Category: Ann Arbor, Michigan

Knee Cap Pain

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16 April 2019

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; where I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care serves patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County.

The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being. 

Knee Cap Pain

In this post I am discussing a common condition that I see at my clinic: knee cap pain. Knee cap pain can present itself multiple ways that may not always be muscular in nature, so you should always check with your doctor before starting any treatment. However, a common reason for knee pain is patello femoral pain syndrome (PFS), where the knee cap begins to increasingly track to the outermost part of the leg bone (femur) with movements such as walking, going up/down stairs, and squatting (pretty much any movement when someone bends their leg). Improper tracking of the knee cap can mechanically be due to a number of problems, and can be years in the making or due to a single traumatic event.

Anatomy

Your quadriceps muscles are key to many movements and activities that you do. The group is made up of four muscles (a “quad”) – rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis obliquus (the VMO). All four then run down to your knee and they join together, becoming a single tendon that surrounds your knee cap (patella). This tendon then continues down to connect to the knee bone (tibia) of your lower leg.

The VMO Connection

The VMO contributes to running, jumping and nearly every other basic movement, because together with your other quad muscles, it’s a powerful knee extensor along with pulling the knee cap to the inside. Anytime you push off the ground, your VMO is involved. It’s also an important knee stabilizer—a critical function that’s often overlooked. The other three quad muscles are either neutral or pull the knee cap to the outside. If you don’t have a developed VMO that can hold its own compared to the other quad muscles, you may experience tracking issues which leads to the vicious cycles of knee pain.

Minimize the Pain and Swelling

Minimizing pain and swelling can be done via an interdisciplinary approach with ice-packs and non-steroidal anti-inflammatory drugs (NSAIDs). Consider using ice-packs over the affected area, fifteen minutes at a time, two to three times a day. No heat, as this only will exacerbate the pain/inflammation cycle. Next, consider NSAIDs as these have anti-inflammatory properties and are used widely for musculoskeletal disorders. Select NSAIDs, such as ibuprofen and naproxen, are available over-the-counter.

Identify your VMO

In a relaxed, seated position with your legs out in front, place a rolled-towel under your knee. Next, feel your VMO by placing your fingers just above your knee cap on the inside aspect of your leg. Extend your leg by bringing your knee cap down into the towel. The extension of your leg should occurring slowly (like 5 seconds), over just a small range. When you do this you should feel the VMO contracting under your fingers. This should be your first exercise. 

Access Range of Motion and Build Flexibility

The first step in improving your situation is going be be determining if you have tight muscles as lack of flexibility can disrupt both the timing and contraction of muscles that will ultimately lead to more pain. From a balance standpoint, a tight muscle may limit the range of motion through which an opposite muscle can move (example of opposite muscles include rectus femoris/glute). Learn what you can about stretching, then find specific flexibility builders such as hip and ankle muscles.

Tape the Knee

Taping the knee is very easy and has been validated by research to help improve the nervous system firing of the weakened VMO muscle. Purchase some athletic or kinesio tape. To apply the tape, place the tape on the outside of the affected knee and pull it across the knee cap inward making sure you have enough pressure that you see a little skin fold crease as you do this. 

Stabilize & Build Strength

Once your swelling has subsided and pain is improving, you need to start with simple non-weighted stability exercises to regain integrity of the joint. Consider one-legged standing exercises. As you progress, start with non weighted strengthening exercises such as lunges, step-ups, and squats. Lastly, if at any point treating your knee becomes too complicated, talk to your doctor about a prescription for physical therapy. 

Free Up Cashflow In Your Budget

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4 April 2019

What are some ways to help free up cashflow in your budget? How about healthcare through Direct Primary Care?

Hi, thank you for coming back for the latest edition of Beyond Primary Care’s blog; where I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care serves patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County.

The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being. 

Today, I’m glad to welcome guest blogger, my friend Dennis LaVoy. Dennis and I co-authored this piece about freeing up cashflow through Direct Primary Care (DPC).

Who is Dennis LaVoy?

Dennis LaVoy is the owner of Telos Financial, a fee based, holistic financial planning firm located in Plymouth, Michigan specializing in serving young professionals and families. Dennis is a Certified Financial Planner (CFP®) professional and a Chartered Life Underwriter (CLU®) founded Telos to provide financial advice and uses his experience, knowledge, and expertise to help families and individuals in Ann Arbor, Detroit, and across the country achieve their financial objectives.

He went to school at Eastern Michigan University where he graduated Magna Cum Laude while receiving his degree in Finance. He has worked 10+ years as a financial advisor and opened his own firm, Telos Financial in February 2018. 

We’re going to discuss some of the financial incentives for using a DPC model.

What could using a DPC practice mean for my budget? 

Health insurance coverage is a very personal decision each family must make on their own, considering their personal values, tolerances, geographic location, and needs. Direct primary care is a membership model of health care that works well in conjunction with a High Deductible Health Plan (HDHP), commonly referred to as ‘catastrophic insurance.’ Combining a DPC membership with a HDHP addresses the main drivers of increasing cost in healthcare, such as the patient being seen in a timely manner, being proactive about your health, and ancillary medical costs (medications, labs, imaging). This allows individuals and families to have extra money on-hand every month, often saving thousands of dollars per year. So, if this type of insurance aligns with your values and tolerances, it can mean big monthly savings for your family versus a higher premium insurance arrangement.

How would it work?

Hospital systems and insurance-based clinics have higher costs for many medical services and their prices do not reflect the true cost of services even after insurance negotiations. When eliminating the costs of using health insurance, many patients can find equally effective and far more affordable options for their healthcare needs.

For example, let’s say your family is pretty healthy overall and have a high premium/low deductible health insurance policy that you pay a lot of money towards every month, where your monthly premium is $1,600, or $19,200 per year.* You believe you are not extracting enough value from your insurance, but still want coverage for those ‘what if’ scenarios. 

Switching to a HDHP insurance plan combined with a DPC membership still means you have that insurance for those ‘what if’ scenarios, but now also you have virtually unlimited access to your doctor where they can focus directly on you and not the middleman (insurance companies). Your new monthly insurance premium is $718*, and by enrolling in a DPC practice for as low as $130** a month you will have $750 in savings every month, or $9,000 per year.

*These figures were obtained by providing realistic information to ehealthinsurance.com to compare health insurance rates for 2 adult non-smokers along with 2 children for comparable health insurance plans that are compliant with the Affordable Care Act (ACA), commonly referred to as Obamacare. 

**This figure was obtained by combining the rates for adults and children at Beyond Primary Care, Ann Arbors only direct primary care practice.

Financial Savings and Opportunities

Combining a DPC membership with a HDHP can save families and individuals thousands of dollars per year where this arrangement is appropriate. Because Direct Primary Care provides so much in a membership, it is gaining national attention for the associated cost savings. A testimonial to this national attention is Consumer Reports listing Direct Primary Care as a top five smart money move in 2019 saying “joining a DPC medical practice will give you around-the-clock access to your doctor and could save you money on primary care.” 

With a couple hundred saved each month, that is money you can have working for you- not the health insurance companies. An extra $9,000 may allow you to create an ‘emergency fund,’ pay off loans, or even invest for the future. 

A $750 savings per month could build a substantial investment portfolio over time. I always recommend working with a financial planner to decide how best to invest for your family, but depending on your income, goals, and life situation, you could also save to a Roth IRA, Traditional IRA, or to a non retirement investment account. 

The Power of Compound Interest

$750 per month is a lot of money for many families. Over time, it can be hugely impactful for long term financial. Let’s further play out the scenario in this example and you have a family of 4 and that you were able to invest $750 per month at 7% growth. 7% is an assumption based on a balanced portfolio, as a point of reference, the S&P 500 from 1937-2017 (90 years) averaged 10.4%. Further, let’s assume in this example the family of 4 is two adults aged 30 and they’ll save for 12 years (Let’s say until the kids move on). 

In this example, at the end of 12 years or age 42 for the adults, you would have saved a total of $108,000 and the account would be worth over $175,400! If they didn’t save another dime after that, the account would be worth over $1,000,000 around their age 65 and 3 months. If they were able to continue the $750 per month savings, when they reached age 65, the account would be worth $1,532,591 on a total investment of $315,000. The numbers really speak for themselves and really demonstrate the power of compound interest. 

Why wouldn’t I do this?

DPC is not available locally in all communities. If you do not utilize healthcare services on a regular basis or when you do, you are just looking for one-off visits or one-time services, DPC probably is not the right fit. As always, it is something you have to consider personally.

If your employer provides a ‘comprehensive’ high premium/low deductible policy, DPC may not initially be advantageous. Still, consider bringing up DPC to your human resources leaders and incorporating into your benefits package. A partial, or fully self-insured model in conjunction with DPC has been show to result in a 30-60% reduction healthcare expenditures. 

The views expressed are my own opinions and do not apply to every situation. Your situation may vary so make sure to consult a professional for advice prior to making any decisions.

Conclusion

Financial planning should take into consideration all your needs and wants, review costs and tolerances, and educate yourself about the options. To learn more about financial planning, Dennis LaVoy, CFP®, CLU®, or Telos Financial please check out his website at https://telosfp.com/. If you believe Dennis may be a good fit for your family and you live in the southeast Michigan (or really anywhere), call him today at 734-468-3050.

These examples are for illustrative purposes only, not indicative of any specific investment product. Material discussed herewith is meant for general illustration and/or informational purposes only, please note that individual situations can vary. Therefore, the information should be relied upon when coordinated with individual professional advice.

Dr. Jeff O’Boyle of Beyond Primary Care is not affiliated with FSC Securities Corporation.

Meet and Greet at Beyond Primary Care

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29 November 2018

Dr. Jeff O’Boyle will host a Meet and Greet at Beyond Primary Care Thursday, December 6th from 5:30 pm until 8 pm. 

Meet Dr. Jeff O’Boyle, check out the personal and all-in-one clinic, and learn what Direct Primary Care offers.

Topics include:

  • How Direct Primary Care works with health insurance
  • What kind of insurance works best with Direct Primary Care
  • How obtaining your medications works with Direct Primary Care
  • How obtaining labs and imaging works with Direct Primary Care
  • How hospitalization works with Direct Primary Care
  • How referrals work with Direct Primary Care
  • Comparing the actual costs of services and products in a fee-for-service system versus Direct Primary Care
  • Dr. O’Boyle will answer any questions you have