General - Related

Internal Medicine - Related

Dermatology - Related

How concerned should I be about skin cancer?
I’ve heard that higher strength sunscreens do not add any benefit. Is that true?
What can I do about my acne?
I’ve heard that sun exposure is necessary for healthy Vitamin D levels. Is this true?
How do I tell if a mole is malignant or needs biopsy?
I am losing my hair. What should I do?
How can I tell if I have been bitten by a brown recluse spider?
What is shingles, and what should be done about it?
How can I treat my toenail fungus?
Are tanning beds really dangerous?
How can I treat poison ivy?
Something is biting my skin and causing itching. How can I figure out what it is?
What are the different types of skin cancers?
How are warts best treated?
I used sunscreen but I still got sunburned. How did that happen?
What is psoriasis and how do I know if I have it?
How do I know if a birthmark is dangerous?
I’ve heard that Accutane is dangerous and unsafe. Is this true?
I have scaly itchy skin. What can I do?
My skin is very dry. What can I do?
What can I do about these brown age spots on my hands and face?

General - Related

How can I make an appointment with a specific physician or provider?

Call the office of the provider you desire to see. New patients are welcome at all of our facilities (by appointment only). Our Urgent Care Center sees patients on a walk-in basis. Back to Top


Do I need a referral from my primary doctor to see a specialist or surgeon?

In most instances no. Self-referrals are welcome. However, certain managed-care insurance plans require prior authorization for specialist consultations. Check with your health plan or benefits coordinator to be sure. Back to Top


I am new in town and don't know who I need to see. How can I choose the appropriate physician?

Tell us a little about yourself or your needs. We will direct your inquiry to the appropriate office or physician. If you wish, include your daytime phone number so we might call you directly.

(Unfortunately, due to confidentiality and security reasons we cannot give medical advise or schedule actual appointments via the internet.) Back to Top


Does Physicians East participate with my insurance plan?

Physicians East participates with most all insurance programs in eastern N.C.. Feel free to call our office to check on a specific plan. Your health insurance benefits coordinator can also assist you. Back to Top


How do I reach my physician after hours for an emergency?

If you are experiencing a life-threatening emergency, call 911 immediately. If your concern is urgent or less serious, then call the office number of your physician. A message operator is always available to forward your page to the "on-call" physician.

REMINDER: Requests for prescription refills should be handled during regular office hours only. Back to Top


How much will an office evaluation cost?

Our fees our based on "usual and customary" fees charged by physicians in this region. We also participate with many insurance carriers that negotiate a discounted fee schedule with us. The actual cost of the visit will vary depending on the level of services provided and any other testing that might be performed. Many individuals will only be required to pay a small fixed "co-pay" depending on their insurance benefits.

REMINDERS:
-- Payment of your portion of the charge is expected at the time of service. We do accept MasterCard and Visa as a convenience to our patients.
-- Financial counselors are available at all locations if you anticipate difficulties in meeting your obligations. Back to Top

Internal Medicine - Related

I checked my blood pressure at the drug store but I got different readings each time. How do I know whether I really have high blood pressure?

The right way of checking blood pressure is to do so after resting for 15 minutes and use a calibrated blood pressure cuff. The diagnosis of hypertension can be made if blood pressure is higher than 140/90 more than twice. Exercise, salt intake, mood and some over-the-counter cold medication can contribute to the variations of blood pressure. If you do have elevated blood pressure or not sure if you have accurate measurement, please go to your doctor's office for further confirmation. Back to Top


My doctor told me that I have borderline high cholesterol and need diet and exercise. What exactly should I do?

Here are some starting points: 1. Choose whole-grain products. 2. Eat 5 servings of fruits and vegetables every day. 3. Limit fried food. 4. Choose nonfat or low-fat dairy products and salad dressings. 5. Choose lean meats and limit egg yolks. 6. Exercise 30 minutes a day, 5 days per week. If you have never had regular exercise, start slow and increase the time gradually. Back to Top


When should I start screening for osteoporosis?

The U. S. preventive service task force recommends screening for osteoporosis in women 65 years or older, or postmenopausal women younger than 65 years old with risk factors. Risk factors include: long-term use of steroids, physical inactivity, having a diet low in calcium, having a small body frame, tobacco use, excessive alcohol consumption, and family history of osteoporosis. There is not enough evidence to support screening in men. Back to Top


I have been exercising 30 minutes per day for several months, but still not able to lose weight. What else can I do?

Research shows that exercising for 30 minutes per day only helps adults to maintain the weight. You will need moderate-intensity exercise for 60 minutes per day for 5 days per week to lose weight. Moderate exercise examples are: walking briskly at 3 miles per hour, water aerobics, slow bicycling, doubles tennis, or ballroom dancing. If you don't have a 60-minute period each day, every 10 minutes counts and can be added up. At the same time, you need to watch your diet. Some simple tips include limiting the use of added sugar, decreasing consumption of soft drinks and decreasing portion size. Back to Top


I got a tick bite yesterday, what can I do?

Please recall the size and the color of the tick, estimate approximate hours that the tick was attached, monitor any local redness, swelling or rash. Call your doctor's office as soon as possible. You may need to be examined and may need antibiotics to prevent or treat Lyme disease, based on the findings. Back to Top


I'm not a smoker, but I have had a constant dry cough for the past 6 weeks. What could be the causes?

There are multiple causes for constant cough, such as allergic nasal inflammation, asthma, bronchitis, medication side effects, and acid reflux. But a constant, dry cough is NOT a normal sign, you need to see a doctor. Back to Top


How can I tell whether I have an allergy problem or a sinus infection?

Both problems can have nasal congestion and post-nasal dripping. When you start to have green or yellow thick nasal discharge, sinus pressure and headache worsened by lowering your head, you most likely have developed a sinus infection. Sometimes it can also be associated with fever, facial pain or earache. Your doctor can best determine a treatment to help your symptoms. Back to Top


What is the best over-the-counter arthritis medication? Is Advil better than Tylenol?

If your arthritis has no inflammation, then Tylenol will help the pain, and glucosamine will help the cartilage health. If inflammation is associated with your arthritis, then Motrin, Advil or Aleve will help both the pain and inflammation. However, those two groups of medication have different side effects. If you have a history of liver disease, you need to use Tylenol with caution. If you have a history of gastrointestinal bleeding, kidney disease, heart failure, or pregnancy, please consult your doctor before using Motrin, Aleve or Advil. Back to Top


I have sinus drainage and sinus infections on-and-off all year around, how can I control it?

The first step is to avoid allergens, or factors that can irritate allergies, and avoid viral upper respiratory infections, which is usually very hard to do. The second step is to control the sinus secretion. You can use normal saline spray or over-the-counter antihistamine medication, such as Claritin or Zyrtec. If the secretions still cannot be controlled effectively, ask your doctor about nasal spray with a steroid component, such as Flonase or Nasonex. The third step will be to use antibiotics for persistent infection. If you continue to have recurrent sinus infection multiple times per year, please discuss with your doctor about a referral to an ear, nose and throat specialist. Back to Top


I have a lot of hair loss recently, what can be the causes?

There are different causes of hair loss based on the location and the speed of loss. Usually diffuse and rapid hair loss is related to pregnancy, severe illness, surgery, changing diet and stress. They may resolve spontaneously after a month or two. Diffuse gradual hair loss restricted to the top of scalp may be related to male hormone, which can be treated with over-the-counter Rogaine. Diffuse gradual hair loss all over the scalp can be caused by hormone, mineral and vitamin deficiency, or medication side effect or autoimmune disease. Discrete hair loss with inflammation can be caused by infection or dermatitis. Back to Top


What is the best medication to quit smoking?

Smoking actually is a behavior and habit. It is not a disease. First, understand that smoking increases the risks of many life-threatening diseases, such as cancer, heart attack and stroke. Second, make up your mind to quit smoking. Third, create the environment to help you quit smoking and remain off smoking, including support from family and friends and social connections. A lot of people claim that they smoke because of stress. You will need to find alternative ways to release the stress and replace smoking. Medications, such as nicotine patch, gum, Wellbutrin or CHANTIX only can help, but they are not magical pills. Back to Top


I have acid reflux, but hate to take medication regularly, is there anything else I can do?

Some behavior changes may help the acid reflux. Some examples are: weight loss, elevating your head when sleeping, no food intake two hours before bedtime, and avoiding overeating. If symptoms still persist, it is a good idea to take antacid medication, because recurrent acid reflux may irritate the esophagus and cause damages. Back to Top


I was recently diagnosed diet controlled diabetes. Does that mean that I will be fine if I control my sugar intake?

Diabetes is more than just a “sugar disease.” It is a metabolic disorder where the body can not use sugar efficiently and leads to multiple complications in different systems. That is why your doctor will do more than just control the sugar, such as monitor your blood pressure and cholesterol, examine your eyes and feet, check protein in your urine and consider the use of aspirin. Back to Top


I have already had shingles infection, do I still need a shingles vaccine?

Shingles vaccine is recommended for most people over 60 years old. It is indicated regardless of whether the person has had a prior episode of shingles. People with active shingles should wait until the rash has healed before getting the vaccine. Because this is a live vaccine, several groups of people should not get the vaccine, including people who have had a life-threatening allergic reaction to gelatin or neomycin, people with a weakened immune system from a disease or medication treatment (check with your doctor), or women who are or might be pregnant. Back to Top


I was diagnosed osteoarthritis or “overuse” arthritis. What are the treatment options?

The treatment for osteoarthritis includes two groups: non-medical and medical. Non- medical treatment includes routine exercise (such as walking, swimming and stretching), weight loss, joint protection and muscle strengthening. Medical treatment includes Tylenol or anti- inflammation medication for pain, capsaicin cream for topical use, Glucosamine for cartilage health, and joint injection with steroids. Back to Top


I always have trouble falling asleep, what can I do about it?

First we need to find out if there are medical problems that might affect your sleep, such as anxiety, depression, chronic cough, sleep apnea, etc. If not related to medical issues, then we have three steps. Step one, establish sleep routine and sleep habit. No food intake or exciting activity two hours before going to bed. Trying to go to bed same time of the day and perform similar activities before going to bed. Step two, we can try over-the-counter sleep aids such as Unisom or melatonin. Step 3, discuss with your doctor about prescription sleep medication. Back to Top


My friend’s doctor gave her pneumonia shot booster, but my doctor said I don't need that. Why are there different recommendations?

Pneumonia vaccine is recommended for everyone after 65 years old. People with weakened immune system need the vaccine even before 65 years old. Then they will need a one time booster 5 years after the primary shot. Examples of weakened immune system include chronic lung disease, chronic cardiovascular disease, diabetes, chronic liver disease, chronic alcoholism and chronic renal failure. Other people who get the vaccination routinely after 65 don't need the second shot. Back to Top


My doctor said my cholesterol is too high and need medication. I heard all the cholesterol medications cause muscle ache. What should I do?

There are several groups of cholesterol medication. One of the groups is called Statin and the most common side effect is muscle ache. There are several medications in this group, including Crestor, Lipitor, Zocor, Pravachol or lovastatin. If you have muscle aches with one type of Statin, you may not have muscle aches with another. If you do have muscle aches with all the Statin medication, there are several other groups of medications that can treat high cholesterol, such as Zetia, niacin , Questran and Welchol. The side effect of muscle ache in those groups is less frequent. See your doctor to determine which course is best for you. Back to Top


I sometimes have a urine leakage and feel embarrassed about wearing an adult diaper.

First we need to check your urine and treat any possible urinary tract infection. Second your doctor may want to check your bladder and make sure there is no obstruction to cause what we cal “overflow leakage”. If you have urine leakage when coughing, laughing or strengthening, you may have a weakened pelvic floor muscle. Then muscle-strengthening exercise such as Kegel exercise should help. If you always feel the urge to go to the bathroom, but cannot get there in time, you may have overactive bladder. Kegel exercise and medical treatment both help but your doctor can best help with your care. Back to Top


I am 72 years old and my doctor always says “because of your age, I will start you with a lower dose of medication. Is there any scientific evidence behind this?

Yes, there is actually scientific evidence to support the adjusted dose for patient older than 65 years old, because the metabolism changes with aging in several ways. 1. The absorption of the medication will be different. 2. The drug distribution in the body will be different due to the changes of fat and water ratio and the concentration of protein. 3. The clearance of the medication from the liver and the kidney would be decreased with aging. 4. Some medication receptors become more sensitive with aging, which leads to increase risk of toxicity. Back to Top


My mother lives alone and she has several falls recently. What can I do to prevent it?

Please bring her to the doctor's office for detailed history and physical exam. We need to find out if she has infection, dehydration, anemia, low blood pressure, irregular heartbeat or mini strokes that make her weak and dizzy. We also need to review her medication list to see if the side effects of medications cause her falls. It would be a good idea to check her vision and hearing too. If everything was normal, it may be a good idea to have occupational health to check the living environment such as lighting, stairways, bathroom, tripping hazards and have physical therapy for gait training. Back to Top

Dermatology - Related

How concerned should I be about skin cancer?

One in five Americans have skin cancer in their lifetime. All occurrences should be appropriately removed. Some, like melanoma, are very high risk to overall health. Fair skin, sun exposure, and especially commercial tanning, increase risk. Regular self-exams, as well as regular skin cancer screenings by a dermatologist, are highly recommended. A personal or family history of skin cancer makes this even more important. Although it does involve a total body examination, the actual exam is quick and simple. Back to Top


I’ve heard that higher strength sunscreens do not add any benefit. Is that true?

The measured SPF (Sun Protection Factor) measures degree of sunburn after sun exposure, and is a very general measurement of sun protection. It is not correct to say that lower SPF sunscreens are just as good as higher ones. In general, in terms of skin cancer prevention, the higher the better. The most important message is that ALL sunscreens work better when applied to the skin than when left in the medicine cabinet. Back to Top


What can I do about my acne?

Acne is predominantly a teenage issue, though it can occur at nearly all ages. There is certainly a hormonal component to it, but it is primarily a condition involving the blockage of oil glands and ducts. Therapy is aimed at both correcting this blockage and at decreasing specific skin bacteria that contribute to the inflammation. An over-the-counter program, can be helpful including, regular, but not excessive, washing. Improving appearance and preventing scarring are both very important. Your dermatologist is your best source. Back to Top


I’ve heard that sun exposure is necessary for healthy Vitamin D levels. Is this true?

Yes and no. The amount of sun exposure that most of us get is more than enough to convert vitamin D in the skin. There is considerable current study regarding Vitamin D levels and what should be considered normal. Though it is also not clear what impact low Vitamin D levels may have, adequate supplementation may be valuable in cancer prevention as well as preventing osteoporosis. This should be discussed with your primary care provider or dermatologist, but DO NOT consider unprotected sun exposure to be the answer. The other harmful effects of this far outweigh the benefits. Back to Top


How do I tell if a mole is malignant or needs biopsy?

The basic reminder is ABCDE. A – asymmetry; B- border irregularity; C- color variations (especially red, white and blue); D- diameter, larger than 5-6 cm; and E- evolution or change. Not all pigmented spots are moles, however, and you should see your dermatologist regularly for examination. Back to Top


I am losing my hair. What should I do?

There are many causes of hair loss, including genetic predisposition, medications, hair grooming techniques, endocrine disorders, and immune system abnormalities. Sometimes simple clinical history and examination will give the answer, while in other cases blood tests or scalp biopsies may be helpful. Your dermatologist is the expert in this and should be consulted early for concerns. Back to Top


How can I tell if I have been bitten by a brown recluse spider?

Recluse bites are usually painless at the time of the bite. Redness and swelling generally occur 2 to 6 hours later, and may be associated with symptoms that include fever, headache, muscle aches, nausea, vomiting, diarrhea, and sweating. Treatment of the area with ice and elevation is usually helpful, and some medications that your dermatologist or primary care provider can prescribe may also be beneficial. Back to Top


What is shingles, and what should be done about it?

Shingles is an acute, blistering, and usually painful skin eruption. It is caused by the same virus that causes chickenpox and is an internally acquired re-infection that is believed to occur only in persons who have previously had chickenpox. If you have shingles, you can give chickenpox to any susceptible individual. Infants, pregnant women, or immune suppressed individuals should particularly be avoided. You should be treated early with oral antiviral medication once shingles is confirmed. A vaccine is available and recommended for those sixty and older. Your dermatologist is best for confirming the diagnosis and for management. Back to Top


How can I treat my toenail fungus?

First, the diagnosis should be confirmed by your dermatologist, as other things can mimic fungal infection, such as psoriasis. Microscopic exam and fungal cultures are used. Treatment is generally challenging. Oral medications have significant side effect risks and are not uniformly successful. Topical treatments can be very helpful but require disciplined use and gradual cleansing/removal of affected areas. See your dermatologist as the appropriate expert. Back to Top


Are tanning beds really dangerous?

YES! The American Academy of Dermatology is strongly against the use of tanning beds. The results include prematurely aged skin (wrinkles) and increased skin cancer risk. This is well documented, and dermatologists have called for more regulation and posted warnings such as those on cigarette labels. This is especially important as it relates to life-threatening skin cancers, that is, melanoma. There have been significant improvements in self-tanning products and sprays that can mimic suntan. These are safe. A very small number of skin conditions benefit from ultraviolet therapy, but this should always be under the supervision of your dermatologist. Back to Top


How can I treat poison ivy?

The first important step is making sure that the diagnosis of poison ivy is correct. This is usually a straightforward clinical diagnosis…known exposure to the plant, and typical distribution, are helpful. After exposure, any clothing, gloves, tools, etc., that may have the poison ivy protein present on them should be thoroughly washed or discarded. Thorough washing of the skin, especially immediately after exposure, is helpful. If eruptions do occur, over-the-counter hydrocortisone and calamine lotions may be helpful. See your dermatologist early for more severe cases and stronger prescription treatments. Back to Top


Something is biting my skin and causing itching. How can I figure out what it is?

In Eastern North Carolina, there are a variety of critters that attack humans. They include fleas, mites, lice, mosquitoes, ants, and unfortunately, bedbugs. Scabies mites and bedbugs can be very difficult to find and successfully identify. Both can be challenging to eradicate once correctly identified, usually under the microscope. Bedbugs are on the rise in the US, and it is a good idea to check some of the several “bedbug alert” websites before choosing a hotel. Back to Top


What are the different types of skin cancers?

The three most common are basal cell carcinoma, squamous cell carcinoma, and melanoma. Basal cell cancer is the least dangerous, but will continue to grow and destroy structures around them. They almost never metastasize, that is jump elsewhere in the body. Squamous cell cancers are slightly more aggressive and have a slightly higher metastatic potential. Melanomas are much more dangerous, and take many more lives annually. They are usually, but not always, dark brown to black in color. All cancers need to be diagnosed early, by your dermatologist, and removed completely and appropriately. Back to Top


How are warts best treated?

All warts are caused by viruses and have a variety of forms. Common warts can occur anywhere, but are most often on hands and feet. They can be managed with over-the-counter commercial products, like Compound W or acid plasters, but frequently your best option for more rapid resolution is to see your dermatologist. The drug store freezing products may also be effective, but are not nearly as cold or effective as what we would use in the clinic. It is, of course, also important that the diagnosis of wart be correct. Other chemical treatment options are also available. Your dermatologist can help. Back to Top


I used sunscreen but I still got sunburned. How did that happen?

Three common problems with sunscreen use are: 1. Not using enough product; 2. Not using it often enough; 3. The product is washed off either by perspiration or water exposure. The sun protection factor (SPF) rating is simply a direct multiple of how many minutes of sun exposure would cause a sunburn. For instance, one minute of unprotected exposure is approximately 15 minutes of exposure and using appropriate application of SPF 15 sunscreen. Consider about 1½ ounces of sunscreen to be sufficient for a full application and use every 1-2 hours during sun exposure. Also supplement with hats, sunshades, and protective clothing. Back to Top


What is psoriasis and how do I know if I have it?

Psoriasis is an inflammatory, itching, scaling condition that typically involves elbows, knees and scalp, but can be much more generalized. Fingernails and toenails may be affected, and in about 5% of patients, the joints as well. It tends to run in families – one affected parent increases the likelihood of having psoriasis significantly, and having both parents affected, much more. It can be managed with a variety of creams and ointments, as well as systemic medications. The diagnosis and treatment is best handled by your dermatologist. Back to Top


How do I know if a birthmark is dangerous?

There are many varieties of birthmarks. Many, such as small red blood vessel marks are completely safe, and many disappear early in life. Others that are pigmented may either require biopsy or removal or they may be markers of some other internal problems that should be evaluated further. Your pediatrician should be competent to screen most of these, but referral to a dermatologist may be appropriate. Do not hesitate to ask. Back to Top


I’ve heard that Accutane is dangerous and unsafe. Is this true?

13-cis-retinoic acid, originally marketed as Accutane, has been a highly effective and useful treatment for severe inflammatory and cystic acne. In many young adults, it has been extremely beneficial. Its use comes with many known risks. The most common and dangerous are birth defects if a woman becomes pregnant while using this medicine. Common side effects (dry skin, cracked lips, nosebleeds, eye irritation, and sun sensitivity) can be managed and are “normal” side effects. If you have severe acne, and more traditional treatments have proven unsatisfactory, talk to your dermatologist. Back to Top


I have scaly itchy skin. What can I do?

Many skin conditions can appear to be dry, scaly and itchy, so treatments will vary with diagnosis. Conditions like fungal infections, seborrheic dermatitis, allergic contact dermatitis, and eczemas can all appear somewhat similar, but their cause and their treatments may be very different. It is best to see a dermatologist, first to confirm the diagnosis based on pattern, distribution, and appearance, and then to receive appropriate treatment recommendations. Back to Top


My skin is very dry. What can I do?

Using a good moisturizing cleanser like Dove, Olay, or other products will likely be a good start. In general, antibacterial and deodorants soaps will tend to be irritating to otherwise sensitive skin. After bathing with lukewarm water (not excessively hot or cold), the appropriate application of emollients (moisturizing creams or lotions) is also recommended. Depending on your age, skin type, and any underlying reasons for the dry skin, the best moisturizers as well as additional treatments are best recommended by your dermatologist. Back to Top


What can I do about these brown age spots on my hands and face?

In terms of preventing further darkening and accentuation of these, sunscreens and sun avoidance are key. Often called liver spots, these flat even colored tan patches do not generally represent any health or skin cancer risk. A number of techniques may be used to lighten or remove these including freezing, lasers and some chemical peels. Most insurers will not likely be willing to pay the expense for this. There are potentially dangerous growths that can look very similar, so consulting a dermatologist is essential. Back to Top