Healthy Eating Tips

Below is a general Healthy Eating Tips handout I give to some of my patients when they are looking for more moderate suggestions on what to eat.  Choose My Plate is another website that many people like to reference for additional suggestions.   This is a general suggestion list and you should discuss this with your doctor if it is right for you before following it.

Healthy Eating Tips

Easiest way to eat healthy is to follow the plate method.  With this method you 1st fill ½ of your plate with green leafy vegetables, then you may fill the other parts of the plate with ½ of of a healthy carb or starchy vegetable and the other ½ with a protein and then add 2 tablespoons of a healthy fat.  Try to stick to whole unprocessed foods.  If counting carbs aim for 75-100/day – but not more than 30-45g in 1 meal.

 

Carbs – Look for things with a lower glycemic index.  Ex think quinoa, sweet potatoes, brown rice.

  • If you are eating pasta try to have it al-dente.
  • Try for varied colors of vegetables and fruits.
  • Fresh and frozen are better than canned. If canned fruit get in water/own juices and if canned vegetable rinse in order to decrease sodium.

 

Meat/Protein – avoid fried or cheese/cream sauces with main dishes.

  • Leaner beef/pork/chicken/eggs/seafood.
  • Try to have fish 2 x week – sock-eye salmon is healthier than many other kinds.
  • Consider plant proteins too – black/pinto/kidney beans, edamame, tofu, tempeh, hummus are all examples.
  • If having lunchmeat please pick a low sodium variety.

Frozen lunches

  • Amy’s and Kashi are 2 brands that have healthier options.
  • Look for <500mg of sodium, 45g/carbs, and 14-20g of proteins when looking at options.

Drinks   

  • More water.  Many people do well with 6-8 glasses a day – if you have heart failure or have been told to watch intake please discuss quantities.
    • Minimize caffeine intake as this can increase anxiety.
    • Avoid high fructose corn syrup and artificial sweeteners. No pop.
    • Limit alcohol to 1 drink a day for women and 2 for men (1.5oz spirits/1 beer/1 glass of wine is 1 drink)

Fats

  • Make them plant based. Olive oils, unsalted nuts and seeds, avocados…
  • If you are still hungry/hungry before your next meal you may need to increase fat or protein content in diet.

Eating Out

  • Try putting ½ of your dinner in a to-go box before starting eating or split the meal. Plan ahead – look up health info ahead of time.

Supplements

  • Consider taking a multivitamin daily. Look for one with “USP Verified” label.

Snacking  – Don’t have a carbohydrate without a protein. Ex maybe apple and peanut butter…

Activity – do at least 30 minutes of activity/day. This increases insulin sensitivity and helps with weight loss and decrease blood sugar.

Log Your Food – this gives you a sense of what you are actually eating.  FatSecret and My Fitness Pals are 2 free applications that you can use on your phone.  FatSecret can also allow you to connect your doctor or other health professional so they can see what you are doing.

 

***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.

So you want to stop smoking?

As a primary care doctor I talk about  a lot with my patients about stopping smoking.  Risks of smoking, how to stop smoking… I had a ex-smoking friend ask me the other day why I bother talking with people about stopping smoking since there isn’t anything I can do to help them anyways.  My jaw just about hit the floor.  Then I started wondering how many people think this way.  And then I decided to write this post about different ways that your physician can help you stop smoking. The main ways are through motivational interviewing, medications, and referrals to other resources.

Motivational interviewing deals with trying to help people understand their reasons for wanting to make a behavior change, and by doing so increasing their motivation to change and hopefully making a commitment to change.  It isn’t about lecturing the patient on the evils of smoking, rather on helping patients to explore their ambivalence about making a change and working towards goals they wish to work towards.  These goals may involve behavioral changes or may also include medications or referrals to outside sources.

There are several kinds of medications that people use to help quit smoking.  There are two prescription medications Chantix and Zyban (also known as wellbutrin).  These medications are used for 3-6months frequently as patients stop smoking and establish other behavior patterns.  If someone has a tendency to deal with their emotions by smoking I find Zyban to be especially helpful. Also – Zyban can be prescribed for <$50/mo where as Chantix may be more like $4-500/mo if insurance doesn’t cover it.  So, I tend to start with Zyban as long as the person is a good candidate for it. 

Nicotine replacement therapy (NRT) is another medication option.  People use patches, gum, lozenges.  A lot has been written about them – I find the American Cancer Society to be a reliable resource and this is a link to their information about nicotine replacement therapy options.   I usually recommend starting with patches and/or gum to people who are smoking a pack a day or more or who have withdrawal symptoms when they stop smoking.  NRT can be used in combination with zyban or chantix if desired.  More recently people have started using e-cigs too, but I am hesitant to recommend the e-cigarettes because I have seen most people switch to them and then not actually wean themselves off of them.  While this does help with second hand smoke exposure, I am not convinced there may not be long term health risks from inhaling them.   When people use the patch the strength they start out on depends on how much they have been smoking – and then decrease the strength of the patch after a month or so. When using the gum it is important to pay attention to how it is used.  Many people chew it like gum – and that leads to them swallowing the nicotine and getting nauseated.  To use the gum properly you chew and then PARK it along the gum line – as if it were dip – and the nicotine is then absorbed that way.  Some insurances cover nicotine replacement systems if it is written as a prescription, also HSA/FSA plans may cover them with a prescription – so please check to see if this is a benefit you have.  If you quit smoking, your health care costs will go down.  That is why insurances may cover it – so if you have this as a benefit please don’t feel guilty about using it.

One of the more common places I refer people to is 1-800-QUIT-NOW.  All they do is talk with people about stopping smoking.  It is a free call and they can do follow-up calls with people if they want.  If you prefer to get more information on-line first the website is www.quitnowkentucky.org .    Another place I refer people to is an app called Smoke Free – Quit Smoking Now – it is available for both iPhones and androids.

 

***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.

Turn your resolutions into reality!

Happy New Years!

Typically New Year’s resolutions involve making a decision to take control of some part of our lives that we aren’t happy with.  For many people this may involve stopping smoking, losing weight, becoming more physically active or other changes that can improve their health.  Below are some things that you can do to increase your chance of being one of the 10% of people who succeed in meeting their goal at the end of the year:

  • Make one goal
  • Get specific with your goal – break it up into steps
  • Don’t do it alone – get an accountability partner, tell your friends/family what you are doing, join a group or work with your doctor.
  • Write down your plan
  • Recognize small achievements along the way – reward yourself in some way
  • Remember it’s a marathon – not a sprint.  You want to make a change and make it stick – not just succeed initially and then go back to prior patterns.
  • Learn from your mistakes – look at what led up to your getting off track and adjust course accordingly – beating your self up or giving up doesn’t change what happened but will decrease your chance of success.

People are more likely to struggle with sticking to their healthy plans if they are lonely, hungry, angry or tired.  Recognize these as high risk situations and developing plans of how to deal with these situations in advance can help increase success rates!

Below is a video I found that reviews goal setting.  I will be writing a few more blogs over the next month addressing tools that people use to meet some of the more common goals.  I’m looking forward to helping you meet your health goals!  Here’s to a great 2018!

 

***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 Blood Pressure Guidelines

American Heart Association changes guidelines for diagnosing Hypertension

The guidelines for diagnosing someone with Hypertension – also known as High Blood Pressure – have changed several times over the years.  The American Heart Association changed these recommendations again this month with calling 130-139/80-89 Stage one  – instead of Pre-Hypertension.  (If you click on this link you will go to their page for ALOT more information)  With this they greatly increased the number of adults who would now be diagnosed with hypertension.  Happily they also recommended lifestyle interventions as the first manner of treatment for most people.  This typically includes losing weight, decreasing salt and caffeine and alcohol intake,  stopping smoking, and increasing exercise.  However, for people with known cardiovascular disease, diabetes or chronic kidney disease they recommend starting on medications as well as lifestyle changes – and getting rechecked every month until blood pressure is under control.

Getting rechecked is really important – it is not uncommon for it to take multiple adjustments to get someone’s blood pressure to goal. That is one major advantage of belonging to a direct primary care practice – you don’t have to worry about how to pay for these follow-up visits – as they are included in your monthly membership fee!

I recommend also getting a blood pressure cuff so that you can check your blood pressure on your own a few times a week during this month.  I recommend getting an Omron brand automated cuff that goes on your upper arm.  Please bring your cuff and your log in to your follow-up visit with me so we can compare your cuff with mine. If you have a HSA or a FSA account please let me know as you may be able to use that money for the cuff if I write you a prescription for a diagnosis of elevated blood pressure.

 

***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.

Breast Cancer Awareness Month 2017

Breast Cancer Awareness months comes every October and I am never sure how to address this topic.  My father-in-law died of breast cancer 14 years ago.  Yes -FATHER-in-law.  There are no recommendations for screening for breast cancer screening in men outside of examining/awareness of male breast tissue.  99% of all breast cancers are in women.  When male breast cancer is diagnosed it is typically further along.  Denial or unawareness of the fact that men can get breast cancer,  and there being less tissue between breast tissue and the chest wall are two of the big reasons.   Symptoms of male breast cancer are similar to female breast cancer – a lump, inversion of the nipple, a lump in the arm pit, discoloration of skin around the nipple, nipple pain or discharge. If a man does find a change in his breast it is important to go have the area examined.  The next step would frequently be to order a mammogram or an ultrasound.  If the testing doesn’t show anything and there is a lump – consultation with a breast doctor would be a good next step.  There isn’t as much literature about male breast cancer as female – Protect the Pecs and the Male Breast Cancer Coalition are trying to help educate the public about it.  Education can lead to earlier detection and a better prognosis.  Please help “Protect the Pecs.

 

***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.

 

 

 

Office open and Open House this weekend!

Crestview Hills doctor’s Direct Primary Care is first in NKY, monthly membership eliminates office copays

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Dr. Cynthia Villacis, independent family physician with Health Connections Direct Primary Care, is shaking up the status quo to offer affordable, quality care for her patients. As the only physician in Northern Kentucky to offer Direct Primary Care, her goal is to increase face time with patients, decrease patient expenses, make health care costs more transparent and continue to provide high quality care.

As health plan deductibles continue to rise across the country, Dr. Villacis is offering an affordable way to ensure health care for routine issues.

After the initial enrollment fee of $150 per family – patients can get primary care for just $30 per month if under age 26, and for those aged 26-64 the cost is $75 per month. The plan includes all visits – either in person or telemedicine, email, phone, or texting consultations with Dr. Villacis, who offers same day or next business day appointments. Villacis compares the service to a Netflix membership – it can use it 20 times a month or not at all for the same price. This structure makes it easier for people to come back for a follow-up visit if needed and to plan for their expenses.

Low-cost options for lab work are also being offered through the office with most blood tests priced at $10 or less. There are no copays or coinsurance, no deductibles, no pre-authorization delays, and no denials – unless a patient chooses to insurance to pay for something.

Dr. Villacis stated, “To be clear, this is not a substitute for health insurance. My plan works great for those who have a high deductible plan, participate in a health sharing ministry, or who are uninsured. Some people have good insurance coverage and low deductibles but choose Direct Primary Care because they just want more time with their doctor. My average visit time is 30 minutes instead of just 10-15 minutes. I think of this as paying for routine maintenance of your body, however, if you get really sick and need to be hospitalized, see a specialist or go to the ER – you would want to have insurance to cover this. People stay healthier with better access and time – Direct Primary Care gives you both. And now it is incredibly affordable. This model is spreading all over the country; there are several thousand DPC physicians so far. I am excited to be offering it in Northern Kentucky.”

Due to the level of care that will be afforded every patient, the number of patients Dr. Villacis will accept will be limited.

Dr. Villacis

Examples of routine services offered in the membership for free include drainage of abscesses, nebulizer treatments, joint injections, lesion removal, and simple sutures, just to name a few. Any routine service provided in a primary care office is included. Tests sent to the lab for evaluation and pathology charges are extra.

The office is located at 527 Centre View Blvd.in  Crestview Hills. Call (859)905-0707 for more information, email her at CVillacisMD@HealthConnectionsDPC.com or check out the website at www.healthconnectionsdpc.com .

There is also an open house scheduled for Friday, September 29th from 4-6p and Saturday, September 30th from 1-4p.

Dr. Villacis is an independent family practice doctor who graduated from St. Elizabeth’s family medicine residency in 2002. She has spent most of the last 15 years working in community health centers in Ohio and commuting from Northern Kentucky. She has also done work in obesity and addiction medicine and speaks Spanish as a second language. She is a member of AAFP, Northern Kentucky Medical Society and the Northern Kentucky Chamber of Commerce.

Health Connections Direct Primary Care

http://www.nkytribune.com/2017/09/crestview-hills-doctors-direct-primary-care-is-first-in-nky-monthly-membership-eliminates-office-copays/

Suicide Prevention Week

This week is suicide prevention week. It is hard for people to ask for help when they are depressed frequently, even harder when they are suicidal. Depression has a way of twisting people’s thinking when it gets really bad. People can convince themselves that loved ones are actually better off without them. Friends and family often sense their suffering but are at a loss of how to help, or those suffering may still put on a good outward show while not giving off clues to their true feelings. People may not ask someone who is depressed if they are having thoughts about suicide because they are afraid they will put those thoughts in their head, or sometimes because they don’t really want to believe that things are that bad and they don’t know how to help.

The first step to preventing suicide is to realize that depression is a medical condition that has treatments. Treatment can be with counseling or medication or with a combination of the two. Counselors or psychologists typically provide the counseling and family physicians or psychiatrists typically prescribe the medications. However, sometimes in a moment of crisis someone may not be able to get an appointment to be seen soon enough and it is hard to know where to turn.

The next step is to realize that asking someone if they are suicidal, doesn’t cause them to become suicidal.  It is important to have an idea of what to do if someone reveals to you that they are feeling this way and to have an idea of possible signs to recognize that someone is feeling this way.   It is also important to realize that just because someone doesn’t ask for help doesn’t mean they don’t want it.  Frequently people may not actually want to die, they may just want the pain to go away.

The following are some signs that people may show if their depression has reached the point where they are feeling suicidal:

  • Talking about wanting to die or to kill themselves
  • Looking for a way to kill themselves, like searching online or buying a gun
  • Talking about feeling hopeless or having no reason to live
  • Talking about feeling trapped or in unbearable pain
  • Talking about being a burden to others
  • Increasing the use of alcohol or drugs
  • Acting anxious or agitated; behaving recklessly
  • Sleeping too little or too much
  • Withdrawing or isolating themselves
  • Showing rage or talking about seeking revenge
  • Extreme mood swings
  • Putting affairs in order and giving away possessions
  • Saying goodbye to family and friends
  • A mood shift from despair to calm

The following are risk factors for suicide:

  • A family history of suicide.
  • Substance abuse. Drugs and alcohol can result in mental highs and lows that exacerbate suicidal thoughts.
  • Intoxication. More than one in three people who die from suicide are found to be currently under the influence.
  • Access to firearms.
  • A serious or chronic medical illness.
  • Gender. Although more women than men attempt suicide, men are four times more likely to die by suicide.
  • A history of trauma or abuse.
  • Prolonged stress.
  • Isolation.
  • Age. People under age 24 or above age 65 are at a higher risk for suicide.
  • A recent tragedy or loss.
  • Agitation and sleep deprivation.

If you or a loved one you know is having serious thoughts of hurting yourself or someone else –  this is a psychiatric emergency. The same way I would ask you to go to the ER if you think you are having a heart attack to be seen, I recommend that you either call 911, go to the nearest emergency room or if you are in Northern Kentucky you can call North Key’s ACCESS 24hr emergency hot line 859-331-3292 for emergent help if you are having a psychiatric emergency. People can also call a suicide hotline at 1-800-273-TALK (8255) or contact a suicide text hotline by texting “Connect” to 741741.

For more information you can also read more on sites like the National Suicide Prevention Lifeline or NAMI or the American Foundation for Suicide Prevention.

Help is out there.  There is hope.  Things will get better.  You are not alone. 

#BeThe1To  Ask. Keep Them Safe. Be There. Help Them Connect. Follow Up.

 

***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.

 

4th of July brief thoughts

I am looking forward to watching the fireworks tonight with my family – as are many Americans.  I am thankful that I have had the freedom to open my own direct primary care business and improve healthcare for others in the process.  There are places in this world where innovation is not as welcome.  I hope that everyone’s pets aren’t too terrified and people are safe in their celebrations. Hopefully the new residents that are on call tonight have a quiet one.  SEO is telling me to make this a longer post – but I am going to ignore it as I am going to spend time with my family/friends – as hopefully you are too!

Seasonal Allergies are here!

Every spring seasonal allergies comes around and misery finds those of us who have allergies to trees, grass or weeds.  In fact, there are more than 30 million people in the U.S. who are affected by allergy symptoms every year.  Sometimes mistaken for a cold – allergies differ in some important features.  Allergies don’t go away after 7-10 days and don’t cause fevers. Either allergies or colds can cause clear runny nose, congestion and fatigue.  Itchy eyes, ears and sneezing are more commonly associated with allergies.

15 years ago allergy medications, other than benadryl, were available by prescription only.  In 2017, patients can choose from antihistamines, nasal steroids, and eye drops that all are available over the counter.  Nasal steroids – such as flonase or nasonex – reduce inflammation and swelling in nasal passages with minimal absorption.  The sprays are typically used daily before, and during allergy season for best results.  Newer antihistamines, such as claritin, allegra and zyrtec, work by preventing histamine from being released.  They are less sedating and last longer than the older ones.   Decongestants shrink blood vessels to relieve congestion and swelling.  Decongestants can raise blood pressure and heart rate, are not recommended for people with several health problems and are usually only used for short periods of time.   Nasal decongestants, such as Afrin, aren’t recommended for more than a few days since people can have worse symptoms when they stop them than they did when they started.  Allergy eye drops, such as zaditor, can help too.  Another option is a medication called singulair – which works by blocking leukotrienes – and helps asthma as well.  For symptoms that aren’t controlled, some people will get allergy shots.  These shots work by changing a person’s immune system over time – commonly over 3 to 5 years.

Some people prefer to use natural remedies for allergies.  Nasal saline – either in spray form or by a neti pot can help clear nasal passages.  Butterbur may help with allergy symptoms, as may quercetin, or stinging nettle.

Even better than treating allergy symptoms is avoiding them.  Simple measures such as keeping doors and windows closed, and showering and washing your hair before bed can help. Using sunglasses can decrease the amount of pollen that gets in your eyes. If you have a dog that goes outside on a high-pollen day, washing the pollen off of him may help too.  Vacuuming twice a week and using HEPA filters in air conditioners to trap pollen spores better can also minimize exposure inside.

If you are still having problems with seasonal allergies despite over-the-counter medications or if you are not sure what is causing your symptoms then I recommend following up with your primary care doctor for further evaluation and treatment.

 

***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.

Colon Cancer Awareness Month

Colon cancer can develop without giving symptoms until it is advanced.  Following screening recommendations can help prevent polyps from developing into a cancer or at least help detect cancer earlier.  Many people avoid screening due to fear, embarrassment, lack of transportation, time or cost.  Many times when a person talks with their doctor they may be able to work through some of these barriers and get tested in a way that works for them.

For most people, it is recommended to get screened for colon cancer starting at age 50.  If someone is at a higher risk based on personal history inflammatory bowel disease,  family history of colon cancer or multiple polyps it may be recommended to start screening much earlier.

The main test I recommend is a colonoscopy.  These tests are done by gastroenterologists, colorectal surgeons or general surgeons.  Colonoscopies may be done in an outpatient center or in the hospital.  It is VERY important to follow the instructions to get ready for this test otherwise the doctor can’t see what they are looking for and things can get missed.  For most people the prep is the most unpleasant part of the test since the procedure itself is generally done under sedation and the patient usually doesn’t remember the test. The specific prep varies from doctor to doctor so if you have had this test before and had a problem with the prep – please let the physician know.

Colonoscopies involve using a endoscope with fiberoptics that the doctor inserts in the rectum up into the large intestine to visualize the whole colon.  This scope is thin – think the width of my pinky finger.

Picture of colonoscope and large intestine

Colonoscopies may be either done as a screening test or to look for a cause of a symptom – like abdominal pain, rectal bleeding, weight loss, anemia, diarrhea or constipation.  If it is done as screening most insurance plans cover this as a preventative benefit.  The frequency of testing varies based on risk factors and the reason for the test.  If it is a screening test and everything comes back fine – usually the recommendation is to get it redone in 10 years.  If there is an abnormal finding during the test, or if the person is at high risk for colon cancer then the test may be repeated in 3 months to 5 years.

Other ways of screening for colon cancer include testing the stool for blood every year, a stool DNA test every 3 years, or a CT colonoscopy, flexible sigmoidoscopy, or a barium enema every 5 years.  If these tests come back positive then the next step is to do a colonoscopy.  This colonoscopy would then be considered a diagnostic test with your insurance and not a screening test and would most likely not be covered as a screening service.  For some people not having to take time off from work to do the test, not having to get a driver to take them to/from the facility, the decreased risk of some alternative tests outweigh the benefit of more definitive and less frequent testing.  In any case it is important to note that a digital rectal exam in the doctors office is NOT enough to assess for colon cancer.  Please contact me to see what is the best way to do your colon cancer screening.

Below is a YouTube video from CNN that discusses colon cancer screening in more detail.

 

***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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