Exciting Changes at Santa Monica Primary Care

If you’ve been to Santa Monica Primary Care lately, you may have noticed some of the exciting changes that have occurred over the last several months. First, you will see that our office is now shared with a great group of our colleagues – with specialties including Obstetrics, Gynecology, Urology and General Surgery. After such an extended period of quiet due to the COVID-19 pandemic, it is nice to have a busy and bustling office again. You will see that our mitigation efforts including spaced appointments, adequate airflow, HEPA filters, masking and 100% staff vaccination compliance remain in effect.

Secondly, Santa Monica Primary Care as you know it is significantly smaller than it was in 2019. We have moved to a physician led practice with physician assistants exclusively in a support role. That means that you will be seeing Dr. Bretsky for in office visits – both periodic preventive examinations and sick visits. As always, we have physician coverage 24 hours a day, 7 days a week 365 days a year.

COVID-19 Update

Last week the FDA authorized the Pfizer vaccine for children aged 5-11 years and it will now move forward to the CDC’s Advisory Committee on Immunization Practices (ACIP) for full recommendation.  The vaccine itself is a series of two shots, spaced three weeks apart with a 10 microgram dose (one third of the adult 30 microgram dose). Although there is not direct applicability to the adult patients of Santa Monica Primary Care, there will undoubtedly be a sigh of relief among parents, grandparents, great grandparents and other relatives of children in this age group.  Some key points from the FDA meeting:

  • Effectiveness: Immune responses of children 5 through 11 years of age were comparable to those of individuals 16 through 25 years of age. In addition, the vaccine was found to be 90.7% effective in preventing COVID-19 in children 5 through 11.
  • Safety: The vaccine’s safety was studied in approximately 3,100 children age 5 through 11 who received the vaccine and no serious side effects have been detected in the ongoing study.

Follow our Twitter, Facebook, Instagram for timely updates.  A timeline summary of our COVID-19 response to date can be found at www.drbretsky.com/covid19

Dr. Bretsky Awarded “Super Doctor” for the 5th Year in a Row

For yet another year, Dr. Bretsky has been recognized as a Super Doctor (www.superdoctors.com). He was first recognized in 2017 and has been selected in every consecutive year since that time.   

The selection process for Super Doctors is a rigorous multi-step process designed to identify physicians who have attained a high degree of peer recognition and professional achievement. Selections are made by independent research and other physicians who are asked the following question: “If you needed medical care, which doctor would you choose?”

Candidates are evaluated on 10 indicators of peer recognition and professional achievement.

  • Years of experience
  • Hospital appointments
  • Fellowships
  • Professional activities
  • Leadership positions
  • Academic achievements/positions
  • Board certifications
  • Publications, lectures & presentations
  • Honors and awards
  • Other outstanding achievement

Dr. Bretsky’s page:  https://www.superdoctors.com/california-los-angeles/doctor/Philip-Michael-Bretsky/aebdc62d-b4f3-4dc3-a98a-237a87e55e8b.html

New Medications to Bring Cholesterol Levels WAY Down.

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 of adverse events. There was no increase in a wide variety of conditions including neurologic, memory, kidney, liver or diabetes. However, the authors did see (pun intended) an increase in cataracts among those patients with LDL levels below 25mg/ml.
So is there such a thing as ‘too low’ cholesterol? Other than the risk of cataracts, so far there does not seem to be a downside.

New Medications to Bring Cholesterol Levels WAY Down.

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 of adverse events. There was no increase in a wide variety of conditions including neurologic, memory, kidney, liver or diabetes. However, the authors did see (pun intended) an increase in cataracts among those patients with LDL levels below 25mg/ml.
So is there such a thing as ‘too low’ cholesterol? Other than the risk of cataracts, so far there does not seem to be a downside.

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. – See more at: http://www.santamonicaprimarycare.com/blog/#sthash.11HBb8yb.dpuf
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 a protective effect of fiber consumption.