Beckie Moore, APRN Brings “More” to DMC

Direct Medical Care Introduces Beckie Moore, APRN

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.

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 Loss

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

 

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

TIMOTHY 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

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?

Ann Riggs, DO

Patient-Driven Affordable Healthcare

Richer in More Ways than One…

Smoking Cessation

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!

Ann Riggs, DO

Patient-Driven Affordable Healthcare

To Flu or Not to Flu

“I have the flu…”

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?

           2 weeks

Common Sense Prevails

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

Stay well!

 

Ann Riggs, DO

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.

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 Symptoms

• Fatigue
• Bone pain
• Muscle pain
• Memory issues
• Depression
• Cardiovascular Disease
• Diabetes
• Hypertension

Vitamin D AKA the Sunshine Vitamin

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 Diets

• Fish
• Egg yolks
• Fortified dairy
• Fortified grains

 

 

 Risk Factors for Vitamin D Deficiency

• Diets 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

 

Tired, Foggy, and Numb?

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…

 

Ann Riggs, DO

Patient-Driven Affordable Healthcare

 

 

Cold Laser Therapy

Cold laser therapy is a novel, non-invasive approach to treating inflammation and promoting healing.

It is FDA approved and has been utilized in America for over 16 years.

Contrary to its name it is not cold at all–it is a pulsatile, low-level laser that will not burn.

 

Cold laser therapy has also been referred to as:

• low-power laser
• low-light therapy
• soft laser
• biostimulation laser
• therapeutic laser
• laser acupuncture

We introduced cold laser therapy in our office over 6 months ago.  We have been impressed with its results for back pain, shoulder pain, elbow pain, heel pain AKA plantar fasciitis, and much more.

The cold laser is thought to work by decreasing inflammation and thus pain by decreasing the following:

• prostaglandin E2
• prostaglandin-endoperoxide synthase 2
• interleukin 1-beta
• tumor necrosis factor-alpha
• neutrophil granulocytes
• oxidative stress
• edema
• bleeding

The greatest advantage is that there are NO serious side effects.  It is a great option to try to avoid medications and surgery.

While insurance is variable on recognizing cold laser therapy as a reimbursable treatment, we are pleased to announce we have had patients receive reimbursement for this service at Direct Medical Care.

 

In as little as 2-4 treatments per week, we have seen 80-90% improvement in symptoms.

 

If no improvement by the 4th treatment alternate treatments can be utilized. Combining therapies can maximize healing and return to health.

Ann Riggs, DO

Patient-Driven Affordable Healthcare

 

Sun…friend or foe?

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.

Submitted by Kim Moppin

Patient-Driven Affordable Healthcare

Direct Medical Care’s Top Ten List

Direct 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