1200 Five Springs Rd.
Charlottesville, VA 22902
Phone: 434.977.1933 | Fax: 434.295.3128
Email:  info@DanielSawyerMD.com
    Specializing in Internal Medicine & Infectious Disease    
COVID Vaccine 03/25/2021
The office will have the Johnson/Johnson COVID vaccine later this month. Please call to inquire about it.
Vitamin D Update 03/24/2021
New data has shown that vitamin D will lessen the severity of Covid 19. A review of 7 studies on COVID 19 severity, ICU treatment and mortality (1368 patients), showed that patients with a good prognosis had significantly higher vitamin D levels compared to those with a poor prognosis.

There are multiple studies that have also shown a benefit from vitamin D use. A meta-analysis of 73 studies showed that supplemental D3 reduced the overall mortality in older adults from cardiovascular disease and cancer death ( BMJ 2014. Apr 29: 348). Further studies have also shown that all cause mortality is decreased when vitamin D levels are maintained between 40 and 60.

An observational study (Am J Geriatric Society 2009 57: 1595-1603) showed the benefit of vitamin D in postmenopausal women regarding osteoporosis, and a reduction in cardiovascular mortality if the vitamin D levels were greater than 40 compared to patients with levels less than 10. This was a prospective observational study.

Vitamin D is recognized to promote cellular differentiation. A meta-analysis of case-control studies compared vitamin D levels in patients with and without colon cancer. There was a decrease in the risk of colon cancer by 40% for each increase in vitamin D levels of 20 ng per ml.

Although there has been differences in outcomes between observational and randomized controlled trials there is a growing wealth of data suggest vitamin D is beneficial particularly when the levels are maintained between 40 and 60.
Shingles Winter 2018
Shingles is a complication of a previous childhood infection with the chicken pox virus. This can cause a dermatomal eruption in the elderly. The consequences of the reactivated virus and secondary dermatolgical eruption can be extremely painful. Occasionally, the pain after the eruption can be severe to last for months to years. This is referred to as post herpetic neuralgia. The shingles vaccine referred to as Zostrix, was only 52% effective in prevention of shingles. The new vaccine is called Shingrex and it is about 90% effective in prevention of Shingles. It is given in a 2 dose regimen, separated by 6 months. There has been local side effects of pain at the injection site, which has been severe enough in 17% of patients to interfere with normal activity. About 10% of patients receiving the vaccine note myalgias, fatigue, headache and fever. Overall, this is a useful vaccine in the elderly as post herpetic neuralgia can be very disabling.
Annual Blood Donations Spring 2018
It should be remembered that routine blood donations are a healthy and productive activity. In a study from the journal Transfusion in 2015, there was an 18.6% reduction in all cause mortality with annual blood donations. This included both a reduction from cancer and cardiovascular disease. Another publication in 2002 showed a 40% reduction in cardiovascular risk with annual donations.

Thus annual blood donations help those patients in need of blood products, but it significantly helps lower mortality in the donor.
Immunizations 8/19/2014
August is national immunization awareness month. There have been new recommendations for seniors over 65 regarding pnemococcal vaccine. Those patients over age 65 who have not received a dose of pneumococcal vaccine, should be vaccinated with a dose of the conjugate vaccine . This should be followed in 8 weeks by a dose of the polysaccaride pneumococcal vaccine . The two different vaccines protect against different strains of the organism, and work thru a different mechanism. This organism, the pneumococcus organism, can result in life threatening pneumonia and meningitis in the elderly. Any adult with a chronic illness as asthma, diabetes or alcoholism should receive the vaccine. Any patient who has had a splenectomy, anyone with the HIV virus and patients who have had a cochlear transplant. Smokers and adults living in a long term care facility should be vaccinated as well.
Knee arthroscopy ineffective in treating meniscal tears and arthritis of the knee. 5/4/2014
Multiple recent and old studies have demonstrated that knee arthroscopy for osteoarthritis is no better than a placebo operation. Both the 2002 article in the NEJM, as well as a recent study in the NEJM, showed no benefit from arthroscopy over a placebo operation. The 2013 study published in the NEJM showed that arthroscopy for a meniscal tear offered no benefit over a sham operation for a meniscal tear. Physical therapy was as effective as arthroscopy.
Marijuana's Effect on the Brain 4/17/2014
In an article published in the Journal of Neuroscience on April16, 2014 by Dr. Gilman, et al , showed that the routine use of marijuana impairs motivation, attention, learning and memory. These impairments were associated with changes by brain MRI in the nucleus accumbens and amygdala. These are areas which are important for emotion. Marijuana is the most commonly used illicit drug in the United States. With legalization in many states, the use of this drug is likely to increase along with emotional and brain structural changes of our youth.
Swine Flu H1N1 11/4/2009
A publication in the November 4, 2009 issue of JAMA, provides the results of the swine flu pandemic in California. Hospitalized and fatal cases were younger than the seasonal influenza and had a median age of 27. While gastrointestinal symptoms occurred infrequently with the seasonal flu (<5%), these symptoms occurred in one third of the swine flu cases. The risk factors for hospitalization and death were the same as seasonal influenza and included diabetes, cardiovascular disease, chronic lung disease and pregnancy ( third trimester ) . In addition, obesity was a significant risk factor for hospitalization with the swine flu.

The rapid tests for influenza are falsely negative in up to 30-40% of the cases. This is a problem defining the illness for both patients and practitioners. Lastly, there are numerous drugs and drug combinations, which are active against the swine flu if introduced early enough in the illness.
Heart Failure 5/11/2005
A recent article in the American Journal of Medicine demonstrates that exercise training for patients with congestive heart failure is both safe and effective. In this article, aerobic excercise improves peak oxygen consuption and quality of life. Patients with congestive heart failure had significant improvement in exercise tolernace, and the ability to manage routine activities of daily living if they participated in excercise conditioning. Thus if you have the diagnosis of CHF, congestive heart failure and have difficulty performing activities you want, consider a monitored excercise program
Flexible Sigmoidosopy after MI 5/10/2005
Sigmoidoscopy is safer than colonoscopy and may be the preferred test for patients with coronary artery disease. In a recent study, flexible sigmoidoscopy was safe for patients who had a recent heart attack. In this group of patients, this form of screening for colon cancer may be preferable.
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