Month: December 2018

Finger Stick, Diabetes Care, Direct Primary Care, Beyond Primary Care, Ann Arbor Doctor

Your Sugar is a Little High- Diabetes Type 2

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11 December 2018

In researching your diabetes care, you may have heard people say they have “a touch of diabetes” or that their “sugar is a little high.” These words suggest that diabetes is not a serious disease. That is not correct. Diabetes is serious, but you can learn to manage it. Most of the steps needed to take care of diabetes are things you do yourself. I will help outline some of these steps in this blog post.

Progression of Diabetes

Keeping your blood sugar (glucose) in your target range can delay the health problems caused by the progression of diabetes. Yes, you read that correctly, diabetes is a progressive condition. Pancreatic Beta Cells (These cells produce, store, and release insulin) function will typically decrease over time. All the strategies listed here and discussed by your health care provider can help delay/prolong this progression.

Exercise & Nutrition

The doctor’s axiom of ‘eat less and move more’ is quite possibly the worst advice any doctor can give, especially if done in a rushed/ inconsiderate manner. Yet, regular movement and diet modification has been shown to improve insulin resistance–the main issue in those with type II diabetes. Moving your body and diet modification can improve A1C levels alone by as much as 4 points! This is far better than any single diabetic medication.

Cholesterol Counts

Diabetics have a higher risk of heart attack and stroke. That’s why doctors treat cholesterol levels more aggressively in those with diabetes

Pay Attention to Blood Pressure

The blood pressure goal of the diabetic person is below 140/80, just like the general non-diabetic population. A side-effect of elevated blood pressure and diabetes is the risk for kidney disease. Damaged filters don’t do a good job.

Get Your Vaccines

Diabetics also have a higher risk of infection. That is likely because bacteria love to live in high sugar environments. For that reason, doctors recommend diabetics get an annual flu shot, in addition to the pneumonia shot once before age 65 and once after age 65 (with at least 5 years in between).

Eye Doctors Aren’t Just For People With Glasses

Every diabetic should also get a yearly eye check that includes being examined by an ophthalmologist (eye specialist) who takes a look at the retina, or the back of the eye, for changes produced by diabetes.

Direct Primary Care, Tuna Salad, Beyond Primary Care, Dr. Jeff O'Boyle, Ann Arbor Doctor

BPC Good Eats: Tuna Harvest

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7 December 2018

Hello and thank you reading my blog at Beyond Primary Care and trying the BPC Good Eats recipes. This featured recipe is a Tuna Harvest Salad. These recipes are my attempt, in a way, to bridge that Doctor’s adage of “Eat Better & Exercise More.” In this post, I will showcase a healthy meal made on a budget, my pictures are pretty decent, and that is how I got into this food endeavor.

Tuna Harvest Salad
Prep Time: 15 minutes
Total Time: 20 minutes
Adapted from: Damn Delicious

Ingredients:
4 (2 oz) cans tuna in water, drained
1 cup greek yogurt
2 teaspoons lemon juice
2 teaspoons dijon mustard
½ cup carrots, diced
½ cup green onions, diced
½ teaspoon garlic powder
Salt and Pepper
4 leaves Bibb lettuce
2 apples, sliced
1 cucumber, sliced
1 (16 oz) package baby carrots
1 (16 oz) package raw almonds
1 lb red grapes, seedless

Instructions:
1) In a medium bowl, combine tuna, yogurt, lemon juice, dijon mustard, carrots, green onions, and garlic powder. Season with salt and pepper to taste.
2) Place lettuce leaves into meal prep container. Top with tuna mixture.
3) Arrange apples, cucumbers, baby carrots, almonds, and grapes around tuna mixture.

Direct Primary Care, Affordable Healthcare, Beyond Primary Care, Ann Arbor Doctor

Direct Primary Care Doesn’t ‘Cherry Pick’ Patients

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4 December 2018

I recently met a doctor and self-proclaimed underserved medicine wonk who bellowed that DPC doctors ‘cherry pick’ healthier and wealthier patients, leaving the the vast majority of individuals without care and fewer doctors to choose from. Nothing is farther from the truth- Direct Primary Care is not concierge medicine. I wanted to scream (I didn’t) that this perception whereby accepting a patient’s insurance somehow improves access to health care. I wanted to point out how the health care services this doctor was providing relies so heavily on third-party reimbursement systems, costs for their medical care have likely gone up. But in the end, the before-mentioned doctor was so entrenched in the health care insurance matrix, I could only use their misconceptions to help educate others.

Direct Primary Care Doesn’t Cherry Pick Patients

Direct Primary Care doctors run their own business so that we can do what is right for a change in health care; Treat individuals the way everyone wants to be treated by giving patients the time and peace of mind they deserve. We have transparent pricing on the care for our memberships, and do not charge more for complicated patients, or management of difficult or chronic medical conditions that require more frequent trips to see the doctor. Our plans work great for anyone at any level of insurance or for individuals at any level of savings and income.

  • No insurance? Whether you have a family, or are a single working mother whose employer doesn’t offer insurance, Direct Primary Care is a great option. We provide the vast amount of medical services needed, there are no surprise bills, and contacting or seeing your doctor doesn’t mean you will have to miss work or school.
  • You have insurance but a high-deductible? Direct Primary care does offer excellent and affordable healthcare that can compliment a person’s insurance. I talked about a better plan- Direct Primary Care with Insurance earlier. Direct Primary Care focuses on decreasing their patient’s need for specialty care, ER visits, and hospitalizations by focusing on health and prevention. Doing so can (and does) reduce the need.
  • Have good, or even great insurance? Direct Primary Care universally recommends all patients have insurance. But having insurance does not mean access or longitudinal care. Having insurance without proper access is tantamount to rationing. With Direct Primary Care, we will exceed your office expectations in getting you in for your appointment with the same provider who knows you and your health- every visit.

Direct Primary Care wants to work for you. 

Opening My Clinic, Beyond Primary Care

My goal with opening a direct primary care practice was to make healthcare more affordable and accessible to everyone in the community. I have worked in the fee-for-service system, up-billing every visit to maximize insurance reimbursement (remember, costs are passed down- ultimately to the patient). I remember the conversations about patient’s prescribed blood pressure medications that cost $100 a month, and how I felt powerless to offer alternative ways of obtaining more affordable medications. I know the gut-wrenching decisions I had to make in cutting short a conversation about a patient’s knee pain because I was already a half-hour behind, offering them to return for a subsequent visit two weeks away.

At some point, my job as a family doctor in the fee-for-service system felt more like just a title and salary. After spending the better part of a decade in medical school and post-graduate training, I wanted my role as a doctor to have value. Value for providing my patients with unparalleled access to care. Value for providing my patients with transparent pricing on health care services and helping them navigate the system when needed. Value for sitting down with my patients, spending the time with them that is needed, and being there. That is the value in Beyond Primary Care.

Ropa Vieja, Family Medicine, Real Medicine, Saving Dollars

BPC Good Eats: Ropa Vieja

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3 December 2018

Hello and thank you reading my blog at Beyond Primary Care and trying the BPC Good Eats recipes. This featured recipe is a Ropa Vieja. These recipes are my attempt, in a way, to bridge that Doctor’s adage of “Eat Better & Exercise More.” In this post, I will showcase a healthy meal made on a budget, my pictures are pretty decent, and that is how I got into this food endeavor.

Slow Cooker Ropa Vieja
Prep Time: 20 minutes
Total Time: 25 minutes (including 8-10 hr slow cooking)
Adapted from: Food Network

Ingredients:
1 (15 oz) can crushed tomato
3 tbsp ketchup
1 tbsp apple cider vinegar
4 cloves garlic, minced
1 ½ tsp ground cumin
2 jalapeno pepper (with seeds), thinly sliced
2 bell peppers (1 red, 1 green), sliced ½ inch thick
1 ½ lbs skirt steak or flank steak
1 onion, thinly sliced
3 tbsp chopped pimiento-stuffed green olives, plus 1 tbsp brine from the jar
2 cups white rice, for serving
Salt and Pepper to Taste

Instructions:
1) Combine the tomatoes, ketchup, vinegar, garlic, cumin, jalapeno, and ¾ tsp salt in a slow cooker.
2) Add the steak, bell peppers, and onion and toss to coat.
3) Place cover on and cook for 8 to 10 hours
4) Coarsely shred the meat with 2 forks, then stir in olives and olive brine. Serve over rice.

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