Happy Thanksgiving!

Happy Thanksgiving!

One thing I sometimes recommend to people is that they make a gratitude list to remind themselves of all the good things that they have going on in their lives.  There are several things that I am particularly aware of being grateful for this year.  Probably the top 2 things are my family and the strength I have found in the Direct Primary Care community.

Most Primary Care physicians today are employed by groups or hospital systems.  As a former employee, I can attest that this is a difficult spot to be these days.  While as an employee I did have the relative security of having an income, I lacked much control over the process of how I cared for patients. Even though I became involved in leadership teams, I was a piece in a much larger system and did not have the authority to make many decisions.  It was frustrating to have ideas about how I could better care for my patients and create a better environment to practice in, and not be allowed to implement any of my ideas for a multitude of reasons.  I found out about Direct Primary Care while reading a practice management magazine – and a light bulb went off. I had a choice.  Patients had a choice.  There was a better way to do things. 

As an independent DPC physician, I am responsible to make sure my office runs the way I want it to as well as providing excellent patient care.  I am a small business owner – something I received precious little training on in residency – which was 16 years ago… I have had so much to learn in this area and I am truly thankful for those who have helped me along the way.  From DPC physicians who opened their practice for me to visit them, to people who coached me on how to write a business plan and sagely advised me to make it for 3 years and not 1; from SCORE mentors advising me on commercial real estate to other members of the Chamber and BNI who have given me suggestions on marketing and bookkeeping.  I am part of a tribe of over 1000 physicians nationwide who are going down parallel paths in opening independent businesses and the support we give each other through Facebook groups, and conferences has been amazing.  I am blessed to have my family who has listened to my ideas, gone to conferences with me, and helps me keep things in perspective as I go through the rollercoaster of being a new business owner.

I am thankful that my mom has completed chemotherapy this month and that my sister and I are living in the same metro area for the first time in 30 years.  I am thankful that my daughter is still able to enjoy her dance and that my son will be graduating from college this summer.  I am thankful that my husband is able to remind me of where I have been and where I am trying to go and WHY I am going there when I get bogged down with daily challenges. And I am thankful for the unquestioning love that our furry friends give us on a daily basis. 

I am privileged to be able to share people’s journey towards better physical and mental health.  Patients open their lives to me and we are able to talk about their goals, dreams and hopes – and how they can try to achieve them.  They share their pain and grief – and I am allowed to counsel them, or just be present with them in the moment. Being a doctor is not a matter of just writing a prescription or a referral – it is much more than this – it is a calling where one human is able to care for another to try to restore and/or maintain health – by drawing on their previous experiences, research and knowledge and melding that with what the other person wants and needs. 

It has been a crazy year and I have much to be thankful for and I am looking forward to what the next year brings.  It’s quite a journey!  Thank you for coming on it with me!

 

How to Measure Your Blood Pressure

How to Measure Your Blood Pressure

Blood pressure measured in my office can be different from blood pressure people may have when they are at home or at work.  In order to figure out how much of a problem someone’s blood pressure is we frequently need them to monitor it on their own.  Below are some common situations where I recommend people check their blood pressure.

1)    If the diagnosis is unclear.  Patients sometimes blame an elevated blood pressure reading on “white coat syndrome” – in other words it is just up because they are in my office but it is really ok the rest of the time.  While sometimes this is true, I really hope that coming to see me isn’t the most stressful part of their life.  If their blood pressure is up when they see me,  I frequently wonder what it is when they get home at the end of a long day!

2)   Sometimes people have concerns like headaches – which can be related to blood pressure – or a number of other health issues.  If they have a headache and check their blood pressure we can see if these problems are related or not.

3) When someone has a diagnosis of hypertension – they can see how their blood pressure is between visits and how it is influenced by different things in their life like stress, smoking, weight loss/gain and also how their blood pressure is in between doctor visits .  Hypertension is a chronic health problem – and like all chronic health problems – people tend to do better when they are actively involved with their own care.  If someone monitors their blood pressure and is seeing that it isn’t where we want it to be then they can let me know and we can figure out what the next steps are instead of waiting for their next scheduled visit.

 

***Note *** This post, like all my other posts, is for general medical information only and is not to be taken as direct advice.  Please consult your personal physician for more information.

Be Careful – It’s HOT outside! Heat Exhaustion 101

Be Careful – It’s HOT outside! Heat Exhaustion 101

Heat Exhaustion is a heat related illness that  can happen after being exposed to hot temperatures for a long time.  People who are overweight, have diabetes or hypertension, are under 4  or over 65 years old, or are taking certain medicines (like diuretics, beta blockers, antipsychotics or antihistamines) are more likely to have problems in this situation but anyone who is working or exercising outside is at increased risk.  Heat exhaustion is more common when the heat index is up – if the temperature is over 90 degrees and it’s humid.

Some  signs of Heat Exhaustion are:

  • Profuse sweating
  • Rapid heart rate
  • Dark-colored urine
  • Dizziness
  • Fatigue
  • Headache
  • Muscle or abdominal cramps
  • Nausea, vomiting, or diarrhea
  • Pale skin
  • Rapid heartbeat

Treatment is – you guessed it – GET OUT OF THE HEAT – preferably into an air conditioned area and rest.   It is also a good idea to drink cool fluids (without alcohol or caffeine), remove any extra clothing, take a cool shower, apply cool towels, use a fan to circulate cool air to speed cooling.  If you aren’t feeling better within 15 minutes it would be a good idea to go to the ER for help as heat exhaustion can progress if not treated.  If someone is confused, passes out or isn’t able to drink cool fluids they should go ahead and go to the ER for treatment without delay.  Untreated heat exhaustion can progress to heat stroke with body temperatures going over 104 degrees and lead to the brain, kidneys, heart and muscles and even death.

Preferable still is to avoid heat exhaustion – wear loose fitting, light weight clothing, drink a lot of fluids, avoid exertion in the middle of the day, limit exercising or working in the heat until your body gets more used to it, avoid alcohol use, and if you start to get muscle cramps and feeling overheated STOP what you are doing and get in a cool area and drink fluids so it doesn’t progress.

After having an episode of heat exhaustion you will be more sensitive to heat over the next week or so, so avoid exercising or working outside in the heat during this time.

Read more information from the CDC about heat illnesses by clicking here.

***Note *** This post, like all my other posts, is for general medical information only and is not to be taken as direct advice.  Please consult your personal physician for more information.

Dealing with Depression

Dealing with Depression

A lot of people have been talking about depression this week in the wake of Kate Spade’s suicide.  Her husband  said she was trying to get help – but she was still suffering.  I don’t know what kind of treatment she was undergoing, but I was saddened to see her to join the list of people who we have lost to depression over the years.  Please know that recovery is possible –  although while you are depressed, you may feel that it isn’t.

Depression isn’t something you can just “snap out of” but there are things that you can do to help yourself.  Since one of the symptoms of depression is decreased energy, it can be overwhelming just thinking about making a change – so start with one and go from there.

Self-care tips for depression

  • Look after your body and your brain
    • participate in physical activity for 30 minutes a day – go for a walk outside if you are able
    • eat healthier meals – avoid foods high in sugar/carbs that can contribute to mood and energy swings
    • avoid alcohol and recreational drugs – alcohol can actually cause depression, people coming off of meth/stimulants can frequently feel depressed
    • sleep in your bed – not in front of the t.v.
  • Find a sense of meaning
    • volunteer
    • talk to your spiritual leader or someone from your worship community
    • journal,  make a gratitude list
  • Decrease your stress
    • postpone any major decisions you can until after you aren’t depressed
    • keep with your daily routine – small things like getting up and making the bed and taking a shower can help – and you may feel worse if you don’t do them
    • allow yourself to leave work at the end of the day and take your weekends/holidays
    • do yoga, meditate, pray
    • do something creative – draw, play music, write poetry, short stories – to get your emotions out – you don’t have to show anyone what you have done
    • spend time with your pet
  • Connect with the community you already have – stronger connections can help you get well faster
    • participate in activities you are invited to even if you don’t feel like it
    • do an activity with a friend you haven’t connected with recently – go get a coffee, go for a walk or swim
    • schedule things in advance instead of waiting to see what you feel like doing – if you are depressed, you may not feel like doing anything

Treatment for Depression

If you have been dealing with symptoms of depression for more than 2 weeks and things aren’t getting better or if your symptoms are severe, talking to your doctor can help get you connected with the help that you need.  You can go for counseling, take medications  (or both) to get relief while you continue the self-help tips I have listed above.  If your depression gets worse and you are thinking about hurting yourself – please reach out and call the Suicide Lifeline 1-800-273-8255.

Depression  can make you feel isolated  – in part due to symptoms of the disease, as well as the social stigma that may go along with it.   You may find community from joining a small group at your place of worship, or through something like Meetup.  If you want to connect with others who are dealing with mental health problems, there are organizations that help with that too.  Groups like NAMI are designed to help people  (and their families) find a community that understands what they are dealing with.  In the Greater Cincinnati area, there is both a Northern Kentucky and a Southwest Ohio NAMI group.  Another agency in Northern Kentucky that provides peer and family support is Mental Health America.

I don’t recommend that you take much time off of work and stay at home if you are depressed.  I have found that the isolation that people feel staying at home and the lack of routine that comes with taking time off, can actually make people worse instead of better.  If your depression is severe – but not bad enough to be in the hospital, participating in a structured program like partial hospitalization or intensive outpatient treatment  can help.   Depression is a medical condition and you can qualify to take time off for treatment if you are covered under FMLA.

The most important thing to remember is that there is hope.  Depression is treatable.  And, you are not alone.

 

***Note *** This post, like all my other posts, is for general medical information only and is not to be taken as direct advice.  Please consult your personal physician for more information.

 

New Colon Cancer Screening Recommendations

New Colon Cancer Screening Recommendations

Colon cancer screening has been recommended to start at age 50 for many years.  The most common choices for screening are colonoscopy every 10 years, stool DNA tests every 3 years, testing  the stool for blood yearly.  Specific recommendations are made based on an individuals risk assessment which includes their past medical history as well as their family history.  Recommendations look at the likelihood and benefit of finding a colon cancer and try to balance that with the risk and cost of the test. There are several agencies that make recommendations on how to screen for cancer – the U.S. Preventative Services Task Force, American Cancer Society, and American Academy of Family Physicians are the 3 that I usually take into consideration.

The American Cancer Society came out last week with the recommendation that screening for colon cancer start at age 45 instead of 50. This was based on the fact that people are developing colon cancer at an earlier age than they used to.  Screening recommendations vary over time – for example: the flexible sigmoidoscopy used to be a recommended option to be done every 5 years – but this isn’t done as much now since it only allows the doctor to see the left half of the colon, and there has been an increase of cancers on the right side of the colon over time.

It is not uncommon for screening bodies to disagree – for example recommendations for screening for breast cancer and prostate cancer vary across these agencies. There is also  a difference in how strong recommendations are.  The American Cancer Society rates this new recommendation as “qualified” or less strong than their recommendation for screening for those 50-75 yo.  The U.S. Preventative Services Task Force, American Academy of Family Physicians and American College of Gastroenterology currently still recommend starting screening at age 50 for someone who is not at increased risk.  The new recommendations by the American Cancer Society were made after looking at data that showed a trend of cancer developing earlier than it used to.  Click here to get a link to the study. 

It is one thing for an agency to make a recommendation, it is another thing for a patient to get it paid for.  At this time it would be unlikely for insurance companies to pay for a screening colonoscopy in a 45 year-old without other risk factors.  It is also important to remember that these recommendations are about screening tests – which implies that the person doesn’t have any symptoms – no rectal bleeding, abdominal pain, stool changes, etc. that are concerning.  If a person has any symptoms, then it would not be a screening test, but rather a diagnostic test and none of the above recommendations would apply.

While screening 45 year-olds for colon cancer may not be routinely covered at this time, there are behavioral changes people can make to decrease their risk.  Colon cancer is associated with cigarette smoking; excess body weight; a lack of physical activity; and an unhealthy diet, including a lot alcohol and red or processed meat, and lacking fruits/vegetables, dietary fiber  and calcium.  Making these healthy changes can decrease risk of colon cancer and as well as many other cancers and chronic diseases.  If someone believes that they need screening for colon cancer earlier than 50 years-old, it would be a good idea to speak with their doctor.

There are a large number of people in their 50’s who haven’t gotten colon cancer screening yet.  Hopefully by seeing that there is a shift towards recommending screening at an even younger age, people from 50-75 years- old will be more likely to go ahead and get screened and get the benefit of early detection or prevention of colon cancer.

 

***Note *** This post, like all my other posts, is for general medical information only and is not to be taken as direct advice.  Please consult your personal physician for more information.

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