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

 

 

 

 

 

 

 

 

 

As the Sun Sets…Vitamin D Deficiency


Vitamin D Deficiency

I often joke with patients that we never checked Vitamin D levels until Dr. Oz brought it to the forefront.  Thankfully he did and we are identifying more and more individuals with vitamin d deficiency and treating appropriately.

VitD8

The Centers for Disease Control and Prevention (CDC) reports that 32 percent of children and adults throughout the US are vitamin D deficient. Estimates of over 95 percent of elderly are deficient. 

 

Vitamin D Deficiency SymptomsVitD5
  • Fatigue
  • Bone pain
  • Muscle pain
  • Memory issues
  • Depression
  • Cardiovascular Disease
  • Diabetes
  • Hypertension
Vitamin D AKA the Sunshine Vitamin

VitD3

How much sun is enough?  You need your skin exposed without sunscreen or protective clothing interfering to be able to convert/produce Vitamin D.  There is an interesting calculator here to shed some “light” on it: Sun Exposure Calculator.  Keep in mind there really are so many factors(skin color, time of year, cloud cover, time of day, etc.) and to depend on the sun for your vitamin D is not ideal.

 

Vitamin D in our DietsVitD2
  • Fish
  • Egg yolks
  • Fortified dairy
  • Fortified grains

 

 

 Risk Factors for Vitamin D Deficiency
  • VitD0Diets limited in the above food sources
  • Limited sun exposure due to occupation, climate, or darker pigmented skin
  • Age
  • Obesity
  • GI issues that impact absorption

 

Vitamin D Supplementation

First and foremost check your levels before supplementing above the daily recommended allowances.  Vitamin D is a fat soluble vitamin and too much can lead to toxicity issues.  Basic guideline for baseline supplementation is 800-1000 International Units daily.   Multi-vitamins often fall short of the baseline supplementation.  Verify how much you are truly getting.   If you are found to be deficient supplementation would be much higher.

 

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

Tour of Direct Medical Care

Welcome to Direct Medical Care

 

Entrance

 

We are excited to share our clinic with you virtually. We have maximized our space for functionality and have tried to maintain a warm and friendly atmosphere.  Come on in and see for yourself…

 

 

 

                                               Direct Medical Care opened October 1, 2013

Established Sign
Established Sign

Our decor has taken off the past few months and everything has been done by our own staff member Kim Moppin.  She has amazing talent and has taken the old and made it new for us all to enjoy!

 

Waiting Area
Waiting Area

 

 

A special thanks to sweet patients who donated the old windows that adorn the wall in our waiting room.  Note the cute lamp Kim recently refurbished to add to the ambiance as well.

 

 

Reception Desk
Reception Desk

 

The reception desk area highlights a repurposed pallet displaying a hand-drawn and hand-painted silhouette of the great state of Missouri.

 

 

Platte County Map
Platte County Map

 

The hall boasts a map of Plattte County. Special thanks to Kim’s husband Chris for hanging and installing all of our new decor.

 

 

 

Our exam rooms:

Room 1
Room 1
Room 1 Shout out to our Pirates
Shout out to our local Platte County Pirates

 

Procedure Room
Procedure Room

Our procedure room is an important room to highlight.   We offer many services to keep patients out of local ERs, urgent cares, specialists offices, etc.  We are able to care for lacerations, skin lesions, IV hydration, simple fractures, electrocardiograms, and stat blood work to name a few.

 

 

 

Additional decor:IMG_7143IMG_7141IMG_7146IMG_7134

 

Hope to see you soon!

Ann Riggs, DO

cropped-dmc-logo.png
Patient-Driven Affordable Healthcare