Dr. Bretsky’s Super Doctor Award Featured in Los Angeles Times

Back in December, it was announced that Dr. Bretsky was named for a second straight year as one of the Super Doctors of California. This award is given to physicians who have attained a high degree of peer recognition and professional achievement. Selections are made by other physicians who are asked the following question: “If you needed medical care, which doctor would you choose?”

The results have now been published online on www.superdoctors.com and in Super Doctors Magazine, a separate publication distributed with the Los Angeles Times featuring approximately 5% of the top physicians in Southern California. Join us in congratulating Dr. Bretsky on this special achievement.

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Flu Recommendations: 2017-2018 Season

With the flu season approaching, we wanted to let our patients know that we now have flu shots available in our office. The Centers for Disease Control (CDC) has published its recommendations on influenza vaccination for the 2017–18 season, and they continue to recommend vaccination for all people aged 6 months and older with only rare exceptions. People who should either NOT have or should WAIT to have the flu vaccine include:

1. Individuals who have had a severe allergic reaction (e.g., anaphylaxis) after previous dose of RIV or to a vaccine component.

2. Individuals with moderate to severe acute illnesses (with or without fever). However, after resolution of the illness, the flu vaccine can be given.

3. Patients with significant egg allergy (i.e. experience more than just hives) should have the vaccine administered by a clinician with significant experience managing allergic reactions (typically Allergist / Immunologist).

Of interest to our patients older than 65, the CDC states that EITHER standard-dose OR high-dose vaccine is acceptable.

The CDC is again recommending against use of the live attenuated influenza vaccine (FluMist), given...Read more

Cases of Colorectal Cancer Increasing Among Young People

After decades of declining colon and rectal cancer rates, data published last week shows that these diseases have been increasing among young adults. Colon cancer rates have increased 2.4% annually among adults in their 20s and 1.0% among those in their 30s. For rectal cancer, the increase is even more dramatic: 3.2% among those in their 20s. For those born around 1990 the rates of colon cancer are more than two fold greater (2.4 times) than those born around 1950. Rectal cancer is over 4 fold greater (4.3 times) for those born around 1990 as compared to those born around 1950.

So the question, of course, is why the dramatic rise after decades of declining rates?

When I discuss colon and rectal cancer risks with patients, I often refer to two classic epidemiologic studies. The first study was done by Armstrong and Doll in 1975. It compared incidence and mortality rates for 27 cancers in 23 countries and correlated these with a variety of dietary habits and other variables. Dietary variables, particularly meat and animal protein consumption, was strongly associated with cancers of the colon and rectum. Further, these investigators confirmed prior data suggesting...Read more

New Medications to Bring Cholesterol Levels WAY Down.

By Dr. Philip Bretsky

Were you aware that there are two new medications approved to treat high cholesterol levels? Traditionally, patients and physicians have relied on the statin class of medication to lower LDL or “bad” cholesterol levels. The most well known of these is Lipitor (you may have seen the commercials). The newer medications are delivered by injection and are in a class called PCSK9 inhibitors.

The new PCSK9 inhibitors can achieve LDL levels far lower than can be achieved by even the highest intensity statins. Whereas one might expect to lower an LDL to under 100mg/ml or under 70mg/ml with Lipitor, studies show that the PCSK9 inhibitors can achieve LDL levels below 25mg/ml. In one study 9% achieved levels under 15mg/ml!

But we must need some cholesterol in the body, right? It must serve some function and, correctly, some researchers are concerned that very low levels of LDL could adversely affect the production of sex steroid hormones and adrenal hormones which rely on cholesterol.

However, a recent study (http://www.onlinejacc.org/content/69/5/471) analyzed 5,234 patients treated for up to 2 years and examined the occurrence...Read more

Improving the Connection Between Patients and their Physicians

By Dr. Philip Bretsky

I recently read an article that described the importance of having a strong and trustworthy relationship with your physician. For obvious reasons, this connection leads to better medical outcomes because patients feel more comfortable communicating with their doctors about personal and sensitive topics. I believe that there are a number of intangibles that make a connection more likely. Helpful to me has been a wide array of life experiences that has afforded me the ability to meet and interact with a lot of different people with a variety of lifestyles.  Everything from my Dad’s graduate students when I was a kid, to living in India for two years, to working with the homeless in London and doing clinical HIV research in the early 1990s. Each of these experiences helped me form a non-judgmental approach to medicine and a general understanding of life’s difficulties and challenges.

Also, being independent and not working for an institution reduces the external pressure that I have. I am not working to attain any health system’s stated goals or measures of quality. I’m focused on what the patient wants and what is best for...Read more