May Blog: National Stroke Awareness Month

May is national stroke awareness month. Every year 800,000 people suffer from a stroke, which makes the incidence of stroke equal to that of heart attacks. While stroke is the fifth leading cause of death, the majority of stroke Read more

May is: Melanoma/Skin Cancer Detection & Prevention Month

  May is skin cancer awareness month. Skin cancer is the most common cancer in the United States and one in five of us will develop skin cancer in our lifetime. Like many other cancers, successful treatment of skin cancer Read more

National Prescription Drug Take Back Days Ensure Proper Disposal of Prescription Drugs

In the US, the use of prescription opioids has skyrocketed. Since 1999, the prescription of opioids has increased four-fold. While it is true that the use of these drugs has led to improvements in medical pain management, it has Read more

April: Alcohol Awareness Month

  April is Alcohol Awareness Month. Marking April as Alcohol Awareness Month began in 1987 with the goal of raising awareness that alcohol abuse is a disease, and, like many diseases, it is a public health concern that can, and Read more

Save Your Vision

Your vision is priceless. When it comes to eye health, sometimes our concerns start with visual acuity problems and end with contacts or glasses. It can be easy to forget that the eyes are related to the health of Read more

May Blog: National Stroke Awareness Month

Physicians Health Network Blog

May is national stroke awareness month. Every year 800,000 people suffer from a stroke, which makes the incidence of stroke equal to that of heart attacks. While stroke is the fifth leading cause of death, the majority of stroke victims do survive. Therefore, stroke is the primary cause of long-term disability.

Strokes fall into two main types. There are ischemic strokes which account for 85% of all strokes. Ischemic strokes occur when the delivery of blood to the brain is blocked by a clot. The brain requires large amounts of blood all day every day, which means this type of blockage quickly causes serious damage to the brain in areas downstream of the blockage. The second main stroke type is a hemorrhagic stroke. In these cases, a blood vessel ruptures and the bleeding creates swelling, pressure, and cell damage. It is also important to recognize a third type of stroke called a transient ischemic attack or TIA. This is not a full-blown stroke, but instead a short-term event that causes symptoms similar to a stroke. TIA’s are sometimes call “mini-strokes”. While individuals with TIAs often recover without permanent damage, having a TIA should be considered a very serious warning sign for a future stroke. In fact, 40 percent of people who have a TIA will have a stroke.

Eighty percent of strokes are preventable. This means that spreading awareness about stroke risk factors and warning signs is a powerful way to reduce the number of individuals who suffer long-term disability after a stroke.

Recognizing when an individual is having a stroke is crucial because faster treatment means less damage to the brain. It is common for an individual who is suffering from a stroke to experience confusion, headache, dizziness, or vision issues. There is also a handy acronym, F.A.S.T., that can be used to quickly recognize when someone is suffering from a stroke:
● F – Face: Is one side of the face drooping or numb? Ask the person to smile and check.
● A – Arms: Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
● S – Speech: Is their speech slurred?
● T – Time: If someone has these symptoms, even if they go away, call 911.

Strokes most often affect older adults; however, 15 percent of ischemic strokes occur in adolescents and young adults and the number of strokes in young adults has increased 44 percent over the last ten years. These statistics mean that spreading awareness about strokes can have a meaningful impact on people of all ages.


May is: Melanoma/Skin Cancer Detection & Prevention Month

Physicians Health Network Health & Awareness Articles


May is skin cancer awareness month. Skin cancer is the most common cancer in the United States and one in five of us will develop skin cancer in our lifetime. Like many other cancers, successful treatment of skin cancer depends on early detection. This means that spreading awareness of skin cancer prevention and detection can be truly lifesaving.

Skin cancers fall into two main categories. There are carcinomas of the basal cells or squamous cells which are the two most common skin cancer types. These are dangerous conditions that should be taken seriously but fortunately, they are highly treatable and rarely cause death. The other main skin cancer type is melanoma which occurs in the pigment-producing cells of the skin call melanocytes. Melanomas cause most skin cancer deaths.

Dr. Aloys L Tauscheck MD, JD, a dermatologist at Paragon Medical Center, says, “Detecting skin cancer in the early stages greatly increases our ability to successfully treat the cancer.” In fact, when detected early, the five-year survival rate for melanoma is 98 percent. Dr. Tauscheck adds, “In order to detect these cancers early it is a good idea to have annual exams with your dermatologist and to consider regular self-checks or partners can check each other. This is important since most melanomas occur on our back.”

Dr. Tauscheck says, “Checking yourself or your partner for melanoma means examining skin spots and moles for certain characteristics.” Dermatologists have developed a handy, easy to remember ABCDE rule that we can use to identify potential problem spots. If you or your partner have a spot that matches one or more of the rules below be sure to call your dermatologist:
● A – Asymmetry – when one half of the spot differs from the other.
● B – Border – when the spot has a border that is irregular or scalloped, or poorly defined.
● C – Color – when the spot varies in color.
● D – Diameter – when the spot is greater than 6 mm across or, in other words, wider than a pencil eraser.
● E – Evolving – when the spot is changing color, shape, or size over time.

Dr. Tauscheck says, “Different skin types have different levels of risk for skin cancer. While those with skin that is very light are at the greatest risk, all skin types carry some risk. Those individuals with dark skin can and do develop skin cancer, including some of the more dangerous melanomas.” This makes skin cancer prevention important for everyone. Here are some skin cancer prevention pointers from the Centers for Disease Control:
● Seek the shade during midday sun
● Use hats and long sleeve clothing
● Use broad-spectrum sunscreen at SPF 15 or higher
● Avoid indoor tanning

By spreading the news about prevention and early detection we improve everyone’s chance of avoiding skin cancer or detecting it early when it is much more easily treated.


National Prescription Drug Take Back Days Ensure Proper Disposal of Prescription Drugs

Physicians Health Network Blog

In the US, the use of prescription opioids has skyrocketed. Since 1999, the prescription of opioids has increased four-fold. While it is true that the use of these drugs has led to improvements in medical pain management, it has also resulted in an Opioid Crisis. The term Opioid Crisis refers to the abuse and deaths associated with illegal and prescription opioids. In 2015, six million Americans abused prescription drugs and the majority of these individuals obtained their drugs from the legal prescriptions of family and friends. In fact, one study found that 61 percent of patients who were prescribed opioids for pain management were given more than they needed and only 41 percent of these patients reported disposing of their unused opioid pills safely. This means there are large quantities of excess pills in the community that could potentially be abused.

The goal of the Drug Enforcement Agency (DEA) sponsored National Prescription Take Back Day is to provide a safe, convenient, and anonymous way to dispose of excess or expired prescription drugs. In other words, the goal is to get these unneeded drugs out the medicine cabinets and out of the community so that they cannot be abused and further contribute to the Opioid Crisis. During just one Take Back Day last year, 456 tons of prescription drugs were collected and safely removed.

Each Take Back Day is also an opportunity to encourage those with substance abuse issues to seek help. A local substance abuse treatment professional can be found using the anonymous locator at

The Sheboygan Police Department, 1315 N.23rd St. accepts prescription drugs for purposes of disposal every day of the year. For information, call 920-459-3333.
The next community Drug Take Back Day is Saturday, April 21, 2018 at St. Nicholas Hospital from 10:00 a.m. until 1:00 p.m.

If you’re not in the Sheboygan area you can search for you nearest sit on the DEA website and if you can’t make it to a Take Back site you can also search for sites in your area that accept drop-offs all year.


Sabatino, M. J., Kunkel, S. T., Ramkumar, D. B., Keeney, B. J., & Jevsevar, D. S. (2018). Excess Opioid Medication and Variation in Prescribing Patterns Following Common Orthopaedic Procedures. The Journal of Bone and Joint Surgery, 100(3), 180–188. doi:10.2106/jbjs.17.00672

April: Alcohol Awareness Month

Physicians Health Network Health & Awareness Articles


April is Alcohol Awareness Month. Marking April as Alcohol Awareness Month began in 1987 with the goal of raising awareness that alcohol abuse is a disease, and, like many diseases, it is a public health concern that can, and should, be treated medically. Dr. Nicole Steinhardt, DNP-BC, Sheboygan Internal Medicine Associates explains, “Alcohol Use Disorder is an overall term for a cluster of disordered behaviors related to alcohol consumption. This includes alcoholism, binge drinking, and others. We should recognize that individuals with alcohol abuse issues have a medical condition and need help from a provider trained to treat addiction.” Some signs that an individual is suffering from an Alcohol Use Disorder are:
• Cravings for alcohol.
• Drinking during the day or in secret.
• Withdrawal symptoms when not drinking such as tremors, nausea, and sweating
• Continued drinking despite negative consequences for one’s family, relationships, or work.
• An inability to stop or reduce one’s drinking.

Dr. Steinhardt says, “In addition to being a serious disease in its own right, alcoholism and other alcohol use disorders are closely related to other health issues. Alcohol is a toxin and chronic, high levels of consumption are damaging to your cells.” You may know that the liver works to detoxify the alcohol, however, in the meantime, it will still travel throughout the body and affect all your body’s systems. “This is why alcohol consumption is a risk factor for many other diseases.”

Here are some of the major connections between alcohol abuse and other diseases:
• Liver disease – because the liver is burdened with detoxifying alcohol, abuse of alcohol is linked to many forms of liver disease.
• Digestive problems – heavy drinking can result in inflammation of the stomach lining, a depletion of vitamins, and other gastrointestinal issues.
• Heart problems – alcohol abuse is associated with high blood pressure, arrhythmias, heart failure, and stroke.
• Diabetes complications – alcohol interferes with the release of glucose from your liver and causes blood vessel damage.
• Alcohol use during pregnancy can cause birth defects, miscarriage, or fetal alcohol syndrome.
• Impaired bone health – chronic alcohol abuse can lead to thinning bones and increased risk of fractures.
• Damage to blood cells, and platelets resulting in circulatory issues.
• Neurological complications – such as nerve damage, dementia, and memory loss.
• Weakened immune system – increasing the risk of illnesses such as influenza and pneumonia.
• Increased cancer risk – long-term excessive alcohol use has been linked to a higher risk of mouth, throat, liver, colon, breast and other cancers.

The good news is that alcohol consumption is a modifiable disease risk factor. Dr. Steinhardt reminds us that, “Social stigma often stops individuals from talking about their alcohol abuse, even with their doctor. Recognizing that alcohol abuse is a disease can help lower the stigma a person may feel and open the door to a conversation about treatment.” In fact, Alcohol Awareness Month starts with an alcohol-free weekend that is designed to be a test. Those individuals who find it challenging to go 72 hours without drinking may benefit by contacting their doctor or an addiction treatment professional.


Save Your Vision

Physicians Health Network Blog

Your vision is priceless. When it comes to eye health, sometimes our concerns start with visual acuity problems and end with contacts or glasses. It can be easy to forget that the eyes are related to the health of the whole body. In fact, the eyes, which are only two percent of your body weight, burn 20 percent of your daily energy. This is a massive amount of energy. Your visual system is the single largest energy user in your body. This means that the health of your eyes and the health of your body as a whole are intimately linked.

Here are some lifestyle factors that can impact your eye health:
• Diet
• Eye protection
• Smoking
• Screen time
• Regular eye exams

Let’s look at some of the details of each one:

Diet – Carrots are not the only vegetable to benefit your eyes. Although they are good sources of carotene. Consider other vegetables as well; especially dark leafy greens such as spinach and kale. In addition, the omega-3 fats found in fish and other seafood are important for retinal health. Deficiency of these fatty acids may increase your risk of certain eye diseases.

Eye protection – Protective eyewear includes safety glasses, goggles, and splash shields. The type of protective eyewear needed depends on the activity. Wear protective eyewear for sports, work, handling chemicals or any activity that puts your eyes at risk. If possible look for polycarbonate glasses which are very strong and shatter-resistant.

Smoking – It is no surprise that smoking is bad for your health, but this is especially true for eye health. All the energy that your eyes use creates a lot of inflammatory by-products. The eyes must deal with these by-products and smoking makes the problem even worse. This is why smoking is related to the development of age-related macular degeneration, cataract, and optic nerve damage.

Screen time – Modern computer screens, TVs, phones, and tablets all flicker and are saturated with blue light. As mentioned, the eyes burn enormous amounts of energy and need to deal with the inflammatory by-products. Because of its wavelength, blue light is high-energy radiation which stresses the eyes by fatiguing the eye’s waste disposal systems. The flickering of computer screens is too fast for us to notice, but it is a source of eye fatigue. When using a screen take breaks every 20 minutes. In addition to resting the eyes use these breaks to look off into the distance. If your device features allow, change the setting to lower the amount of blue light and increase the amount of red light coming from the screen. Examples of these features include night mode on Android devices and night shift on Apple devices.

Regular eye exams – Often eye exams are not a top-priority for children and young and middle-aged adults. However, a dilated eye exam can be important for to assess your eye health and screen for progressive diseases. These exams are recommended annually for any individual over 60 and for African Americans over 40. Regardless of your age, if you feel an eye exam is right for you contact your eye care professional.


Campello, L., Esteve-Rudd, J., Bru-Martínez, R., Herrero, M. T., Fernández-Villalba, E., Cuenca, N., & Martín-Nieto, J. (2013). Alterations in Energy Metabolism, Neuroprotection and Visual Signal Transduction in the Retina of Parkinsonian, MPTP-Treated Monkeys. PLoS ONE, 8(9), e74439. doi:10.1371/journal.pone.0074439

March is Colorectal Cancer Awareness Month

Physicians Health Network Health & Awareness Articles


Since 2000, March has been the month to promote awareness of colorectal cancer. Many individuals raise awareness on March 2nd by showing off their blues to call attention to the prevalence of this cancer.

Jennifer Giebel, APNP at Sheboygan Cancer & Blood Specialists says, “Colorectal cancer is highly treatable which makes spreading awareness truly a potential lifesaver.” At the end of the large intestine are the colon and the rectum. When cancer occurs in these areas it is known as colorectal cancer. When it becomes metastatic, this type of cancer most commonly spreads to the liver. Colorectal cancer is the second leading cause of cancer death in the US and it affects women and men equally. The incidence for African-Americans is 20 percent greater than it is for Caucasians. Individuals with a first-degree relative with colorectal cancer, meaning a child, sibling, or parent have two to three times greater risk. “Colorectal cancer can occur in individuals of all ages but is most common in people over 50 years of age. However, it’s important for younger individuals to be aware of the risk factors for this disease to avoid mistakenly ignoring early symptoms,”

Screening for colorectal cancer is very important. This is because the earlier colorectal cancer is found the greater the chance of successful treatment. According to Giebel, “Men and women should have regular screening starting at age 50. Regular screening enables us to find precancerous polyps or colorectal cancer early when they are most easily treated.” In fact, when colorectal cancer is found in early stages, the 5-year survival rate can be 90 percent.
Symptoms can include:
• A change in bowel habits or the shape of the stool.
• Persistent abdominal discomfort – Including cramps, gas, feeling full, bloated or pain.
• Rectal bleeding – Finding blood in your stool or in the toilet after bowel movement.
• Weakness, fatigue or unintentional weight loss.
• The urge to have a bowel movement when the bowel is empty.
• Dark or black stools

In addition to regular screening, you can reduce your risk of colorectal cancer by making some positive lifestyle changes. These include:
• Avoid excess alcohol consumption
• Maintain a healthy bodyweight
• Avoid (or quit) smoking
• Be physically active

Treatment options vary, and Jennifer says, “The course of treatment depends on the size, location, and stage at which the cancer is found. Some smaller, local, early-stage tumors can be treated with surgery alone”. Some of the common treatment strategies for colorectal cancer include:
• Surgery
• Chemotherapy
• Biological Therapy
• Liver-Directed Therapy
• Radiation Therapy

“Symptoms can also be associated with many other health conditions and early colorectal cancer often does not cause pain. Contact your physician if you have symptoms and need to determine the cause,” said Giebel. Consider proudly wearing your blue on March 2nd and help spread to word that early detection of colorectal cancer can be a lifesaver.


February is Heart Health Awareness Month

Physicians Health Network Health & Awareness Articles


In February heart-shaped decorations, cards, balloons, and chocolates appear everywhere. This is a great reminder that since 1964 February has been American Heart Month. Heart disease is the leading cause of death for men and, through the efforts of groups like the American Heart Association, there is growing awareness that it is the leading cause of death for women as well.

Dr. Louie Coulis, MD, FACC, Coulis Cardiology says, “When dealing with heart disease risk it can be helpful for those concerned to look at their risk factors in two categories. Those they can change or modify and those they cannot.” Your age, sex, family history, and racial background cannot be changed. However, those factors that can be modified with lifestyle changes are:

• Blood pressure
• Body weight
• Cholesterol
• Exercise
• Smoking
• Type II diabetes.

“Targeting the modifiable risk factors means that doctors and patients can work together to make dramatic reductions in heart disease risk,” said Dr. Coulis. For example, diabetes is strongly linked to heart disease. In fact, the most common cause of death among type II diabetics is heart or blood vessel disease and their risk of death due to a cardiovascular event is as much as six times greater than non-diabetics. Unregulated blood sugar worsens the risk of heart disease but as Dr. Coulis notes, “even with controlled blood sugar a diabetic’s risk of heart disease is elevated.”

Likewise, smoking is a powerful heart disease risk factor. Smoking doubles one’s risk of heart attack and, according to Dr. Coulis, “smokers who quit can see a four-fold reduction in their risk of heart disease. Quitting also reduces the secondhand smoke exposure for others, which is also a heart disease risk factor.”

Most people survive their first heart attack and make a functional recovery. Dr. Coulis says, “The improvements in emergency cardiology mean that, if caught in time, those who suffer a heart attack can be treated. Still, it is a good idea for individuals at risk of heart disease and their loved ones to be acquainted with the symptoms of a heart attack.”
The symptoms of heart attack include:
• Chest pain, shortness of breath or fatigue. It is important to note that approximately 1/3
of people who have a heart attack do not feel any chest pain. Many of these are women,
non-Caucasian, or older than 75.
• Pain in the middle of the chest which can spread to the back, neck, jaw or arms.
• Nausea & vomiting which are sometimes mistaken for food poisoning or the stomach flu.
• Gas-like pain or pressure in the stomach area which is may be mistaken for indigestion.
• Lightheadedness or dizziness.
• Feelings of restlessness, sweating, or anxiety.
• Bluish lips, hands, or feet.
• Heavy pounding of the heart or abnormal heart rhythm.
• Loss of consciousness.

The word is spreading. There is greater awareness of heart disease, its risk factors, and the symptoms of a heart attack. If you are interested in assessing and lowering your risk of heart disease see your doctor.

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February: Go Red for Women!

Physicians Health Network Blog

You may know that heart disease is the leading cause of death for men. But did you know that heart disease is also the leading cause of death for women? In fact, in the US, 44 million women are affected by heart disease and women under the age of 55 who suffer a heart attack do not recover as well as men in the same age group. In other words, heart disease is as important for women to pay attention to as it is for men.

Heart disease affects all women, but it is important to note that African American and Hispanic women are at greater overall risk and more at risk of developing heart disease earlier in life.

It is estimated that 80 percent of heart disease and stroke events can be prevented with lifestyle changes.

This is why spreading awareness among women is so important and that’s exactly what the American Heart Association’s Go Red for Women campaign is all about. On February 2nd women, and men, will wear red to call attention to the importance of cardiovascular health for women and to help bust the myth that heart disease is only an issue for men.

The connection between heart disease and men’s health is well-known but cardiovascular research has begun to appreciate the risk women face and how that risk differs from men. For example, the classic heart attack symptom for a man is chest pain. While women may also experience chest pain, they are more likely to experience the other types of discomfort associated with a heart attack such as shortness of breath, nausea, vomiting, back pain or jaw pain. Here is a list of heart attack warning signs for women:
● Chest discomfort that lasts more than a few minutes or that goes away and comes back.
● Discomfort in other areas such as one or both arms, the back, neck, jaw or stomach.
● Shortness of breath.
● Cold sweat.
● Nausea or lightheadedness.

Some heart disease risk factors cannot be controlled such as age, race, and family history. But women still have an enormous ability to change their personal risk of heart disease by paying attention to the risk factors they can control by making changes in their lifestyle behaviors. The following lists the risks that can be managed through lifestyle changes to lower your risk of heart disease.
• High blood pressure
● Smoking or tobacco use
● High blood cholesterol
● Lack of regular activity
● Obesity or overweight
● Diabetes

If you need to make improvements in these areas be sure to see your doctor.

Remember to put on your red apparel on February 2nd and help spread the word. Heart disease isn’t just a concern for men.


January is Thyroid Awareness Month

Physicians Health Network Health & Awareness Articles


January is Thyroid Awareness Month. The thyroid gland is a butterfly-shaped endocrine gland
found in the front of the neck. When functioning properly the thyroid often gets little
attention. However, a malfunction can have a profound impact on health and wellness. The
thyroid gland regulates the human body and its metabolic processes much like a thermostat
regulates a furnace or a gas pedal regulates an automobile engine. In other words, the thyroid
gland, by producing thyroid hormones, affects how our cells use energy. Like the gas pedal,
thyroid hormones increase the body’s metabolic rate. In fact, most of your cells have receptors
for the thyroid hormones which means that the thyroid has an enormous effect on our body.
The thyroid regulates body temperature, it influences brain health, heart function, muscle
strength, bone density, and much, much more.

The thyroid hormones have powerful effects and so the thyroid must be carefully
controlled by the body. Too little thyroid hormone and key processes around the body slow to a
crawl. Too much thyroid hormone and the same processes rev dangerously high. Dr. Liz Zurich,
D.O. from Sheboygan Internal Medicine Associates explains, “While the thyroid gland controls
many processes in the body, it is itself controlled by other glands.” That control comes down
from the pituitary gland in the brain in the form of thyroid stimulating hormone (TSH) As the
name implies, TSH signals the thyroid gland to release two hormones. One is triiodothyronine,
also known as T3, and the other is thyroxine, also known as T4. Just as the thermostat in a
house signals the furnace to shut off when the house is getting too warm, the release of T3 and
T4 into the bloodstream signals the pituitary gland to stop producing TSH. This type of control
forms an elegant loop known as a feedback loop.

Imagine a malfunctioning thermostat leading to either an overworked furnace or a furnace that
will not kick on when needed. Dr. Zurich says, “The thyroid gland can malfunction in a similar
way, becoming either underactive or overactive. We call these disease states hypothyroidism
and hyperthyroidism.” When normal thyroid function is disrupted many essential metabolic
processes can also become either underactive or overactive and lead to profound negative
health effects.

Dr. Zurich says, “There are several causes of hyperthyroidism, such as inflammation, viral
infection, or cancer, but most cases are caused by Graves’ disease. Graves’ disease is an
autoimmune disorder in which immune antibodies overstimulate the cells of the thyroid.” This
results in an enlarged and hyperactive thyroid that is producing too much T3 and T4. This
condition is most common between the ages of 30 and 50 and afflicts women more than men.
Because the thyroid influences so much that goes on in the body it is no surprise that almost
every organ can be affected by hyperthyroidism. It is also no surprise that the list of
hyperthyroid symptoms are diverse:

● Increased appetite
● Weight loss
● Nervousness or anxiety
● Irritability
● Increased perspiration
● Racing or irregular heartbeat
● Hand tremors
● Difficulty sleeping
● Muscle weakness
● Osteoporosis
● Diarrhea
● Goiter
● Bulging eyes or vision issues

The numerous and diverse symptoms associated with thyroid dysfunction means that,
sometimes, other health issues can resemble thyroid dysfunction. The thyroid may unfairly take
the blame. Your physician is best equipped to help you determine if you have a health issue
related to the thyroid gland. Dr. Zurich says, “When we want to test for thyroid dysfunction we
can check the levels of TSH, T3, and T4. These levels can tell us if the thyroid is overactive or
underactive. We may also test for the relevant antibodies in cases where Graves’ disease is

The best course of treatment for hyperthyroidism is determined by the patient and his/her
physician. In some cases, it is necessary for the patient to have their thyroid gland ablated, or removed. Thyroid hormone replacements are then taken to maintain normal levels. “Treatment for Grave’s disease, or other cases of hyperthyroidism, include anti-thyroid medications, surgery, or radioactive iodine,” said Dr. Zurich.

Observe thyroid awareness month with an appreciation of the important role the thyroid gland
plays in our health and wellness.

Smith, T. J., & Hegedüs, L. (2016). Graves’ Disease. New England Journal of Medicine, 375(16),
1552–1565. doi:10.1056/nejmra1510030

Opioids and the Battle Against Pain

Physicians Health Network Blog

Atit Shah, MD
Advanced Pain Management
2124 Kohler Memorial Dr.
Sheboygan, WI 53081

Medical Education
University of Illinois College of Medicine, Peoria, IL
Advocate Lutheran General Hospital, Park Ridge, IL
Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, N.Y.
Case Western University, Cleveland, OH

Board Certifications
Pain Management
Fellowship Trained in Pain Management

Professional Memberships
American Medical Association
American Society of Anesthesiology
New York State Society of Anesthesiology
North American Neuromodulation Society

The only person who really knows the extent and severity of your pain is yourself. It is my mission and goal to help alleviate your pain and allow you to gain your life back. I believe if we work together, we can accomplish this mission. – Atit Shah, MD

Prescription opioids, such as oxycodone, hydrocodone, and morphine, do more than block pain. Dr. Atit Shah, MD from Advanced Pain Management explains, “Opioids can have undesirable effects. They can depress the respiratory system which can become dangerous and lethal even when not abused or misused. They can also create feelings of euphoria and lead to dependency.” In fact, one-quarter of the patients on long-term opioid therapy will develop dependency.

The risk of prescription opioid abuse varies widely between people and the incidence varies widely between regions of the US. Risk factors for opioid abuse include:
• Obtaining overlapping prescriptions from multiple providers.
• Taking high daily doses of prescription pain relievers.
• A history of mental illness or alcohol or substance abuse.
• Living in rural areas and having a low income.

Achieving effective pain management presents a challenge. Healthcare providers must strike a balance between the chronic pain management needs of their patients and the risks of longer-term abuse or addiction. Dr. Shah says, “While we need to find solutions to the Opioid Crisis, we do not want to stop focusing on how important pain is to the patient and their health. The solution is not less pain management. Rather, it is better pain management.”

One of the pillars of the Department of Health and Human Services’ strategy to combat the opioid crisis is to promote better pain treatment. Such improvements may come from the development of better opioid medications that act on the specific receptors for pain but ignore the receptors that create euphoria and addiction. Other alternatives are pain-blockers from other drug classes such as anticonvulsants, cannabinoids, anti-inflammatory, corticosteroids, antidepressants, or interventional options.

Dr. Shah says, “A pain treatment does not have to completely replace opioid drugs to help. Any treatment that lowers the patient’s need for opioids is a step in the right direction.” Nerve blockades, for example, help patients use fewer opioids immediately after surgery. Modalities such as electrical stimulation, through the skin or directly to the spinal cord, can lower pain perception. Non-drug treatments, such as cognitive behavioral therapy, physical therapy, yoga, or meditation, may also help liberate patients from opioids.

Another important step in combating the crisis is overcoming the stigma surrounding it. Dr. Shah says, “Prescription drug dependency is often perceived as a criminal issue. Rather, opioid dependence should be a medical issue. Stigmatizing it like a criminal issue makes those individuals suffering from opioid dependence less likely to tell their loved ones and seek help.”

The recognition that pain control is integral to good patient care and medical outcomes has led to an explosion of opioid prescriptions. So much so that it has turned into a crisis of abuse, addiction, and overdose. As we search to resolve the crisis we must avoid minimizing pain and the suffering that occurs with inadequate pain control. Dr. Shah says, “The pitfalls of pain management strategies that over-rely on opioids are becoming more and more apparent. As we shift away from overreliance on opioids, we must take care to keep our sights set on pain and the effect pain has on patients and their health outcomes.”


Boscarino JA, Rukstalis M, Hoffman SN, et al. Risk factors for drug dependence among out-patients on opioid therapy in a large US health-care system. Addiction 2010;105:1776–82.