My Epiphany as a Doctor: Navigating Today’s Healthcare for My Own Family–Part 2

When the Doctor’s Family Needs Medical Care

ShoulderBlog1My husband Craig had been complaining about his right shoulder hurting the summer of 2017.  To be the spouse of a doctor can be challenging because getting my attention medically can be tough at home.

We had tried conservative care with ice and ibuprofen for months.  We tried cold laser therapy. We even tried steroid injections with minimal relief.  He had significantly modified his activities due to the pain.  Shoulder Blog 4

The final straw:  he could no longer play catch with his daughters.

We got an MRI of his shoulder scheduled.  Our cash pricing through our Midwest Direct ShoulderBlog 2Primary Care Alliance was $240.00 cash at a local free-standing imaging clinic.

The MRI revealed no full thickness tear of the rotator cuff but there was a partial tear with joint effusion and chronic tendinosis and tendinopathy.

I consulted an orthopedic specialist online through Rubicon MD who recommended surgical evaluation over continued conservative care.

An online referral was started with the Surgery Center of Oklahoma.

In January 2018 Craig was set-up for a surgical consult late Thursday afternoon with anticipated surgery the following Friday morning in Oklahoma City.  We braved the typical January weather from KC to OKC.

After reviewing Craig’s case, the anesthesiologists/owners of the Surgery Center of Oklahoma hand-picked Dr. Couppens as the surgeon.  This former US Olympic team doctor met with Craig and modified the surgical plans with him given the magnitude of adhesive capsulitis(aka frozen shoulder) that had developed.
shoulder-blog-14.jpgThe next morning we arrived bright and early for surgery.  While Craig was being attended to I got to enjoy the company of Dr. Keith Smith and Dr. Steven Lantier the masterminds behind the Surgery Center of Oklahoma and the pioneers in the movement for price transparency.

The surgery was deemed a success and we drove home later that day.  The road to recovery included lots of rehabilitation over the next several months and we are now happy to report Craig is once again playing catch with his daughters.

 

Ann Riggs, DO

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My Epiphany as a Doctor: Navigating Today’s Healthcare for My Own Family–Part 1

Giving up Traditional Health Insurance

Blog 1 AI had blogged about them and had seriously considered them–cost sharing plans.

High-Deductible-Health-Plan-paired-with-a-Health-Savings-AccountI resisted giving up my traditional health insurance because of the beauty of the triple tax savings with the Health Savings Account(HSA) that I married to my high deductible plan.  I saw such value in that piece that I lost out on the bigger picture–saving money without sacrificing care.

What changed?AllieJ

I paid for my daughter’s surgery out of pocket in 2016 when the cost for the negotiated insurance pricing was higher than actually just paying cash.

I saved almost $1200 by paying cash.  Click to see the details in my previous blog.

AND

My traditional high deductible healthcare insurance plan I carried in 2016 was increasing from $820.00 per month to $2100.00 per month. 

The plan was not only going up by $1280.00 per month but it offered less coverage and had a higher deductible

The decision to move to the cost sharing plan was easy at this point.  We chose to go with Liberty HealthShare

Our cost became $450.00 per month for our family of four and our out-of-pocket portion or unshared amount(deductible) became $1500.00 annually.
Blog 1 B

Ann Riggs, DO

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Specialists at Your Service

We Do Know a Little Bit about a Lot…

Rubicon8As family practitioners we are expected to know a wide range of topics and health conditions.   And while we pride ourselves on knowing as much as we can about all things medical, it is impossible for us to know all the intricacies of specialty medicine.   We realize that a physician or colleague that focuses on one area of medicine has insight in that area that we might not have.

 

 

Rubicon3A Team of Specialists

Never fear at Direct Medical Care we have a team of hundreds of specialists available to us for consultation.

 

 

Rubicon MD

Over the past year we have been utilizing an online service called Rubicon MD.  It is an online eConsult platform that gives us access to hundreds of specialists and subspecialists in medicine.   What often takes three to six months to get consultation we can get in less than 24 hours.   Not to mention the cost to see that specialist after that long wait is estimated to exceed $200.

Rubicon2

Quality Care that is Timely

Rubicon5Last night I was reminded what an incredible offering it really is for our patients:

I had an interesting case that had me puzzled and decided to ask the specialist via Rubicon MD for some input and guidance.   I put together the clinical history and data at 6PM and had a response by 9PM.   The patient’s case was reviewed and reassurance that we were managing things correctly with added precautions on what to do moving forward.

Better care for patients that is affordable and timely is another added bonus at Direct Medical Care.

 

Ann Riggs, DO

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Welcome Dr. Parker to the Team!

PhillisParkerHeadShot (2)

On the eve of Dr. Parker’s first day in the clinic at Direct Medical Care I thought it only appropriate to share a little more information on her. Check out her bio:

Dr. Parker was born and raised in the Kansas City area.  She is one of six children of Dr. and Mrs. C. Phillip Pattison who reside in Weston, Missouri. After spending her freshman year of high school at Shawnee Mission Northwest she moved with her family to Rolla, Missouri where she graduated from Rolla High School in 2001. She returned to Kansas City later that year to attend the University of Missouri-Kansas City, School of Medicine. Upon graduation, she was chosen as the recipient of the Society of Academic Emergency Medicine Award. Dr. Parker spent one year at the University of Indiana Emergency Medicine Program in Indianapolis. After a year of Emergency Medicine training she chose to return to her passion for primary care medicine. She completed a residency in Family Medicine, followed by a Fellowship in Geriatric Medicine at St. Vincent Hospital. During her time in Indianapolis, Dr. Parker married her husband, Dr. Matthew Parker, and had three sons. Dr. Parker and her family returned to the Kansas City area in 2013 and they reside in Weston, Missouri.  She was employed as a Family Medicine physician at the Cerner Corporation through August 2017. During her time at Cerner she was the recipient of multiple patient service excellence awards. Dr. Parker chose to pursue a new path in medicine by joining Dr. Ann Riggs, Beckie Moore, and staff in her Direct Medical Care clinic in January 2018.  Dr. Parker is thrilled to be providing affordable, comprehensive, and most importantly, compassionate care for her patients. 

ParkerFamWelcome to Dr. Parker and her family to Direct Medical Care and our community!

 

Ann Riggs, DO and Staff

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Cold? Flu? What to Do??

Cold? Flu?

What to Do??

flu

This is the time of year that patients come in with many questions about the cold and flu. Should I get the flu shot? What happens if I get the flu? What do I do for the common cold? Though there are many things you can do to avoid catching these nasty viruses this winter, there is one remedy in particular that everyone should know about. Black elderberry has a long history of use in colds, and several studies in humans have shown that black elderberries not only reduce the severity, but also the duration of influenza. As a matter of fact, when the H1N1 flu was going around, the National Institute of Health screened a wide range of natural products to see if they had antiviral activity, and black elderberry ranked very high. Black elderberry has both antiviral and antibacterial properties, having effectiveness against influenza A, influenza B, and several gram positive and negative bacteria. Elderberry can be safe and effective for many of the common respiratory complaints people have during the cold and flu season. It’s safe for children, and safe for adults as well, making elderberry an essential member of your medicine chest this winter. I personally get my elderberry from www.mindfullymadeforyou.com to support local small business!

 

Beckie Moore, APRN

Integrative Medicine Fellow

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Baby Boomers Beware

The Scarehepc2

The recent commercial promoting screening for hepatitis C in the Baby Boomers has scared many of my patients and their friends. Scare tactics usually work for a desired action, but is this really necessary?  I would argue it is not.

Hepatitis C Commercial

The Facts

Hepatitis C is a virus that is transmitted by blood exposure.  It is estimated that almost 3.2 million people in the United States have the virus.

The hepatitis C virus can cause liver damage, can cause cancer, and can cause death because of the liver damage or cancer.  You can also have the virus and never develop symptoms.

hepc1

Risks for acquiring hepatitis C:

tattoos, blood transfusions, organ recipients, accidental needle sticks, IV drug use, and sexual intercourse

 

 

 

My Thoughtshepc3

Pharmaceutical companies that have a vested interest in the drugs used to treat hepatitis C have a lot to profit with increased diagnosis.  With increased screening, we get increased diagnosis which leads to increased usage of medications which leads to huge monetary gains for the pharmaceutical companies.  While we do not include hepatitis testing in our routine labs we do recommend annual evaluation of liver enzymes which indirectly looks for the presence of hepatitis C.

And while I have certainly lost patients from a variety of disease processes, I have never had a patient die from hepatitis C…don’t be scared regarding this issue, talk to your doctor.

 

Ann Riggs, DO

 

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Magnificent Magnesium

mag7.jpg

Role of Magnesium

mag5

 

Magnesium is #12 on the Periodic Table and is a mineral that plays a role in many bodily functions. There are over 300 reactions in your body that depend on this vital mineral.

 

Magnesium Deficiency

It is estimated that 80% of individuals would benefit from magnesium supplementation. Magnesium is not checked on routine lab evaluations.  Common signs of possible magnesium deficiency are below:

mag4

Magnesium Sources

Dietary sources:

  • mag1dark leafy greens
  • nuts
  • seeds
  • fish
  • beans
  • whole grains
  • avocados
  • yogurt
  • bananas
  • dried fruit
  • dark chocolate

Magnesium supplements:

There are so many forms of magnesium salts used for repletion and supplementation.

  • Magnesium Ascorbate
  • Magnesium Aspartate
  • Magnesium Bicarbonate
  • Magnesium Carbonate
  • Magnesium Chloride
  • Magnesium Citrate
  • Magnesium Fumarate
  • Magnesium Gluconate
  • Magnesium Glutamate
  • Magnesium Glycinate
  • Magnesium Hydroxide
  • Magnesium Lactate
  • Magnesium Lysinate
  • Magnesium Malate
  • Magnesium Orotate
  • Magnesium Oxide

Which is best???  And to be honest until writing this blog I had never considered the differences.  In my research, I now recommend one of the following:

Magnesium Citrate–induces more gastrointestinal side effects for individuals that may suffer from constipation

Magnesium Glycinate–induces less gastrointestinal side effects for individuals that do not have any constipation issues

Magnesium Oxide–most available, affordable and side effect profile more neutral

 

Ann Riggs, DO

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**disclaimer:  noted misspellings/grammatical errors in graphics but felt graphics value outweighed the errors.

 

Beckie Moore, APRN Brings “More” to DMC

Direct Medical Care Introduces Beckie Moore, APRN

BeckieFB

Beckie Moore, APRN was born in Wichita, Kansas and raised in Platte County, Missouri. After 12 years in Platte City, Missouri, she and her family settled just north of Dearborn, Missouri, where she enjoys her time away from patient care on her farm.  Beckie graduated valedictorian from North Platte High School in 1983.  She has been an RN since 1987.  Beckie went on to earn her Master’s degree in nursing from the University of Missouri, Kansas City in 1999.  As a Family Nurse Practitioner in the Northland for over a decade, Beckie noticed patients interested in and seeking alternative options that were not taught in her traditional western medicine education.  Seeking answers and education for herself, she discovered that the University of Arizona offered a two year medical fellowship in Integrative Medicine. Beckie completed her fellowship in 2016. She hopes to compliment patient care with her new knowledge base. Her passion is treating root causes of illnesses and promoting wellness at every turn.

Sneezing, Runny Nose, Itchy Eyes are Here

ALLERGY SYMPTOMS

  • Cough
  • Runny nose
  • Sneezing
  • Itchy nose
  • Sore throat
  • Watery eyes
  • Puffey eyes
  • Itchy eyes
  • Asthma flares
  • Difficulty breathing
Grastek5TIMOTHY GRASS ALLERGIES

One of the most common allergens is grasses and specifically timothy grass.  We are seeing these right now. While preventive treatment is ideal, treatment is currently focused on relieving the symptoms. There is a new option for allergy sufferers of common grasses for future seasons.  The middle of freezing temperatures is when the grasses are dormant.  It is that time that preventive treatment needs to start.

The newest option to treat for the timothy grass allergen is Grastek.   This is immunotherapy in a pill. For those that have endured the weekly shots this is a novel, relatively painless approach to immunotherapy that can be done in the comfort of your own home.

Grastek covers Timothy grasses but also has cross coverage to other grasses.

It should be started for seasonal care 12 weeks ahead of pollen and throughout the season or taken consecutively for 3 years.

Click on the following link for more information on administration of Grastek.

RAGWEED ALLERGIES
ragweed

Another common allergen that is on the horizon is ragweed.  Fortunately, our timing of discussing this form of treatment is ideal.  The same manufacturer of Grastek has developed a similar treatment for ragweed with the prescription drug Ragwitek.

Ragwitek like Grastek should be taken 12 weeks before the allergen season.  In this geographic area the typical ragweed season begins about August 15.  That gives an estimated start date of the medication in mid-May.

Ragwitek is taken similarly to Grastek with pre-seasonal and seasonal administration or continuous administration for 3 years.

TRADITIONAL ALLERGY CARE

Many other treatments remain the mainstay for allergy treatment: Grastek4

Oral Medications:

Antihistamines

  • Cetirizine–Zyrtec
  • Diphenhydramine–Benadryl
  • Fexofenadine–Allegra
  • Loratadine–Claritin, Alavert

Decongestants

  • Phenylephrine
  • Pseudoephedrine

Leukotriene Antagonist

  • Montelukast Sodium–Singulair

Nasal/Ocular Medications:

Steroids

  • Flonase
  • Nasacort
  • Nasonex
  • Qnasl
  • Rhinocort

Antihistamines

  • Astelin
  • Pataday
  • Patanase
  • Pazeo
  • Zaditor

Decongestants

  • Ephedrine
  • Oxymetazoline–Afrin, Sinex
  • Phenylephrine

Cromolyn

  • Nasalcrom

Anticholinergics

  • Ipratropium Bromide–Atrovent

Nasal Irrigation

  • Navage
  • NeilMed
  • Neti-Pot

Avoidance:

While avoidance can be difficult here are some pointers that may help:

  • Stay indoors when the pollen count is high especially between 5AM to 10 AM when pollen counts are highest
  • Wear a mask when mowing or avoid mowing altogether
  • Choose grasses for your lawn that produce less pollen–dichondra and irish moss are some examples
  • Mow frequently to keep grass short
  • Keep windows closed
  • Avoid attic fans
  • Bathe pets frequently
  • Do not dry clothes outdoors
  • Minimize alcohol intake as it leads to dehydration and increased sensitivity to allergens

Another topic to come…How do I know what I am allergic to?

Ann Riggs, DO

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