​Dear Concierge Members:
 
I trust this email finds you in good health and spirits ahead of the Thanksgiving holiday. As your dedicated healthcare provider, I wanted to take a moment to express my sincerest gratitude for the privilege of being a part of your wellness journey.
 
Throughout our interactions, whether for routine check-ups or times when you've sought my guidance, I have been continually impressed by your commitment to your health and honored by the trust you have placed in me. Your dedication to making positive changes has not only reflected on your own well-being, but has also inspired me in my profession.
 
It's patients like you who remind me why I chose to be a physician—to make a positive impact on lives, to provide care, and to be a source of support. Your openness in sharing your concerns and your active participation in healthcare decisions have truly made our doctor/patient relationship a remarkable one.
 
Please remember that your health and well-being remain my top priority. If you ever have questions, need guidance, or simply want to discuss an aspect of your health, please don't hesitate to reach out. I am here to provide you with the best service possible.
 
As we continue this journey together, I am excited to witness your progress and support you in achieving your health goals. Thank you once again for allowing me to be a part of your healthcare team.
 
Wishing you a Happy Thanksgiving.
 
Warm regards,
 
Dr. Gina Brar

​This month I would like to address a topic we may not always discuss: oral health and its relationship to systemic health. It has been 40 years since a relationship was observed between atherosclerosis and alveolar bone loss (in the tooth sockets). At the time, little was known about the nature of the relationship, but now this is an area of increasing interest among researchers and clinicians. Let’s take a closer look.
 
Systemic conditions associated with poor oral health include diabetes, cardiovascular disease, bacteremia/endocarditis, pneumonia, gastritis, rheumatic arthritis, cancer, liver and kidney disease and dementia. A person with poor oral health may exhibit tooth loss, gingivitis (swollen bleeding gums), halitosis (bad breath) and periodontitis (bone loss in the tooth socket). Beyond a lack of oral hygiene, culprits contributing to poor oral health include genetic factors, xerostomia (dry mouth), bruxism (jaw clenching), diet (excessive sugar consumption), gut dysbiosis and smoking.
 
What is the mechanism by which the relationship between oral hygiene and systemic health exists?
 
In general, inflammation that is allowed to fester (advances from acute to chronic) doesn’t remain contained, regardless of where it occurs. Meaning the oral inflammatory mediators and pathogenic bacteria can translocate systemically via the damaged periodontium to damage other organs and systems.
 
In addition, the same inflammatory burden and bacteria may be absorbed extra-orally via inhalation or ingestion. This is the case when bacteria associated with gingivitis or periodontitis is aspirated leading to pneumonia, a common nosocomial infection. If ingested, it may lead to endocarditis or gastritis. In some cases, specific oral bacteria have been linked to specific diseases, such as atherosclerosis. With diabetes, a bi-directional relationship exists. Periodontal disease is a complication of poorly managed blood sugar and acute inflammation (such as that in gingivitis and periodontitis) reduces the uptake of glucose and reduces the efficiency of insulin. Thus, diabetes can cause periodontal disease and periodontal disease can exacerbate diabetes.
 
A final consideration is the relationship between the gut microbiome (GMB) and overall health. Dysbiosis in the GMB is a culprit in numerous conditions and disease states, because the digestive system initiates with the oral cavity.
 
There is much we are still learning about the relationship between oral health and systemic conditions/diseases. We do know that maintaining oral health includes:
 

• Daily brushing and flossing. A soft brush is your go-to on this one. A hard toothbrush is not a friend to your gums and enamel. Add a water pick if you have the counterspace for it.
• Tongue scraping
• Replacing your toothbrush every three months or if you have been sick
• Visiting your dental hygienist at least twice a year, more often if indicated or recommended
• Replacing missing teeth or broken filings
• Addressing bruxism either with a mouthguard created by your dentist or by injecting Botox into the masseter muscles
• Identifying xerostomia, which is a common side effect of many medications
• Quitting smoking if you are a smoker

 
It has been said that the oral cavity is the mirror reflection to one’s overall health. If you have concerns, please schedule a visit with me for a discussion. I am happy to collaborate with you and your dental team to shine that mirror.
 
 

Preparing for Travel
 
After a few years of a very uncertain travel market and amid subsequent changes to the industry, many of us are resuming regular travel and taking much needed vacations. But before you hit the roads and skies for travel, be sure to prepare yourself and pack your bags for medical scenarios.
 
Importantly, make sure to refill all your prescriptions ahead of your trip at least one week in advance of your departure and always bring at least a few extra days’ worth of medication with you. With the state of the travel industry, there is a high probability of your return not going quite as planned. You should always pack your medications in your carry-on—not in your checked suitcase—just in case your luggage is lost.
 
The Pack Smart Guide from the CDC offers a checklist to help you prepare for a healthy trip, including prescriptions, medical supplies, over-the-counter medicines, supplies to prevent illness or injury, first-aid kits and important documents. Many items in this list would be especially helpful if you are heading off the grid or traveling to an exotic location where medical supplies are not conveniently available at a local drugstore.
 
Also, keep in mind, I do not offer travel vaccines and would need to refer you to a travel health specialist, so, please plan ahead. The CDC offers a complete list of destinations with travel health notices, recommended vaccines and precautions to consider for your specific destination.
 
Finally, make sure to enter my concierge contact details into your phone—including my cell number and email—and remember to pack your membership card so that you can reach me with any medical concerns during your trip. I can potentially offer a telemedicine visit, call in a prescription or, based on your destination, help to arrange a visit with a local Concierge Choice Physicians provider if needed.
 
As always, feel free to reach me with any questions. Safe travels!

​End-of-life care planning is important while we’re still healthy, and the pandemic has made it clear that illness and disability are not reserved for the elderly. Do your loved ones know your thoughts and wishes should a situation arise? According to the National Institute on Aging, 1 in 3 people guessed incorrectly when asked how their loved one would want their end-of-life care handled. It can be an uncomfortable subject to discuss and, in some families, maybe even a taboo subject. However, advance care planning empowers our loved ones when it comes time to handle our end-of-life care and decisions and helps make sure that our preferences and arrangements are known and honored.
 
One primary aspect of advance care planning includes legally designating a person to make healthcare decisions for you if you are unable to communicate these decisions yourself. This designated person is known as a healthcare proxy (or durable power of attorney healthcare agent, surrogate, representative, attorney-in-fact, or patient advocate). A healthcare proxy decides the types of medical care, procedures, treatments, or services you receive, as well as who provides that care and where. If not otherwise predetermined in advance care directives, they may also make decisions about autopsy, tissue and organ donation, and what happens to your body after death.
 
The American Bar Association has a helpful guide for selecting a healthcare proxy.
 
Your appointed healthcare proxy will have access to your medical records. If you are a Medicare recipient, Medicare will need to know about this individual which can be communicated by completing their Authorized Representatives form.
 
It is important to note a separate document is required to assign a person to handle your finances. Your healthcare proxy can only make medical decisions for you. Contact your lawyer for more information on a power of attorney for your finances.
 
I encourage a discussion about assigning a healthcare proxy and opening the conversation of advance care planning—including a Living Will—at your next visit. For Medicare patients, this is a covered service under Medicare Part B during your Annual Wellness Visit. For non-Medicare patients, feel free to call my office to schedule an appointment, or speak with me about your advance care planning thoughts and goals at your next annual concierge physical exam.

Dear Patients:

Three years ago, we were met with a global health crisis that resulted in many of us putting our other health concerns on pause, and I want to be sure you have all shifted your focus back to your overall health and wellness.

Have you kept up with your yearly physical? Is it time to do a full review of your medicine and treatment regimens? Have you gained or lost significant weight? How are your stress levels, sleep patterns, fitness programs and anxiety? 
​
Your annual comprehensive examination could be the foundation of your good health. For example, diseases and conditions such as high blood pressure, diabetes, thyroid problems, cancer, etc. can be asymptomatic for a long time. However, a thorough history, physical examination, laboratory testing, and an in-depth discussion may prove revealing and lifesaving. We can also take advantage of this time together to create a plan to help you meet your wellness goals.

Let’s partner toward your best health. Please contact our office to schedule your annual exam. And as always, I am available should you have any concerns or questions.

Sincerely,

​Dr. Brar