Month: February 2019

Anxiety (in part) Explained

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22 February 2019

One of the most common medical conditions I treat as a family medicine doctor is anxiety. You most likely know what anxiety is, or personally know someone who suffers from anxiety. At my family medicine clinic, Beyond Primary Care, located in Ann Arbor Michigan, all appointments are a minimum 30 minutes, with opportunities to increase the appointment time. This length of time is an important for the treatment of any mental health concern.

What Is Anxiety?

Anxiety has many faces. Among others, it is that feeling of stress, apprehension, relentless worrying, tightness in your stomach or chest, racing thoughts, restlessness, rapid breathing, diarrhea, lack of concentration, and insomnia.

Does a person have to experience all those symptoms to have anxiety?

Absolutely not.

Does having even just one symptom mean you need medical treatment?

The best answer is that it depends on you and the severity is.

Anxiety is a NORMAL Human Emotion

Dr. Jeff O’Boyle (who is writing this posts) experiences anxiety, you (who is reading this post) have experienced anxiety. Everyone has experienced anxiety. I feel a bit like Oprah when I just wrote that. Regardless, the truth is we all experience anxiety from the moment we are born.

Think about your own children, or other children you knew as newborns. The frequent cycles of crying and calmness. The newborn doesn’t know why they are wet, why they are hungry, why they feel cold, why they can’t sleep. So they cry. This is in part- anxiety. Eventually, after a few weeks (or months for some parents), the newborn stops crying. Overtime when there is a dirty diaper, or it learns that it will be feed every 3 hours, or the baby starts connecting it’s sleep cycles and starts doing it’s nights- much to the relief of the parents- the crying and fits decrease. The point is, we all have anxiety as newborns. We develop coping mechanisms though, inherent within our own emotional control centers to deal with this anxiety.

Treatment of Anxiety

Just as no two people are affected the exact same way by anxiety, there is no “one size fits all” treatment that cures this condition. What works for one person might not work for another. The best way to treat yourself is to become as informed as possible about the treatment options, and then tailor them to meet your needs.

In my professional opinion, becoming informed about anxiety does mean you have to be honest to yourself with how you feel. Extending that honesty to your family and friends you trust, and honest to your healthcare provider is crucial is knowing that your mental health is not something to deal with alone.

Patience with Treatment

It also takes time to find the right treatment. It might take some trial and error to find the treatment and support that works best for you. Understand how these treatments work and that they don’t work immediately. Anxiety cannot be treated like a case of bronchitis, where you get a course of antibiotics and poof- you are better in 10 days. In today’s society, I feel we are so focused on instant gratification and grossly appreciable results that we lose focus on the long-term control and relief.

Your emotional system only knows where it is at right now based upon where it just was. This is why in this work we are constantly reassessing our intervention afterwards. Where are you now? Now we do something. Where are you now? So we know if we are being effective or not. Do you want to waste your time doing stuff if you don’t know it’s working? I don’t. I want to do more of the stuff that is working and less of it that isn’t. As a doctor I’m constantly measuring.

But measuring anxiety, or any other component of mental health is not done over minutes to days, but weeks to months. Again, patience is key to treatment.

BPC Good Eats: Brussels Sprout and Apple Pizza

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19 February 2019

Hello and thank you reading my blog at Beyond Primary Care and trying the BPC Good Eats recipes. This featured recipe is a Brussels Sprout and Apple Pizza. 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.

Brussels Sprout and Apple Pizza
Prep Time: 30 minutes
Total time: 1 hour
Adapted from: Hello Veggie

Ingredients
1 prepared pizza crust
3/4 cup raw walnuts
3 tablespoons shredded parmesan cheese
2 tablespoons olive oil, divided
Salt and pepper to taste
4 ounces Brussels sprouts, trimmed and thinly sliced
1 large apple, cored and thinly sliced
1 tablespoon honey
1 tablespoon roughly chopped fresh thyme
3/4 cup shredded fontina
1 tablespoon balsamic glaze

Instructions
1) Preheat oven to 425F
2) Place walnuts, parmesan cheese, and 1 tablespoon olive oil in a food processor and process until crumbly. Season with salt and pepper.
3) In a large skillet over medium-high heat, add 1 tablespoon oil. Once heated, add the brussels sprouts and apple splices; cooking about 10 minutes- until apples and sprouts being to brown.
4) Add the honey and thyme to the skillet and stir until mixed, then remove the skillet from the heat.
5) Top prepared pizza crust with walnut mixture, then the sauteed Brussels sprouts and apples. Top with shredded fontina cheese.
6) Bake for 10-15 minutes.

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BPC Good Eats: Spinach and Cheese Ravioli with Meatballs

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8 February 2019

Hello and thank you reading my blog at Beyond Primary Care and trying the BPC Good Eats recipes. This featured recipe is a Spinach and Cheese Ravioli with Meatballs. 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.

Creamy Spinach and Cheese Ravioli with Meatballs
Adapted from: Peas And Crayons
Prep Time: 20 minutes
Total Time: 40 minutes

Ingredients
1 lb prepared meatballs
1 (9 oz) package small refrigerated ravioli
2 teaspoons olive oil
1 medium red onion, chopped
4 cloves garlic, chopped
2 tablespoons butter
2 tablespoons all purpose flour
1 cup milk with extra to thin sauce as needed
½ cup parmesan cheese, grated
2 tablespoons pesto
Salt and pepper to taste
½ cup mozzarella cheese, grated

Instructions
1) Bring a medium pot of water to a boil.Cook the ravioli according to package directions until al dente. Drain water ravioli, place ravioli in a bowl and set aside.
2) Place a saute pan over medium-high heat, cook the meatballs until tender.
3) While the pasta and meatballs cooks, heat the oil in a large stainless pan/skillet over medium-high heat. Add the onion and cook until tender and translucent, approx. 5 minutes. Add garlic for 2 minutes.
4) Add butter and garlic to the pan. Once butter has melted, add flour and whisk constantly with a metal whisk until the butter and flour are well combined and the mixture darkens in color a bit.
5) Pour in milk and whisk vigorously to combine. Whisk often until mixture thickens. Add parmesan, pesto salt, and pepper.
6) Once your sauce has reached desired thickness, fold in your chopped spinach and cooked ravioli and meatballs.
7) Thin sauce if desired with additional milk and adjust salt and pepper to taste. Remove from heat, top with grated mozzarella and cover with the pot’s lid to melt the cheese.

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Direct Primary Care Works With Your Insurance

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5 February 2019

Hi, thank you for reading! My name is Dr. Jeff O’Boyle. I am a board certified family medicine physician. My clinic, Beyond Primary Care is located in Ann Arbor, Michigan. In this post I am answering a common question that I receive, and that is does Direct Primary Care (DPC) work with your insurance? The answer for a vast majority of DPC clinics is yes, DPC works with your insurance, but not for your insurance. This is an important distinction.

DPC does not work FOR your insurance

This is the essence of DPC, that it works directly for you- the patient! We forgo insurance payments in order to save our patients from the arbitrary, intrusive decisions that inevitably follow with third-party payers (health insurance). Furthermore, since DPC practices are independent, we are free from hospital contractual agreements and can offer reduced prices on laboratory tests, imaging, and medications. As noted by this Wall Street Journal article, hospital systems are ignorant of their actual costs. Instead, they often increase prices to meet profit margins.

DPC works WITH your insurance

While DPC’s goal is to cover the vast majority of healthcare needed for all individuals, there are many instances in which a patient may need to utilize their insurance to see providers or utilize services outside the membership.

Specialist Referrals

This would be when a member needs to see a specialist for a condition that requires care past what could be offered in a family medicine clinic. Examples include physician specialist, psychiatrists, counselors, and physical therapists.

Say a member needs a referral to an oncologist- which is a doctor that specializes in the diagnosis and treatment of cancers. No one ever anticipates needing a such a doctor. But when called upon, a DPC doctor will work to find a doctor that accepts your insurance, help coordinate your care, while minimizing your financial impact. How do we minimize your financial impact? If that specialist requires imaging, medications, or blood work, DPC practices will work with you to find the lowest costs– often through our DPC clinics- that meet the needs of the health provider. 

Hospitalization Coordination

From time to time, accidents or serious medical conditions do occur and an elevated level of care is required where a member needs to be monitored 24/7 by a team of doctors and providers.

An example could be a member suffers a broken arm from falling and needs to be hospitalized for a major surgery. DPC will help communicate with your inpatient hospital team of providers making sure they know your current health status and working towards understanding your options for care upon discharge. While we may not be able to care for you in the hospital, we can certainly use virtual medicine (also known as telemedicine) to discuss your needs and questions. We can also give you helpful advice to make sure you won’t receive any unexpected bills from the hospital upon your discharge.

The following picture is a hospital bill from a patient who posted her hospital bill online. The patient was contemplating hurting themselves and walked into an Emergency Room seeking help. The patient states the “physician charges” are NOT shown that bring the grand total to over $18,000!

Here is some FREE Doctor Advice from Beyond Primary Care: In the hospital, ask to know the identity of every unfamiliar person who appears at your bedside. If you’re too ill, ask a companion to serve as gatekeeper. Write it down. What seems like a pleasantry may constitute a $700 consultation

Special Medications

One of the coolest features about DPC is many practices offer in-clinic dispensing of hundreds of generic medications, often at substantial price differences compared to retail pharmacies. Still, there are times a member needs or would benefit from a certain medication that is brand name only (very expensive) and would be best obtained through insurance that requires a prior-authorization from the insurance company.

In this scenario, we will work to fill out the necessary paperwork to get your needed medications at reduced costs or even reach out to the pharmaceutical companies seeking a reimbursement or free supplies on your behalf. A great example is we got one of our members Vivitrol, a vital medication for Medication Assisted Therapy in Addiction Medicine. This medication costs over $1,000 on the market, but we worked to get our member the medication FREE of charge with their insurance. Did I mention the office visit and the injection itself were included with the membership? So the patient literally paid $0. Saving money for our patients gets me so excited!