As 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.
A Team of Specialists
Never fear at Direct Medical Care we have a team of hundreds of specialists available to us for consultation.
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.
Quality Care that is Timely
Last 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.
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.
Welcome to Dr. Parker and her family to Direct Medical Care and our community!
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!
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 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 cancause 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.
Risks for acquiring hepatitis C:
tattoos, blood transfusions, organ recipients, accidental needle sticks, IV drug use, and sexual intercourse
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.
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.
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.
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:
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?
No better time to discuss smoking cessation than when we are at the new year and resolutions are starting to fade while the freezing temperatures outside continue. I tell my patients that are contemplating smoking cessation that if successful they will be richer in more ways than one. The health benefits of smoking cessation are clear. The often overlooked benefits of smoking cessation are the return of significant time and money.
decrease in bronchitis, COPD
decrease in blood pressure
decrease in heart rate
decrease in ALL cancers
decrease in diabetes
decrease in osteoporosis
decrease in rheumatoid arthritis
decrease in erectile dysfunction for men
decrease in ectopic pregnancies, miscarriages, small birth weight in pregnancy
decrease in second hand smoke decreases sudden infant death syndrome, ear infections, respiratory illnesses, and asthma
We never seem to have enough of either time or money and smoking cessation recaptures both.
The actual cost savings can be calculated here. The following depicts the savings realized when smoking 1 pack per day with a cost of $5.70 per pack:The amount of time spent smoking is estimated at 6 minutes and 20 seconds per cigarette. Calculations for smoking 1 pack per day equates to over 2 hours per day.
If you extrapolate the value of your time then your costs rise exponentially.
Smoking Cessation Aids
So you are ready but want some help. There are over-the-counter, prescription, and alternative options to help you be more successful.
Nicotine nasal sprays
Bupropion is a common anti-depressant medication that was once marketed as Zyban. This medication can diminish the cravings and withdrawal symptoms from the nicotine.
Chantix is for smoking cessation only and can diminish the cravings and withdrawal while also blocking nicotine effects from smoking.
E-cigarettes–long term safety has been unclear but recent studies identify significant concerns on safety and effectiveness
No better time than the present to kick the habit as you will be richer in more ways than one!
Influenza strikes every year and leaves much to be discussed. The flu statistics reveal that the highest risk groups are those 65+ years of age followed by those 0-4 years of age. The other high risk groups include pregnant women and those with chronic respiratory illness or those with weakened immune systems.
Seasonal influenza is typically the following with rapid onset:
Seasonal influenza is not typically:
The only absolute is a positive influenza swab. Unfortunately the test can be inaccurate. Some studies suggest the influenza swab is only 30% accurate while others suggest 70% accuracy. The best case scenario it misses 3 out of 10 individuals with influenza. This makes clinical suspicion and evaluation by your physician key in diagnosis.
Tamiflu or other antivirals are the only prescription form of treatment but have their limitations. They need to be started within 48-72 hours of onset of symptoms. Antivirals when started early in the course of the illness can decrease the severity of symptoms and length of course but are not a cure. Large families or those with high risk individuals may opt to take antivirals as preventive or prophylactic care when a known influenza carrier has been diagnosed.
Supportive care is the true mainstay of care for anyone with influenza:
There are always lots of opinions regarding vaccination. While it is not a perfect vaccine as far as guaranteed coverage for influenza, it is safe.
The CDC recommends annual vaccination for everyone 6 months of age and older.
Vaccination is one way to protect yourself from influenza and can reduce the severity of illness if contracted and prevent hospitalizations in addition to doctor visits and time off work.
Does the flu shot cause the flu?
No but can cause a flu-like response with mild headache, joint pains, and fever
How long until I am covered after receiving the vaccination?
Vitamin B12 deficiency May be Making you tired, foggy, and numb…
Fatigue is one of the most common complaints I hear from my patients that unfortunately can be caused by many things. Vitamin B12 is one of those causes and it is quite common. Vitamin B12 plays a crucial role in energy as it aides the conversion of our foods to energy for the body.
Patients often complain of difficulties focusing, forgetfulness, and just a general fuzziness. Vitamin B12 helps in cognition with overall brain health. Deficiencies can also lead to general mood disorders, depression, and insomnia due to its role in production of certain natural brain chemicals.
The classic presentation of B12 deficiency is a “stocking-glove distribution” of numbness. The hands and feet are described as numb or tingling. Vitamin B12 is utilized by the body in the maintenance and repair of the nervous system.
tongue changes–smooth, burning, or red
shortness of breath
diarrhea or constipation
Am I deficient?
If you have any of the above mentioned symptoms it is worth getting a simple blood test to evaluate your levels.
medications that decrease absorption–classically antacid medications
disease processes that affect absorption such as pancreatitis and inflammatory bowel diseases like Crohn’s Disease or Ulcerative Colitis
gastric surgery for weight loss
Vitamin B12 Dietary Sources
The human body doesn’t make vitamin B12 so dietary sources are essential. Common dietary sources:
Vitamin B12 Supplement Options
Vitamin B12 supplements come in pill form, sublingual tablets, nasal sprays, and injectables. Many people can’t absorb vitamin B12 through the gut so nasal absorption, oral absorption, or injections are often preferred.
Vitamin B12 deficiency is easily detected and easily treated if you look for it…