4610897?1393869202
Joseph Sclafani, M.D.  
Male, 34
Richmond, VA

Interests: Internal Medicine, arrhythmia
My Posts
Jun 13, 2014 in the Internal Medicine Expert Forum - 5
Hello, thank you for your question. Patients with beta thalaseemia may absorb increased amounts of iron to the point where they may have clinical iron overload. Often times the serum ferriting is markedly elevated up to values of 2000 to 4000 ng/mL (normal 40 to 200 ng/mL). Very Respectfully, Dr. S
Jun 09, 2014 in the Heart Rhythm Expert Forum - 1
Hello. Thank you for your question. Yes your symptoms could be related to the heart. You are reporting two symptoms that could be explained by a unifying diagnosis (one disease explains both). That is, your shortness of breath and left sided chest pain discomfort. If one of my patients reported these symptoms I would do the following: 1. Complete histo...
Jun 09, 2014 in the Internal Medicine Expert Forum - 2
Hello. Thank you for your question. The decision to start rabies post-exposure prevention treatment depends on many factors, including how a patient is exposed and whether the animal can be observed or tested for rabies. For bats, people who have direct contact with a bat should be offered rabies treatment. However, treatment is not necessary if the person ...
May 28, 2014 in the Internal Medicine Expert Forum - 9
Hello. Thank you for your question. It is not uncommon for patients to have splenomegaly (enlarged spleen) with no prior diagnosed or evident condition. This problem is evaluated with a good history (including travel history, prior malignancy (cancer)), physical exam, complete blood count (CBC), liver function tests, urinalysis, and chest x-ray. It sounds ...
May 17, 2014 in the Heart Rhythm Expert Forum - 3
Hello. Thank you for your question. The symptoms you are investigating are called palpitations. In your case, your palpitations are felt as a detected fast heart rate. Artifact is a benign finding. It just means there was interference that caused false data. This can occur if the ECG leads were disrupted or you coughed or something like that. Your Ho...
May 07, 2014 in the Heart Rhythm Expert Forum - 3
Hello. Thank you for your question. Sinus arrhythmia is a benign finding that should not cause symptoms. The "extra-systoles" is another way for describing a PVC, or premature ventricular contraction. That can cause symptoms and is usually treated with beta blockers like you are on. For severe cases, different antiarrhythmics (with more pote...
Apr 27, 2014 in the Heart Rhythm Expert Forum - 1
Hello. Thank you for your question. The symptoms you are describing of palpitations, tachycardia (rapid pulse), and chest discomfort. Symptoms such as those warrant an evaluation. Even if your ECG was normal when you went to walk-in clinic, it only means your ECG was normal for the 6 seconds you hooked up to the ECG machine. The best way to evaluate pal...
Apr 27, 2014 in the Internal Medicine Expert Forum - 2
Hello. Thank you for your excellent question. Nystagmus, or rhythmic oscillations of the eyes, is usually in one direction (the fast beating component) toward the normal ear, whereas sometimes in central vertigo it can reverse direction. Also, in peripheral vertigo the nystagmus is horizontal, whereas in central vertigo it can be in any direction. You c...
Apr 23, 2014 in the Internal Medicine Expert Forum - 2
Hello. thank you for your question. A GFR>60 indicates normal renal function. Some patients have high normal serum creatinine for a number of reasons including age and increased muscle mass. This does not indicate impending renal failure. In regards to spleen size, it may indicate a hematologic problem. If your spleen was enlarged you could ask your ...
Apr 22, 2014 in the Internal Medicine Expert Forum - 1
Hello. Thank you for your question. The majority of ribes exposures occur from animal bites. However, there have been cases when bites are not involved. One such example is the virus being aerosolized in bat caves. I am not aware of rabies being spread from saliva left on food. The 4 major animal resevoirs has been reported to be bats, raccoons, skunks,...