Cori Then and Now…Transformation Tuesday

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Cori is an avid football fan and is loyal to our Kansas City Chiefs.  Last spring she set out on a transformation that has changed her life.

Not only does she look fantastic but she feels healthier and happier with her progress. She is a mother of three active children and is excited to be setting a good example for them by being healthier and taking care of herself.

Cori’s encouragement for others is to be prepared for hard work.  The results will not be instant and expect setbacks.  It really is about making small steps towards a bigger goal.

How did she do it?  Hard work.  Nothing compensates for hard work.  She began running and really watching her diet.  Her diet focus was not only about healthier choices but also portion control.   Cori has completed two half-marathons and has plans for more.

Go Cori and Go Chiefs!

 

Ann Riggs, DO

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When our model hits home–the proof is in the pudding.

 

pudding

Pudding Proof

I recently had the opportunity to experience the pitfalls of my own commercial health
insurance.  I tell patients all the time “the proof is in the pudding.”  Well it was my turn to see how this pudding really was in the health insurance world.

 

 

Recurrent Streprapid_strep_pos

This past fall my daughter was hit with yet another bout of strep throat.  She has fought it throughout her young life.  At the age of seven I made the call to consult with one of my favorite ENT docs.  It was an easy decision that she would do better if we proceeded with tonsillectomy and adenoidectomy.

 

High-Deductible-Health-Plan-paired-with-a-Health-Savings-AccountHigh Deductible

I, like so many of my patients, have a high deductible plan that I have married with an HSA(Health Savings Account).  I knew the bulk if not all of the cost of the procedure would be my responsibility.  I did not hesitate to ask for cash pricing.

Insurance Negotiated Pricing vs Cash Pricing

Pricing for any surgical procedure needs to include the following fees:

  1.  Surgeon’s Fee
  2.  Anesthesiologist’s Fee
  3.  Surgical Facility’s Fee

INSURANCE NEGOTIATED PRICING:  

Surgeon $372.51
Anesthesiologist + Facility $2624.00
Total Cost $2996.51

CASH PRICING: 

Surgeon $402.50
Anesthesiologist $578.00
Facility $879.83
Total Cost $1860.33

FINAL PRICING AND SAVINGS:

I was actually able to pay the insurance negotiated pricing for the surgeon and the cash pricing for the anesthesiologist and the facility.  My final pricing was $1830.34 for the entire procedure.  And there lies the proof in the pudding:

Almost $1200 in Savings

Happy Healthy Kid at Great Cost Savings by Paying Cash

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Bear was Free!

Ann Riggs, DO

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Poison Ivy Prevention–Are you ready to ditch the itch?

Leaves of three, let them be!! Hairy vine, no friend of mine!! Raggy rope, don’t be a dope!! Berries white, run in fright!! Growing up in the midwest, most of us are well informed of this itchy summer issue. We know to avoid the plant, wear protective clothing, and wash the oil off as soon as exposed.

Image result for poison ivy, leaves of three, let them be

 

As a young child I was never allergic and spent most of my summers exploring the woods, marveling at the wonders of nature. When I developed a rhus (poison ivy, poison oak, poison sumac) allergy as a young adult, it seriously impacted my enjoyment of the summer!!

Five years ago I heard of a pharmacy in Warsaw, Missouri offering a poison ivy prevention treatment. My husband and I had recently purchased a farm with extensive poison ivy actively growing. I had spent the last 3 summers requiring multiple steroid injections for poison ivy so both of us decided to give this a try.

And it WORKED!! Each year it works even better. Some people get complete immunity. I have never been that lucky but have significant less skin eruption with direct contact of the plant and no spread. I have not required steroid treatment for 4 years now and might get one small blister in the area of direct skin contact with the plant.

This is a homeopathic treatment and does not impact medications or supplements. Poison Ivy Oral Solution is designed to work as a preventative to help protect against getting poison ivy. The cost for members is $40 and the cost for non-members is $60 at Direct Medical Care.  This solution is held in the mouth for 30 seconds and then swallowed. Poison Ivy Solution is best taken between meals. Mint flavored foods or mouthwashes must be avoided 30 minutes to one hour before and after administration. The first dose of the medication should be administered in a physician’s office, the other’s may be taken at home. Patients taking the Poison Ivy Solution during the plant’s active growth phase (late spring and summer) should keep away from the plant until all three vials have been taken.

First dose monitoring in the doctor’s office is related to the active ingredient in the solution. It contains a dilution of the resin of the plant Rhus Toxicdendron. I have not seen a case of allergy to the solution, but it is theoretically possible.

The treatment success I have experienced is part of the reason I pursued integrative medicine. It opened my eyes to the possibilities of alternative treatments. I typically order my own solution in March and will be putting an order in soon.

Are you ready to ditch the itch?

Beckie Moore, Integrative Family Nurse Practitioner

 

 

 

 

 

 

 

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.

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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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More Frazzled Than Dazzled?


stress1Whether you are traveling or hosting the holidays, this time of year brings with it an abundance of stress. Finding the perfect gifts and dealing with difficult family members can, for some, overshadow the reason for the season. Oh, and everyday life keeps on ticking as well.

What can we do to slow down, relax, remain healthy and enjoy??

Try this simple breathing exercise. It’s called the 4-7-8 breath and can actually alter our nervous system. It is calming and relaxing, it is free and it is easy!

Digital Download: Relaxing Breath, Calming PosterFirst, exhale completely, blow all that stress and frustration OUT.

Second, inhale through your nose to the mental count of 4.

Third, hold your breath for a mental count of 7.

Next, exhale through your mouth to a mental count of 8.

Lastly, repeat this sequence for a total of 4 breath cycles.

I recommend starting and ending your day with this breathing exercise and adding it in any time you feel stressed throughout your day.

This is quick, anyone can do it and it has research proven health/relaxation benefits.

This simple breathing technique can help us erase some of the stress in our busy lives.

The power of the breath! Is it really that easy? Try it and find out. Prepare to be Dazzled!!

—Beckie Moore, Integrative Family Nurse Practitioner

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Magnificent Magnesium

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Role of Magnesium

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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.

 

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
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Sun…friend or foe?

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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.”

skincancerribbonOne 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.

skincancerpreventIt’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.

Skincancer6Another 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.

skincancerabcde

 

 

  • 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.

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Submitted by Kim Moppin

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Go Red for Women

GoRed

American Heart Association Statistics:
  • Heart disease is the No. 1 killer of women and is more deadly than all forms of cancer combined
  • Heart disease causes 1 in 3 women’s deaths each year, killing approximately one woman every minute
  • An estimated 43 million women in the U.S. are affected by heart disease
  • Ninety percent of women have one or more risk factors for developing heart disease
  • Since 1984, more women than men have died each year from heart disease
  • The symptoms of heart disease can be different in women and men, and are often misunderstood
  • While 1 in 31 American women dies from breast cancer each year, 1 in 3 dies of heart disease
  • Only 1 in 5 American women believe that heart disease is her greatest health threat
  • Women comprise only 24 percent of participants in all heart-related studies
Risk Factors:
  • womenheartdzHigh blood pressure
  • High cholesterol
  • Diabetes and prediabetes
  • Smoking
  • Obesity
  • Physical inactivity
  • Family history of early heart disease
  • History of preeclampsia during pregnancy
  • Unhealthy diet
  • Age (55 + for women)
Know the signs:
  • Pressure, squeezing, fullness or pain in the center of your chest
  • Pain in one or both arms, back, neck, or jaw
  • Shortness of breath
  • Cold sweats
  • Nausea and/or vomiting
  • Dizziness or lightheadedness
  • Women can have more of the atypical signs rather than frank chest pain
    Heartattacksx

Direct Approach To Weight Loss

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The New Year often brings renewed commitment to weight loss or healthier choices.

I spend a lot of my time as a physician counseling patients on how to approach weight loss.

wtmgt4What is the key to successful weight management?  It truly is simple.  You need to have a calorie deficit.   A calorie deficit is when your daily calories burned are greater than your calories consumed.

The difficulty is that the number of calories burned in a day is so variable from person to person.  We each have what is called our basal metabolic rate which is the amount of calories our body uses just sitting around.  A 200 pound muscular male may have a basal metabolic rate of 3000 calories per day while a 200 pound obese male may have a basal metabolic rate of 1200 calories per day.  Comparing diet plans to your neighbor should never be done.  Discovering the calorie deficit for you as an individual to successfully lose weight is the key.

I had a discussion with a registered dietician/personal trainer about a client who was gaining weight despite her great efforts in the gym.  She had her on an 1800 calorie a day diet.  I pointed out that her basal metabolic rate is probably too low to allow for 1800 calories.  If she wtmgt9is working out one hour in the gym and burning 600 calories during that time and her basal metabolic rate is 1000 calories, she will gain weight.  The proof was in her lack of weight loss, but she went ahead and pursued VO2 max testing.  This test evaluates oxygen consumption at rest and estimates your basal metabolic rate.  I was not surprised when her results came back at 800 calories per day.

There are always questions about tools to help with weight loss.  Yes, there are many things that can be used to help aid in weight loss, but they are only tools to help you do the fundamentals. We all know individuals that have had success with surgery or medicine only to regain the weight and more.  If you use the aids to help you eat good food in appropriate portions, you will have success.  When surgery or medicine is used as the solution rather than the aid, failure is likely.

I am a runner and have learned fundamentally that it takes time and energy, methodically wtmgt7putting one foot in front of the other.  I have tools to help make the process easier—good supportive running shoes, inspiring music, and an app on my phone to tell me good job as I go.  The truth is I still have to run.  Weight loss is the same.  You still have to do the fundamentals—remember calorie deficit.

So what should a good diet plan focus on other than the number of calories?    Real food and not processed food which includes fruits, veggies, lean meats, and dairy.   This should be the mainstay of your diet.

weightmgt6Poor diet choices cannot be compensated for by hours in the gym—the math just won’t add up for an appropriate calorie deficit. Exercise is good and necessary for a healthy lifestyle, but it is not the key to good weight management.

 

Ann Riggs, DO

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