The Calorie Creep

But Doctor I am not eating that much…

While there are always exceptions rarely does one become overweight by not eating.

The balancing act of  creating a calorie deficit is key for weight loss.  Please see my prior blog post regarding the fundamentals of weight loss:

Calories Consumed < Calories Expended= Weight Losswtmgt4

It can be one misstep in your day that will sabotage all your good efforts.  Stealing the term introduced to me by an inspiring patient, I would like to bring “the calorie creep” to life in the pictures below:

Keep in mind it does not have to be junk food that can be your calorie creep–avoid the creep in whatever form!

Ann Riggs, DO

Patient-Driven Affordable Healthcare
Patient-Driven Affordable Healthcare

 

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

Patient-Driven Affordable Healthcare
Patient-Driven Affordable Healthcare

Richer in More Ways than One…

Smoking Cessation

Smoking0No 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
  • Smoking4decrease 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.timeandmoney

  • 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:Smoking5The 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.  Smoking7

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.

Smoking8Over-the-counter options:

  • Nicotine patches
  • Nicotine gum
  • Nicotine lozenges

 

 

Prescription options:

  • Nicotine inhalerssmoking9
  • 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 groupsSmokingQuit

No better time than the present to kick the habit as you will be richer in more ways than one!

Ann Riggs, DO

Patient-Driven Affordable Healthcare
Patient-Driven Affordable Healthcare

Alternative Affordable Healthcare “Insurance” Option

 

The Alternativeaffordablecare

My patients often prove to be my best resource in providing patient-driven affordable healthcare.  A viable health coverage plan eludes many of us and often those with a plan quickly discover its shortcomings.  One of our earliest members at Direct Medical Care introduced me to a great alternative to healthcare “insurance”–health cost sharing plans that are truly affordable.  These plans have been around for over 20 years and I anticipate they will become more and more favorable with the current direction of healthcare.

Health Cost Sharing Plans
  • Health Cost Sharing Plans(HCSP) do qualify as approved health insurance coverage by the Affordable Care Act.  
  • The general philosophy is in line with Direct Medical Care’s as HCSPs “seek to return health care to a private, patient-centered model” and “(are) designed to restore and protect the doctor-patient relationship.”
  • Our patients using these plans attest that their experiences have exceeded their expectations.

Check out the following cost sharing plans:

 

samaritanSAMARITAN MINISTRIES

Samaritan Ministries was established in 1994.  Their focus is Christians helping Christians.  Not only are they focused on the financial burdens taken on by the community of Christians but the physical, emotional, and spiritual burdens as well.

 

 

MEDI-SHAREMedishare

Christian Care Ministries was established in 1993.  Their focus is on carrying each other’s burdens while utilizing not only financial resources but individual talents, networks, and their faith.

 

 

LIBERTY DIRECTLiberty-Direct-Logo

Liberty Direct was also established over 20 years ago and interestingly has the same share amounts today that they did when they began.   They focus on helping like-minded individuals who are committed to their individual health and well being of their community.

 

Ann Riggs, DO

Patient-Driven Affordable Healthcare
Patient-Driven Affordable Healthcare

 

 

 

 

 

 

 

 

 

To Flu or Not to Flu

“I have the flu…”Flu3

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:

Flu2
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 children doctorbe 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 Flu1limitations.  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.

Flu4The 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?

           2 weeks

Common Sense Prevails

  • avoid contact with those with symptoms
  • wash your hands
  • eat healthy
  • exercise
  • rest

Stay well!

 

Ann Riggs, DO

DMC Logo
Patient-Driven Affordable Healthcare

 

 

 

 

 

Tired, Foggy, and Numb?

Vitamin B12 deficiency May be Making you tired, foggy, and numb…
b12def5

 

TIred?

B12fatigueFatigue 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?b12def6

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?b12def3

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

b12def4The 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…

 

Ann Riggs, DO

Patient-Driven Affordable Healthcare
Patient-Driven Affordable Healthcare

 

 

Much Needed ICD-10 Codes

ICD-10 codes: Making the practice of medicine “better”

 

ICD10Engine

V97.33XD: Sucked into jet engine, subsequent encounter

How does one survive to even have a subsequent encounter?  I guess it has been done before: Jet engine survivor.

 

ICD10inlaws

 

Z63.1: Problems in relationship with in-laws

We see the applicability here…this will be used often.

 

 

 

ICD10duck

W61.62XD: Struck by duck, subsequent encounter

Watch out for ducks–especially during migration…

 

ICD10spacecraft
W22.02XD: V95.43XS Spacecraft collision injuring occupant, sequela

Just saw this last week…

 

 

ICD10bucket
W16.221 Fall in (into) bucket of water causing drowning and submersion

…why? just why??

 

 

ICD10bizarre
R46.1: Bizarre personal appearance.

All a matter of opinion…

 

ICD10skating
V00.01XD: Pedestrian on foot injured in collision with roller-skater, subsequent encounter

Beware of the roller skater this summer!

 

 

ICD10WaterSkiBurn

 

Y93.D: V91.07XD:  Burn due to water-skis on fire, subsequent encounter

One of my greatest fears!

 

 

Floods2015

 

X38.XXXA Flood, initial encounter
X38.XXXD Flood, subsequent encounter
X38.XXXS Flood, sequela

Using all three codes this year!  

 

 

Ann Riggs, DO

Patient-Driven Affordable Healthcare
Patient-Driven Affordable Healthcare

Direct Medical Care’s Top Ten List

TopTenDirect Medical Care’s Top Ten Patient Experiences

1—“Dr. Riggs your glow is back.  You seem so happy!”

2—A patient gets access to care for $400.00 vs $2400.00 that literally saved his life

3—A patient is reimbursed $300.00 of his $500.00 annual membership with his first claim submission.  “I feel like I hit the jackpot!”

4—Access to CT scan for cash at $350.00 vs hospital quote of $3382.00

5—The proof is in the pudding:  a patient puts families expenses into a spreadsheet with previous year’s expenses and finds marrying his plan with our services would have resulted in over $7500.00 in savings in one year

6—Our Medicare patient not only gets it but loves our model–he knows how doctoring used to be and the true costs of using your health insurance

7—Wholesale drugs that offer convenience and lower cost of short and long term medications.  $140.00 for one month of blood pressure medication dropped to $28.00 for the same medication.   Annual savings of $1344.00.

8—“The nose doctor(AKA Dr. Riggs) is right next to sonic—that is genius!”

9—“I really feel like I should pay you more.”

10—Every time a patient says, “It just makes sense.”

Ann Riggs, DO

Patient-Driven Affordable Healthcare
Patient-Driven Affordable Healthcare

The Itsy Bitsy Spider

BrownRecluse2Brown recluse Season

Spring cleaning outdoors and indoors is in full swing and spiders are making their return.  In the Midwest we always have the concern for brown recluse spider bites.   The spiders are mostly active beginning in March and going through October.

BrownRecluseMap
Regional Distribution of the Brown Recluse Spider

 

The brown recluse spider is more active at night and tends to like dark, undisturbed locations.  Watch out for dead timber outdoors and dark corners in your garage and basement.

 

 

 

The brown Recluse Spider
Typical Appearance of Brown Recluse Spiders
Typical Appearance of Brown Recluse Spiders

Size: 0.25-0.75 inches

Color:  cream-colored to dark brown or blackish gray

Markings: violin on back(note other spiders with similar)

The Brown Recluse Spider BITe

The brown recluse is a venomous spider.  Its bite is known for large necrotic skin lesions but often only results in a small pimple or pustular lesion.

Pustular Lesion
Pustular Lesion
Necrotic Lesion
Necrotic Lesion

 

 

 

 

 

Treatment for Brown Recluse Spider Bites

There is no anti-venom for a brown recluse spider bite.  Treatment is supportive and is directed at the inflammation, necrosis, and secondary infections.  The following are possible treatments:

  • Tetanus immunization if not current
  • Antibiotics for any secondary infection or prevention of secondary infection
  • Anithistamines to help with any swelling or itching
  • Prednisone to help with inflammation while controversial is commonly used
  • Dapsone also controversial has been used to help with the necrosis
  • Pain medications
  • Wound care
Prevention and Brown Recluse Spider Control
  • Clean up wood piles and keep away from your house
  • Keep your bed away from walls and declutter under bed, avoid bed skirts
  • Keep clothes off the floor
  • Watch out for infrequently worn shoes, garden gloves, baseball mitts, etc.
  • Watch out getting things out of storage areas i.e. cardboard boxes
  • Generalized decluttering
  • Use sticky traps to assess population burden and control

Ann Riggs, DO

Patient-Driven Affordable Healthcare
Patient-Driven Affordable Healthcare

Family Docs Going Back to Their Roots

Grandpa“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—Accountabilityaccountable 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.  AccessibilityIt 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 Affordabilityinsurance 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.

Ann Riggs, DO

Patient-Driven Affordable Healthcare
Patient-Driven Affordable Healthcare