Tag: Ann Arbor

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.

Anaphylaxis and Epinephrine

admin

7 January 2020

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; where I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.

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

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

Anaphylaxis

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

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

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

The Physical Reaction

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

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

Treatment

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

Epinephrine

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

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

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

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

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

You Should Not Wait to Use Your Epinephrine

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

You Should Not Be Afraid of the Epinephrine Device

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

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

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

Epinephrine Cost

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

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.


Roasted Red Pepper Pasta

admin

23 November 2019

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; where I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services. 

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

This featured recipe is a Roasted Red Pepper Pasta. 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.

Roasted Red Pepper Pasta

Adapted from: LaurensLatest
Prep Time: 10 minutes
Total Time: 30 minutes

Ingredients:

2 tablespoons butter
1 medium onion, diced
5 cloves garlic, minced
2 (12 oz) jars roasted red peppers, drained
1 cup vegetable stock
1 tablespoon fresh basil
½ tablespoon dried basil
½ cup heavy cream
1 cup parmesan cheese, grated, divided
1 (12 oz box) pasta, cooked
Salt and Pepper to taste

Instructions 

1) Preheat skillet over medium heat, melt butter.
2) Saute onion until tender, about 5-10 minutes. Stir in garlic, cook until fragrant. Remove from heat.
3) Pour onions and garlic into blender, add in red peppers, vegetable stock, salt, pepper, and dried basil. Pulse until smooth.
4) Pour back into skillet and stir in cream. 
5) Once pasta is cooked, pour into the sauce along with ½ parmesan cheese and toss.
6) Dish and serve topped with remaining cheese and basil.


Sedera Health + Beyond Primary Care = Premium Healthcare Without Insurance

admin

19 November 2019

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; where I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.

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

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

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

The American Health Insurance Experience

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

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

Front End, Back End

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

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

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

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

Why are we paying for them in the same manner?

Have you heard of Sedera Health?

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

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

Sedera + Small Businesses + Direct Primary Care

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

Final Thoughts

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

Vegetarian Pot Pie

admin

22 October 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 Vegetarian Pot Pie. 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.

Vegetarian Pot Pie

Prep Time: 15 minutes
Total Time: 45 minutes

Ingredients

¾ cup chopped yellow onion (~½ onion)
1 large clove garlic, minced
2 cups veggie broth
2 cups frozen mixed veggies (corn, carrots, green beans)
¼ cup milk
¼ cup unbleached all purpose flour
2 bay leaves
sea salt and black pepper
1 batch biscuits

Instructions

1) Preheat oven to 425
2) Add 2 Tbsp olive oil to large saucepan over medium heat, then add onion and garlic and pinch of salt– stir. Cook until soft.
3) Add the flour and stir with a whisk, then slowly whisk in the broth.
4) Add milk, and bay leaves and stir. Simmer until the mixture is thickened (about 10 minutes). If it still appears to thin, scoop out ½ cup of the broth and add 1-2 tbsp more flour and whisk back into the pot to thicken. Wait a few minutes, repeat if necessary
5) While the sauce is thickening, prepare biscuits. Cut out , leave unbacked, and set outside
6) Once the sauce is thickened, add the frozen vegetables and cook for 4-5 more minutes. Taste and adjust seasoning.
7) Discard the bay leaves and divide the mixture evenly between 5-6 lightly greased ramekins or 8×8 baking dish. 
8) Top with biscuits and brush the tops of biscuits with melted butter. 
9) Set your ramekins or 8×8 dish on a baking sheet to catch overflow and bake until the biscuits are golden brown and the filling is bubbly (about 14-17 minutes). Let cool for 5 minutes before serving.