Category: Ann Arbor, Michigan

Breast Cancer Screening in Ann Arbor

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13 October 2020

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; Breast Cancer Screening in Ann Arbor. In Beyond Primary Care blogs 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 an insurance free, membership based family medicine and addiction medicine clinic. Beyond Primary Care is the first and highest rated Direct Primary Care clinic serving patients in Ann Arbor and throughout Saline, Dexter, Chelsea, Ypsilanti and beyond giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.

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. 

In this blog post, I wanted to discuss an important healthcare decision females and yes- males need to consider as we age: Breast Cancer Screening

Breast Cancer Screening in Ann Arbor

Breast Cancer

Breast cancer is a cancer that occurs when individual cells in the breast grow uncontrollably. Inside the breast, there are different areas where breast cancer can begin including lobules, ducts, and connective tissue. 

  • Lobules are glands the produce breast milk
  • Ducts are tubes that carry breast milk to the nipple
  • Connective tissue- like the force- is around everything and holds everything together

Why Breast Cancer Is Important

Breast cancer is the second most common cancer among women in the United States, only behind lung cancer. White women and black women get breast cancer at about the same rate. However, discrepancies in diagnosis and treatment exist because black women have a higher morbidity than white women. 

While most commonly discussed among females, breast cancer can actually affect males as well. Nearly 1 out of every 100 breast cancers diagnosed is found in a man. While rare compared to females, it is not to be ignored as males are more likely than women to be diagnosed with advanced breast cancer, most often attributed to a decreased awareness.

In 2017 for the State of Michigan, there were 7,582 breast cancer related cases reported- nearly 119 new cases for every 100,000 females screened. Recent epidemiological studies have suggested that incidence rates for breast cancer has been slowly increasing since 2004. Recent studies have concluded that increases in body mass index (BMI) and declines in the average number of births per woman (both breast cancer risk factors) have likely contributed to the recent increases. 

Breast Cancer Screening

The American Cancer Society (ACS) recommends for women at average risk to begin breast cancer screening at age 45. Women should get mammograms every year until the age of 55, at which point they can switch to every other year or continue yearly screening.

Factors for individuals to be considered average risk include not having:

  • A personal history of breast cancer
  • A family history of breast cancer
  • A genetic mutation known to increase risk of breast cancer (eg- BRCA gene)
  • Has not had chest radiation before the age of 30

It is mentionable that the United States Preventative Task Force (USPTF), another major panel that develops evidence-based recommendations for clinical preventive services, continues to recommend screening starting at age 50 years of age.

Why the difference in Screening Recommendations? It comes back to the harms versus the benefits of screening. Ahh yes, too much of anything can sometimes be fraught with unintended consequences. As example, the sensitivity of mammograms is generally higher in older women because of less denser breast tissue than younger women. However, If you’re reading this blog post, you have already accomplished the awareness for the need of screening. That’s a win, let’s leave it there for now.

Breast Cancer Risk Factors

Risk of breast cancer is due to a number of factors, with the main risk being a women and getting older. Most women have some risk factors. However, most women will not get breast cancer. Other risk factors include:

  • Genetic mutations such as BRCA1 and BRCA2
  • Menstrual history of having periods before age 12 or after age 55
  • Dense Breasts
  • Family history of breast or ovarian cancer in a first-degree relative (mother, sister, daughter)
  • Previous radiation therapy to the chest
  • Lack of physical activity
  • A higher body mass index (BMI)
  • Tobacco use

Breast Cancer Screening Tests

Once risk factors have been determined or a female has reached a particular age, the decision to be screened for breast cancer should be started. Below I discuss the most common types of breast cancer screening we encounter. 

Mammography

This is a low-dose X-ray of breast tissue and currently the gold-standard in breast cancer screening. Early detection of breast cancer by mammography reduces the risk of breast cancer death and increases treatment options, including less extensive surgery and/or use of chemotherapy. 

3D Mammography

This is called Digital Breast Tomosynthesis (DBT) and is actually a combination of multiple breast images, along with 2D breast mammography to construct a 3D image of the breasts She studies have found 3D mammography to be more sensitive, however this is not a wide spread imaging test available to all and may not be covered by insurance. 

Thermography

Thermography utilizes a special camera to measure the temperature of the skin on the breast’s surface. It is based on the ideas that cancer cells are growing and multiplying faster, thus blood flow and metabolism are higher in a cancer tumor. As blood flow and metabolism increase, skin temperature goes up. It involves no radiation.

In regards to radiation, I can certainly appreciate the concern to be less invasive and more natural. However, according to Wakes Medical Campus (Chapel Hill, NC), the total radiation dose for a typical mammogram with two views each breast is about 0.4 mSV. As perspective, they say we are normally exposed to 3 mSV of radiation each year just from our natural surroundings. Additionally, breast cancer screening via mammography is statistically about x20 more sensitive than thermography. Meaning, a radiologist may find a mass with thermography at stage 2, they likely could of found that same mass at stage 1 with mammography- and thus differing survival rates. 

Breast Self Awareness

While monthly self-breast exams are no longer recommended based on increases in rates of false positive, all women should become familiar with both the appearance and the feel of heir breasts. Any changes should be promptly reported to their physician.

Other Tests

Such as breast magnetic resonance imaging (MRI) and ultrasounds are sometimes used on a case-by-case basis depending on risk factors and history of abnormal results. 

Why You Should Have Breast Cancer Screening

At Beyond Primary Care, we encourage females to be proactive about their breast health and work with imaging centers that perform mammography screenings. The Affordable Care Act (ie- Obamacare) requires that Medicare and all new private health insurance plans cover screening mammograms without any out-of-pocket expenses to patients. 

Note: screening mammograms are only covered through insurances. If your initial screening returns and advises follow-up, either a diagnostic mammogram, a breast ultrasound or MRI, working with Beyond Primary Care to determine your out of pocket costs is advised as some imaging price are more affordable without health insurance.

Please contact Dr. O’Boyle directly with any questions or to schedule an appointment to discuss further. I look forward to hearing from you!

Where To Get The Flu Shot In Ann Arbor

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9 September 2020

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; Where to Get the Flu Shot in Ann Arbor. In Beyond Primary Care blogs 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 an insurance free, membership based family medicine and addiction medicine clinic. Beyond Primary Care is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.

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. 

In this blog post, I wanted to update my patients and any prospective patients…

Where To Get The Flu Shot In Ann Arbor

Flu season is just around the corner and according to the Centers for Disease Control (CDC) for the 2019-2020 cycle there have been upwards of 56 million Americans affected by flu-like illnesses resulting in nearly 25 million medical visits, a half million hospitalizations, and nearly 50,000 influenza deaths. 

This is why we advocate for getting a Flu shot before the start of the Flu season- we want to prevent people from going to the hospital and potential serious consequences, i.e- death from the Influenza virus.

The flu shot is a little bit of a booster to remind your immune system what may be coming ahead. A similar process is going on with the coronavirus vaccine trials. The vaccine reminds people’s immune system what that virus looks like, so that when they are exposed they either 1) don’t get the virus or 2) get a very mild case.

Flu and Covid-19

Now more than ever, it is important to get your Flu shot. We do not want to see a Flu season with a Covid season together. Flu and Covid-19 are both respiratory illnesses, but are caused by different viruses. The Flu is caused by infection with influenza viruses, and Covid-19 is caused by a new coronavirus (called SARS-CoV-2).

It is possible to have the Flu and Covid-19 at the same time. At Beyond Primary Care we can test for both the influenza virus and Covid-19 at the same time. 

How can the Flu shot help me?

There are many reasons to get the Flu vaccine each year. Here is a summary of the benefits of the Flu vaccine.

  • Flu vaccine protects yourself from getting the flu
  • Flu vaccine can reduce the risk of flu-associated hospitalization for children, working age adults, and older adults
  • Flu vaccine helps prevent serious medical events associated with some chronic conditions such as heart disease, diabetes, and chronic lung disease.
  • Flu vaccine helps protect women during and after pregnancy
  • Flu vaccine can be life saving in children
  • Flu vaccine has been shown in several studies to reduce severity of illness in people who get vaccinated but still get sick

If you’re on the fence about a flu shot, here are five arguments to see if I can change your mind.

Getting vaccinated yourself may also protect people around you, including those who are more vulnerable to serious Flu illness, like babies and young children, older people, and people with certain chronic health conditions.

What are Flu Symptoms? What Should I lookout for?

Symptoms of the Flu and Covid-19 are similar, which makes it extremely difficult to tell the difference based on symptoms alone. Common symptoms that the Flu and Covid-19 share include:

  • Fever or feeling feverish/chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue (tiredness)
  • Sore throat
  • Runny or stuffy nose
  • Muscle pain or body aches
  • Headache
  • Some people may have vomiting and diarrhea, though this is more common in children than adults

Different than the Flu, Covid-19 may include a loss of taste or smell. While a person typically develops symptoms one to four days after an infection, with Covid-19 typically develops symptoms 5 days after being infected, although time range can vary.

Is it too early to get the Flu Vaccine?

Once the flu vaccine is administered, it takes your body about two weeks to develop antibodies to the virus. The vaccine should confer about 6 months of immunity. So, the earlier the better in terms of administration. We do see the flu start peaking in October with another peak in March every year. 

Reasons to NOT to get the influenza vaccine?

Truthfully the only individuals who should not get the Flu shot are infants younger than 6 months of age or people who experience a severe (life threatening) allergy to a prior dose of a seasonal Flu vaccine.

People with egg allergies just need to be monitored for the influenza vaccine, as an egg allergy is not an absolute contraindication.  A 2012 review of published data, including 4,172 egg-allergic patients (513 reporting a history of severe allergic reaction) noted no occurrences of anaphylaxis following administration of the Flu vaccine. 

This suggests that severe allergic reactions to egg-based influenza vaccines are unlikely. On this basis, some guidance recommends that no additional measures are needed when administering influenza vaccine to egg-allergic persons 

People with a cough or cold can still get the flu shot. 

The Flu shot is an inactivated virus and cannot cause influenza, Flu shots given may cause injection site soreness and pain, redness, swelling, fever, malaise and muscle aches- all of which are usually mild and go away on their own.

Where To Get The Flu Shot In Ann Arbor

Protect yourself and your family (and friends and co-workers) from the Flu this year! To make an appointment with Dr. Jeff, head over to our scheduling link to view our availability. Just as a reminder, we will be offering our patients opportunities to get their vaccines on select Saturday mornings, in which case an email will be separately sent to all Beyond Primary Care members.

Thank you for reading.

  • Dr. Jeff O’Boyle with Beyond Primary Care

Racism in Healthcare

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27 August 2020

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; How Racism in Healthcare. In Beyond Primary Care blogs 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 an insurance free, membership based family medicine and addiction medicine clinic. Beyond Primary Care is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.

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. 

In this blog post, I wanted to update my patients and any prospective patients on important discussions to have anytime, but especially now and that is:

Racism in Healthcare

Black lives matter. Black lives matter to us as physicians, community members, and more importantly as fellow humans. I acknowledge that the medical system has repeatedly treated the African American community in ways that lead to unacceptable health outcomes. 

Race is a social construct used to separate humans based on the amount of melanin- the amount of pigment- in their skin. We see racism on the other end of the melanin spectrum as well, when individuals produce little or no melanin- a condition called albinism. Race is one of many societal constructs that have systematically oppressed and marginalized groups of people including but not limited to:

  • Immigrants
  • LGBTQ
  • The most visible at this time, the African American community 

Health Disparities

Data demonstrates that African American women and infants have increased rates of death in childbirth. African Americans have lower life expectancy. More recently African Americans have been disproportionally killed by the Covid-19 pandemic. 

This is due to many factors. We recognize that healthcare workers carry implicit biases that affect the quality of the care they provide, oftentimes unconsciously. In the past, there have been more blatant racists efforts undertaken by the healthcare system,- the Tuskegee Syphilis Study being an egregious example of such shortcomings.

While in medical school, I actively participated in small group sessions aimed at recognizing and addressing medically underserved populations. Accessing basic needs is difficult for minority populations- people like:

  • Migrant farm workers
  • Prison populations
  • Individuals struggling with substance abuse and addictive behaviors
  • Individuals lacking financial and medical literacy
  • People without safe and affordable housing, etc..

All of these scenarios contribute to poorer health outcomes that affect minority communities the hardest.

The Point Of This Blog Post

One of my favorite medical educators- a Jack McFarland doppelganger- use to tell me and everyone:

“There are no mistakes, just educational opportunities.”

In the spirit of “Dr. Jack”, please do interpret this post as a way to place blame or to shame any group of individuals into defensive posture, but to elevate the discussion surrounding the increasing permeating manner that racism is affecting, and will continue to affect large parts of our community.

Moving Towards A Better Future

We recognize that racism exists. We also recognize that we, the people of Ann Arbor, greater Michigan, and this great nation must unite together to form meaningful solutions. Beyond Primary Care is committed to doing our small part by continuously pushing the status quo of healthcare to become more inclusive and more mindful of the catastrophic financial effects our current healthcare system has on those who are most vulnerable. 

It’s small, but it’s what we can do well and what we promise to do for those in our care.

Thank you for reading.

– Dr. Jeff O’Boyle with Beyond Primary Care

Where Can I Find A Sublocade Doctor In Michigan?

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7 August 2020

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; Where can I find a Sublocade Doctor in Michigan. In Beyond Primary Care blogs 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 an insurance free, membership based family medicine and addiction medicine clinic. Beyond Primary Care is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.

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. 

In this blog post, I wanted to answer a common question…

Where can I find a Sublocade doctor in Michigan?

First, Sublocade Explained

Sublocade is a brand name medication available by prescription only from physicians or other professionals with a special Drug Enforcement Agency (DEA) license. Sublocade is actually injectable Buprenorphine, one of the active medications in brand name medications such as Suboxone and Zubsolv. This medication is delivered directly to the physician’s office, and is typically given every 28 days- roughly once a month.

Sublocade is injected by a physician as a liquid right under the skin in a patient’s abdominal area. Once inside someone’s body, it turns into a solid gel that gradually releases buprenorphine at a controlled rate all month.

What is Sublocade used for?

Sublocade is used to treat opioid addiction, a type of substance use disorder that is classified as a neurobiological disease. Addiction has genetic, psychosocial, and environmental factors influencing its development and manifestations. 

A great way to think of how opioids and the medication works is to imagine your brain has a bunch of empty ice cream cones on it- we’ll call these ‘receptors.’ When the ice cream- we’ll call these ‘opioids,’ enters the space by the brain, they normally fit right into the empty cone. Unless you have a dairy allergy or are lactose intolerant, this will feel really good for most people. 

This same mechanism is what happens for opioids (pills, drugs) in the brain, when they result in a release of Dopamine creating a sense of pleasure and reward.

Sublocade and the medication in it, buprenorphine, attaches to those ice cream cones making other scoops of ice cream less likely to park. 

Why Sublocade Is Important

The simple answer is this medication is a method of harm reduction against opioid use disorder, and it saves lives. I previously talked about what ‘harm reduction’ is in a post about The Sinclair Method here.

According to the Centers for Disease Control:

  • 40% of overdose deaths are due to natural opioids such as morphine and codeine or semisynthetic opioids such as oxycodone or hydrocodone
  • 15% of overdose deaths are attributed to synthetic opioids such as fentanyl
  • 10% of overdose deaths are attributed to methadone
  • 35% of overdose deaths are attributed to heroin

While on Sublocade, individuals will receive a continual delivery of the medication buprenorphine all month, and it only requires a once-monthly injection by a trained physician. 

This is important. 

Why? The injection takes out any compliance issues for many folks battling opioid addiction such as:

  • Forgetting doses
  • Missing doses
  • Losing medication

The injection also results in a safer community through less diversion of the Buprenorphine films or tablets. 

Where to find Sublocade Doctors in Michigan

You can always click through the Sublocade website and look for providers that way. In addition to being a board certified family medicine doctor, I am also a board certified addiction doctor. I utilize buprenorphine products such as Sublocade, Suboxone, and Zubsolv at my clinic, Beyond Primary Care in Ann Arbor, Michigan. I use an eclectic and personalized approach towards assessing and resolving your life changes and stressors. Not a ‘cookie cutter’ one size fits all plan. In addition to a thorough health history, I am going to ask about your family, where your quality of life is being most affected, and—most importantly—what you want to do.

Reach Out For Help

If you think some health concerns of what you may be experiencing may be due to excessive opioid consumption, or if you notice any coworkers, friends, or family members silently struggling, send them a link to this post so that they can join the conversation!

You can also contact Dr. O’Boyle directly. I look forward to hearing from you!

Treating Menopausal Symptoms

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19 May 2020

Hi, thank you for coming back for the latest edition of the Beyond Primary Cares blog; treating menopausal symptoms. In my blogs 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 an insurance free, membership based family medicine and addiction medicine clinic. Beyond Primary Care is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.

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. 

In this blog post, I’m glad to welcome a guest blogger, my friend Liza Baker. Liza is the owner of Simply: Health Coaching and is a full-time health coach and nonprofit consultant, author, blogger, and podcaster with a soft spot for supporting women in their 40s and above. This is a collaboration blog-piece, where we wanted to educate our patients and the community on treating menopausal symptoms, specifically how role lifestyle and nutrition can positively influence those changes, and what medications can positively influence those changes.

Menopausal, peri-, and post-

First, a little bit of clarity to the menopause timeline:

  • Menopause is defined as the complete cessation of the menstrual cycle for 12 months, after which time it is extremely rare for it to resume. The average age at which menopause occurs in the United States is 52.
  • Peri-menopause is the period of our lives when our bodies (if not our conscious thoughts) begin to move toward the end of our child-bearing years, and it can begin as long as 10 years before the final menstrual cycle—that’s right: you can enter menopause as early as your late 30s to early 40s. And yes, you can still get pregnant during these years! (As we know from the British comedy Sex Education!)
  • Women are considered post-menopausal once they have been cycle-free for 12 months.

Importance of Identifying Menopausal Symptoms

Every woman experiences menopause differently. Some of us reach the end of our cycles almost without noticing; others don’t have a period for some months and then get surprised to find that it was just loitering in there—and then we need to start the countdown over again. Your “regular” periods may have stopped years ago—regular in the sense of timing and in their length and heaviness. 

Like most women, you may have an idea what to expect:

  • Physical symptoms such as hot flashes, night sweats, vaginal dryness, dizziness, nausea, breast tenderness, insomnia, skin changes, abnormal uterine bleeding, urine incontinence, and headaches. 
  • Changes in mood such as increased anxiety, reduced sex drive, memory issues, and fluctuations in mood. 

These symptoms can last months to years, and even post menopause, you can still sometimes “feel menopausal.” These symptoms can be severe, disruptive, and even feel embarrassing at times. 

In a previous blog post, Liza reminds us that it doesn’t help to approach this shift in hormones as a problem, like we are entering this stage of life from the perspective of “we’re broken.” Instead, it’s important to approach this as a woman’s health experience within the context of identifying your own symptoms and getting clarity about possible therapies for treating menopausal symptoms.

Treating Menopausal Symptoms —and causes

You may have mined the women’s health section of your local bookstore looking for informed (dare we say evidence-based) resources to guide you. What you likely found is a broad spectrum of seemingly science-based approaches from “here is why you should be on hormone replacement therapy (HRT)” to “here is why you absolutely should NOT be on HRT!”

Liza is a firm believer that when advice falls on a spectrum (HRT: YES! NO!), the truth likely lies somewhere in the middle. And having learned that many of the top health problems in our country are so-called “lifestyle diseases”—meaning that they can be reversed and/or prevented through our food and lifestyle choices.

Putting Experience Into Practice

Liza’s personal experience with peri-menopause involved a large number of the most commonly recognized symptoms listed above—including raging migraines after decades of their absence and an appearance by anxiety and panic attacks, neither of which she’d ever experienced before.

And perhaps because Liza had been raised with fairly good food and lifestyle choices and began to make even better ones once she had her own family, many of my/her symptoms were quite mild.

That said, as a health coach, her work with clients is based on the principle of bio-individuality: your perimenopause is not my perimenopause; what works for you may not work for me; your kale may be my kryptonite. Dr. O’Boyle explains it this way: “Discussing the scope of treatment … is extensive and always carries asterisks for certain populations…. Treatment is multi-dimensional and must be individualized, your classic N of 1 trial.”

What matters most is that we—as patients/clients and as practitioners—take a holistic approach: yes, it’s about reducing the severity of symptoms—and about taking a longer view of what caused them and how we can shift that in a more positive direction. It’s as much (more?) about prevention as it is about a cure.

And it’s about giving you—the patient—permission to have some agency over your health care. As Dr. O’Boyle says, “Mainstream medicine has a challenge: continue to ignore your story and lose you to a subjective fantasy built on the mistakes of our brain, or join you in your life story ensuring you are taking responsibility for your wellbeing while making you central to the care and cure.”

Treating Menopausal Symptoms with Medications

The stress involved with menopause can be disruptive on many levels. Some women feel awful, and don’t want to be subjected to a physical exam, let alone interact with a physician when they can’t interact with their families, co-workers, and friends in a way that has meaning. At Beyond Primary Care, you can be assured there will be no judgement, no unnecessary physical exams, just compassion and an opportunity to share your story.

At Beyond Primary Care, I use an eclectic and personalized approach—not a “canned” conversation- towards accessing and resolving life changes and stressors. In a thorough health history, I am going to ask about your family, where your quality of life is being most affected, and—most importantly—what you want to do. I find validation of your concerns and education are often powerful methods in support when you are not feeling well. As you read above, some women prefer enhancing their diet and exercise along with support in allowing their symptoms to play out more naturally.

If more holistic approaches of treatment don’t work, I [Dr. Jeff O’Boyle] can get innovative with estrogen and progesterone hormone replacement therapy (HRT), depending on your needs. Getting the dosage right using hormone patches, pills, and creams is always individualized, and I [Dr. Jeff O’Boyle] works with my [his] patients to customize how much or how little may be needed. While HRT is sometimes a last resort for a woman, the relief it gives can be life-changing. Additionally, just like a great chef (shamless cook book plug) with their ingredients, I am constantly measuring and remeasuring your for safety and goal achievement.

Decisions, decisions

Consider this your permission to make a decision about treating perimenopausal symptoms based on what’s right for you—because you do have options!

If you suspect some of what you are experiencing may be due to perimenopause, or if you notice any coworkers, friends, or family members silently struggling, send them a link to this post so that they can join the conversation!

Please share comments and questions below. You can also contact Dr. O’Boyle or Liza Baker directly. We look forward to hearing from you!

Anaphylaxis and Epinephrine

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7 January 2020

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 is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.

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. 

In this blog post, I wanted to talk about severe allergic reactions, namely anaphylaxis and epinephrine.

Anaphylaxis

Anaphylaxis is a severe, sometimes life-threatening, allergic reaction that occurs within minutes to several hours of exposure an allergy-causing substance (allergen).

In any body allergic reaction, your immune system will respond to the presence of an allergen (whether food or environmental) by releasing histamine and other body chemicals. These chemicals cause the symptoms of allergies, in their mild form are annoying, such as the runny nose of hay fever (allergic rhinitis) or the itchy rash of poison ivy. 

Unfortunately though, the symptoms can progress and be much worse and involve the entire body. Anaphylaxis is the most severe allergic reaction. In anaphylaxis, body chemicals cause serious skin symptoms, such as hives and swelling, as well as severe breathing problems, such as swelling in the throat, narrowing of the lower airways and wheezing. Anaphylaxis is a life-threatening medical emergency.

The Physical Reaction

There are different shapes and forms of a severe reaction. Symptoms of anaphylaxis usually occur within seconds to minutes of exposure to the allergen, but symptoms can be delayed for several hours.

  • Feeling light headed, faint, difficulty breathing, couching, wheezing, weakness
  • Confusion, anxiety, panic, or a feeling of impending doom
  • Measurable symptoms such as rapid pulse or profuse sweating.
  • Itchy hives, which may blend together to form larger areas of skin swelling
  • Swelling of the lips, tongue or eyes
  • Nausea, vomiting, stomach cramps, diarrhea
  • Paleness, bluish skin color
  • Throat swelling -like a golf ball stuck in your throat, hoarseness 

Treatment

Symptoms of anaphylaxis usually require treatment with epinephrine, by injection. People who have had anaphylaxis can carry a pre-loaded syringe containing epinephrine.

Epinephrine

You have probably heard about this drug before, but some of what you think you know may not be correct.

Epinephrine is safe, and you already have epinephrine in your body

Epinephrine is a naturally occurring hormone. At-rest plasma epinephrine levels are 0.035 ng/mL. It is the hormone that is part of our fight-or-flight response. When you are scared or excited, and also when you are exercising, your epinephrine levels surge, but even when you sleep, there is a little epinephrine circulating in your body. Levels over 10 times that amount have been measured in persons exercising, and even higher than that in people under mental stress. 

The standard adult dose of self-injecting epinephrine (0.3 mg of 1:1000 epinephrine) raises the level of epinephrine in the body from an average of 0.035 ng/mL to about 10 times that amount.  It would require more about 20 such injections to reach a toxic level.

If you were given the injection right now, all that would likely happen is that your heart rate and blood pressure would increase to a moderate degree and that you might feel slightly shaky. Epinephrine is metabolized very quickly, and you would not feel this effect for long.

You Should Not Wait to Use Your Epinephrine

You might hope the allergic reaction won’t be “that bad,” and you might be right, but it’s important to know that a delay in use of epinephrine is linked to poorer outcomes and prolonged hospitalizations.

You Should Not Be Afraid of the Epinephrine Device

The device itself might look big, but the injection needle is not. It’s just like getting a flu shot. As mentioned above, the main side effect you might experience is feeling a bit shaky after using the device.

You Should Go to the Emergency Room (ER) After Using the Epinephrine for Anaphlaxis

You may have been told that you have to go to the ER after using your epinephrine device. That’s not because of the epinephrine; it’s because the allergic reaction probably requires further monitoring. In the past, I have talked about why NOT to go to the emergency rooms. Anaphylaxis is not one of those scenarios. Many patients also need more than one dose of epinephrine for anaphylaxis or other emergency treatments; that may be due to the severity of the allergic reaction or simply because the device was not used correctly (the most common mistake is not holding the device against your thigh for the time required for the full dose of medication to be delivered). So a trip to the ER is the safest thing to do after using epinephrine.

Epinephrine Cost

You may of heard EpiPen’s manufacturer, Mylan Pharmaceuticals, had increased the price of a two-pack over several years to $600 or more—even for people with insurance. For some families—especially those who needed more than one EpiPen pack to protect their kids during severe allergy attacks—that price was still way too high. As a Direct Primary Care doctor, I have worked towards making epinephrine affordable to my patients, with a 2 pack of injectors costing less than $100. 

Obstructive Sleep Apnea

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26 December 2019

Obstructive Sleep Apnea

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 is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.

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. 

In this blog post, I wanted to talk about Obstructive Sleep Apnea (OSA).

Your Spouse Says You Snore, a LOT

Everybody snores, right? How bad can it be though? You never hear it.

The changes are gradual, so gradual you may not see the pattern. You finally get tired of the criticism so you make your way to an ear, nose, and throat specialist to tell you have a deviated septum. Maybe they tell you you have a uvula (that dangling skin in your throat) that needs trimming. You consider surgery, but that is a big step. 

Eventually you may start getting depressed. Maybe your personal or work relationships start deteriorating. You start to see a therapist who recommends you back to a psychiatrist, who dutifully puts you on a cocktail of anti-depressant medications. 

At some point you make it back to your primary care physician, where you relay some of this information during a yearly physical. The spouse says they are worried because you seem to stop breathing at night (Apnea), then suddenly gasp for air followed by resuming your slumber as if nothing had happened.

Your physician says your sleep may be a key to your problems.

Other symptoms of Obstructive Sleep Apnea include:

  • Excessive and inappropriate daytime sleepiness
  • Insomnia
  • Problems with memory and/or concentration
  • Impotence
  • Headaches
  • Fatigue

What Causes Obstructive Sleep Apnea

According to the American Academy of Sleep Medicine, Obstructive Sleep Apnea is a sleep-related medical condition that results in an almost complete blockage of airflow despite your body’s effort to breath. This is caused when the muscles in the pharynx (throat) relax during sleep, allowing all the supporting tissues of the throat to collapse and block the upper airway. These apnea episodes, or pauses, can last between 10 and 30 seconds, but some may progress longer. 

This lack of breathing drops your blood oxygen saturation that ultimately sounds an alarm in your brain to cause a temporary arousal from sleep that typically restores normal breathing. This can occur hundreds of time in a single night resulting in poor and episodic sleep quality resulting in the above symptoms.

Diagnosis

You will be advised to undergo a sleep study. This sounds absurd on the face, what doctor would routinely want to observe anyone while they sleep? In fact, you may never see the ‘sleep doctor.’ There are many ‘sleep laboratories’ around the nation, often staffed with sleep technicians where you can have up to 36 separate electrodes placed on you while you are asleep. The laborites sleep technician will likely be helping you with all of this. 

I personally encourage my patients to complete home based sleep studies, as example using Somno Services. With Somno Services, they ship all the necessary equipment to you at your home. This allows my patients to complete the assessment in the comfort of their own homes at a fraction of the cost a sleep laboratory would charge, around $175 versus $1,000+ at a sleep clinic. Following completion, you simply repackage the materials and send it back.

After a few days, the sleep doctor will review the data collected and be able to confirm a diagnosis.

Realistic Treatment Options

CPAP therapy (Continuous Positive Airway Pressure) as pictured below is a standard of therapy. Once you have a diagnosis, you will have to get the proper equipment from a medical supply store. Finding a proper fitting mask is key to this. 

Wearing an oral or dental appliance can be an alternative to CPAP. Oral devices work by holding the tongue in place or by sliding the jaw forward while you sleep. Again, this is a device that may need some fine-tuning by a trained sleep specialist or supply store.

Surgery. Some surgeons may say that corruption of nasal structures or throat structures can reduce or eliminate extra tissues in your throat preventing the collapse that leads to Obstructive Sleep Apnea. While surgery may indeed help in some cases, I encourage all my patients to review the harms and benefits of the surgery vs non surgical options, ask about success rates, and ultimately factor in costs.

Weight loss. I absolutely hate the old doctor’s adage of ‘eat less and move more.’ Weight shaming is not a motivating strategy. Know though, reductions is weight and ultimately body mass can significantly reduce or even eliminate the weight of the tissue pressing onto the airway. Losing weight, like any other medical condition, requires a multi-dimensional approach including potentially mental imagery and therapy, nutritional support counseling, a safe exercise program, and regular biometric feedback.

Sedera Health + Beyond Primary Care = Premium Healthcare Without Insurance

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19 November 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 is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.

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. 

In this blog post, I wanted to talk about Sedera Health, which is a cost-sharing model that can help with that ‘Back End’ healthcare coverage.

To be 100% upfront, myself nor my clinic- Beyond Primary Care, have any special relationship or financial interest in Sedera to disclose. I am simply educating the public and my patients on affordable coverages for those ‘what if’ scenarios.

The American Health Insurance Experience

In 2018, the average monthly cost for health insurance for an individual was $440.00 and for a family of 4 the average cost rose to $1,168.00, per month. That’s $14,016.00 per year. But wait, there’s more. The average deductible for that same family was $8,232.00 with many plans being over $10,000.00. What does all this mean?

Well, if you need any major medical coverage for your family, be prepared to pay about $22,000 in out-of-pocket costs before your insurance kicks in. We can’t afford to get sick anymore. For a large number of Americans and businesses, this is the new reality. Monthly health insurance costs increase every year while at the same time out-of-pocket deductibles have sky-rocketed.

Front End, Back End

You may of heard the terms ‘back end’ and ‘front end’ healthcare coverage before, but what does that mean? 

Front end is basically any, and the vast majority of healthcare services that you would routinely use. Such as a regular doctor visit, needing medications, blood laboratory work, routine imaging, scheduled procedures. 

The back end of healthcare are any surgeries, hospitalizations, or emergent care situations that may arise. Surgeries, hospitalizations, and emergency room care can be inherently expensive. People can go bankrupt from these events. That is why we recommend some ‘back end’ coverage.

However, treating a rash, urinary tract infection, common cold, or doing a well visit is vastly different than brain surgery.

Why are we paying for them in the same manner?

Have you heard of Sedera Health?

So, what is medical cost sharing? There are better options out there for you. Sedera Health is one of those options. 

Sedera Health uses a medical cost-sharing model to challenge the status quo of health insurance that many of us have become so frustrated with. Instead of making payments to an insurance company that do not have your best interests at heart, medical cost-share members make payments to a community fund and those funds are only drawn upon when they are needed. Typically, members can save between 30-50% of what they were paying in insurance premiums and can chose a set amount that they are willing to pay as an initial unsharable amount. This can amount to $1,000s of dollars a year. So, you get lower costs and predictable expenses for those times when you do have major medical events.

Sedera + Small Businesses + Direct Primary Care

Sedera Health offers employer groups of 5 or more a group discount on their cost-sharing for a Direct Primary Care membership. At Beyond Primary Care we believe that great healthcare should be affordable, accessible, and authentic for our members and that is why we have decided to discuss Sedera Health as an option. With your Beyond Primary Care membership you can add Sedera Health medical cost sharing to help cover the back end of your individual health risk with those larger major medical expenses. Then, let your Beyond Primary Care take care of all your primary and preventative care issues and rely on Sedera Health for the other wraparound medical needs for a total healthcare solution.

Final Thoughts

Beyond Primary Care + Sedera are working together to help you on your journey to great health. It’s premium quality healthcare with peace of mind for those ‘what ifs,’ without the high cost of insurance premiums and out-of-reach, out-of-pocket expenses.

Ways Your Family Doctor Helps You

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25 September 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 is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services. 

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. 

In this blog post, I wanted to talk about family medicine and what exactly can your family doctor (such as myself) do for you. 

Family Doctors

Family doctors are trained to practice a spectrum of comprehensive primary care medicine ranging in ages from newborns, toddlers, teenagers, and through adults including end-of-life care. I like to say we take care of people at all ages and stages, guiding males and females through the complexity of human health and helping coordinate care of their health.

Why such a broad age range? That allows your family doctor to better know you and your family over what is hopefully an extended period of time- years to decades. Not just days to weeks. Family doctors don’t just see you when you are ill and at your worst. This continuity allows us to give you that longitudinal care which can help aid diagnosis, understanding, and treatment of any medical condition far more than someone just seeking that ‘one-off’ or ‘one-time’ visit.

Imagine you love your car. You depend on it. In return for continued performance you have to put periodic maintenance into it such as oil changes, new tires, new brakes, etc. You could go to a different auto shop every time.

The mechanic who doesn’t know your car may lift the hood and start tinkering with the engine even if it’s the radio that’s making the noise because he doesn’t do radios, he does engines. 

But, like any other process, you want trust. Trust that the mechanic is going to recognize you (and your car) every time you go in and can be counted on to tell you when there may be a forthcoming issue. You also want that person to be approachable and genuine in their assessments and responses. 

In much the same way, you want trust, sincereness, and consistency with a family doctor. These are attributes of a family medicine physician, not urgent care or other ‘one-time visit’ clinics. 

Family doctors specialize in the diagnosis, treatment, and prevention of acute and chronic conditions. 

Acute issues such as:

  • Rashes
  • Urinary tract infections
  • Colds / congestion
  • Skin wounds that needs stitches
  • Chest pain
  • Shortness of breath and so much more.

It is our goal to try to keep you out of the emergency rooms, and instead in the familiarity of your home and family. 

Chronic issues Family Doctors treat include:

Not Just Sick Visits

Don’t let all those illnesses distract you though! Family doctors are not just there for the ‘what if’ scenarios, giving you only that ’reactive’ healthcare that is part of America’s cost control problem. Family doctors are ‘PROactive ‘ physicians.

This is why we encourage ALL of our patients to have at minimum yearly physicals were we can have a conversation about what we can do together to keep you healthier, longer. Infants and children often times have to be brought in multiple times a year for wellness checks to make sure they are growing properly and meeting milestones to keep up with their peers. There are few other physician specialties that actively work to keep you continuously healthy than family doctors. 

Keeping It Simple

Family doctors are not referral specialists. Referral rates to specialists in the United States are estimated to be at least twice as high as in Great Britain. Family doctors can help you control your healthcare costs through the elimination of unnecessary referrals to medical specialists.

As you can see, a good family doctor can cover 95% of all medical conditions. Family physicians knowledge is expansive. Because of this eclectic knowledge base, there is less likely a chance of the proverbial ‘hammer and nail’ approach than you may find with more specialized, narrowly focused physicians. 

Life Expectancy Increases

You will also live longer with a primary care physician! If you take a population of 10,000 and add a family doctor, there is a statistically significant drop in the death rates.

With family doctors your care will be individualized and engaged with a guided decision making approach. 

I believe knowing the person is way more important than knowing the disease. 

Deconstructed Egg Salad Sandwich

admin

16 August 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. 

This featured recipe is a Deconstructed Egg Salad Sandwich. 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.

Deconstructed Egg Salad Sandwich

Prep Time: 30 minutes
Total Time: 30 minutes 
Adapted from: Spoon Fork Bacon

Ingredients (makes 4 sandwiches):

– 1 baguette with ends removed, sliced lengthwise
– 3 tablespoons olive oil
– 6 large eggs, hard boiled, shelled and sliced
– handful of greens
– 1 avocado, pitted, and mashed or sliced
– handful sweet gherkins, sliced lengthwise
– red onion, sliced
– Salt and pepper to taste

Instructions:

1) Bring oven to 400 F. Place baguettes on tray. Drizzle with olive oil and bake until lightly toasted.
2) Once toasted, top baguettes with avocado spread, greens, onions, sliced egg, and sweet gherkins. Season with salt and pepper, serve.