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February:American Heart Month

2/1/2021

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Part of self care means taking care of our hearts.  At the beginning of every year the most common new year’s resolution is to increase or becoming or increasing physical activity.  Every day is a fresh start.  If you have fallen off track or if you have not started on your goal.  February is a great month to start again.
Heart disease is one of the leading causes of death for both women and men.  Per the CDC in 2020 over 600,000 deaths were attributed to heart disease in the US.  There are important things to embark upon heart healthy living. 
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Step 1: Understand your risk:

There are certain risk factors that are not modifiable—meaning that there is nothing that you can do to change them.  This includes but is not limited to age, family history, sex being male or female, and ethnicity/race. 
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Photo by Hush Naidoo on Unsplash
Now there are certain risk factors that you can modify.  These include factors such as blood pressure, cholesterol, level of activity, diet high in saturated fats, diet high in salt, smoking.  Addressing these risk factors can have a positive impact and lower your risk in regards to heart disease overtime.
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Step 2: Educating yourself about a heart healthy lifestyle:

When treating my patients I always encourage lifestyle change and modification if possible before considering medication.  Using resources such as a wellness coach or nutritionist are helpful resources to achieve your goal.  Unfortunately not all insurance companies cover such wonderful preventative measures.  Check with your insurance company to see if those things are covered and then discuss options of lifestyle changes with your provider.
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Photo by Content Pixie on Unsplash

Step 3: Making choices and taking steps:

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Photo by madison lavern on Unsplash
My nutritionist said it’s not what you do 20% of the time that counts but what you do 80% of the time that is key.  I have always advised my patients that depravation is not ideal for longterm sustaining lifestyle changes.  But making choices to make small changes to your lifestyle are important and can be helpful.  The goal of 30 min of physical activity 5 times a week recommended by the American Heart Association may be a lot to start off with so I recommend that my patients start off with 10-15minutes 7 days a week to create the habit and then slowly progress.  Schedule an appointment with your provider to discuss ways to slowly incorporate healthy choices in your lifestyle to make lasting changes to begin modification of some of the modifiable risk factors. 
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January is Cervical Health Awareness Month

1/23/2021

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CALL TO ACTION!  CALL TO ACTION!
If you are reading this please take a moment to forward this to any woman that you know.
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Each year more than 13,000 women in the US are diagnosed with invasive cervical cancer.  These days cervical cancer is not only easy to detect but is also preventable if 2 things are done:
  1. Vaccination
  2. Papanicolaou Screening

Vaccination: HPV Vaccine

Human Papillomavirus vaccines can help prevent infection from the high risk subtypes of human papilloma virus that can cause cervical canceler and also some of the low risk types that can cause genital warts.  Both men and women are recommended to be vaccinated.   If given in the preteen years only 2 doses of the vaccine are needed however the vaccination is available for both men and women up to the age of 45 years old.
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Photo by Lucio Patone on Unsplash

Papanicolaou Testing

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Also more commonly known as the PapSmear is a test that is done to determine cell changes at the cervix cause by HPV.  Typically when this gynecological test is done co-testing is done for HPV virus is done as well which is an important way to determine if there is HPV present.

If you have not had your Cervical Cancer screening done recently talk with your primary care provider.  As a primary care provider I routinely address basic well woman needs for my patients.  However, if you do not feel comfortable with your primary care provider then see a gynecologist
The most important thing is to make sure you are up to date on your Cervical Cancer Screening!
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Self-Breast Exams and Breast Self Awareness

10/30/2020

 
Do you do self breast exams?  If not do not feel ashamed there are many women that don’t.  In fact the USPSTF and the ACOG no longer directly recommend monthly breast exams.  Now the recommendation is breast self-awareness which focuses on having a sense of what is normal for you breasts so that you are aware of even small changes. Well what better way to be aware of your breasts than with periodic self-breast exams.
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Personally in my practice I encourage women to try and do it 4 times a year.  If you find anything abnormal or concerning don’t panic but do report your findings to your health care provider who might then perform a clinical-breast exam before considering any imaging studies
So what exactly is a self-breast exam:  Check out my In The Clinic Video: Self Breast Exams.

Adult Vaccinations: What you need and what you may not need.

9/21/2020

 
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Photo by CDC on Unsplash
As a pediatrician for adults vaccinations are an important part of preventive medicine.  Here is the breakdown of the vaccines that are recommended by the CDC and and explanation as to which ones are needed and why. 

TDAP/TD (Tetanus Diphtheria and Pertussis):

This is a vaccination that is recommended every 10 years.  Usually given initially in childhood it is recommended that that the vaccine is repeated every 10 years.  This vaccination protects you from 3 bacteria: 1)Clostridium tetani which causes “lock jaw” or stiffening of other muscles that can lead to breathing difficulties or even death.  2) Clostridium diphtheria which can also cause difficulty breathing difficulty, paralysis and death 3) Bordetella pertussis which can cause “whopping cough”.  Pregnant women and close family members are recommended to have an update of the vaccination to protect the newborn from peruses as infants are at an increased risk for a severe course from the organism. 

​MMR (Measles, Mumps, and Rubella):

This vaccination is usually one that is given in childhood.  If you are unsure and preparing for college physicals it’s likely colleges will want proof of vaccination or will want proof of immunization with titers.  If your tigers show that you are not immune then you will need booster vaccinations. 

​Varicella and Shingrix:

If you were born before 1980 like myself then you may recall having the chicken pox.  Those after 1980 likely received the Varicella vaccine which protects from chicken pox (also known as Varicella zoster which is a herpesvirus).  Once infected zoster sits dormant in areas of our nerves where it can reactivate and cause shingles.
f you don’t recall if you’ve had the chicken pox or the vaccine, titers are a way to test if you have immunity.  If you don’t have immunity then I do recommend having a conversation with your PCP about your vaccination options.

​HPV Vaccine (Human Papilloma Virus):

Human Papilloma Virus has thousands of subtypes.  There are several subtypes that are associated with 6 types of cancer: cervical, anal, oral, penile, vaginal, and vulvar cancer.  The HPV vaccine ideally is given between 11-26 however can be given up to age 45.

Hepatitis A&B Vaccine:

Hepatitis A and Hepatitis B are the only hepatitis vaccinations that can be vaccinated against.  Hepatitis A usually causes a minor self-limited illness and patients usually recover easily without any damage to their liver.  Hepatitis B however can develop into a chronic infection and lead to liver cancer, liver failure, or worse.  

If you are not sure if you have been immunized, ask your provider to check your lab work for confirmation.  

​Meningococcal Vaccine:

Usually give. In childhood often boosters of the meningococcal vaccine are indicated for those at high risk for meningitis.  Examples are those going off to college, those who have sickle cell disease, those whose spleen have been removed, etc.
Usually this is not considered a standard or routine vaccinations for those who have left their college days behind. 

Pneumococcal Vaccine (Prevnar and Pneumovax):

Patients with asthma, COPD, interstitial lung disease, HIV, diabetes mellitus, chronic heart disease, chronic liver disease, and smokers should be considered for this vaccine.
A lot of people think that the pneumonia vaccine stops you from getting pneumonia but it actually protects you from some variations of the bacteria Streptococcus pneumoniae that can cause serious invasive infections that are severe and life threatening.

​Haemophillus Influenza B:

Individuals who have medical illnesses like HIV, sickle cell, asplenia, cancer requiring chemotherapy, radiation therapy, or bone marrow transplant, or complement deficiency syndromes.

​Influenza Vaccine:

This vaccine is one that is recommended yearly.  While many people feel that the vaccine is not necessary or feel that they get sick after the vaccine I recommend given the current pandemic that you reconsider and talk with your provider.
For more of my thoughts about this vaccine or any of the others check out my video “Adult Vaccinations” on YouTube.
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Finding a PCP: Are You Ignoring Your Check Engine Light?

8/30/2020

 
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Photo by Kunle Atekoja on Unsplash
If there is one thing that has come out of the pandemic for some of my patients, its a moment to take stock in their health.  I have had a influx of patients establishing care for the first time in years because they have realized as one patient put it, "My check engine light has been on for years."

What is a P.C.P.?

P.C.P. stands for Primary Care Provider.  Provider is usually considered a physician however, a provider can be a nurse practitioner or a physician assistant.  You should check with your insurance company as some insurance provider preclude your P.C.P. being anything other than a physician.  

A question I sometimes get from patient is wondering if the care is the same between a physician, nurse practitioner and physician assistant.  Physicians go to medical school and residency focusing on primary care for a total of 7-8 years.  Nurse Practitioners who are also registered nurses undergo extensive training for 6-8 years depending on their focus which includes their education to become a nurse.  In 22 states (I believe) NP's (nurse practitioners) can function autonomously (or in other words have full practice authority).  Whether you are seeing a nurse practitioner, physicians assistant, or physician.  It is important to establish a relationship with someone that you feel you can trust.
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Why you should have a P.C.P.

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From American Heart Association
I have always liked the moniker that I am a "Pediatrician for Adults".  It makes the scope of what I do a little easier for people unfamiliar with a PCP or internist to latch on to.  Having a PCP, in my view is like having a friend whom you can go to when you aren't feeling well or having a friend that you talk to yearly just to make sure you are on  track for the goal of being healthy.  My job as a provider is to help make sure that you have as much knowledge as I can to make the decisions that impact your current health and your future health.  
Using the car metaphor the best time to know a mechanic is not when something is wrong with your car but before.  When you have one car you want to take your vehicle to someone that you trust, someone that you know, and someone who knows just how important your one vehicle is to you.  In my life I try to be proactive as much as possible vs reactive.  When you check engine light is on and the car is making a clunking sound and stalling periodically you don't want to go interviewing mechanics to fix the problem.  You want to know exactly who to go to and what to expect.  The same can be said for your health.

​I recommend that you consider getting a provider if you don't have one.  If you haven't seen your provider in >1 year now's the time to reconnect.  My healthiest patient's are always encouraged to follow up with me yearly.  If they are still healthy it's a quick visit to just make sure they are on track. Your yearly physical is really a time for us providers to make sure everything is going okay with you routine wise.  It is not the time to bring up everything that you have felt throughout the course of the year--that's what a sick visit is for.


Sick visits are visits you make to your provider to discuss problems that you have been experiencing to determine what needs to be done to address them if anything at all.  

Follow up visits are visits to follow up on chronic medical issues if you have any such as diabetes, hypertension, high cholesterol, hypothyroidism, etc that need periodic monitoring to make sure that your chronic medical issues are stable and well managed.  

But I digress...the key take away point here is that having someone that you know and trust before a problem possibly arises is always better than meeting someone in the midst of an ongoing problem.  So take a proactive tip from a proactive person (most times) and get a PCP if you don't already have one. ​

How to find a PCP.

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Photo by Christina @ wocintechchat.com on Unsplash
Deciding to get a PCP is easy finding one can be challenging and daunting.  My suggestion is to first ask around to friends and family that you trust.  Word of mouth referrals are a powerful tool.  I will also say that not every match is made if heaven but it is a good place to start.
I try to tell all my patients when they first meet me that I may not be their cup of tea.  Not every provider is the same and not every provider will fit for every patient.  I am FAR from perfect.  As a provider my goal is that you find a physician you feel comfortable with to establish a longterm relationship with.  If it's not me but someone else in my practice that's fine.  I'll still say "Hi" and treat you with respect if you leave my practice because my hope for everyone is the best care for them.

​I say this to say that if you don't like one provider at a practice that doesn't mean that the other providers are off limits.  Shop around you might find someone else there that you to mesh with.


Another way to find a PCP is to let your fingers and google do the walking.  This is a risky move because there are some great providers with some lousy scores (stars) all because patient's who are satisfied and happy do not think to write good reviews.  Its just like at restaurants--ask a manager if they hear more complaints or compliments about their food, service, or establishment and you are likely to find they hear more complaints which is why I always (before COVID) makes sure when I receive excellent service to ask for a manager.  I feel back for the server because they tend to panic a bit but I always try to assure them that its a good thing but it still puts them on edge until after I speak with the manager who confirms that I was only complementary.  I digress again...(I do that a lot)...using Google for reviews can be helpful but beware that if you see bad reviews read what the comments were and what the problem was--staffing issues don't necessarily reflect on the providers ability or bedside manner.  So keep that in mind.

Another resource is your insurance company to see who is in network.  Starting their coupled with an on-line search is a resource that saves the hassle of finding out too late that a provider is not covered by your insurance.  Don't forget you can "interview" providers.  Yes you will be "doctor shopping" and yes you will have to fill out a lot of forms over and over again, and yes there will be a copay likely but it is a way to meet a provider in person and get a feel for their style of practice and bedside manner.  ​

7 Tips to Lower Exposure Risk For Coronavirus

5/13/2020

 
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Photo by CDC on Unsplash
As the United States reopens at various rates and stages I am frequently asked, “What can I do to protect myself?”  As a provider this leaves me in a very frustrating position because we do not have a vaccine at this time and we are still learning new presentations and manifestations of this illness. 
Here are 7 tips that I give to my patients that I thought I would share:

​1.    Hand washing:   While I am a proponent of soap and water for 20 seconds, hand sanitizer (if you can find it) is better than nothing.  Even as the restrictions for staying at home are lifted please remember the basic care is important.  Hand washing is fundamental!
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Photo by Logan Troxell on Unsplash
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4.     Be selective and thoughtful:  As states lift restrictions it is imperative that careful consideration is given to gatherings.  I would  advise anyone to avoid going out and congregating in areas where social distancing is not possible.  I would recommend that as you resume your routine activities; such as going to the barber/hair stylist or even going to your healthcare appointments; inquire what policies and practices they are engaging in to promote social distancing.

2.     Wear your mask:   As restrictions loosen, I continue to recommend that you wear your mask in large gatherings with others that you don’t know intimately.  You cannot assume that everyone will be COVID-19 free.  So protect yourself and your loved ones.
3.   Avoid touching your face:  I know it is so hard to do it after you have been asked not to do it.  The eyes, nose, and mouth are entry routes for infectious organisms particularly COVID-19 which is spread as respiratory droplets. If you do touch your face just wash your hands and try again!
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Photo by Paulo Silva on Unsplash
6.     If you feel ill STAY HOME:  Very simple request but I know as a provider it is very hard to do.  Having a strong work ethic I have the tendency to work and see patients even when I am ill.  However,  because this virus is new and we are still learning about how it presents.  It is imperative for all of us to have a  low index of suspicion when we feel ill and to  stay  home and quarantine--until we have more widely available testing options. 
5.     Take care of your chronic medical conditions:  If you don’t have any make sure you have seen a primary care provider (PCP) for your yearly checkup—if you suffer from chronic health conditions such as diabetes, heart disease, asthma it’s important that you ensure that your chronic health disease are managed and under control.
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7.  Stay informed through reputable sources:  There is a ton of information on the internet and unfortunately a lot of it is not accurate.  Be mindful where you are getting your information from.  Please make sure it is from reputable sources.  Just as you would vet your doctor, dentist, or any other health care provider please vet the information sources discussing COVID-19 recommendations.  The spread of incorrect information is just if not more dangerous than the virus that we are fighting. 
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COVID-19 Info a PCP Perspective

4/25/2020

 

What is Coronavirus or COVID-19?

Viruses are infections that cannot be treated with antibiotics.  Viruses can only replicate inside of a living organism.  Coronaviruses are a class of virus which have  many types; some causes disease or illness in animals or people.  COVID-19 was named due to it origination in China in 2019. 
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Photo by Fusion Medical Animation on Unsplash

How does it spread?

While a lot is being learned about this new virus what we do know at this time is that it is spread via droplets found in the air after someone sneezes or coughs.  Droplet spread does not spread far in the air however because of its weight will fall onto surfaces or the ground within seconds.

What are symptoms?

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Photo by Annie Spratt on Unsplash
The presumed symptoms are emerging as we learn more about this infection and how it operates.  As of now the most common symptoms are:

*Cough
*Fever
*Shortness of breath
*Muscle aches
*Sore throat
*Loss of taste or smell
*Diarrhea
*Headache
Pretty general right?  Exactly these symptoms are not considered specific to COVID-19 which is why it’s been very important as practitioners that we obtain a very thorough history of our patients and families.

In severe cases of the illness patients can suffer from respiratory distress, kidney problems and even death.

How is COVID-19 diagnosed?

It’s not easy!  Until there are more lab tests available the main method of diagnosing the illness is clinical.  This means the diagnosis is made by your provider having a thorough history of your symptoms, risk or exposure or history of exposure. 
Laboratory tests--specifically the nasal pharyngeal swab--can confirm the diagnosis but the diagnosis is made based on symptoms at presentation.  This is why mild cases can sometimes appear similarly to a flu or bad cold.
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Photo by Cory Checketts on Unsplash

What are the treatment options?

Despite what you here there is no treatment for COVID-19 at this time. NONE!  I stress this because there are many reports regarding possible usage of medications such as Hydroxychloroquine and Azithromycin however neither of these drugs has been proven to be effective in treatment of this illness and the risks of these medications used together or even alone include arrhythmia, blurred or loss of vision which can be permanent, heart failure, angioedema—swelling of the skin.  I stress no matter what you hear the FDA has not approved either drug for treatment in COVID-19 cases.

How deadly is the infection?

As of April 21, 2020 when I was typing out this post there were 823,786 confirmed cases in the US with 44,845 deaths.  This means that 778,941 cases that have been tested have resolved!  While the deaths are staggering the numbers of individuals who have recovered are hopeful.  Also what is hopeful is that not everyone has been tested.  While this is very much a frustration for most statisticians, providers, and individuals it also means that potentially there are cases that have not been confirmed that have also resolved due to lack of available testing.
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Photo by Martin Sanchez on Unsplash

​Should I be tested?

According to the CDC not everyone needs to be tested for COVID-19.  The CDC has specific guidance for patients as well as providers on who should be tested. 

If you aren’t sure talk with you primary care provider about your symptoms and discuss if testing is necessary.

What to do if I think I have COVID-19?

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Photo by Sharon McCutcheon on Unsplash
Stay in place!  Stay away from others.  Wash your hands routinely and clean routinely uses surfaces in your home frequently (e.g. tables, door knobs, countertops, phones, computers and keyboards, etc). Things you can use to clean—basic soap and water.
Next disinfect surfaces—you can use diluted bleach on appropriate surfaces or other house hold disinfectants like (lysol, windex, comet, etc).
Treat your symptoms—Tylenol for fever.  Stay hydrated.  If you have a fever you are loosing more water than you think so hydrate hydrate hydrate!
Monitor your symptoms—if you should start to notice:

*trouble breathing
*persistant chest pressure
*confusion or excessive sleepiness or difficult to awaken
*bluish lips or face

Or other symptoms that have you concerned contact your primary care provider
If you were not tested but suspected that you were positive and as a result self-quarantine the guidelines are you can end your quarantine if you have not had a fever for 72+ hours (without the use of medication) AND your symptoms have improved AND 7 days have passed since your symptoms first started.

Where can I get more information?

The CDC website is a very reputable source and the best (in my opinion) source for information so start there.  Another source to use if your primary care provider.  If you have questions schedule a virtual visit or telephone visit with your primary care provider to discuss symptoms or concerns.  As providers part of our job includes education.
In the end remember we are all in this together!  We will get through this together by being well informed, cautious, and patient.

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    Clinic moves at a fast pace.  Every month my goal is to feature a topic that came up during my clinic or to discuss health topics that you are concerned about.

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    Disclaimer: I am a physician, but I am not your physician. The information on this website is for general informational purposes only and is not meant to substitute for medical advice. This website does not create an physician-patient relationship. The author is not liable for any illnesses, losses or damages related to actions of failure to act related to the content in this website.  If you need specific medical advice, consult with your healthcare provider.
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