Family and Primary Care Medicine

Fratellone Medical Associates is a full service medical practice integrating both conventional and alternative therapies for adults and children.

Safety is a major concern in any treatment for disease. Nutritional supplements should be used with discretion and under the guidance of a health care professional. Unfortunately, patients view that if a supplement at 500mg is good, then 1000mg will be better. This is almost never the case. Some medical conditions require the use of both conventional and alternative therapies, and even some of these treatments may require intravenous supplementation as well as oral supplementation.

These are some of the diseases we provide treatment in our medical center in New York City

Acne

Acne is a disorder of the skin that causes the pores to clog and produce pimples, also known as whiteheads and blackheads most often on the chest. Sometimes in extreme cases acne can spread to the upper neck, back chest and shoulders. It is usually a problem in adolescence, but can be seen in adulthood for other reasons.

Causes:

• Heredity
• Stress
• Seasonal changes
• Diet
• Food allergies
• Cosmetic sensitivity
• Sun Exposure

Treatment:

• Find the underlying causes especially if food/environmental allergies
• Vitamin A and its precursors

- Reduce the production of pore clogging sebum
- Doses range from 10,000 – 25,000 IU
• Vitamin E

-Allows Vitamin A to be utilized more effectively
• Zinc

- Studies have shown that increased amounts of this trace mineral
• Vitamin B 6

- Especially for women during flare ups before or during menstrual cycle
• Omega Oils ( EFA)

- Studies have been done on all oils, but there is more research on Evening Primrose Oil (EPO), and Borage Oil

Back Pain

Back pain is the second most common ailment presenting to a doctor's office next to the common cold. It also accounts for the increased disability cases as well as sick days for employees. One must remember the spine is a finely tuned instrument that needs its “band pieces” to work in synchrony with the whole orchestra. The band pieces include the ligaments, muscles and bone.

The first step after the physical examination is to have the patient undergo various testing which include common x-rays as well as either CT or MRI. These tests are needed to further delineate bone structure, fractures, ligament tears, herniated discs and even osteoporosis.

Treatment: This depends on the type of injury , We do know that bed rest is essential. You body will be in tune when it is time to move. While lying in bed there are three simple exercises that can be done.

• Bent knee sit-ups-while in bed lie on your back with your knees bent. Extend your arms towards your knees, and do a sit – up . You do not need to actually sit up. Just lift both your shoulders and head off the bed.



• 2. Pelvic tilt- I have always found this difficult to do, but once I had the maneuver it truly helped my back pain. Lie on the bed or floor and tilt your pelvis so that the small of your back ( the curvature area) is flattened to the floor. Press your back down while counting to twelve



• 3. Wall press- this requires that you get out of bed, if able. Stand about 10 -1 2 inches from a wall. Bending your knees, let your back rest against the wall. Press the small part of your back into the wall, feeling the stretch in both the back and in the anterior ( front part) of your thighs. Hold for a count of twelve.

1. Supplements

• Vitamin C - either as powder or intravenous
• Vitamin E - 400 IU daily
• MSM either as capsule, topical gel and powder.
               -The dose should be a minimum of 3 grams,
                 although individuals can increase to 12 grams/day
                 in divided doses.
• Proteolytic enzymes – as Wobenzyme
• Ginger and tumeric
              -Anti inflammatory herbs
• White willow bark
              -The active ingredient in aspirin
  

2. Laser Therapy and Biomodulation

3. Prolotherapy

4. Chiropractor

5. Physical therapy

6. Acupuncture

7. Massage

Canker sores

Canker sores, also known as the common mouth ulcers, usually viral in origin
These sores can be solitary or in clusters and appear as small round ulcers with raised red borders. The cause is unknown, but thought to be a malfunction in the immune system of some level.

Causes

• Stress
• Vitamin deficiencies
• Food allergies
• Heavy metal intoxication
  
  

Treatment

• Zinc- Used topically as ointment, or as zinc lozenges
• Genitan violet- Used traditionally as the initial treatment. Effective although can stain both the teeth, gums and your clothes
• Probitocs- The “good bacteria” Can be taken as capsule or as powder. Make sure your probiotcs contains all species, and not only limited to Lactobacillus
• B vitamins – especially Vitamin B6, B 12 and folic acid
• DGL- Deglycyrrhizinated licorice which stimulates the production of mucous to coat and protect the gastrointestinal tract
• Aloe vera gel- Used for burns; but a very effective herbal antibiotic
  
  

Common Cold

A cold is caused by a virus, usually the rhino or adeno virus Some of the symptoms of the common cold include  stuffy nose, sneezing, dry sore throat, fatigue and even some temperature.

Causes:

• stress emotional or physical

       -reduces immune system
• lack of proper nutrition

       -increase in refined carbohydrates
• increase alcohol intake
• increase caffeine intake

• the usual trip to the doctor for an antibiotic is not the answer

-the visit might include a throat culture or complete blood count (CBC)
• first strengthen immune system

-discuss stressful factors- work, home, etc
-proper diet
-proper amounts of sleep
-supplements to boost immune system including herbal antibiotics
• increase intake of fluids
• do not exercise when have the common cold. Missing one or two days at the gym is the best choice
• gargle with salt water with fresh squeezed lemon juice

Supplements

• Echinacea
• Goldenseal
• Aloe vera
• Yarrow
• Ginger
• Grapeseed extract
• Garlic

-Vitamins

• Vitamin C
• Zinc lozenges
• Vitamin A
• Essential Oils

Conjunctivitis - also known as “ pink eye “ Signs and symptoms: eye becomes pink, feels itchy and gritty, and crusted eyelids caused by discharge. The true definition is the inflammation of the conjunctiva of the eye. If this occurs routinely this is allergic conjunctivitis.

Treatment:

• first differentiate between allergic and viral conjunctivitis
• keep eye clean, wash hands and wash discharge away

- warm water solution – one quart of warm water with boric acid ( 1 teaspoon)
• do not share washcloths and towels
• change bed linens, towels and your pillowcase
• prescribed antibiotic ophthalmic (eye) drops if necessary

Heartburn

Countless people suffer from digestive disorders which can result in nausea, bloating, diarrhea, heartburn, constipation, coated tongue , belching, foul breath, a bad taste in the mouth and even palpitations and shortness of breath.

Heartburn is burning in the chest. This can either come from cardiac systems or gastrointestinal. It is vital that if you experience heartburn you must call 911 and go to your nearest emergency room. Heartburn can be the first sign or symptom of impending heart problems.

If you know that you are experiencing heartburn—you might have had it after a heavy meal which is normal for you. Perhaps there is too much hydrochloric acid in your stomach or even not enough digestive enzymes in your system.
This type of heartburn can be caused by heavy meals, coffee, medications, spicy food and even alcohol.

Heartburn can lead to esophagitis (inflammation of the esophagus), gastric ulcers and even infections like Helicobacter pylori.

Treatment:

1. Find the cause
2. Check laboratory data as liver function tests, amylase, and lipase
3. Check out food allergies or sensitivities
4. Helicobacter antibodies
5. Candida antibodies
6. Refer to gastroenterologist if needed for endoscopy

Herbal Treatments:

1. Fennel ( Foeniculum vulgare )
a. fennel has been used as a culinary spice for centuries
b. it imparts a smoothing effect to the mucous membranes
c. especially used for excessive belching and flatulence

2. Rosemary ( Rosmarinus officinalis )
a. another herb used as a culinary spice
b. it belongs to the mint family
c. the young leaves, tops and flowers are prepared as a tea for treating stomach disorders and nervousness


3. Okra ( Hibiscus esculentis )
a. due to its mucilaginous and bland nature it is used as a demulcent food
b. demulcent is defined as its coating-like properties
c. relives irritation of the mucous membranes
d. especially used for gastric ulcers

4. Olive ( Olea europaea)
a. easily digested and a smoothing and healing effect of the digestive tract
b. it reduces stomach acids and will not increase your cholesterol levels

5. Slippery Elm ( Ulmus fulva )
a. the inner bark traditionally used as a food and medicine by American Indians
b. one of nature’s best demulcents
c. absorbs toxic substances
d. allows for better food assimilation and elimination
e. sometimes used with wild flower honey

6. Mastica ( mastic gum)
a. harvested from the sap of a tree in Greece, this herb is first line therapy for treating Helicobacter pylori
b. it is generally taken twice a day with 2 tablets in the morning and 4 tablets before bedtime
c. usually advocate taking for a 6 – 8 week treatment course


Impotence

Over the years, men in my practice have identified three basic problems – prostate disease, lack of sexual desire and impotence. As men get older we have little or less interest in sex with our partner. This lack of desire may be linked to stress, medications, and depression. There are even psychological problems that can trigger impotence. Men realize that they cannot perform as they did two years prior. This lack of confidence is paralyzed by anxiety to even try. Perhaps their partner has issues of his/her own. Counseling and reassurance can often help.

The definition of impotence is simply a permanent or temporary inability to have or maintain a sufficiently rigid erection to achieve intercourse.

Contributing Factors:

1. Alcohol intake
2. Medications especially anti depressants and cardiovascular medications
3. Low hormonal levels as testosterone and DHEA
4. Cigarette smoking
5. Penile atherosclerosis
6. Previous prostate surgery
7. Depression

Treatment:

Herbal “Viagra”

Most herbal aphrodisiacs are quite safe but you must take the correct amount. Always start with the recommended amount after careful research and see how you respond. You must always remember to eat a good balanced diet with limitations of the refined carbohydrates, manage your stress, drink plenty of water and love your partner as long as you both continue to lust for one another.

At Fratellone Medical Associates we recommend “herbal” treatments before prescribing medications.. Some of these herbal remedies are:

1. Ashwagandha ( Withania somnifera )
     a. This herb has been used for thousands of years as an aphrodisiac
     b. “ sweat of the horse” is the literal translation
     c. Used as an energy tonic, strengthening the body and enhancing libido
2. Damiana ( Turneta diffusa ssp. )
     a. Calms anxiety and induces restful state of mind
     b. It is sometimes referred to as the superlative sexual tonic
     c. Not easily available
3. Gingseng ( Panax gingseng , American gingseng )
     a. Promotes energy, stamina and endurance
     b. The active component, ginsenosides affect hormonal balance
     c. Enhances circulation by increasing nitric acid. Nitric oxides allows blood vessels to relax and enhances blood flow
     to the sexual organs ( the penis)
     Nitric oxide is the reason why conventional medications like viagra, levitra and cialis are used
4. Gokshura ( Truibulus terrestris )
    a. In reality , this herb is an Ayurvedic herb
    b. Used to support proper function of the genitourinary tract and prostate
    c. Enhances prolonged endurance during intercourse before ejaculation
    d. Enhances pleasure and satisfaction in a sexual experience
5. Maca ( Lepidium meyenii)
    a. Optimizes erectile dysfunction
    b. Increases quality of semen and sperm motility
6. Muira puama ( Ptychopetalum olacoides )
    a. Sometimes known as “ potency wood” –used in Brazil
    b. Nervous tonic enhancing sexual libido and increases circulation- having a positive effect of the erectile tissue

Other treatments include

1. Testosterone – individually compounded in a cream form depending on your blood level. Blood levels must be checked regularly as testosterone can have a negative impact on the prostate

2. DHEA – this hormonal precursor can enhance energy and increase the production of testosterone. Blood levels must also be checked regularly as DHEA can have a negative impact on the prostate

3. L-arginine – this amino acid when taken increases the production of nitric acid similar to the conventional drugs as viagra. This amino acid must be taken in large amounts to exert its effect. Normal doses are 3 – 9 grams /day. Blood levels of CRP ( C-reactive protein) must be taken regularly

4. Zinc – this trace mineral is crucial to the production of testosterone. I suggest 50mg of zinc daily.

Migraines

If you are an individual that suffers from migraines, you know how debilitating this type of headache can be. A migraine must be differentiated from cluster or tension headaches. There are many neurologists who exclusively treat migraines. However, once the migraine starts, you often have to rely on a conventional drug medication.

If you experience any three of the following, you are more likely to have a migraine rather than a cluster or tension headache:

1. History of migraines in the family
2. Only affects one side of the head
3. Usually more than one attack
4. Experience an “aura” - flashing light, blind sports and even irritability before the onset
5. Stomach distress as nausea and vomiting


The important fact is that not all migraine sufferers have different causes. Not all migraines are alike, they are individualized. One migraine suffer may have an aura while others may not.

Causes of Migraines:

1. Food allergies or food sensitivities

a. foods that contain ‘amines’ which dilate the blood vessels thus causing rebound vasodilation may precipitate an
    attack Some of the food include
           i. bananas
           ii. cabbage
           iii. eggplant
           iv. pineapple
           v. tomatos
           vi. cheese
           vii. wine
           viii. aged meat
           ix. yeast extracts

b. MSG and nitrates can precipitate an attack
c. Artificial sweeteners as Aspartame, Saccharin can precipitate attacks

2. Alcohol , especially red wine can precipitate an attack
3. Menstrual cycles
4. Stress and anxiety
a. Promotes release of hormones and neurotransmitters
5. Change in daily routine
a. Sometimes precipitated by the holidays
b. Change in work schedule
6. Change in climate
7. Heavy metal intoxication especially mercury
8. Caffeine

Treatments:

1. Herbal treatment
a. Feverfew ( Tanacetum parthenium/ Chryanthemum partthenium)
    i. Effective treatment and prophylactic for migraines
    ii. Double blind studies have proved its efficacy
    iii. Active ingredient is parthenolide. This is a spasmodic that makes smooth muscle in the walls of the brain
        ( cerebral) circulation less reactive to vasoconstrictors
    iv. For prevention: standardized feverfew extract (.25 umg daily)
    v. For acute attacks: 1 – 2 grams parthenolide daily
    vi. Side effects: gastrointestinal discomfort
    vii. Should be reserved for those who are not responders to conventional treatment

2. Chelation
    i. Chelate the toxic metal as mercury after a provocative challenge with either DMSA, DMPS or EDTA

3. Food allergy panel ( IgG)
    i. avoidance or elimination once test is performed
    ii. desensitize with sublingual immunotherapy


Our approach at Fratellone medical treatment center is to provide our patients for extensive ongoing conventional medical care, while providing the most effective integration with alternative treatments.