North Bethesda Primary Care

Do you know what we here at NBPC love more than practicing primary care?

Nothing. Absolutely nothing. Practicing primary care is the best!

See below a photo of Dr. Possner holding court at a meeting of primary-care-in-training aficionados a few weeks ago through his alma mater, Johns Hopkins Bayview.

And this is why we need to be judicious about imaging. Just like how with the Field of Dreams if you build it they will come, if you scan people's chests you will find things...most of which don't wind up benefitting patients, and some of which will kick off therapeutic mis-adventures. Of note, "clinically relevant" here does not equate cancer but rather a finding that needs to be followed, usually to no ultimate consequence.
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Over 40% of Non-smokers Have at Least One Lung Nodule

Diagnostic Imaging (8/13/24, Hall) reports that researchers have found that “over 40% of non-smokers have at least one lung nodule and nearly a quarter of this population has clinically relevant nodules based on low-dose chest computed tomography (CT) scans from 10,431 non-smokers in the northern Netherlands.” The investigators came to this conclusion after reviewing “findings from low-dose chest CT scans for 4,812 never smokers and 5,619 former smokers with 7.9 median pack-years and 27.4 median quitting years.” The findings were published in Radiology.

Like with most physical dependencies, it developed insidiously for me. Right in front of my eyes. But I didn’t recognize it until it was too late.

I’m physically dependent on physical activity. I crave it. I hanker for it. Whether it’s resistance training at the gym or 5 minutes walking alternating with 5 minutes running, I have to do it — at least some of it — every day. Even on vacation (!); see photo on a hike in the Hudson River Valley. If I don’t, I feel lowsy, definitely worse than before I started exercising.

About this drug, not to the others, I say, “Just Say Yes.”

Please join us in warmly welcoming the latest addition to the North Bethesda Primary Care family – Tamika Monroe! Effective today, Tamika has joined Yenifer up front guiding the NBPC ship as we help you navigate your healthcare journey through the bad and good swells of life, the gale-force winds of medical change, and Dr. Possner’s never-ending quest to engage in wordplay.

Tamika joins us from Trinity Washington University, where she served as a certified medical assistant in the general medicine health clinic. I know I speak on behalf of all of us – Dr. Zeki, myself, and * especially * Yenifer, who was answering the phones, rooming patients, and drawing blood all by her lonesome for the past 3+ years – when I say we couldn’t be happier to have Tamika on board!

Helping you stay healthy and being there for you when you aren’t so healthy. Your trusted medical advisors. That’s what it’s all about!

Several patients have asked what the scoop is on COVID vaccines for this coming fall. Here it is!
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FDA Advisers Unanimously Recommend Next Round of COVID-19 Vaccines Target JN.1 Variant

The New York Times reports, “A committee of advisers to the Food and Drug Administration voted on Wednesday [6/5/24] to update the formula for the COVID vaccine ahead of an anticipated fall immunization campaign, now an annual step to try to offer better protection against versions of the virus in circulation.” The panel’s unanimous vote “recommends a formula aimed at combating the variant JN.1, which dominated infections in the United States in February, or a version of it.”

Apologies for the late nature of this post, but if you have a bicycle that you no longer need — regardless of the condition — consider donating it TODAY, Sunday, 5/19/24, 1-4 PM to Bikes for the World, a non-profit organization dedicated to bringing bikes (and jobs servicing those bikes) to communities in need overseas.

My older son is organizing a donation event today at The Siena School at 1300 Forest Glen Road in Silver Spring. Hope to see you there!

'Tis the season for lifting mulch bags....

On that note, don't make the same kind of mistake people made -- according to the fine print -- in 1993...and every year of humanity before 1993 and since. Face what you are lifting, squat down, hold it close, and use your legs!

I saw this poster at Joint Base McGuire-Dix-Lakehurst while on a tour of the Hindenberg disaster site. That's a WHOLE other story....

Today was another non-stop busy day at North Bethesda Primary Care, interrupted only briefly by the partial solar/cellular eclipse.

Lest she compromise the vision essential to her flawless blood draws, Yenifer opted to remain on the shaded side of the street.

Dr. Zeki remained at a second undisclosed location for succession purposes, just in case.

What happens when you inform your children they are the beneficiaries on your insurance policy? They very helpfully offer to assemble your new grill. Ka-BOOM!!!!

Do minimize your amount of grilled food. A little bit is ok, though….

Ha-ppy Doctors' Day to us
Ha-ppy Doctors' Day to us
Ha-ppy Doctors' Day to...u-us....
Ha-ppy Doctors' Day to us!

Did you know that March 30 is Doctors' Day? Well, it is!

What do YOU love about North Bethesda Primary Care? Feel free to share your adoration here.

And if no one posts anything, don't worry, Dr. Zeki and I will know it's because you are overwhelmed with emotion and simply no words will suffice.

LEFT: This is your centrifuged blood.

RIGHT: This is your centrifuged blood on carbs, alcohol, and no exercise (eww).

Yenifer says don’t do carbs, alcohol, and no exercise.

(This public service announcement posted for free by North Bethesda Primary Care)

Big news from a few days ago: Wegovy (semaglutide that is FDA-approved for obesity only and, as of 3/8/24, also cardiovascular risk reduction) is approved for coverage in Medicare Part D plans, at least for patients who have cardiovascular disease. Previously Medicare did not cover this medication for any reason.

We here at NBPC firmly believe that obesity is a chronic medical condition and, like with any number of other chronic medical conditions (such as asthma, osteoarthritis, hypertension), sometimes lifestyle change is not enough to address it. Sometimes, even after lifestyle change, the chronic condition remains poorly controlled and that's because there is a biological underpinning.

If someone with asthma were to not smoke, to not have a pet, and to avoid other irritants and yet still wheeze, we wouldn't blame that person. Instead, we would give that person an inhaler.

We must approach obesity the same way. If after reasonable dietary change and exercise someone is still struggling with his/her weight, we need to augment the treatment plan with tools, such as medication, that address the biology.

What we need to do now as a healthcare system is make these medications more accessible both physically -- there continue to be supply issues -- and financially. Medicare's recent decision is a step in the right direction, at least toward that latter point.

For more information on the Medicare change, check out https://www.washingtonpost.com/business/2024/03/21/wegovy-medicare-part-d/.

Medicare plans can cover Wegovy for patients with heart conditions The federal government said that its prescription drug insurance for seniors will cover the popular weight-loss drug to treat patients with heart-related conditions, after the regulators broadened Wegovy’s regulatory label this month.

We know what you’re thinking. You’re thinking, “Hmm, I haven’t heard about the COVID vaccines lately, and I’d really like to hear more about them!!!”

Well, you’re in luck. Yesterday the Centers for Disease Control and Prevention (CDC) announced that adults 65 years old and older should receive a SECOND updated COVID shot, whether Moderna, Pfizer, or Novavax. The CDC has reported that the current COVID shots are about 50% effective in preventing symptomatic COVID infection, including for the current predominant strain, JN.1. People who are moderately to severely immunosuppressed already could get a second updated shot.

In other words, if you are 65 years old or older and/or moderately to severely immunosuppressed, you should get a second updated COVID shot if it’s been at least 4 months since your last shot; if you recently had COVID, you should wait at least 3 months before getting another shot.

After four years of COVID, many of us have become inured to the impact that COVID still has on certain people. In the U.S. alone, COVID is hospitalizing nearly 20,000 and killing 1,000+ each week. Many of these folks are 65 years old or older and/or not up-to-date on their shots.

If you come down with nasal congestion, a sore throat, or a cough, we urge you to check a rapid antigen COVID test. In fact, check at the beginning of symptoms and, if negative, check again in 2-3 days before you chalk up your symptoms to “just a cold”; we’ve found that it can sometimes take a few days before people test positive for COVID. When it comes to COVID, what can be “just a cold” for you can be much more for someone else – just ask the 20,000 and 1,000+ Americans getting hospitalized and dying, respectively, each week! – so it’s still worth trying not to spread the infection.

Drs. Possner and Zeki

Coronavirus Disease 2019 CDC provides credible COVID-19 health information to the U.S.

Growing up, one of my favorite cartoon shows was _Transformers_. I can still hear in my head part of the show's theme song, namely "More than meets the eye!"

I'm reminded of that line when I read a news blip like that at the bottom of this post. The results of this study are all over the medical news. For the full study check out https://www.jci.org/articles/view/176411/pdf.

I've been practicing medicine long enough to know that what sounds worthy of being practice-changing may not actually be and, in fact, often is not.

Alternating COVID (or other multi-series) vaccines between the arms is simple enough to do, but does it really make a difference? I want to make 3 points that were not included in the headlines:

1.) There was a previous study looking at this question, https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(23)00308-0/fulltext #%20, which showed the opposite result -- that getting both COVID shots in the same arm may be more beneficial. The authors of the current study acknowledge this and think they have an explanation for the disparate result, but maybe they're wrong.
2.) Most people are no longer like those in these studies. They are not COVID-naive. They have either had COVID infection or COVID vaccine at this point. And
3.) The determining factor, in my opinion, will be whether or not alternating arms translates into reduced infection, not just some increased assay results, which is the outcome we care about the most.
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Alternating arms for vaccination may produce a more powerful immune response

The New York Times (2/6, Mandavilli) reports, “If you’ve presented the same arm for every dose of a particular vaccine, you may want to reconsider. Alternating arms may produce a more powerful immune response, a new study suggests.” Investigators “studied responses to the first two doses of COVID-19 vaccines,” and found that “those who alternated arms showed a small increase in immunity over those who got both doses in the same arm.” The study was published in the Journal of Clinical Investigation.

JCI - Contralateral second dose improves antibody responses to a two-dose mRNA vaccination regimen BACKGROUND. Vaccination is typically administered without regard to site of prior vaccination but this factor may substantially impact downstream immune responses. METHODS. We assessed serological responses to initial COVID-19 vaccination in baseline seronegative adults who received second–dose bo...

Here at North Bethesda Primary Care we believe in the power of words in Medicine, both to diagnose and to treat.

Along these lines, please find below a poem I discovered today that really resonates with me. I never thought about having hope for the past, but apparently Robert Frost did, as well as David Ray, the poem's author. Enjoy!
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Thanks, Robert Frost
By David Ray

Do you have hope for the future?
someone asked Robert Frost, toward the end.
Yes, and even for the past, he replied,
that it will turn out to have been all right
for what it was, something we can accept,
mistakes made by the selves we had to be,
not able to be, perhaps, what we wished,
or what looking back half the time it seems
we could so easily have been, or ought...
The future, yes, and even for the past,
that it will become something we can bear.
And I too, and my children, so I hope,
will recall as not too heavy the tug
of those albatrosses I sadly placed
upon their tender necks. Hope for the past,
yes, old Frost, your words provide that courage,
and it brings strange peace that itself passes
into past, easier to bear because
you said it, rather casually, as snow
went on falling in Vermont years ago.

In the words of the wise Yenifer Ozuna, "Looks like flu is back, Doc!"

We've had several patients as of late abused by this age-old nemesis. One need only peruse the weekly CDC influenza-like illness map (see below) to know we're in trouble.

So what can YOU do to keep from getting the flu?

Here's Dr. P's secret to avoiding respiratory sickness -- SARS for short:

1.) Wash your hands frequently. And don't touch things that don't need to be touched.
2.) Do not touch your face, and heaven forbid you touch the corners of your eyes or pick your nose! That's how people directly inoculate themselves with virus. And don't say you don't pick your nose; we all do (except me).
3.) Choose your exposures carefully and use a mask judiciously. We already weigh other pros/cons -- such as time, money, and opportunity costs -- when deciding whether or not to get together with others. The risk of contracting the flu should factor into those calculations right now.
4.) Eat healthily, get at least 6 hours of sleep, and exercise. I can't promise healthy living will help you avoid the flu, but they will better position you to deal with the flu if you get it...and these practices are good for you, in general.

Not only is Dr. Zeki a gentlewoman, she's also a scholar!

Check out her publication, hot off the press today. Way to go, Dr. Zeki!

Subacute thyroiditis due to COVID-19 vaccine In this report, we present a case of a 90-year-old female who exhibited a sudden onset of confusion and severe generalized weakness after receiving her second dose of mRNA SARS-CoV-19 vaccination 19 days prior to her admission in 2021. Her thyroid-stimulating hormone (TSH) levels were low, while her...

The day has finally arrived!

Today was Dr. Zeki‘s first official day at NBPC. I’m pleased to report that, as of 4:30 pm, the physician still lives!

Yenifer and I couldn’t be more excited to have Dr. Zeki as part of the team, as evidence by the decorations.

What’s with the shiny award that she’s holding, you ask? That’s reserved for Dr. Zeki’s first meet and greet, which is scheduled for this Wednesday. Stay tuned….



Today is the 3rd Anniversary of North Bethesda Primary Care opening its doors!

Thanks to all of our patients for entrusting us with their health and, in doing so, making our practice possible. We love ya!

And to the mystery patient who sent us matching NBPC leather jackets -- leather, as you may know, is the traditional 3rd anniversary gift -- to complement the motorcycles we cruise on into work every day, thank you!

(Just kidding. No one sent us leather jackets. And we don't have motorcycles.... Yet.)

Now THIS is a form of high fructose corn syrup I can endorse.

Happy Thanksgiving, everyone!

Not many people can say that they’ve literally run to the Eastern Shore. I’m proud to say that I can now officially be counted among them! Not only that, but my time was my best so far — per my phone 53 min 36 sec, with about 6 of those seconds spent trying to shut off the location tracker (so really 53 min 30 sec, but who’s counting).

Thanks to Team NBPC for joining me in this endeavor — Natasha, Matt, Carol, Jan, Steve, Gene, and Meg. Unfortunately, Yenifer could not join us as she had a funeral to attend. Yenifer, you were with us in spirit.

Go after your own exercise challenge for your health. It’s not a bridge too far….