Top10MD Blog


 7 months ago    Leave a comments (0)

Urinary incontinence or stress incontinence is a common and often embarrassing issue that no one likes or wants to talk about; if you’re experiencing urinary incontinence, you are not alone. Nearly 25-million people in the United States have the same problem. Men don’t get off, either approximately 10% of men are susceptible to this condition. When urinary incontinence prevents you from going places, participating in sports activities, and enjoying that belly laugh it’s time to do something about it. Common among post-menopausal women it’s not limited to the older generation; urinary incontinence also affects young adults as well, especially new mothers. Many women neglect to inform their doctor, due to the embarrassment of the issue. Beforehand, it seemed as if there was no hope for you outside of surgery, but now, a new device InTone is a treatment that is changing the lives of people everywhere with no surgery.

What Is Urinary Incontinence?

Urinary incontinence is bladder leakage. It happens when we run, jump, and even laugh; this occurs when the muscles that hold urine weaken causing you to urinate when you’re not supposed to. That muscle is a voluntary muscle; which means, you have control over it. The problem occurs when that muscle becomes lack, or you lose total control over it. Your symptoms can be mild meaning you leak occasionally, or they can be severe meaning you are always leaking. It may feel as if you cannot make it to the bathroom in time and if you do, your bladder may never feel empty. If you are experiencing these symptoms, it’s time to get help.

Treatments for Urinary Incontinence

Treatments for urinary incontinence depend on several factors:

  • What type of incontinence you are suffering from
  • Your age
  • Your general health
  • Your mental health

By exercising your pelvic floor with Kegel exercises; these exercises help to strengthen the urinary sphincter and muscles that contribute to control urination; thereby, reducing your stress incontinence.

Bladder training is another method, and there is also medications along with botox or a sacral nerve stimulator. When all else fails, surgery is your best option. If you plan on having children or not through having children, you will need to discuss this with your doctor. If you are finished having children, or you have had a hysterectomy that eventually caused your bladder to drop you may be a candidate for the following non-surgical or surgical procedures:

Non-Surgical Treatment for Urinary Incontinence

Intone– a device developed to stop urinary leakage. Intone is the most effective, nonsurgical treatment available today to prevent urinary leakage. Intone takes you through 12-minutes of voice-guided pelvic floor exercises, visual biofeedback, and muscle stimulation.  Office visits will be required to customize your device to your specific needs. These exercises are completed once daily for six days a week for 90-days in the privacy of your home.

Surgical Procedure Options for Urinary Incontinence

  • Sling Procedure: There is a new mesh that is inserted below the neck of the bladder to support the urethra and stop urine from leaking out.
  • Colposuspension: This procedure lifts the bladder neck and has shown to help patients with stress incontinence.
  • Artificial Sphincter: This procedure involves inserting an artificial sphincter or valve to control the flow of urine from the bladder into the urethra.

What’s My Next Step?

If you’re struggling with incontinence, you don’t have to suffer in silence any longer. You don’t have to be afraid to talk to your doctor about it as there are options for you. Call today, and you will be off to a better quality of life including your ability to laugh without fear.

Dallas Gynecologist and Functional Medicine Specialist Maryann Prewitt, MD is Director and Founder of HealthWellnessMD. Dr. Prewitt is Fellow and Board Certified by the America College of Obstetricians and Gynecologists. Dr. Prewitt holds a Master’s Certification in the da Vinci Surgery System – this minimally invasive technology has revolutionized the way surgery is performed today. Dr. Prewitt has been named 2016 | 2017 Top10MD an honor only 1-in-3 doctors succeeds with this recognition in the United States. Call Dr. Prewitt’s office today and schedule an appointment at 469-619-1066.


 11 months ago    Leave a comments (0)

Back in the good old days, life was different for women. Childbirth was a game of heads and tails if the mother was going to survive, PMS was considered by others as an imaginary problem or women were crazy, and menopause was just another stage of life that every woman had to endure. Thanks to advancements in medicine and science, women don’t have to accept the results of hormone imbalances.

Women across the country now have an improved quality of life thanks to hormone replacement therapy. There’s no need to have to endure the struggles of menopause if the remedy is simple, just replacing your missing hormones.

Estrogen Pellet Therapy

The most important hormone for women is estrogen. Without proper levels of estrogen, woman are at risk for serious health consequences such as osteoporosis, heart disease, colon cancer, impaired vision, premature ovary failure, Alzheimer’s disease, Parkinson’s disease, diabetes and tooth loss.

Estrogen receptors are located throughout the body and brain when estrogen levels are low, or our body is not manufacturing estrogen such as when you have a hysterectomy the symptoms of hormonal imbalance such as moodiness, bone loss, loss of skin elasticity, and cognitive functions decline. Working with a physician than understands the consequences of low estrogen can help women avoid the trouble hormone imbalances can cause.

Testosterone Pellet Therapy

The testosterone hormone provides a woman with muscle tone and mass, mental clarity, and libido. When testosterone is low, women often complain of brain fog, weight gain, and even with regular exercise, poor muscle tone. Low testosterone can also be dangerous to a woman’s overall health. When a woman lacks testosterone, she can suffer from anxiety, insomnia, anger, sadness, and depression. Without hormone therapy, the imbalance of testosterone can lead to osteoporosis, muscle atrophy, and muscle and joint pain.

Bio-Identical Hormone Pellet Therapy

Hormone deficiency can have severe effects on the brain, muscles, bones, heart, and metabolism. Without balanced testosterone and estrogen levels, women suffer more than need be. To gain back your vitality, to avoid or prevent the pains of menopause, and to stay healthy for the long-term bioidentical hormone therapy can be your best friend.

Dallas Gynecologist and Functional Medicine Specialist Maryann Prewitt, MD is Director and Founder of HealthWellnessMD. Dr. Prewitt is Fellow and Board Certified by the America College of Obstetricians and Gynecologists. Dr. Prewitt holds a Master’s Certification in the da Vinci Surgery System – this minimally invasive technology has revolutionized the way surgery is performed today. Dr. Prewitt has been named 2016 | 2017 Top10MD an honor only 1 in 3 doctors in the United States succeeds with this recognition. Call Dr. Prewitt’s office today and schedule an appointment at 469-619-1066.


 1 year ago    Leave a comments (0)

Did you know that after the age of thirty, your body could produce between 3% and 10% fewer hormones per year? Those percentages increase even further as you age. Having the right balance of hormones in your body is essential for staying in good health. Balanced hormones can also help prevent diseases that are brought upon by the natural decline of hormones as you age, such as osteoporosis as cardiovascular disease. Hormone pellets have been around since 1939. Pellet therapy is one of many types of bioidentical hormone therapy. It involves your doctor inserting a small pellet under the skin the size of a grain of rice. It is usually inserted into the upper part of your buttocks or hip. The pellet is placed every three to six months and contains the same hormonal and chemical structure as your body’s natural hormones. The pellet releases all-natural, bioidentical estrogen or testosterone, which is slowly and consistently metabolized into your body as needed over the next three to four months. Depending on your lab results, your pellets will contain customized levels of either estrogen or testosterone. This slow secretion of bioidentical hormones mimics the way your body naturally produces the hormones it needs in order to keep functioning normally.

When To Consider Pellet Therapy

Your body’s natural hormone production begins to decline after you reach your mid-twenties. Hormone imbalance symptoms can be present by your mid-thirties, and men and women start replacing hormones usually between the ages of 35 and 40. If you are experiencing hormone imbalance symptoms, seek testing and treatment as soon as possible. You could negatively affect your future health and quality of life if you delay in addressing these hormone imbalances.

Some of the most common hormone imbalance symptoms are:

  • Anxiety, Depression, and Irritability
  • Weight Gain/Belly Fat
  • Loss of Muscle Mass
  • Food Cravings
  • Digestion Problems
  • Fatigue
  • Insomnia or Poor Sleep Patterns
  • Low Libido
  • Sweating

What Are The Benefits?

Pellet therapy may be the path you need to regain energy and muscle strength. It can even give you a greater ability to lose weight. You can experience an increase in your mental clarity and your quality of life, feel happier and younger again, and even prevent age-related illnesses.

Pellet therapy is a great way to optimize your hormone levels with a sustainable and easy method of delivery. Ask your doctor if pellet therapy is right for you!

Susan K. Linder M.D., P.A. is a Diplomat of the American Board of Anti-Aging, Functional & Regenerative Medicine. She is also board certified in Physical Medicine & Rehabilitation, with a subspecialty board certification in Pain Management. Dr. Linder is the Medical Director of HealthSpringMD conveniently located in Fort Worth, TX. For more information on nutritional health, bio-identical hormone replacement therapy, and overall Optimal Wellness, visit Dr. Linder’s website at or call today to reserve a seat at one of her free educational seminars 817-926- 7671.


 1 year ago    Leave a comments (0)

It can happen to the best of us. We wake up wanting to hit the snooze button, bury our head in the pillow and sleep for just a few more hours. Or, we desperately need a nap just to get through those afternoon meetings. Functional medicine expert Dr. Susan Linder, Medical Director of HealthSpringMD, shares that there is no single approach to optimizing energy. Doctor Linder suggests, “Neither diet nor exercise alone will balance your body’s complex energy needs. Energy, or lack of energy, is often the result of a various combination of lifestyle habits such as your diet, stress management, sleep, exercise, hormone balance, and detoxification”

Many factors play in your energy, health, happiness and appearance. Are you familiar with the afternoon slump? Are you struggling to power through the day? There are a few ways to bring your energy levels up, without feeling too wired to sleep at night.

Make Fiber Your Breakfast Buddy

Breakfast choices can make a world of difference between feeling sluggish, or feeling “full steam ahead.” It is important to remember that what is put in your mouth is what fuels you throughout the day. Meals that provide the most gusto are full of fiber and protein. This combination not only helps you feel full but keeps your blood sugar steady, preventing the sugar crash you’d get with a breakfast of donuts and sugary coffee. Eliminate the fruity cereal, and try eggs with Sautéed potatoes and vegetables using healthy oils like coconut. You will definitely feel the difference in your energy level.

Give Yourself a Break, Lots of Them

Studies have shown that those who take several short breaks throughout the work day are more efficient, and make fewer mistakes than those who just take one or two longer breaks. Breaks can help you be more productive while avoiding burnout. Set aside a few minutes to take a brisk walk, read a few chapters in your favorite book, have prayer or meditation time, or enjoy some full body stretches.

Provide the Right Fuel

Is your stomach growling? You will want to reach for healthy fuel for your body, which most likely means walking straight past the vending machine. Simple carbs and sugars that you’d find in a candy bar or bag of chips will raise your blood sugar, but then come crashing down, leaving you more ready for a nap than you were before. Plus, you’ll still feel hungry and need to eat more. Instead, bring a healthy snack from home to avoid the coffee shop muffin temptation. A handful of almonds or an apple with almond butter would both be excellent choices.

Get Moving

Did you know that a brisk, 10-minute walk can provide you with more energy than a candy bar? It not only improves your circulation but may also lift your mood, and improve your concentration. If you are sitting at a desk during the day, every hour or two get up and take a quick walk, even if it is just for a few minutes outside to enjoy a breath of fresh air.

Assess Your Stress

Stress is something we all struggle with in this day and age. The key is not to let it win. Some stress may help motivate you, but too much stress can hurt your productivity, concentration, and overall health. It can cause insomnia, anxiety, and exhaustion. Make the necessary changes in your life to eliminate unnecessary stress. If your work is taking a toll on your health, talk to your Manager or Human Resource Representative about your options. If finances are worrying you, seek guidance from a financial advisor to take control. Are relationships causing a strain? Seek a good counselor. The key to beating stress is to manage it before it beats you.

Dr. Susan K. Linder is a Diplomat of the American Board of Anti-Aging, Functional & Regenerative Medicine. She is also board certified in Physical Medicine & Rehabilitation, with a subspecialty board certification in Pain Management. Dr. Linder is the Medical Director of HealthSpringMD conveniently located in Fort Worth, TX. For more information on nutritional health, bio-identical hormone replacement therapy, and overall Optimal Wellness, visit Dr. Linder’s website or call today to reserve a seat at one of her free educational seminars 817-926- 7671.


 1 year ago    Leave a comments (0)



 2 years ago    Leave a comments (0)

Naturopathic medicine is the basis for what most of us refer to as Functional Medicine. Naturopathic medicine emphasizes prevention and the self-healing process through natural therapies. Naturopathic doctors combine centuries-old knowledge and philosophy that nature is the most effective healer with current research on health.

The foundations of naturopathic medicine are rooted in several principles:

  • First, do no harm
  • The healing power of nature
  • Discover and treat the cause, not just the effect
  • Treat the whole person
  • Prevention is the best cure
  • The Physician is a teacher

Naturopathic therapies are supported by many disciplines including naturopathic medicine, clinical nutrition, homeopathy, psychology, conventional medicine and spirituality. A Naturopathic diagnosis focuses on the underlying cause of the disease.

Naturopathic doctors, also known as ND’s, are primary care physicians who have attended a 4-year naturopathic medical school, are clinically trained, and many receive additional training in areas such as midwifery, acupuncture, and Oriental medicine. Naturopathic doctors view natural remedies as complementary as well as primary and work with other medical professionals when appropriate. Most ND’s provide primary care through office-based private practice and work in every aspect of a family’s health, from babies to geriatric care.

The Naturopathic view of illness is that it is not something that just “happens” to us, but rather the body’s way of communicating abnormalities with us. It is not enough to merely calm down a symptom, as the symptom is the communication, but find and treat the root cause of the symptom.

Dr. Margaret Christensen is Board Certified as a Fellow of the American College of Obstetrics and Gynecology. Dr. Christensen provides care at her Dallas practice, Carpathia Collaborative. Dr. Christensen has been named Top10MD for 2015-2016. Only 1 in 3 doctors succeeds with this recognition in the United States. To schedule a consultation with Dr. Christensen link to her profile or call 214-553- 5522 today.


 2 years ago    Leave a comments (0)

Although men make greater amounts of testosterone than women, the hormone is essential for the survival of all animals. When testosterone falls below essential levels, both sexes suffer difficulty concentrating, decreased sexual desire, and diminished memory. Most people understand that testosterone is a hormone that is important for men, but did you know it is also a vital hormone for women to maintain a high quality of life?

“It’s easy for women to consider these problems as a normal part of the aging process,” says Dallas Fort Worth’s Functional Medicine Expert Dr. Margaret Christensen- “but they shouldn’t. Anyone who is experiencing these symptoms will need to have their hormone levels checked to determine the best treatment to help feel their best.”

Here are several of the more common symptoms of low testosterone in women:

Weight Gain & Difficulty Losing Weight

  • Midlife weight gain is so common that women often assume it is just part of getting older, but if you are unable to control your weight or have changes in muscle tone and bone density, you may be showing symptoms of low testosterone. Many women with low testosterone experience muscle loss and increasing weight gain.

Decreased Sex Drive

  • Just like in men, testosterone affects sexual arousal in women. Low testosterone can affect women’s sex lives by:
    • Reduced libido, sex drive
    • General lack of interest in sex
    • Vaginal dryness, which can cause painful intercourse

Hair Loss

  • Hair loss is one of the most visible symptoms of low testosterone. Hair loss can occur on the head or other areas of the body. Be aware if your hair is getting patchy or you need to shave your legs less frequently. Testosterone supports healthy hair production and maintenance, so keep an eye out for any hair loss, on your head or otherwise.

Mood Swings, Depression and Low Mood

  • If you are experiencing unexplained mood swings, sudden bouts of depression, or are feeling blue or “low”, then you may be suffering from low testosterone. Testosterone is vital in mood regulation in the body, low levels of testosterone can make it difficult for the body to regulate itself.

Exhaustion and Fatigue

  • Always tired? Even after a full night’s sleep? You could be experiencing one of the symptoms of low testosterone in women. Another common symptom for women with low testosterone is difficulty sleeping through the night. A healthy hormonal balance is key to achieving consistent, restful sleep.


  • Another possible symptom of decreased testosterone levels is anxiety. Anxiety, like depression, is another mood that can result from imbalanced hormones causing changes in your brain chemistry. If you suddenly are experiencing bouts of anxiety, or panic attacks, it’s time to talk to your doctor about low testosterone.

Difficulty Concentrating

  • If you find that you are having difficulty concentrating on ordinary tasks, especially when having always been able to concentrate easily on the task at hand, then you may be suffering from low testosterone.

Dr. Margaret Christensen is Board Certified as a Fellow of the American College of Obstetrics and Gynecology. Dr. Christensen provides care at her Dallas practice, Carpathia Collaborative. Dr. Christensen has been named Top10MD for 2015-2016. Only 1 in 3 doctors succeeds with this recognition in the United States. To schedule a consultation with Dr. Christensen link to her profile or call 214-553-5522 today.


 2 years ago    Leave a comments (0)

We tend to think of “hormones” as something you don’t need until after menopause, but the truth is that many women’s hormones start lagging long before periods stop. “It is possible to reclaim your vitality,” says Dr. Amir Baluch, Medical Director of Juvia Med Spa – “You can feel good again with a proper lifestyle, diet, and the assistance of bioidentical hormones.”

Do you find you are so moody that your friends, kids, or even pets are keeping their distance? Do you feel tired no matter how much sleep you get, especially in the afternoon? Has your sex drive decreased? Do you feel constant brain fog? Are you carrying extra weight you can’t seem to shed, no matter how much you diet?

If you do, you don’t have to believe the best part of life is behind you, that growing older means a constant progressive decline in how you feel. Hormones are one of the several steps you can take to help improve energy levels. They can be the foundation for other changes in your lifestyle and getting your groove back. They can help you regain the stamina you once had and feel young and vibrant again.

What Can Bioidentical Hormones Do For You?

  • Heightened libido
  • Stronger bones
  • Healthy weight loss
  • Better sleep
  • More energy
  • Improved vaginal lubrication
  • Improved mental focus
  • Assistance with anxiety and depression
  • Minimized hot flashes and night sweats

If you think your hormones might be out of whack, and you want to look and feel younger, bioidentical hormones might be beneficial for you. Contact Juvia MedSpa for a free consultation and evaluation.

Functional Medicine Specialist, Dr. Amir Baluch, MD is Board Certified and Medical Director of Juvia Med Spa. Dr. Baluch has been named Top10MD for 2015-2016. Only 1 in 3 doctors succeeds with this recognition in the United States. He has published over 50 articles, book chapters, and continuing education material in peer-reviewed journals and trains other physicians on wellness and medical aesthetics. To schedule, a consultation with Dr. Baluch click the link to his profile or call 817-427-3700.


 2 years ago    Leave a comments (0)

Do you always feel tired, moody and depressed? Do you still feel tired after waking up from a full night’s rest? Are you a zombie without your morning coffee and find it near impossible to say no to sugary and salty foods?

These are all symptoms of adrenal insufficiency, or in lay terms, “adrenal fatigue”. You aren’t alone; Up to 80 percent of adults suffer from adrenal fatigue, a health problem that continues to be misdiagnosed or overlooked. “With proper care, and addressing underlying causes in a whole systems approach, most people experiencing adrenal fatigue can get back to feeling their best again,” says Functional Medicine Specialist Dr. Margaret Christensen.

What is Adrenal Fatigue?

Adrenal insufficiency is a combination of symptoms that appear when the adrenal glands function below the needed level. Most commonly associated with intense or prolonged mental, emotional, or physical stress, as well as chronic toxic exposures, it can also arise during or after acute or chronic infections, especially respiratory infections such as influenza, bronchitis or pneumonia. As the name suggests, its principal symptom is fatigue that is not relieved by sleep. However, it is not a readily recognizable entity like chicken pox or a growth on your body. Those with adrenal fatigue may not have any visible signs of a physical illness; however they live with an overall sense of feeling ill. Most will use coffee, cola, or other stimulants to make it through the day.

Symptoms of Adrenal Fatigue:

  • Trouble thinking clearly
  • Chronic fatigue and weakness, especially in the morning and afternoon
  • Low sex drive
  • Cravings for foods high in salt, sugar, or fat
  • Multiple food allergies
  • Alternating diarrhea or constipation
  • Dry and thin skin
  • Poor memory
  • Unexplained hair loss

What Causes Adrenal Fatigue?

When your adrenal glands are not able to meet the demands of stress (mental, emotional, or physical) on the body, “adrenal fatigue” can begin. The stress on the adrenal system originates in the hypothalamus- the brain’s command center where alarm inputs from multiple internal and external factors are processed. When the hypothalamus registers significant stressors, it signals the adrenal glands, located on top of each kidney, to release cortisol and adrenaline and other hormones to regulate immune function, energy production, heart rate, muscle tone, and other activities that help your body cope with stress. One of their most important tasks is to get your body ready for the “fight or flight” stress response, which means increasing adrenaline and other hormones.

This response increases your heart rate and blood pressure, slows your digestion and gets your body ready to face a potential threat of challenge. While this response is good in the short term, many of us are perpetually faced with stressors (work, environmental toxins, not enough sleep, worry, anxiety, etc.) and are in the “fight or flight” mode for far too long- much longer than was ever intended from an evolutionary standpoint. Surgery, the loss of a loved one, or a constant emotional stress can all cause the adrenals to respond. There are various phases of adrenal hormone production from an acute alarm phase, to chronic over responding with cortisol and adrenaline, to the exhaustion stage– the point when the adrenals are no longer able to keep up with the signals from the hypothalamus. The best way to screen for this is through salivary diurnal cortisol testing throughout the day to look at the response pattern along with adrenal reserve or DHEA levels. It is also important to look at other hormones such as estrogen, testosterone, progesterone and thyroid hormone function when evaluating the fatigue and creating a recovery plan.

On The Mend

Most people experiencing adrenal insufficiency can expect to feel good again when they seek proper care with a practitioner who can address the issues from a whole systems perspective. Maintaining a healthy diet, going to bed before 11 pm, B vitamin supplementation, hydration, daily mindfulness meditation, regular movement, detoxification support, and supplementing with adaptogenic herbs can all help you recover. For those that don’t recover quickly with the appropriate support, there needs to be an in-depth evaluation of more severe exposures including pesticides, chemicals, and toxic mold, or chronic infections like Lyme or other tick-borne diseases, as well as buried trauma from previous accidents or abuse.

The most important step to healing is to identify and remove stressors and underlying toxins at all levels. Emotional stressors such as personal or work relationships or financial problems need to be discussed with your provider to help us brainstorm resources for managing these areas. It might require a change in hours or even occupation. Allow yourself to enjoy some daily stress relieving activities, whether a long walk, prayer, meditation or reading a book. Some find that weekly massages are helpful. Engage in activities that create laughter and a happy environment, and stay away from those that drain you. Life is too short to waste time on those who steal your joy. Make the necessary changes to restore your health!

Dr. Margaret Christensen a Dallas Certified Functional Medicine Practitioner. Dr. Christensen received her medical degree from the Baylor College of Medicine in Houston, and her board certification as a Fellow of the American College of Obstetrics and Gynecology. Dr. Christensen is a co-founder of Carpathia Collaborative and currently serves as faculty for the Institute for Functional Medicine. To schedule a consultation with Dr. Christensen, click on her profile or call her office at 972.248.9083.


 2 years ago    Leave a comments (0)

Rheumatoid Arthritis is a chronic autoimmune inflammatory disorder affecting your joints and may cause pain in your hands, feet, knees, shoulders, neck, elbows and hips.

Know Your Level of Disease Activity

Rheumatoid arthritis or RA affects approximately 1 percent of the population translating to more than 2 million Americans yearly, with a 5:2 ratio of women to men. RA strikes many people in the prime of their lives and most often affects people in their early 30s – 60s. Rheumatoid arthritis is different than osteoarthritis. RA causes considerably more inflammation than osteoarthritis. It is considered an autoimmune disorder– meaning that the body’s immune system reacts against itself. Inflammation from RA may result in swelling, pain, and subsequent damage to the joints. Unlike osteoarthritis, RA affects the entire body. People diagnosed with RA often complain of extreme fatigue and a general sense of malaise.

RA can range in severity from manageable to mildly debilitating to completely disabling. Early diagnosis is important in slowing the progression of joint damage as damage can sometimes occur in as few as six months of the disease’s onset. Some common medications, which have been used for years to treat RA, include Plaquenil, Azulfidine, Methotrexate, Arava and Minocycline. Minocycline is not FDA approved but has been useful for patients with mild disease. These medications may be all that is needed to treat mild RA and may be sufficient for patients with moderate to severe RA.

Medications for Rheumatoid Arthritis

If you read magazines or watch television, you will most likely see advertisements for newer medications to treat Rheumatoid arthritis. Some examples include injectable biologics such as Enbrel, Humira, Remicade, Simponi, Cimzia, Rituxan, Orencia,and Actemra as well as oral Xeljanz. These anti-inflammatory medications have been miracles for some patients who have moderate to severe RA. But, on the other hand, these medications can also have potential side effects in some patients, which include but not limited to serious infections, some types of cancers, and other risks. Just because you have a diagnosis of RA, does not mean that that you need to take these medications. Whenever you’re prescribed a new drug, it is good to ask the doctor, do you feel that the benefits of taking these medications outweigh the potential risks?

Am I a Candidate for Medications?

If you’re newly diagnosed with RA, there is no way to know for sure whether or not you will develop damage and deformity in your joints and might benefit from aggressive management. On the other hand, your Rheumatologist should be able to tell you if you are at increased risk of joint damage and might benefit from medication. Know your level of disease activity. Ask your Rheumatologist if they feel you are in remission or have mild, moderate, or severe RA activity?

Most patients with mild disease activity do not go on to damage their joints and do not need biologics or Xeljanz.

Do I Have a Mild, Moderate or Severe Case or RA?

There are many tools Rheumatologists use to determine your disease activity.  Examples include:

  • DAS Score – This is a number that is calculated based on your pain, how many tender and swollen joints you have and a lab test called the sedimentation rate (ESR) or C-Reactive Protein (CRP) Based on the number, your doctor can classify you as having no disease activity (or remission) low, moderate or high disease activity.
  • HAQ Score – This score is entirely based on your symptoms and your level of function.
  • VECTRA Blood Test – This is a new blood test that measures 12 markers of inflammation and will give you a number that corresponds to low, moderate, and high disease activity. It’s expensive, but currently the company that sells the test caps patient charges around $25.
  • Imaging 
    • Plain Radiographs – If your doctor feels you have signs or symptoms of active RA, and there is already damage on your plain x-rays, then most likely you will be classified as having moderate to severe activity.
    • Ultrasound ­– Some doctors are using ultrasound in their office to look for early joint damage. The doctor doing the test must have a lot of experience with this technique to use if effectively.
    • MRI – Doctors may order this test to look for early damage. Word of caution! Radiologists who read these films sometimes comment on findings that may not be clinically significant. Your Rheumatologist in response to an MRI report may feel the need to be overly aggressive in their management and in some cases may not be warranted.

Know Your Body & Educate Yourself!

Always consider a second opinion if there is a question about diagnosis and treatment of your RA. RA is a chronic condition, and most patients take medications for a long time that may have potential risks. If you’ve recently been diagnosed with RA or arthritis or have been suffering from the disease for some time now, consider reading “Arthritis without Pain; the miracle of TNF blockers,” by Laurie Hesser and Dr. Scott Zashin to learn more. It’s easier to manage a disease process when you understand it.

Dr. Scott Zashin is a respected Dallas Fort Worth Texas Rheumatologist. He is duel board certified by the American Board of Rheumatology and the American Board of Internal Medicine. Dr. Zashin is the Medical Director of Dallas Rheumatology. Some of the above information about rheumatoid arthritis is from his and Laurie Hesser’s book Arthritis Without Pain, a comprehensive guide for patients considering or undergoing treatment with the TNF blockers Enbrel®, Remicade®, or Humira®. All rights reserved. For more information on rheumatoid arthritis, pain relief and getting back to feeling great visit his website: or call today to schedule a time to meet with Dr. Zashin 214-363-2812 personally.

Arthritis Foundation on how doctors measure disease activity.

Disclosure: Dr. Zashin currently or has been in the past, a speaker or consultant to some the manufacturers of the products mentioned in this blog.


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