Tag: Family Medicine

High Blood Pressure

admin

8 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. 

In this blog post, I wanted to talk about hypertension, also known as High Blood Pressure.

You Feel Normal

A person with painful urination is more likely to accept a diagnosis of a urinary tract infection. A child with with wheezing and shortness of breath is more likely to accept a diagnosis of asthma. People diagnosed with high blood pressure are puzzled, saying “How is this something I have” when you don’t feel any different. Symptoms sometimes validate a diagnosis. However, unlike many other illnesses, high blood pressure rarely has identifiable symptoms. As a matter of fact, you may of heard Dr. O’Boyle forbiddingly warn this is the ‘silent killer.

Is High Blood Pressure Dangerous

You may of heard the phrase ‘benign essential hypertension,’ but rest assured, this is an antiquated term. Much like describing a suspicious skin lesion, we use the words ‘benign’ or ‘malignant’ to describe two completely opposite threats. This is not the case when it comes to high blood pressure. 

I mentioned earlier that high blood pressure uses the alias the ‘silent killer’ because if blood pressure is uncontrolled, complications may include heart attacks, strokes, and kidney failure.

It is a very real threat.

What is Blood Pressure?

When I take a patient’s blood pressure, always with an inflatable cuff around your arm, I express the measurement back to you as two numbers. The number on top (systolic) and the number on bottom (diastolic), for example 120/80. The top number indicates how much pressure your blood is exerting against the walls of arteries when the heart beats. The bottom number indicates how much pressure your blood is exerting against your artery walls when the heart is resting between beats. Both numbers matter. 

The difference between a Normal or High Blood Pressure

I adhere to the clinical practice guidelines set forth from the American Academy of Family Physicians. As you can see from the chart above, a normal blood pressure is less than 120 on the top and less than 80 on the bottom. A definition of high blood pressure starts at a top number of 140 or greater and a bottom number of 90 or greater. 

The Odds

Per the Centers of Disease Control (CDC), 1 in 3 adults in the United States will have high blood pressure. This is why I check your blood pressure, a part of what is called ‘vital signs,’ at every visit. 

How Does This Happen?

Knowing the cause of any disease is helpful. Yet for high blood pressure, I rarely find just one cause. In fact, in medical jargon, ‘essential’ as in ‘essential hypertension’ means ‘of unknown cause.’ There are usually multiple factors at work. Some can not be prevented, such as:

  • Genetics
  • Race
  • Age

Genetic risk is complex and various between individuals as some people have protective genes and others don’t. Some ethnicities have high risks of elevated blood pressure (eg- non Hispanic African American people are more likely to have high blood pressure than other races). There is nothing you can do about it. You also can’t stop aging. 

As we age, that doesn’t mean we can’t do anything to tackle modifiable factors, such as:

  • Being Overweight
  • Smoking
  • Lack of Physical Activity
  • Stress
  • Drinking too much alcohol

Testing: Cheap and Easy

You know I check your blood pressure at every visit. But if people had the ability to check more often, the more effectively we could manage this condition. Blood pressure monitors are available at reasonable prices (typically $25-50), and can be done in the comfort and privacy of your own home. Just like our subjective feelings such as happiness, sadness, stress, and restlessness, our blood pressure varies throughout the day too. This is why I recommend monitoring blood pressure at home for at-risk individuals multiple times a day. 

Treatment

Discussing the scope of treatment for blood pressure is extensive and always carries asterisks for certain populations. Just like the causes, I always say treatment is multi-dimensional and must be individualized, your classic N of 1 trial.  Part of that treatment may include:

  • Medications
  • Exercise
  • Naps
  • Smoking cessation
  • Diet modification
  • Relaxation techniques

Naps are for babies, right? I love a good nap when given an opportunity. Research has shown people who sleep for 30-60 minutes, typically after a midday meal, had a 5% lower average 24 hour ambulatory systolic blood pressure than those who did not sleep, even when adjusted for age, gender, BMI, smoking status, salt intake, alcohol intake, exercise, and coffee consumption. Something to dream about. 

Ways Your Family Doctor Helps You

admin

25 September 2019

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

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

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

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

Family Doctors

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

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

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

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

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

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

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

Acute issues such as:

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

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

Chronic issues Family Doctors treat include:

Not Just Sick Visits

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

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

Keeping It Simple

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

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

Life Expectancy Increases

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

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

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

Storytelling in Anxiety and Depression

admin

12 August 2019

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

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. 

Storytelling

We talked about what anxiety is in an earlier post. In this post I am discussing something that is important to me in treating any mental health condition- especially anxiety and depression- and that is storytelling.

Why We Listen

Not only is it a way of relaying information about my patients when discussing care (eg- talking to a therapist to find the best medication), but it is an an essential way I continue to learn at work. It has struck me recently that even more than these obvious examples, storytelling has a direct impact on not only how we understand anxiety and depression (or any disease) but the process of healing itself, from the perception and expectations of the patient to the diagnosis and treatment by the physician. One thing I find myself doing on a daily basis as a physician is listening to patient’s stories. I sit down with them, make myself present, and just listen.

Listen For Understanding

Think about any instruction list TELLING you how to do something: 
Step 1: take an anti depressive medication, followed by 
Step 2: get 8 hours of sleep a night, followed by
Step 3: walk 30 minutes each day, and so on. 

People may complete the task, but long term learning for long term success from this method is limited. When someone is stuck in the dark hole that is anxiety or depression, it’s hard enough just getting OUT of bed in the morning, let alone doing any number of tasks. Treating anxiety or any mental health condition is not comparable to assembling a piece of furniture from Ikea.

Now, compare this to learning something from a story, where someone has pushed their own human experience and emotion into those tasks. Hearing the struggles, failures, and successes through story are more likely to shape your ability to learn and cope. Understand there are some conditions that we treat through empathy and ability to get to know people at people at a deeper level. The conversation can lend the support you need as you navigate the ‘hard’ in your own life.

Our Stories Are Ourselves

Sharing your story will help you feel better. Why are you not sharing your story? Perhaps you feel embarrassment, fear, resignation? If you do not share your story then those thoughts and feelings are just randomly going through your mind, and you may only be inclined to be reactive towards them when they do pass through… that is randomly.

We use stories to describe to others our needs, and mental health is no exception. It doesn’t make much difference what we leave in and what we take out, what is important is that we tell the story. There is magic in that. It’s in the listener and storyteller- us. And for each and every ear, it will be different. And it will affect us in ways that we can never predict. From the mundane to the profound. You may tell or hear a tale that takes up residence in your soul, becomes your blood and your purpose. That story will move you and drive you. And who knows what you might do because of it.

The Challenge

The truth is today we are not treating everyone we need to who suffers from anxiety or depression, and can not do so if we continue to insist on one-on-one therapy with only an ‘expert.’ If listening to and sharing stories helps people, how can we withhold it? It will be there, doing its thing, whether you want it there or not. To ignore it seems to me to be the least ethical thing one could possibly do.

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.

Tortellini Pasta Salad

admin

15 June 2019

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

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

This featured recipe is Tortellini Pasta Salad. 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.

Tortellini Pasta Salad

Prep Time: 20 minutes
Total Time: 1 hr
Serves: 4

Ingredients:

– 1 package tortellini, cooked per package instructions
– 4 carrots, sliced thin
– 2 cups Edamame
– 1 (6 oz) jar, Roasted Red Peppers
– 12 oz thick cut salami, diced
– 2 tbsp apple cider vinegar
– 3 oz honey goat cheese, crumbled

Instructions:

1) Add all ingredients to a bowl and allow to sit for at least 30 minutes before dividing and serving.

Guide to Erectile Dysfunction, Beyond Primary Care, Primary Care, Family Doctor

Guide to Erectile Dysfunction

admin

11 June 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. 

Erectile Dysfunction

In this post I am discussing a common condition that I see at my clinic: erectile dysfunction. Let me repeat that last part- a common condition. If you suffer from erectile dysfunction, you are not alone. Those two words can make any man nervous. It affects all men but becomes increasingly prevalent as we age. At least 12 million U.S. men between 40 to 79 years of age have it, but can occur at any age. Older individuals are more likely to experience health conditions that require medication, which can cause or even worsen ED. It is a very emotional and sensitive topic to discuss.

Anatomy & Physiology

The penis consists of two parallel cylinder-shaped tissues called the corpora cavernosa that run the length of the penis, a hollow tube called the urethra that is responsible for expelling urine and ejaculate, erectile tissue surrounding this tube, and various arteries and veins. The process of erection involves increased blood flow and pressure to the penis, and those cylinder-shaped tissues mentioned above become engorged and expand- thus an erection. Erectile dysfunction (ED) occurs when those tissues fail to become engorged or the penis fails to maintain rigidity and resumes a normal shape.

Essential Components for Function

How ED is affecting one male may not be the reason for you. Your doctor will help to differentiate which components are affecting you and this is important in differentiating treatment options.

  • Your interest and desire for sexual activity (libido)
  • Ability to obtain and maintain an erection
  • Ejaculation (orgasm)

Select Causes of ED

Male sexual arousal is a complex subject. Discussing in broad terms, ED can generally be separated into two categories: physical and mental health. Many instances of ED may involve causes from both categories.

Physical Causes

  • Medications: Take a look at your existing medications. Several medications may lead to ED. As example, anti-depressants like SSRIs (citalopram, fluoxetine paroxetine, sertraline) used to treat mental health concerns and Beta-blockers (metoprolol, carvidilol, labetalol)  used to treat blood pressure can cause ED. Review all your medications with your doctor.
  • Smoking: Compared with men who have never smoked, the risk of ED is increased by 51% in current smokers and 20% in ex-smokers. Ask your doctor for help in quitting.
  • Diabetes: If you’ve ruled out other causes, there’s a chance your ED is due to diabetes. Patients with diabetes are three times more likely to develop ED. Review your risk for diabetes or work with your doctor to bring your sugars under control.
  • Low Testosterone: Also called hypogonadism, is a condition that generally occurs to all men as they age. By age 80, 50% of men will have testosterone levels in the low range, however the decline is faster in some men than others. Testosterone levels can affect  a man’s overall health including sex drive and sexual function.

Mental Health Causes

  • Sexual Performance Anxiety: This happens when a man anticipates a problem during the sexual encounter and, as a result becomes anxious while attempting to have sex. Doubt and insecurities may take over your thoughts: “Will I get hard enough?” “Will I maintain an erection?” “How do I compare?” “What if I can’t finish?” These pervasive questions can ruin any performance. Talk to your doctor because once people understand the mental that cause anxiety and how to reduce or eliminate them

Treatment

  • Exercise and Nutrition: A change in eating and drinking habits can potentially reverse the contributing causes.
  • Therapy: Seeing and talking to an accredited sex therapist can lead to an overall happier sex life for men and their partners.
  • Medications: The availability of oral medications such as Viagra, Levitra, and Cialis, make it much easier to treat erectile dysfunction. However, medications should be part of a more comprehensive long-term plan. At Beyond Primary Care, we wholesale generic Viagra 100 mg, 10 pills to our patients for $4.20.
  • Testosterone Replacement Therapy: For men experiencing sexual frustration and have low testosterone, testosterone replacement therapy is a safe and effective way to return T-levels to the normal range.

Banana Bread

admin

4 June 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. 

Banana Bread

This featured recipe is Banana Bread. 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.

Adapted from: Allrecipes
Prep time: 15 minutes
Total time:  75 minutes

INGREDIENTS:

2 ripe bananas
⅓ cup melted butter
⅓ cup brown sugar
⅓ cup white sugar
1 egg
⅓ cup plain greek yogurt
1 tsp vanilla extract
¼ tsp salt
1 tsp baking soda
1 ½ cups all-purpose flour

Instructions:

1) Preheat oven to 350. Spray 9×5 loaf pan with non-stick spray.
2) Peel bananas and place into large bowl. Using fork, smash the banana until mushy.
3) Add melted butter and sugars. Stir until smooth.
4) Add egg, yogurt, vanilla, baking soda and salt. Stir.
5) Add flour ½ cup at a time. Batter should be thick but unable to hold a shape.
6) Bake for 50 – 60 minutes.


Ham & Cheese Pot Pie

admin

24 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. 

This featured recipe is Ham & Cheese 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.

Ham & Cheese Pot Pie

Adapted from: Philadelphia on AllRecipes
Prep Time: 15 minutes
Total Time: 50 minutes

Ingredients

1 teaspoon brown sugar
10 ounces ham, sliced and cut into cubes
1 cup cheddar cheese, shredded
2 cups frozen mixed veggies (corn, carrots, green beans)
2 green onions, chopped
1/2 cup chive & onion cream cheese
2 cups veggie broth
1/4 cup milk
1/4 cup all purpose flour
1 batch biscuits
3 tablespoons butter

Instructions

1) Preheat oven to 425
2) Add large saucepan over medium heat, then add ham and brown sugar- stir. Cook until browned.
3) Add the flour and stir with a whisk, then slowly whisk in the broth.
4) Add milk 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) Microwave cream cheese spread in microwaveable bowl on for 1 minute or until completely melted, stirring every 15 seconds.
7) Once the sauce is thickened, add the frozen vegetables, shredded cheese, and cream cheese and cook for 4-5 more minutes.
8) Divide the mixture evenly between 5-6 lightly greased ramekins or 8×8 baking dish.
9) Top with biscuits and brush the tops of biscuits with melted butter.
10) 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.


Knee Cap Pain

admin

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. 

Spinach Tuscan Chicken

BPC Good Eats: Spinach Tuscan Chicken

admin

13 March 2019

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

Spinach Tuscan Chicken
Prep Time: 15 minutes
Total Time: 1 hour
Adapted from: Alvin Zhou at Tasty

Ingredients
4 bone in, skin on chicken thighs
2 teaspoons sea salt
2 teaspoons pepper
1 tablespoon olive oil
5 cloves garlic
1 onion, diced
2 tomatoes, diced
4 cups spinach
2 cups heavy cream
Salt and pepper to taste
1 tablespoon cornstarch
½ cup parmesan cheese, grated
2 tablespoons parsley, chopped

Instructions:
1) In a medium bowl, season the chicken with salt and pepper.
2) Place a skillet over medium-low heat, add the olive oil.
3) Place the chicken thighs skin side down and cook for approximately 12-15 minutes. Move the chicken around to ensure even cooking. Flip the chicken, cooking for another 15 minutes until chicken is cooked through. Remove from pan and cover with foil.
4) To same skillet, add the onion and garlic, stirring until onions are translucent. Stir in tomatoes and spinach until spinach is wilted.
5) Add the heavy cream, salt and pepper. Bring to a boil.
6) Remove 1 cup cream mixture into a small bowl, add the cornstarch and stir until dissolved. Once dissolved, add mixture back into skillet.
7) Add the Parmesan cheese and parsley, stirring until thickened
8) Place the chicken back in the pain, spooning the sauce on top of the chicken.

1 comments

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.