people develop a fear of dogs that can be difficult to cope with. We can talk about your feelings, especially if you are feeling very anxious or frightened.

If you have been bitten by a dog and your skin has been broken, it is important that you seek medical care as soon as possible. Due to the urgent nature of this type of injury, we will go out of our way to accommodate you. Make an appointment as soon as possible after the injury occurs to reduce the risk of infection.

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Urinary Tract Infection (Bladder Infection)

Posted by on May 15th, 2013

Dr. Bella Zimilevich, MD“Urinary tract infection, or bladder infection, is a common problem. If you have a urinary tract infection, ignoring the symptoms will not make it go away and may lead to complications. It is best to come in and see me as soon as possible if you think you may have one”.

– Dr. Bella Zimilevich, MD

What causes urinary tract infection?

Bladder infections (urinary tract infections) are very common, especially in women. Why? It’s basic anatomy 101- the urethra, the tube that carries urine from the bladder to the outside of the body, is much shorter in women and the rectum, vagina and urethra are close together, making it easy for bacteria to spread from one area to another. Women are more prone to bladder infection during pregnancy because the weight of the growing baby places a lot of pressure on the bladder. In men, the urethra is much longer, which means that bacteria must travel a greater distance to reach the bladder. However, as men age the prostate gland often enlarges, which can make it difficult to completely empty the bladder.

Untreated bladder infections may lead to pyelonephritis (kidney infection), which is far more serious and can make you very sick. A kidney infection can be life-threatening if it spreads to the bloodstream. For this reason, it is best to treat simple bladder infections before they cause serious illness.

What are the symptoms?

If you have a bladder infection, you may notice:

  • burning pain with urination (this is usually the symptom that will make you run to pick up the phone and call for an appointment!)
  • hematuria (blood in the urine which may be visible or microscopic)
  • lower belly discomfort
  • urinary frequency (feeling as though you need to run to the washroom constantly)
  • urgent need to urinate (“I have to go NOW”)
  • cloudy or foul-smelling urine

If you have a kidney infection, you will feel very ill. You may experience flu-like symptoms, including fever, chills, headache and flank pain (pain in your back just below your ribs). You may feel nauseated and lose your appetite. Older adults may become confused or even delirious. Sometimes confusion is the only symptom of urinary tract infection in older individuals.

What can I expect at my appointment?

To diagnose a urinary tract infection, I’ll ask you about your symptoms. I may examine your belly to rule out any other causes of your symptoms and press on (palpate) your kidneys to see if you have any pain that might indicate kidney involvement. You will be asked to provide a urine sample. If we determine that bacteria in your urine is the likely culprit for your symptoms, I will prescribe an antibiotic. Your specimen will be sent for culture to determine the type of bacteria that is causing your infection.

What is the treatment?

If we determine that you have a bladder infection, I will prescribe an antibiotic. Remember, it is very important that you finish all of your medication. Do not stop taking the antibiotics even if you feel better after a day or two- stopping the antibiotics too early may result in reinfection and may make it harder to treat. If you have a urinary tract infection, you should drink plenty of fluids. This will help to keep you well hydrated and also helps to wash the bacteria out of your urinary tract.

If you have symptoms of a bladder infection, don’t delay. Make an appointment to come in to see me- I’ll have you on your way to feeling better in no time at all.

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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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