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
My Thoughts
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.
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:
Magnesium Sources
Dietary sources:
dark 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
Patient-Driven Affordable Healthcare
**disclaimer: noted misspellings/grammatical errors in graphics but felt graphics value outweighed the errors.
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.
RAGWEED ALLERGIES
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:
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?
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.
Health Benefits
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
Non-Health Benefits
We never seem to have enough of either time or money and smoking cessation recaptures both.
Money
Time
Time=Money
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.
Over-the-counter options:
Nicotine patches
Nicotine gum
Nicotine lozenges
Prescription options:
Nicotine inhalers
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.
Alternative options:
E-cigarettes–long term safety has been unclear but recent studies identify significant concerns on safety and effectiveness
Hypnosis
Acupuncture
Support groups
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:
Symptoms of Influenza
fever
chills
profound fatigue
headaches
joint pain
runny nose
cough
sore throat
Seasonal influenza is not typically:
nausea
vomiting
diarrhea
Diagnosis
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.
Treatment
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:
fluids
rest
acetaminophen
Flu Vaccine
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.
Common questions:
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…
TIred?
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.
Foggy?
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.
Numb?
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.
Other Symptoms?
pale skin
tongue changes–smooth, burning, or red
heart palpitations
shortness of breath
diarrhea or constipation
vision difficulties
Am I deficient?
If you have any of the above mentioned symptoms it is worth getting a simple blood test to evaluate your levels.
Risk Factors:
age
vegetarian/vegan
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:
meat
poultry
seafood
dairy
eggs
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…
So it’s summertime right? …time for the beach, lake, swimming pool, water park, and baseball games. You pack up all your gear and head out to have some fun in the sun. And sometimes it’s hard to remember to pack the sunscreen, apply it, not to mention reapplying it all-day-long. Then there’s that nice tan glow we all love to have in the summer. But…..
“More than 3.5 million cases of non-melanoma skin cancer are diagnosed in the US each year, and more than 73,000 cases of melanoma are expected to be diagnosed this year.”
One in five Americans will develop skin cancer in their lifetime, melanoma being the most deadly form. In fact, an estimated 9,940 people will die of melanoma in 2015. Prevention is obviously key when it comes to skin cancer. Daily use of a sunscreen with SPF 15 or higher reduces your risk of developing squamous cell carcinoma by 40 percent and melanoma by 50 percent.
It’s an easy thing to over-look…I mean it’s the sun, we go outside, we go inside, it’s our world, and therefore easy to forget. But trust me, for those of you that have been blessed to not have gone through it in your life, there’s nothing scarier than hearing that your best friend, your 36 year old sister, has been diagnosed with Stage II Melanoma. And there’s no time that is longer or goes by slower than the time it takes for lymph node biopsy results to come back. There’s no exposure, from the sun or tanning bed that is “better” for you or less harmful than the other. Sunless or “spray tan” is a good option to consider if you feel like you need some color or that summertime glow.
Another important step is having annual skin checks, as well as watching for any changes to existing or new moles on your body. This one, to me, is a no-brainer. Skin cancer is the one form of cancer that allows you to see your tumor…right there, in plain sight, on the outside of your body. The woman with the lump deep in her breast, guy with a tumor on his kidney or deep in his brain, or child with cancer in their bone marrow didn’t have that chance. It was hidden inside, not able to be seen, causing harm, just waiting to be found. So take advantage of the chance to have this particular cancer identified and stopped in its tracks as soon as possible.
“Each year there are more combined incidences of skin cancer than the combined incidence of cancers of the breast, prostate, lung, and colon.”
There are some key characteristics, known as the ABCDEs of skin cancer, that you can look for to help identify a potentially dangerous mole.
Asymmetry
Border
Color
Dimension
Evolving
So get outside this summer and have a blast enjoying this time of year and all the activities that go along with it! Just remember to drink plenty of water and make sure to wear sunscreen to protect yourself from the harm that our sun’s rays can cause….and hey, take heart in knowing that you’re preventing all those future wrinkles.
I found myself laughing the other day when a patient quoted back to me, “Water is my friend.”
I say it several times a day with a bouncy little cadence, “Water is your friend. Water is water–not pop, coffee, or tea. Water is water.”
Whether a patient is sick, well, seeking diet advice, or general well-being, the phrase makes its way into my patient interactions multiple times a day. A very simple concept but so often ignored.
Water is essential
The average person is made up of 55% water–60% in men and 50% in women. While water is found in all tissue, the bulk of the water is found in your lungs, blood, skin, muscles, brain, and bones.
Water is key in:
brain function
lung function
muscle function
bone health
regulating body temperature
maintaining weight
transporting of blood containing oxygen and nutrients to all tissues
How Much should I drink?
We have probably all heard the eight cups of water a day rule. While this is a good rule, you may fall short of your body’s daily needs.
A better estimate as depicted in the graphic to the left takes weight into account. Keep in mind the fitter you are the more water you need as lean tissue contains more water than adipose tissue.
Your activity levels are also going to increase demands on water intake as well. With every 20 minutes of exercise anticipate a minimum of 6 oz of additional water intake.
Thirst is not a good indicator. If you are thirsty you are already behind on your water balance.
Your urine is another tip-off to your hydration status. It should be clear to light yellow.
Why Doesn’t Pop, Coffee, or Tea Count?
Pop(or soda), coffee, and tea are traditionally consumed with caffeine. It is the caffeine that takes them off the list as providing you any hydration. In fact, the caffeine acts as a diuretic and robs your body of essential water. Rule of thumb I tell patients is to consume an extra cup of water for every cup of caffeinated beverage or avoid them altogether.
“Oh, the good old days—the good old days when your doctor was accountable, accessible, and affordable to you.”
Grandpa remembers when Doctor Johnson used to make house calls. He also remembers seeing him at the local baseball fields helping his best friend David with his twisted ankle that hot July summer night after he slid into home plate. Grandpa says when Grandma was having troubles getting her medicines Doctor Johnson called the hometown pharmacy to ensure they got delivered on Saturday. Grandpa doesn’t recall ever having troubles getting in to see Doctor Johnson and certainly doesn’t recall being rushed through a ten minute appointment. He also said if their neighbor Judy couldn’t pay her bills, well good old Doctor Johnson just took care of her. Oh, the good old days—the good old days when your doctor was accountable, accessible, and affordable to you.
Here enters a new model of practice that is sweeping the country for primary care services—Direct Pay Care. Patients forego insurance to cover their preventive care for drastically discounted prices. Doctors spend less time on paperwork, compliance checklists, and coding issues so they can focus on spending time with and taking care of their patients.
Just the other day my six-year-old daughter asked me why I became a doctor. Well, it certainly wasn’t to argue with insurance companies over covering a test I felt was clinically indicated. It wasn’t to document for eight hours of my twelve hour day to justify my care. And it certainly wasn’t to be told whether I was a good doctor or not by a checkbox.
In this day of escalating healthcare costs and regulations, many family physicians are finding themselves turning back to their roots to practice medicine as Doctor Johnson did. Most family physicians went into family medicine because they like taking care of people. Unfortunately with the demands today in our current system, the focus has become less and less about caring for patients.
Accountable
Imagine if your doctor was accountable to only you. Not to insurances nor government—accountable just to you. Some family doctors are doing exactly that and going back to focusing on their patients’ needs without excessive regulatory distractions. By avoiding some of the red tape imposed by insurance and government entities, the doctor becomes more accountable to the patient. It is estimated that the average family doctor spends only one third of his or her time actually with their patients. So what is your doctor doing the other two thirds of the time? He or she is charting, coding, and arguing with insurance companies. Clearly this does not improve your care.
Accessible
Imagine if your doctor was accessible to you. A wise physician mentor once told me no matter how talented or nice I was as a physician, if I wasn’t “accessible” I was no good to my patients. It is commonplace to wait weeks or even months to see your “regular” doctor. It can be challenging to get a nurse to return a phone call let alone a physician. This has become the standard of care that is accepted by patients. This should not be the standard as the physician patient relationship is sacred, and the quality of care suffers because of it. Some family doctors are making themselves accessible by email, open access to charts, same day appointments, and even providing patients their personal cell phone number.
Affordable
Imagine if your doctor was affordable. Direct pay family doctors are back to taking cash for their services at a fraction of the cost of insurance pricing. The average family’s annual health insurance premiums are over $13,000. That cost is shouldered by the employer and the employee and does not reflect co-pays or out of pocket expenses. The standard use of insurance outside of healthcare has been to cover catastrophes. We would never expect our car insurance to pay for an oil change or our house insurance to pay for a new carpet. Our expectation for our health insurance to cover our every day preventive medical care has made health care costs rise exponentially. By eliminating insurance usage at the primary care level, the cost of care and the potential savings to the patient and their employer are staggering.
It has been and is common practice for an employer to pay $500 monthly for an individual’s premium. While the employees don’t see that expense, it does affect them. If the employer were to move to a high deductible plan monthly premiums would drop to under $200. That is $300 in savings for the employer. That money could then be applied to a Health Savings Account that is tax-free money the employee can use for healthcare expenses now or later. In addition, a portion of the savings could also be used to supplement the employee’s salary.
The latest trend in healthcare coverage has been to provide these lower premiums and higher deductible plans combined with health savings accounts. This is a fundamental change that supports the direct pay model. Your dollars are maximized with heavily discounted rates for office visits, labs, and imaging while your remaining money is put into your health savings account rather than lost to insurance premiums.
Accountability, accessibility, and affordability are making a comeback and it is about time. “They just don’t make things like they used to,” said Grandpa. Well Grandpa, many physicians have listened and are trying to do just that with Direct Pay Care.
dark leafy greens
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.
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.
The CDC recommends annual vaccination for everyone 6 months of age and older.
