Getting squeezed by health insurance premiums?

Getting squeezed by health insurance premiums? Is your insurance covering less? Charging more premiums? More in copays?

You have options!

Consider direct primary care! Here’s a fascinating Bloomberg article. Cobble together coverage that works for you.

Posted in Uncategorized

Men, do you know your cholesterol level?

Men, do you know your cholesterol level?  There was a recent lipid (cholesterol) guideline released by the American College of Cardiology/American Heart Association which showed that men with a low-density lipoprotein (LDL) component of cholesterol of at least 190 benefit from starting a statin drug.  The study showed a clinically and statistically significant reduction (!!) in cardiovascular events (meaning heart attack and stroke) in those who took a statin daily.  Additionally, it is also thought that all-cause mortality is decreased in these men after starting on a statin drug.

Want more specifics?  This study enrolled men 45 to 64 years of age with an LDL level of at least 155.  They randomized them to either receive pravastatin 40 mg or a sugar pill (placebo).  There was a 20 year follow-up.  There was a consistent  25% relative reduction in cardiac events with the use of statins for those with an initial LDL of 190 or more.  This study excluded men with a known vascular disease, meaning this study was studying how well did statins work for primary prevention of cardiovascular disease.

Want even more information?  Look up Analyses from the WOSCOPS (West of Scotland Coronary Prevention Study).

Posted in Cholesterol, General Medicine- Adults, Male issues, Uncategorized | Tagged , , , , , , , , , ,

Antibiotic prescribing is rampant at urgent care and retail clinics. Does this surprise anyone?!

Antibiotic prescribing is rampant at urgent care and retail clinics.  Does this surprise anyone?

JAMA Internal Medicine recently published a study including 2.7 million urgent care visits, 48,000 retail clinic visits, 4.8 million emergency department visits and 148.5 million medical office visits. Read this…. there are a sufficient number of patient visits to extrapolate antibiotic prescription habits in different locales. n321/55331295/ photos/en321/55331295/

In the study, antibiotic prescriptions are linked to 39% of urgent care and 36.4 of retail clinics.  This contrasts with 13.8% of emergency department visits and 7.1% of medical offices.

For suspected viral respiratory illnesses which antibiotic use is inappropriate, antibiotic prescriptions were given at 45.7% of urgent care visits whereas emergency departments gave antibiotics 24.5% of the time.  Medical offices gave antibiotics 17% of the time and 14.4% of retail clinic visits.

The risk is that antibiotic over-prescription may cause antibiotic resistance.  This is important when a patient truly has a bacterial infection.  You would like antibiotics to work when INDEED you need it.

Your best care is given by a physician who knows you, who you trust.  Secure a primary care physician and cultivate a relationship.  Your healthcare would be more individualized, with better follow up.

Posted in General Medicine- Adults, infections, Uncategorized | Tagged , , , , , , , , , , , ,

Breastfeeding linked with reduction in diabetes…

Breastfeeding linked with reduction in diabetes…

This is not new news, as my children are now teenagers…and this was known then. What is new is the percentage DROP in incidence of diabetes in mothers who breastfed per JAMA Internal Medicine.

The Coronary Artery Risk Development Studying Young Adults (CARDIA) study followed 1,238 women aged 18-30 for 30 years.  Their blood sugar was tested over the course of the study.  Women who had breastfed for at least 12 months had a 47% (!!!) lower relative risk of developing diabetes during the ensuing 30 years compared to those mothers who did not breastfeed.

Did the study take into account other factors?  Yes!  They adjusted for race, number of pregnancies, physical activity, weight change, and gestational diabetes status.

What if you breastfeed for 6-12 months there was a 48% reduction in the risk of diabetes and those who breastfed for 6 months, there was a 25% reduced risk of diabetes.

What if you have gestational diabetes (high blood sugars during the pregnancy that doesn’t occur when not pregnant)?  If the mother did not breastfeed, she has a 2.08% higher risk of diabetes per YEAR compared with women who breastfed for at least 12 months.

Why is this?  It is thought that lactating women have lower circulating glucose both when fasting and after eating.  These women also have lower insulin secretion and 50 grams of glucose per 24 hours is diverted into the breast to help make milk.

How many women breastfeed?  It is estimated that 55% of women breastfeed at 6 months and 33% breastfeed at one year.

What do you need to breastfeed?  You need breasts (any size will work), patience, support, and the desire to breastfeed.  There are some women who do not make milk… but you will never know until you try.  I urge women to dedicatedly breastfeed for the newborn’s first 2 weeks of life with professional lactation support, if needed.  This support is offered through the hospital they delivered at or with outside breastfeeding organizations like La Leche.  Do these steps before deciding that she does not make milk.  The mother can always supplement with formula to help give the newborn the nutrition needed.

Want more information? doi:10.1001/jamainternmed.2017.7978


Posted in breast, food, General Medicine- Adults, Pediatrics, pregnancy, Uncategorized, Women's Health | Tagged , , , , , , , , , , , ,

One more form of birth control “bites the dust.”

One more form of birth control “bites the dust.”  Which one?  What was its history? Why?

The Bayer company is taking Essure off the market.  Essure was marketed as a nonsurgical alternative to “tying tubes.”  Instead of a surgical tubal ligation, done in the operating room under anesthesia, Essure is a small, flexible metal coil that fits into each fallopian tube.  The insertion requires the Essure to be placed through the cervix, into the endometrial (uterine) cavity, and then a coil is placed into each of the right and left fallopian tubes.  The ensuing inflammation causes permanent scarring within 3 months of insertion…so that the blockade will not let egg and sperm meet.

The device has had a troubled past.  The FDA placed a black box warning on the Essure warning physicians and patients about the risk of device migration, allergic reaction, pain, and implant perforation.  This credible warning caused a sales drop of 70% of Essure.  Not surprising, right?!

So, Bayer has decided to discontinue the sale of Essure.  The FDA has vowed to “remain vigilant” to protect women who have already had the device implanted.  Device removal also has risks.  If you have Essure implanted and have no problems, no further investigation is needed.  If you have Essure implanted and have pain or other problems, see your physician.

I hope this helps.  See anatomy below… pretty cool, huh?!

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Posted in contraception, vaccines, Women's Health | Tagged , , , , , , , , , , , , ,

Why does your doctor NOT look you in the eye?

IMG_3631Why does your doctor NOT look you in the eye?  Please click to watch this brilliant and entertaining video from a fellow physician Dr. Zubin Damania, better known as rapper ZDoggMD.

Entitled “EMRs killed medicine”


Posted in General Medicine- Adults, Uncategorized | Tagged , , , , , , , , ,

Medicare’s proposed fee payment changes are NOT in your best interest…

Medicare’s proposed fee payment changes are NOT in your best interest…

Medicare would like to “streamline” physician documentation.  And, in exchange for this, they are decreasing the reimbursement for many office visits.  Most Medicare patients are complex, as there is a lifetime of medical conditions to consider.  Many Medicare patients have multiple medical conditions and, as a physician, I aim to address them all at each visit.  This means the patient can spend more time living OUTSIDE of my office and not seeing me for one medical condition per office visit.

What Medicare is proposing is like…. if I am a restaurant owner, every customer can order a filet mignon, but be charged for a kids meal.  This is unsustainable.

The New York Times recently had a good article

In my town, many physicians do not accept Medicare as the reimbursement schedule AS IS barely covers the overhead costs (rent, utilities, office staff, medical malpractice insurance, etc).  With this proposed change, if it passes, I am certain that fewer physicians will accept Medicare.

If you would like to speak up for yourself, please email the IRS directly.  They will accept comments until September 2018.  Input and search for CMS 1693.15721269254_39d2144a7a_k.jpg

Posted in General Medicine- Adults, Uncategorized | Tagged , , , , , , , , , , , ,