Category: Health & Wellness

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!

Direct Primary Care Employer Healthcare

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16 September 2020

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; Direct Primary Care Employer 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 discuss an important healthcare option for employers that takes care of employees while reducing overhead:

Direct Primary Care Employer Healthcare

First, Direct Primary Care (DPC) Explained

Direct Primary Care isn’t insurance. Instead, it’s a unique high value membership that can be offered as a standalone employee benefit or used to supplement high-deductible health plans and catastrophic plans. At its basic level, DPC means the doctor works directly for the patient. No private insurance, no medicaid, no medicare, no middlemen. Since we are insurance free, DPC clinics contract with employers through a membership.

Think Netflix… but for Medicine.

In return for a flat monthly membership of $50 at Beyond Primary Care, the employees and their families are provided with an incredible level of personal care including virtually unlimited office visits, in-clinic dispensing of wholesale medications, and wholesale blood work done at the time of appointment when necessary. 

Discover Who Needs Direct Primary Care

With the advent of the gig economy– which encompasses a range of full-and part-time jobs done by the growing cohort of contingent workers- nearly every U.S. industry will be employing a substantial amount of part-time and contract workers who won’t qualify for traditional health insurance coverage. These jobs include but are not limited to…

  • Real Estate workers
  • Drivers
  • Restaurant workers
  • Custodians
  • Healthcare workers
  • Accounting / Finance professionals
  • Software Development Experts

These are occupations with high levels of non-benefited employees. 

According the the latest 2018 data, nearly 160 million American’s received their health benefits through an employer. But premiums and deductibles are pushing employer-based coverage increasingly out of reach. Additional businesses that would benefit from Direct Primary Care include:

  • Businesses with self-funded health insurance
  • Businesses who see their health insurance premiums going up and up every year
  • Employers concerned about health benefits with regards to recruitment, retention, and workplace wellness.

Why Direct Primary Care Is Important to Employers

On average, employers are spending $6,715 per employee per year for healthcare. Employers are tired of sitting around their board table every year and wondering how much of the health insurance increase is coming out of the employees pocket.

This is important.

Why? With Direct Primary Care the less employers spend on a health insurance plan, the more they can put back into salary or additional benefits. Employers can focus on building community-owned healthcare versus building the archaic insurer-owned healthcare. Employers can take active management of their spending patterns and discontinue relying on the traditional “passive management” approach provided by the ‘BUCAH’ insurances (Blue Cross, United Healthcare, Cigna, Aetna, Humana).

Currently employers have no power over healthcare costs with health insurance as it’s a patchwork in access to your physician and a free-for-all in which the prices of life-or-death essentials like insulin or epinephrine are set at whatever the market will bear. Efforts to check those prices are routinely trampled on by interest groups that hold influence over our lawmakers.

This important.

Why? The goal is to maximize employee health and minimize cost to the employer. Your employees are probably being crushed by out-of-pocket fees and lack of physician availability. Innovate by subscribing your employees (and maybe their families too) as a group to a local Direct Primary Care office. At no extra cost- you will get.

  • deeply discounted prices for blood tests
  • deeply discounted prices for radiology studies
  • generic medications dispensed from the office at near wholesale cost

As example, at Beyond Primary Care, Dr. Jeff O’Boyle can get pretty much any generic medication for my patients at just a fraction of the cost. As example, we’ve had a patient paying $40 a month for a medication at Walmart and pay $8 for three months at Beyond Primary Care.

A Note For Brokers

Direct Primary Care has become a key enrollment strategy to fill the healthcare solutions gap. If you are new to the Direct Primary Care movement, the good news is that Direct Primary Care is an easy sell. Employees need accessible and personalized coverage, and employers are happy with how affordable it is. If you ignore Direct Primary Care during open enrollment, you are leaving thousands of revenue dollars for yourself on the table as Direct Primary Care is a key strategy

“You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.” – Buckminister Fuller

Direct Primary Care Employer Healthcare

Are you ready for some out of the box thinking on benefits? Don’t overcomplicate it. Qualifying for employer healthcare solutions at Beyond Primary Care offerings can be as simple as having at least 5 enrollees, and the cost can be as low as $50 per employee per month. Our clinic eliminates claims, pre-existing conditions, and other complications.

There are no losers with Beyond Primary Care. The employer can attract and keep talented members with great healthcare, reduce absenteeism, and brokers have a gap coverage product that can start paying off right immediately to assist in funding open enrollment. 

Educate Those Employers and Employees

If you think your business or you work for a place that would benefit from the services of Beyond Primary Care, send them a link to this post so that they can join the conversation. Many employers may have only a vague idea of what direct primary care is, believe it’s too expensive, and don’t understand how to introduce new benefits to employees who never had them before. Let’s change that!

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

Why Insulin Costs So Much

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12 September 2020

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; Why Insulin Costs So Much. 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 discuss an important healthcare question that often gets talked about: Why Insulin Costs So Much

Why Insulin Costs So Much

First, What Is Insulin

The hormone insulin is produced by an organ in the belly called the pancreas, and insulin production is regulated through a feedback loop based on blood sugar levels in the body. Insulin assists cells in the muscles, fat, and liver to absorb glucose (sugar) in the blood, and that glucose acts as energy for these tissues. 

The most common problem associated with insulin is diabetes, and diabetes falls into two categories. Individuals with type 1 diabetes have a pancreas that no longer makes insulin and they need insulin injections to use glucose from meals. Individuals with type 2 diabetes make insulin, but their bodies have resistance to it and most individuals need to take pills or insulin injections to assist their bodies to use glucose for energy.

Insulin can not be given as a pill. Like other proteins, insulin would be broken down too much during digestion and thus it needs to be injected. For type 2 diabetes who need insulin or type 1 diabetes who require insulin, there is no alternative medication. 

The Insulin Supply Chain

In economics, inelastic demand occurs when people buy the same amount of a product, whether the price drops or rises. This occurs in many situations, from gasoline to food to medications- like insulin.

My demand for food is relatively inelastic—I will quickly die without it—but that doesn’t mean that any grocery store can extract hundreds of dollars- increasing prices from me each week. If they tried to do so, many other grocery stores will gladly win my business with lower prices and said previous grocery store will lose business (likely for good). 

Inelastic demand is only a problem for consumers if there is limited competition among the suppliers of a good. Notably, the lack of manufactures to produce insulin is one of the main culprits of out-of-control costs.

There are only three incumbent manufacturers of insulin serving the U.S. market: Eli Lilly, Novo Nordisk, and Sanofi. Pricing of insulin is very complex and involves many layers of middlemen including wholesalers, Pharmacy Benefit Managers (PBMs), healthplans, and pharmacies. Within the system, there is no agreed-upon price for any insulin formulation.

Kickbacks, Prices, and Middlemen Increasing Your Insulin Prices

According to the American Diabetes Association (ADA), the average list price of insulin has nearly tripled since 2002. In 1996, when Eli Lily’s Humalog first came out, the price for a one-month supply was $21. As of 2019, that vial is around $275, a 1,200% increase on the original price. Further data indicates when one insulin manufacturer increases the price for a given insulin preparation, the other insulin manufactures often increase their prices by a similar amount quickly afterwards. 

“Third parties and other barriers to care are not only increasing the prices of insulin, but physicians can’t really do what we believe is right and best practices for our patients and give our patients a voice in their healthcare.” ~ Dr. Jeff O’Boyle 

Worse, these manufacturers ruthlessly exploit the patent system to fend off competition. Pharmaceutical companies use lawsuits combined with incremental patent changes that enables the manufactures to extend the patient on the drug. These practices prevent insulin from going generic and other manufactures from producing more affordable versions.

In fact, insulin manufactures and pharmacy benefit managers (PBMs) such as CVS, Express Scripts, United Health, and OptumRx have been accused of artificially inflating prices for insulin in a class action suit brought in 2020. According to the suit, these manufactures aggressively increased the prices for insulin past what they would have charged had there been no scheme. 

Health Insurance Doesn’t Help The Insulin Costs

Why doesn’t competition among the BUCAH (BlueCross, United, Cigna, Aetna, Humana) health insurers force the manufactures to offer plans tailored to the different needs of patients? As example, the needs vary drastically from a person suffering from Crohn’s disease versus a type one diabetic). There are complex reasons for this- including the pharmacy benefit managers discussed above- but a major one is the tax privileged treatment of employer provided health insurance.

In 2018, nearly 160 million Americans got their health insurance through heir job, which at best puts a weak bargaining pressure on health insurers brokered through employers rather than employees. This lack of bargaining leaves the employed individual needing the lifesaving medication powerless and exposed to the expensive out-of-pocket costs. 

Moving Forward

We recognize that cost-containment for life-saving medications such as insulin is a human right. We also recognize that we, the people of Ann Arbor, greater Michigan, and this great nation must unite together to form meaningful solutions.

We commit to doing our small part here at Beyond Primary Care by continuously pushing the status quo of healthcare to seek out more affordable treatment solutions to offset the 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 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

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!

What is the Coronavirus? Get Answers Here

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27 February 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 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 talk about the coronavirus, what it is, how is it spread, what are symptoms, and how to protect yourself.

What is the Coronavirus?

Coronaviruses represent a large group of viruses, not just one we are hearing about in the news and media lately. These Coronaviruses are categorized as “Zoonotic diseases,” meaning they are transmitted between animals and people. The Coronavirus this blog is referencing (COVID-19) initially occurred in an animal or seafood market in the city of Wuhan, China. The disease has since spread throughout China and to a number of other countries.

On the ‘skin’ of the Coronavirus are a huge number of spikes (proteins) that give it the appearance of a ‘crown.’ Crown in latin = Corona. Just like the Human Papillomavirus (HPV), which is the causative agent such as non life-threatening conditions like foot (plantar) warts or very dangerous conditions such as cervical cancer, there are many subtypes of Coronavirus. 

Think of subtypes like the seasoning, basil. There is cinnamon basil, Greek basil, lemon basil, well- you get the point.

Some of the subtypes cause respiratory illnesses as minor as the common cold, while others cause pneumonia. These tend to be mild. However, just like HPV, there are some types of Coronavirus that can cause severe disease, such at the China 2019 Novel Coronavirus. This new Coronavirus being spread has not been previously identified in humans.

Situation in the United States

There are 59 total cases of the China 2019 Novel Coronavirus. Eight U.S states have confirmed cases including Massachusetts, California, Washington, Arizona, Texas, Wisconsin, Illinois, and Nebraska. 57 cases have been diagnosed as a result of travel or being evacuated from high-risk countries. 2 cases are believe to have spread person to person within the U.S.

Being present on public transport areas is a major risk factor for transmission. This Coronavirus appears to be spreading easily in China, but not as much in the United States.

The Centers of Disease Control (CDC) states to prepare for the ‘inevitable’ spread of the coronavirus within the United States. 

The CDC calls this Coronavirus “a serious public health concern.” 

The City of San Francisco, despite not having any confirmed cases of the Coronavirus, has declared a local emergency because it is a major travel connection hub. 

How is the Coronavirus spread?

The exact mechanism (as of publication of this blog post) has yet to be discovered. In general, it is thought respiratory droplets – such as what comes out your nose or mouth when you cough or sneeze- or objects that have been contaminated with the virus, are the source of the Coronavirus. 

How does the Coronavirus present?

A number of symptoms can present ranging from mild to severe. Symptoms typically take between 1 and 14 days to appear once the virus is contracted. Mild symptoms include fever (anything over 100.4F), cough, body aches, fatigue, sore throat, cough, and shortness of breath. Severe symptoms include pneumonia, kidney failure, and even death. 

Currently, the only means of diagnosis is testing through a technique called Reverse Transcription-Polymerase Chain Reaction tests that can diagnose the Coronavirus from respiratory samples. This test is currently not available at any outpatient clinics in the United States.

These tests are only at selected U.S. States and local public health laboratories, Department of Defense (DOD) laboratories, and some international laboratories. 

Protect Yourself

Currently there is no specific medication to combat the Coronavirus. Additionally, there is yet to be a vaccine- although these are in development. Treatment if someone is infected is supportive care.

A number of hygiene practices to help prevent the spread of the Coronavirus include covering your mouth and nose when sneezing or coughing (such as the vampire cough depicted above), washing your hands with soap and water frequently, and wearing masks if you could have the virus or around other people you care for who may have the virus.

Fish Antibiotics For Humans

admin

26 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 an actual patient of mine about to fish antibiotics for humans, the barriers of obtaining affordable medications, and how to obtain affordable medications.

My Patient’s Fish Antibiotic Story

A kind man in his 30s finds out about my clinic last month saying ‘direct primary care’ is perfect fit because even though he works full time, his employer does not offer him health insurance. He explains his employer is a contractor for a major shipping company (think top 3), but since they are contractors, they are not entitled to the same benefits.

He has been without any healthcare for the past 3 years saying “I can’t afford BlueCross.”

The newly enrolled patient says discovering Beyond Primary Care was serendipitous, because he has been experiencing left ear pain so bad for the past 2 weeks, that he was going to do something about if finally. Curious, I ask what he plan was and he replied he had been reading about ‘fish antibiotics for humans’ on the internet.

Since you don’t need a prescription for that he could avoid the healthcare costs associated with establishing care with a new physician and price of medications at a retail pharmacy.

A Dangerous Idea

Yes, so taking fish antibiotics for humans is a real thing. A quick google search turned up numerous unscientific medical survival guides. I read the reviews for aquarium antibiotics. However, taking medications that are 1) not for humans, 2) not prescribed by a licensed physician and 3) not properly dosed is incredibly dangerous. 

Misuse of any medication can cause serious illness. The medications used for many animals and vertebrates do NOT require FDA approval, so there is no regulation over the manufacturing of the medication that one would take.

I always tell my patients for any medication that they have effects, thus they may have side effects. Additionally, using antibiotics for self-diagnosed illnesses may lead to antibiotic resistance, which ultimately hurts the individual using the medication and society in the larger picture. 

Improving Affordable Healthcare and Transparency

Antibiotics are not necessarily all expensive either. Some large retail pharmacies in the state of Michigan even offer certain types of antibiotics for free (you still need a prescription from a physician). The patient did have an ear infection. Because we are a ‘Direct Primary Care’ clinic, the patient was prescribed AND dispensed the antibiotic from our office at the time of the visit.

The cost of the drug prescribed to this particular patient through Beyond Primary Care was $1.95.

Many of us are accustomed to thinking that we pay health insurance premiums to get access to a lower cost for health care medications — that being the “negotiated rate” or “contracted rate” that the insurance company and the payer agree to in contract talks. But increasingly we are hearing that insured people are paying more than uninsured people.

Additionally, evil organizations out there called Pharmacy Benefit Managers (PBMS- more on them on a later post) are yet another middlemen in our insane medical billing industry that can increase the prices we pay for medications.

No Quick Legislative Road

In late 2019, the current white house administration released new rules requiring hospitals to be more proactive with price transparency by publishing their charges and negotiated rates. Great right? If we go on Amazon, we can see the description, reviews, and price for everything. We expect and demand price transparency with all our other transactions. Same for healthcare now.

However, even within a few weeks of this executive order, hospital systems and insurer across the nation are suing to keep their prices a secret. The hospital systems and insurers know that if their costs become public knowledge, they stand to lose millions of dollars because people will simply shop around for the best market price, something we do for every other service.

Is there an easy solution?

In my opinion, the best advocates for patients to obtain affordable and transparent healthcare are those independent from a large hospital/health system– such as those who operate as Direct Primary Care (DPC) physicians.

Pork Tenderloin

admin

8 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. 

This featured recipe is Pork Tenderloin. 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.

Pork Tenderloin with Brussel Sprouts and Butternut Squash

Adapted from Family Circle: Sheet Pan Pork
Prep time: 30 minutes
Total time: 1 hour

Ingredients:

1 Butternut squash
1 lb of brussel sprouts (approx. 4 cups)
1.5 – 2 lb pork tenderloin
Olive Oil
1 tbsp mustard
1 tsp paprika
1 tsp garlic powder
1 tsp salt
1 tsp tumeric
1 tsp thyme
½ tsp pepper

Instructions:

1) Peel and Chop Butternut squash into 1 inch cubes. Trim brussel sprouts as needed. Set aside.
2) Mix Mustard and all spices.
3) Trim silverskin and excess fat from tenderloin. Rinse off and pat dry with a paper towel. Spread mustard mix all over tenderloin.
4) Heat pan to medium-high. Add tenderloin. Brown all sides (6 – 8 minutes, 2-3 per side). Remove from pan and set aside.
5) Add veggies to the sheet pan. Add olive oil, additional salt, pepper, and thyme. Toss to coat. Spread veggies around the perimeter of the pan, leaving room in the middle for tenderloin. Add tenderloin. 
6) Bake at 350 for 25-30 minutes. Give generous drizzle of olive oil over the entire pan. Check the doneness of pork (should be 145 internal temp). Remove pork, wrap in foil, rest for 10 minutes. Turn oven temp up to 400. Return the pan of veggies to the oven for 5-10 minutes until caramelized.
7) To serve sliced pork against the grain and serve up with a scoop of veggies. Drizzle pan juice over top.


Tuscan Tortellini Soup

admin

28 December 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. 

This featured recipe is a Tuscan Tortellini Soup. 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.

Tuscan Tortellini Soup

Adapted from Cooking classy
Prep: 10
Total: 35 min

Ingredients

2 Tbsp olive oil
1 ½ cups chopped carrots
1 ½ cups chopped yellow onion
1 cup chopped celery
2 cups chopped green beans, about 1-inch pieces
2 cups chopped zucchini
4 cloves garlic, minced
3 (14.5 oz) cans vegetable broth
2 (14.5 oz) cans diced tomatoes 1 tsp each dried basil and rosemary, crushed
½ tsp dried thyme
Salt and freshly ground black pepper, to taste
1 (9 oz) package refrigerated 3-cheese tortellini
3 cups packed spinach
Shredded Parmesan cheese, for serving

Instructions:

1) Heat olive oil in large pot over medium-high heat. Add carrots, onion and celery and saute 3 minutes.
2) Add green beans and saute 3 minutes longer. Add zucchini and garlic and saute for 1 more minute. 
3) Pour in broth and tomatoes. Add basil, rosemary, thyme, and season with salt and pepper to taste
4) Bring to a gentle boil, then reduce heat to medium and allow to boil, about 8 minutes.
5) Add tortellini and boil 5-7 minutes longer.
6) Stil in spinach and cook 2 minutes longer.
7) Serve warm with parmesan cheese.


Obstructive Sleep Apnea

admin

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.