Category: Health & Wellness

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.

Avoid the Sneeze Pee

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18 January 2019

Adult Guide to Urine Incontinence

At my family medicine clinic, Beyond Primary Care, located in Ann Arbor Michigan, I see a fair number of individuals who experience urinary incontinence. Urinary incontinence is when urine leaks, from a number of causes, that becomes frequent or severe enough to be a problem. Incontinence happens in men and women. Unless I specifically ask some individuals, some may think that incontinence is an unavoidable part of getting older or a known consequence of child birth. I wanted to tell everyone that urinary incontinence can be addressed with both non-medication and medication intervention. In this guide, I talk about non-medication treatments.

Your Anatomy

The bladder is a hollow sac (like a balloon) with muscular walls. It sits behind the pelvic bone. The bladder is part of the urinary system, which includes two kidneys, two ureters, a bladder, and a urethra. The kidneys take waste and water out of your blood to make urine. The urine travels down your ureters to the bladder. When you’re ready to urinate, the urine empties through the urethra.

What is Average

It sounds like kind of a lot, but, depending on how much liquid you drink, peeing roughly 8 times during the day is average. Even though it’s annoying, getting up once to twice during the night is also considered normal. Most bladders hold about 2 cups of fluid (473 mL). A classic excuse among the frequent pee-ers: “I just have a small bladder!” Turns out, there’s some truth to that seemingly odd refrain. Anatomically, everybody can be different, just like some people are tall and some people are short.

Turn Perception into Measurements

If you’re irked by how much time you spend atop the throne, consider keeping a diary to chart your bathroom breaks. When you actually tally up your trips, what feels like a lot might be totally normal. Again, most bladders hold about 2 cups of fluid. If you’re going to the bathroom frequently and producing less than that, that may not be normal.  And yes, you should actually measure. Grab a container and see if you’re hitting 1.5 to 2 cups.

Existing Medications &  Other Causes

  • Take a look at your existing medications. Medications may lead to incontinence. As example, diuretics (water-pills) used to treat high blood pressure can cause the kidneys to make a lot of urine really quickly. Review your medications with your doctor. 
  • Diabetes: If you’ve ruled out other causes, there’s a chance your constant peeing is due to diabetes. If your blood sugar’s high, the kidneys won’t be able to process all of it, and some can spill into the urine. That sugar will essentially pull more water out of you, so you’ll be generating more pee. 
  • Urinary Tract Infection:  Signs of an infection may include pelvic pain, increased frequency, increased urgency, and possible blood in the urine.
  • Pelvic Support and Urinary Tract Problems: The pelvic organs are held in place by supportive tissues and muscles. Problems occur when these tissues are stretched, weakened, or altered by stool impaction, pregnancy, childbirth, abnormal growths, fistulas, or aging.

Treatment to Avoid the Sneeze Pee

Keep Drinking Fluids. Understandably, if you spend a lot of time thinking you have to pee, you might be inclined to dehydrate yourself just a touch. If you don’t drink as much, you won’t have to go as often, right? Turns out this way of thinking is bladder sabotage. When you drink less, the urine becomes more concentrated, and the more concentrated it is the more irritating it can be to the bladder, which can trigger the sensation that you have to go more often.”

Timed voids. The good news for the small bladdered is that you can train your bladder to hold more fluid. If you give into the urges too often, you are training the bladder not to hold as much (Just don’t hold it so long that it starts to hurt). You could be inadvertently doing this if you’ve preemptively started emptying your bladder more frequently in just-in-case scenarios, like in hopes of warding off leakage, say, before a workout.To train your small bladder to bulk up, implement “timed voiding”:

  • Urinate every 30 minutes for two days, whether you have to go or not.
  • Add 15 minutes to the regimen: Urinate every 45 minutes for two days.
  • Keep adding 15 minutes to this regimen, until over time you have trained your bladder.

Hitting the (pelvic floor) gym. The stronger those down-there muscles, the easier it is to hold urine in. It’s better to learn how to use your muscles to tighten the pelvic-floor area. Yes, we’re talking about Kegel exercises. If you don’t already know, the exercises are performed by tightening and releasing the muscles you’d use to stop the flow of urine without moving anything else in your body. Find your pelvic muscles by tightening the rectum as if trying not to pass gas or pinching off a stool. Done best after emptying the bladder. Tighten and hold for up to 3-5 seconds, then release and relax 5 seconds. As muscles get stronger, progress to 10 seconds. Do these exercises 10-20 times a session, 3 times a day. Remember to breath normally. It may take 4-6 weeks to notice results.

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.

Cold and Sinus Infections

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2 November 2018

Cold and Sinus Infections invariably go hand-in-hand with winter. Snow isn’t bad for a month or so, and living in Michigan I do tolerate brief stretches of freezing temperatures. But for complete honesty, my favorite part of winter is that it always ends. Yet, for those days and months with freezing weather, everyone tends to huddle inside together and germs and viruses are increasingly spread. This can lead to the common cold or sinus infection.

 

Fortunately, the possible solutions for people with an infection have never been better. Now, before you rush to get antibiotics, consider some important points from this well-written piece:

 

  • Between 90-98 percent of sinusitis infections are viral and won’t respond to antibiotics.
  • At least 200 viruses can cause the common cold. None will respond to antibiotics.
  • Only 5-10 percent of sore throat cases in adults are caused by strep throat.

 

Remember that coughs ad other URI symptoms can take between 7-21 days to resolve. The average duration of a cough is 18 days. You may just have to be patient. But do NOT get discouraged! The goal during this time is symptomatic care.

 

What can you do for symptomatic care? Ahem, FREE ADVICE!

 

  1. Minimize exposure! I am not talking about locking yourself in your house until winter ends, but keep washing your hands or using hand sanitizer as frequently as possible.
  2. Contain that cough and/or sore throat. Studies show that honey that is either by itself or mixed with a liquid works just as well- or sometimes better- than leading (and drastically more expensive) anti-sore throat/cough medications. Honey can safely be used in any children > 1 yr old.
  3. Nasal Steroids. When symptoms are bad enough to need a daily medication, these medications do a great job on reducing overall inflammation in the nasal cavity.
  4. Dunk your head in the ocean! Ok, just kidding. We are in Michigan. But make your own saline rinses and use the suction bulb as I detailed I while back.
  5. Hydrate. Your body will interpret hydration as fatigue. With all that mucous you are producing, you need to replenish it.
  6. Antihistamines. These are what most people think of as ‘allergy medicine.” While they aren’t quite as effective as nasal steroids, they act more quickly and usually work well.

Suction Bulb, Our Sinus Savior

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25 October 2018

The picture is a plastic suction bulb, or ‘booger sucker’ as newborn parents like to say. You can find these in most stores, typically in the newborn section for $1-2. Why am I posting about this you ask? Suction bulbs allow us to do nasal rinses. The traditional method has been the net pot, but I prefer the suction bulb. Nasal rinses are an ancient practice that has been shown to have benefit relieving both allergy and cold symptoms.

 

Essentially, it involves sending a stream of saline (salt-water) solution up one side of your nose and back out. No, I do not believe it has to go in one nostril and out the other. Gag! The act of bathing the turbinates and sinuses in saline water is all this is required, along with a thorough blowing of the nose afterwards.

 

You can buy individual packets to mix with water, but because my readers are thrifty- I suspect they want to make their own. To make your own:

 

  1. In any container, combine 2 tablespoons of household table kosher salt (iodine free) or sea salt, 1/8 teaspoon baking soda, and 1 cup (8 oz) of lukewarm sterile or boiled (but cooled) water.
  2. To do the rinse, stand over the sink.
  3. Place the tip (not entire nose piece) of the nozzle into the nostril aiming slightly away from the septum (the midline wall the divides your nostrils).
  4. Lean your head forward, and squeeze the saline water aiming for the back of the eyeballs.
  5. Repeat with the other side, allow the water to drain, and blow your nose with tissue.

 

Yes, what comes out is disgusting and you may get a salty taste in your mouth, but you will feel better. I typically advise people to rinse x4-8 per day. The bottom line is the more you do this, the better you will feel- quicker.

Family Medicine: For The Entire Family

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23 October 2018

At Beyond Primary Care, we have a narrow focus- you and your family. Dr. O’Boyle is a dually board certified Family Medicine Doctor, and sees children of all ages, whether that is for the urgent needs, school physicals, check-ups, or that mysterious illness that you have questions about.

 

One of Dr. O’Boyle’s biggest annoyances of traditional physician offices are their limited hours and seemingly robotic answers from the on-call services. Does your child only get sick between 9 AM and 5 PM, Monday through Friday? If they do get sick during this time period, you have endless ability to take off time from your work (usually a half-day or more) to be seen at the office? Experience the on-call doctor reading the hospital script that if your child is sick you should take them to an urgent care or emergency room? Then the wait time at these locations!

 

At Beyond Primary Care, we will work with you to make time for convenient appointments, whether you need to be seen traditional working times or after-hours. Additionally, we because we know you so well, we offer our patients ‘virtual home visits,’ or ‘tele-medicine.’ Many illnesses can be diagnosed and treated with a simple conversation by phone or webcam. There is no corporate legalese with Dr. O’Boyle. When you enroll and call, you speak directly to Dr. O’Boyle and will get unabridged advice and care.

 

What are the benefits of having your family enroll in a direct primary care practice? According to this newspaper, DPC patients are 52 percent less likely to require hospitalization than patients under a traditional model. By providing the vast majority of care needed at the primary care level, a DPC doctor can allow a person to purchase the bare minimum insurance policy that is right for their family. The savings with this alone can be thousands of dollars each year.

Affordable Blood Work

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16 October 2018

Did I mention that at Beyond Primary Care in Ann Arbor Michigan, we aim to bring affordable blood work to you by being 100% transparent about our pricing? I have mentioned this before about individual medications, but after all, there is more than just medications to be transparent about. 

 

Can you remember an instance where a doctor advised you to get blood work done, but they didn’t know if your insurance would cover it or even how much it would cost? There are examples of this occurring all the time in the news. Such as a $17,000 bill for a urine drug screen or owing $478 dollars for a complete blood count and comprehensive metabolic panel (Our shameless self-promoting plug, Beyond Primary Care’s total price for these tests is $17.28). As a personal example, my wife recently got blood work for what the doctors described as a nominal cost. Yet, the explanation of benefits we received stated the insurance would not cover the tests, which are priced at 4-figures! Upon discovering this and discussing with both the insurance and the doctor’s office, no one has yet to give us reassurances or answers. No transparency there. 

 

The jury is still out on my personal experience, but you can avoid the headaches and uncertainty of this type of disjointed healthcare. At Beyond Primary Care, if lab work is needed, Dr. O’Boyle will discuss with you the reason for the blood work and discuss the total costs of the blood work before beginning. Dr. O’Boyle performs his own blood draws (naturally at no additional cost to you), and then finally sends them out to be interpreted at those agreed upon reduced costs.

 

What about those affordable blood work results? Dr. O’Boyle will communicate with you what the laboratory study means, perhaps in office, through a phone call, or a text- just to give you peace of mind. That is comprehensive family medicine.

We have Flu Shots!

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5 October 2018

At Beyond Primary Care, we have Flu shots in stock! A lot of our practice encompasses preventative medicine, i.e- being proactive about your health! We encourage adherence to the CDC immunization guidelines that are endorsed by the American Academy of Family Physicians, the American College of Physicians, and the American Academy of Pediatrics. We understand the hesitancy that some patients have regarding vaccines and are happy to discuss these concerns together.

 

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

 

1) It’s still a common misperception: the idea that you can get the flu from the flu shot
This is, of course, in-correct. The influenza vaccine is made from an inactivated virus. If you got sick in the past around the same time, you likely had a viral cold and attributed those symptoms to this. The most common side effects are a sore arm, and perhaps a little swelling. A very small proportion of people, 1 to 2 percent, get a degree of fever. That’s not the flu, that’s the body reacting to the vaccine.

 

2) You are vulnerable
People 65 and older are at higher risk of flu-related complications, but the flu can knock young, healthy people off their feet, too. It does every year. Here is a downer about the flu, a 172 American children (under the age of 18) died from the flu last winter. The flu can, on occasion, take a young, healthy person and put them in the intensive care unit. Ask me the story of this.

 

3) Getting the Flu shot is your civic duty
Nobody wants to be the dreaded spreader, yet everybody gets the flu from somebody else. According to the Centers for Disease Control and Prevention, people who have caught the flu virus are contagious one day before they start to feel sick and for up to seven days after. Check out this great NPR video if you really need convinced.

 

4) You can still get the Flu, but you won’t be as sick 
The flu virus constantly evolves, forcing new vaccines to be brewed each your to match the strains. Per the CDC, people who get the flu shot have a 40-60% lower chance of getting seriously ill than the unvaccinated. Yes, you can still get the flu despite vaccination, but generally those cases will have milder illnesses than if they skip the vaccine.

 

5) Pregnant women who get the Flu shot protect their babies from the flu
Women who are pregnant should be vaccinated to protect themselves. Still, the vaccine also offers protection after babies are born as mother can pass the protection on, across the placenta. This will protect their baby during the first six months of life, until the baby is old enough to be vaccinated