Tag: Ann Arbor Doctor

Knee Cap Pain

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16 April 2019

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

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

Knee Cap Pain

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

Anatomy

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

The VMO Connection

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

Minimize the Pain and Swelling

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

Identify your VMO

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

Access Range of Motion and Build Flexibility

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

Tape the Knee

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

Stabilize & Build Strength

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

Free Up Cashflow In Your Budget

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4 April 2019

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

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

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

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

Who is Dennis LaVoy?

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

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

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

What could using a DPC practice mean for my budget? 

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

How would it work?

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

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

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

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

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

Financial Savings and Opportunities

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

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

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

The Power of Compound Interest

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

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

Why wouldn’t I do this?

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

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

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

Conclusion

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

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

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

Direct Primary Care keeps Medication Costs Low

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19 March 2019

Hi, thank you for reading! My name is Dr. Jeff O’Boyle. I am a board certified family medicine physician. My clinic, Beyond Primary Care is located in Ann Arbor, Michigan. In this post I am answering a common question that I receive, and that is how does Direct Primary Care (DPC) keep medications costs low for it’s members? Offering low priced medications is a key feature of virtually all DPC practices, and is something that is done to increase the value of a membership. Just how low? Many DPC practices do in-clinic dispensing and can provide hundreds of medications to their patients at a tenth of the costs that many national retailers can provide.

How DPC Practices Keep Medication Costs Low

DPC practices, like pharmacy retailers have applied for and obtained their medication dispensing license from their respective states. This allows a DPC provider to contract with pharmaceutical wholesalers of medications, the same wholesalers who retail pharmacies such as RiteAid, Walgreens, or CVS may use.  My clinic, Beyond Primary Care, uses two wholesalers of medications, AndaMeds and Bonita Pharmaceuticals. 

These wholesale companies sell the medications, often in large quantities to the DPC practice. However, unlike hospitals and retail pharmacies where selling medications IS their business – resulting in the expected mark-ups (250%!) and high-prices as noted by the American Journal of Pharmacy Benefits– DPC practices turn around and sell the exact same mediations to their patients at those near-wholesale prices. As noted, DPC sell the medications to their members in this innovative manner because our primary business is taking care of you and NOT being just a pharmacy. Your membership for care to a DPC practice allows for this innovation. 

Savings from Medication Costs

You may be or may know some people who take multiple medications. Medications for blood pressure, diabetes, urinary incontinence, anxiety, heart conditions, COPD, or erectile dysfunction may add up to hundreds of dollars a month you are paying out of your pocket. Compare this to the costs I charge my members for the exact same medications. Often times the money saved in medication costs alone pay for a DPC membership! Don’t see your medication on my sample list? Don’t worry, I may still stock it or I can order it too!

* Prices are subject to change without notice, one month supply listed unless noted

Did I Mention In-Clinic Dispensing?

Many DPC practices do in-clinic dispensing of medications. Once the doctor evaluates you and discusses the best course of treatment, that provider can have the necessary medications dispensed to you before you leave the office. In urgent situations, this saves you time, energy, and of course MONEY, something that rarely happens in fee-for-service medical offices. 

Obtaining Specialty or Brand Name Medications

As I mentioned in my earlier post, there are times a member needs or would benefit from a certain medication that is brand name only (very expensive) and would be best obtained through insurance that requires a prior-authorization (what is prior authorization) from the insurance company.

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

Why NOT To Go to the Emergency Room

admin

8 March 2019

Hi, thanks for reading! My name is Dr. Jeff O’Boyle, and I am a board-certified family medicine doctor who owns his own clinic, Beyond Primary Care located in Ann Arbor Michigan. Like most family medicine doctors, our goal is to keep our patients healthy and out of emergency rooms if at all possible. My best friend is an emergency room doctor and I have the utmost respect for the care ER doctors provide and the role they serve in medicine. I have seen people in emergency rooms with life-or-death conditions such as chest pain and shortness of breath, and am grateful we have skilled providers in this area of medicine.

Why Not to Go to the ER

Yet, I meet a good number of people who utilize an emergency room like it’s a one-stop-shop for all their medical health. People going to emergency rooms for dental pain, refills on blood pressure medications, common colds, and various other complaints that have been manifesting themselves over the past 3 months. As a Direct Primary Care (DPC) family medicine clinic, I promote and encourage that longitudinal care with my patients to ask me for medical advise or treatment that can’t be achieved in emergency rooms. Here is some free advice why NOT to go the emergency room.

1) The ER doctor doesn’t know YOU

The trust that develops over time between a doctor and a patient (or family) is absent. It is also extremely helpful to have seen a sick individual or child when they were healthy, to know how far from their baseline they are.

2) You don’t know the ER doctor

Sick people are not happy people, and it’s hard to do a physical exam on someone stressing out. A familiar face causes less distress, and allows the doctor to do a better evaluation.

3) “Emergency” does not mean that you’ll be seen soon

 The ER team takes care of the sickest patients first. If you have a minor illness and a severely ill or injured person rolls in, you’ll be waiting a while.

4) It’s expensive

 Really expensive as noted here and here. It costs about $1,000 more to evaluate a minor illness in the ER than it does in an office setting–and that’s without any tests.

5) You will probably have tests

 This means needle sticks, radiation exposure, and increased cost. Often, a DPC doctor could do a thorough physical exam and schedule a follow-up the next day, all at no additional cost to you. But the ER gets one shot, and they can’t afford to miss something, so they tend to over-order imaging and labs.

6) The ER’s job is to figure out what you don’t have

 They are not tasked with figuring out exactly what is going on and solving every problem; the focus is on ruling out life-threatening conditions and deciding which patients need to be in the hospital. This often frustrates patient’s who come in wanting answers.

7) There are sick people there

 In the summer it may be vomiting or diarrhea. In the winter, it’s the flu. Emergency rooms do their best to keep things from spreading, but viruses haven’t survived this long by being bad at what they do. If you weren’t sick when you went in, you may be soon.

8) If the beds are full, really sick people can’t be seen

This is more altruistic, like vaccinating yourself so nobody else gets the flu–but it’s real. Every ER has a limited number of beds, and when they’re full, they’re full. If they’re full of relatively healthy people, the really sick ones sit in the waiting room until a bed opens up.

So What Should You Do?
Find a Primary Care Doctor that you trust

This is the most important step, and it’s one that you should take when you are healthy. A good physician can identify diseases early, track a child’s growth and development, provide reassurance when that’s all you need, and handle the vast majority of acute illnesses. If–or rather, when–you get sick, your doctor has access to her records and history, avoiding expensive and unnecessary repeat testing. That doctor will understand your personality and perspectives, and you will be less scared of a familiar face. Look for a Direct Primary Care doctor, who routinely offers same-day sick visits, weekend hours, and phone availability even when the office if closed–a lot of ER visits can be avoided by talking through symptoms over the phone.

Anxiety (in part) Explained

admin

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 what 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.

Direct Primary Care Works With Your Insurance

admin

5 February 2019

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

DPC does not work FOR your insurance

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

DPC works WITH your insurance

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

Specialist Referrals

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

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

Hospitalization Coordination

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

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

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

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

Special Medications

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

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

Avoid the Sneeze Pee

admin

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.

Neurontin, Gabapentin, Controlled Substance

Gabapentin as a Controlled Substance

admin

10 January 2019

This past Monday, 1/7/18, the state of Michigan classified Gabapentin (brand name Neurontin) as a controlled substance (C V) as it has been increasingly been reported abused by some patients.

Gabapentin is approved by the Food and Drug Administration (FDA) to treat epilepsy and neuropathic pain caused by shingles. That is it! However, as many people already recognize it is prescribed ‘off label’ by health care providers for various reasons including including depression, anxiety, migraine, fibromyalgia, muscle and joint pain, and bipolar disorder. According to some estimates, over 90% of Neurontin sales are for off-label uses. A report by IMS health found that 57 million prescriptions for Gabapentin were written in the U.S. in 2015, a 42% increase since 2011.

Many providers, including myself, have never screened for Gabapentin abuse in the past as this medication is not tracked by the state’s controlled substance tracking system nor is it typically detectable in most office-based urine drug screens. When Gabapentin is taken alone there is little potential for abuse. Yet, when taken with other drugs, such as opioids, muscle relaxants, and other anxiety medications, there are reports that Gabapentin can have a euphoric effect.

While I see the concern for making Gabapentin a controlled substance in Michigan, it is going to be a tremendous headache for everyone. The community, hospitals, treatment facilities, and doctor offices.

Isn’t it ironic that Michigan is locking up Gabapentin (which IS affordable and has good application when used appropriately) but legalizing marijuana?

It will eventually be easier for people to smoke a joint then get Gabapentin.

Currently, a month supply at Beyond Primary Care for 300 mg (90 pills) is $4.59. The street value for Gabapentin just went up because of this classification and that makes me concerned. Hell, the CDC lists Gabapentin as a non-opioid alternative treatment for pain control. This move by the State of Michigan makes my job as a physician, patient advocate, and provider certified in chronic pain management increasingly harder to deliver affordable and effective treatment to my patients.

Virtual Home Medicine in Direct Primary Care

admin

3 January 2019

Hi, thank you for reading! My name is Dr. Jeff O’Boyle. I am a board certified family medicine physician. My clinic, Beyond Primary Care is located in Ann Arbor, Michigan. In this post I am answering a common question that I receive, and that is how does Direct Primary Care (DPC) take care of it’s members with virtual home medicine? Virtual home medicine, also referred to as telemedicine, is a where you connect with your doctor via phone or computer’s webcam without physically being in the doctor’s office.

The Exception rather than the Rule

Why is it nearly impossible to get a doctor to talk with you over the phone in a timely fashion? Because because certain services like virtual home medicine are typically not be reimbursed by private insurance carriers and government payers. Nearly 40% of what we do in medical offices the patient doesn’t actually have to be there. But why are you there? That is the only way for doctors in a fee-for-service system to get reimbursed for your care, is to actually make the patient physically come in to the brick-and-mortar office to be seen- no matter how routine (eg- common cold, urinary tract infection) or obscure (filling-out paperwork for FMLA or work) the visit seems.  

Standard of Care with DPC

Under the DPC model of care, we naturally provide such care – yet another freedom we enjoy together as a result of our independence from the restrictions of third-party payment. As noted by this Forbes article, telemedicine pairs well with DPC. Since DPC has opted out of insurance contracts altogether, and we contract directly with you, the patient. DPC offers our patients around-the-clock access to primary care medical needs in exchange for an average fee of $50-75 per month. Phone calls, emails, texts, FaceTime- are included in a patient’s membership. Patient are routinely connected with their doctors within minutes to hours when reaching out, versus days to weeks with fee-for-service doctors.

Benefits of Virtual Home Medicine

One of the defining characteristics of DPC is that we keep our practices small so we can spend more time with our patients. Because we have the increased time in our visits to know you well, we can streamline your care when you’re sick away from home or even at home. Many illnesses can be diagnosed and treated with a simple conversation by phone or computer webcam.

Say you are traveling out of state and feel sick. You have access to a conversation with your DPC doctor from your pocket. We will discuss your symptoms, discuss management, then we’ll locate the nearest pharmacy and order the medications most appropriate for your present circumstances.

As a doctor, there have been times where I have seen patients- with just the act of walking from the waiting room to the examination room- get winded or experience excruciating pain. Why would doctor offices allow this? Where is the concept ‘first, do no harm?’ If you are local, often times the DPC doctor may deliver the medications right to your address, saving you the hassle of a trip that may potentially worsen the condition.

Curbside Referral Consult

Adding more value the DPC membership at no additional cost to our patients is many DPC practices participate with electronic consults, or online consultations for speciality care. Primary care can handle nearly 80-90% of all medical conditions, but there are times when a condition may be past our scope of practice. Instead of rushing the patient to the nearest specialist, which will result in a bill likely through the patient’s insurance, many DPC practices seek medical advice on behalf of our patients through an online service call RubiconMD. Through this online service, many DPC practices pay a monthly fee where we can get medical advice on behalf of our patients from more than 100 medical specialities. The company guarantees a response time within twelve hours. The DPC physician fills out the necessary forms, get’s the response through the RubiconMD service, then will pass this medical information onto the patient- at no cost! 

BPC Good Eats: Turkey Wrap

admin

20 December 2018

Hello and thank you reading my blog at Beyond Primary Care and trying the BPC Good Eats recipes. This featured recipe is a Turkey Wraps. 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.

Turkey Wrap
Prep Time: 15 minutes
Total Time: 20 minutes
Adapted from: Damn Delicious

Ingredients:
1 lb deli Turkey meat
1 (7 oz) package cheddar cheese slices
1 cup spinach, destemmed
1 (6 ct) spinach tortilla package
½ cup Greek yogurt
1 cucumber, sliced
1 (16 oz) package baby carrots
4 oz assorted nuts

Instructions:
1) Lay spinach tortillas flat, spread a tablespoon of greek yogurt on one side.
2) Place cheese, turkey, and spinach centered over yogurt in spinach wrap.
3) Bring bottom edge of tortilla tightly over turkey mixture, folding in at the sides. Continue folding until the top of the tortilla is reached. Cut into 5-6 pieces.
4) Place turkey wrap, cucumber, baby carrots, and nuts into meal container.

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