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Seasonal allergies, or commonly called hay fever, are a group of conditions that may cause a person to sneeze, have a stuffy nose, or a irritating runny nose. These symptoms happen certain times of the year when the irritants are in full exposure. Some of these irritants include:
In response to the body attacking the invaders, the body releases enzymes that cause allergic symptoms, like sneezing, coughing, and runny nose. Usually, folks get seasonal allergies during their childhood and the symptoms can get better or worse over time. How do I get tested? Ask your doctor about testing options. A simple physical exam is all that may be needed to diagnose seasonal allergies. However, an allergy skin test is recommended to find out what exactly you might be allergic to. During a skin test, the physician will drop a substance that you might be allergic to on your skin and make a tiny prick in your skin. Then we watch and see if it gets red and bumpy! That's it! Ok, so I have seasonal allergies, now how do I help my body fight this battle? 1. Nose rinses - Using salt water to rinse the inside of the nose cleans and gets rid of the pollen in the nose. Buy a neti pot or sinus rinse at your neighborhood CVS, Walmart or other convenience store! 2. Steroid nose sprays - Be patient with these. It takes a few days to weeks before they start working. 3. Antihistamines - The goal of this class of medications is to stop the symptoms, like itchy eyes, sneezing, runny nose, etc. Remember, some antihistamines can make you feel sleepy, like Benadryl. So, please consult with a physician regarding what you are taking, even though it is over the counter. Medications interact and can influence how you feel. 4. Allergy shot - These are usually every week or monthly administered by a physician. Again, this may take months to work. 5. Allergy pills - These are usually placed under the tongue. They work similar to allergy shots. These can be taken everyday for several months of the year. All of these treatments must be discussed with your primary care physician. Can seasonal allergies be prevented? Absolutely! If you know exactly what time of the year you get allergies, talk with your primary care physician. By starting your medication 2 weeks prior to that time of year, symptoms may be prevented. If you are allergic to pollen, try the following things:
So, it's not just you who thinks this allergy season is bad. There's science to back up what you are feeling! Recently, we had an urgent call where someone was in considerable amount of knee pain and requested our help in getting the right medical treatment for this knee pain.
LiveActive Primary Care jumped into action. Within an hour of taking the call, after evaluation of the knee, an MRI seemed necessary to further evaluate this knee. Their insurance carrier wanted prior authorization, which would delay the whole process, so we were asked to look for cash pricing. One institution quoted the MRI as a little over $3,000, whereas our imaging partner offered the same MRI, got him with a same day appointment and a same day read at a price of $400! That is a huge savings and considerably more efficient. The MRI was completed within an hour. A CD with uploaded MRI images was made and given to our client as they exited the imaging facility. In the meantime, we arranged an orthopedic consult within the next couple of hours. A report of the MRI was faxed to LiveActive Primary Care that same afternoon. Our client was seen by the orthopedist, the images were reviewed by the orthopedist, we had a copy of the MRI reports, and a complete evaluation with a treatment plan the same day! The total cost for the client was $400 out of pocket! Compare that to what would have happened in the traditional model: The client would most likely go the ER and have to fill out a bunch of paperwork. After an hour or 2, maybe more, they would then proceed to the exam room where they are asked several questions, intravenous fluids would be started, pain medications would be given - even tylenol in the ER is much more expensive than what you can buy at the store, a host of labs would be done. After answering the nurse's questions, they would answer the same questions AGAIN with an actual doctor. ER staff may proceed with an X-ray first and then later decide the client needs a follow up MRI as an outpatient since the MRI scanner is booked up with other patients. After another several hours, the client would leave with pain medications in hand, likely some combination of narcotics and tylenol to follow-up wth his primary care doctor. The total cost of this model, even suggesting that there was no MRI done in the ED would easily be thousands of dollars with insurance! More importantly, the case was simply evaluated on the surface only to delay the actual imaging that was needed with a high price tag; not to mention the amount of time that was wasted just waiting around for the evaluation to be done. Even if the ED cost is covered with Health Insurance, Medicare or cost is not an issue, the efficiency is incredible when we take away insurance and remove all the considerable barriers in our health system, which only impedes quality and efficient care delivery. That is the LiveActive experience! Our incentive is not to add services to make a profit; instead, our focus is on maximizing the patient experience with little to no cost for our members. Primary care should not be expensive and it most definitely should not be difficult to access. This is only one of many stories that we live everyday. Come join the movement in revolutionizing how primary care is done and experience the difference with LiveActive Primary Care! What is influenza? Influenza is an acute respiratory illness caused by Influenza A and Influenza B virus. It mainly is prevalent during the winter season. Although the virus can be debilitating, it is a self-limited infection in the general population. This is termed uncomplicated influenza. The worst cases that cause an increase in morbidity and mortality in certain-high risk populations are cases of complicated influenza. What is the current status of the virus? The CDC gathers information and updates their website weekly. At the end of January 31, 2015 the CDC reports there have been 21 cases of H1N1 and 569 cases of H3N2. In the United States, the majority of recently circulating influenza virus have been susceptible to oseltamivir (Tamiflu), zanamivir, and peramivir. It should be noted that there have been some strains that are resistant to Tamiflu; this includes the H1N1 and H3N2 detected worldwide. The CDC still recommends antiviral treatment with oseltamivir, zanamivir, or peramivir as early as possible for patients who are confirmed or suspected influenza who have severe, complicated, or progressive illness. You can find more information by visiting the CDC. How is influenza transmitted?
Transmission of the virus often is as a result of contact with an infected person. This can be from respiratory secretions, like sneezing and coughing. Large particle droplets do not remain suspended in the air and they travel only short distances (about 6 feet). In healthy adults, viral shedding can be detected 24 to 48 hours before illness onset. In clinical trials, shedding ceased after 6 to 7 days in most studies, up to 10 days in some trials. In the elderly, immune suppressed, and those with chronic illnesses, viral shedding was detected on average 6 days. What makes influenza so "complicated" if it is self-limited? Pneumonia is the most common complication of influenza. This can range from primary influenza pneumonia, which can be severe enough that causes hypoxia and even death. In addition, secondary bacterial pneumonia contributes substantially to morbidity and mortality. This is especially concerning in the population aged greater than 65 years of age. Cardiac complications include heart attack, inflammation around the heart, including myocarditis and pericarditis. What is the treatment? Given the growing resistance to antiviral agents, physicians have the responsibility of reserving these agents for those who are at high risk for complications, hospitalizations, and evidence of lower respiratory tract infection. The current recommendation is to treat with zanamivir and oseltamivir for all individuals confirmed or suspected of influenza virus infection who are severely ill. Antiviral treatment should be within 48 hours of symptom onset. There is also evidence to use antiviral agents for outpatient patients who present more than 48 hours after symptom onset with confirmed or suspected influenza infection and who are at increased risk for complications provided they are still not improving. If an individual has uncomplicated influenza then antiviral agents are generally not recommended. The usual over the counter medications to help with symptoms, plenty of rest, fluids, and nutrition should suffice to treat this illness. What is the value in getting the flu vaccine? Remember from the above discussion that there are 2 types of influenza: A and B. The current vaccine protects individuals from type A H1N1 and other subtypes of type A influenza as well as type B. The prevalent H3N2 strain is resistant to the current vaccine. This should NOT prevent individuals from getting vaccinated. During the 2003-2004 influenza season, according to the CDC, the inactivated influenza vaccine effectiveness against the laboratory-confirmed influenza was 60% among healthy persons and 48% among those with high-risk medical conditions in a case-control study among people 50-64 years old. The live vaccine has been shown to be associated with reductions in severe febrile illnesses of 19% and febrile upper respiratory tract illnesses of 24% in healthy adults according to the CDC. Please visit http://www.cdc.gov/flu/professionals/vaccination/effectivenessqa.htm for more information. The data also suggests that as a society, the flu vaccine reduces health care costs. Thus, there is not only a health benefit, but also an economic benefit of getting vaccinated. I encourage you to inform yourself of the illness and the vaccine to make more informed decisions for you and your loved ones. As always, consult with your primary care physician if you have any other questions. The recent outbreak of measles at Disneyland is a reminder of how infections that once were eradicated can re-emerge in the 21st century. The California Public Health Department had 59 confirmed cases since the outbreak started in December. Several more cases were confirmed in states outside of California, like Mexico, Oregon, Washington State, Colorado, and Utah. There are reports that the outbreak may have started at the Anaheim park between December 15th and 20th. Since these confirmed cases, there has been a push for unvaccinated individuals to stay away from the theme parks or get vaccinated. Children younger than 12 months should not be taken to these parks or infected areas, as they are unable to get the vaccine and thus are susceptible to the infection. It is important to remember that this infection has moved away from the parks and into schools and other communities. This recent attack begs the general public to re-visit the age old anti-vaccination discussions since the 1800s. In fact, there was the Vaccination Act of 1853 that ordered mandatory vaccination for infants up to 3 months old. This Act extended the age to 14 years in 1867. Of course, these age thresholds have changed. The World Health Organization (WHO) recommends the first dose of vaccine to be given at age 9 months in high risk areas, and 12 months in low prevalence areas. Fear of the measles vaccine causing autism is based on no actual evidence. Here is some evidence to back this statement: Stratton K, Gable A, Shetty P, McCormick M. Immunization safety review: Measles-mumps-rubella vaccine and autism. Washington, DC: Institute of Medicine, National Academies Press; 2001. What the heck is measles? Measles is an infection that is a viral infection that causes a rash, fever, and a cough. The virus can be spread from person to person. There is a vaccine that can prevent measles. It is called the MMR vaccine. This vaccine is unique in that it protects against, measles, mumps, and rubella. People need 2 doses of this vaccine to protect against measles. So who is at risk?
What are the symptoms? The initial symptoms may include the following: 1. Fever as high as 104 F 2. Feeling sick, as if you have the flu 3. Loss of appetite 4. Spots in the mouth that look like grains of salt After the initial symptoms people start feeling better after 2 days after the rash starts. By day 3 and 4 the rash turns brown and goes away. The skin might peel or flake off. Other symptoms include cough, shortness of breath, chest pain, or headache. How can you make a diagnosis of measles? The clinical history is most important as is the physical exam. Anti-measles IgM and IgG is generally detectable in 3 days after the appearance of the rash. It may be negative on the day of the rash and as well as 30 days after the rash appears. So getting to your doctor as quickly as possible is important. However, please notify your doctor that you are coming as measles is infectious and the people in the clinic might be susceptible to the infection upon your arrival. Is there a treatment for measles? Not particularly. The treatment for measles is supportive. There is some role for vitamin A in certain settings. Intravenous fluids and treatment for any super imposed infections is critical. This means that there might be pneumonia or ear infection on top of the acute measles infection, Has the recent outbreak affected your perspective on vaccinations? Primary care has lost its appeal over the last few years. If you look at healthcare delivery from a distance, you will notice that there is this unnecessary rise in specialty care. Almost every organ is specialized! I am all for it, but boy does it get confusing as there are so many people who get involved in one's care. In the meantime, the average primary care visit has reduced to just about 7 minutes. So, how can a primary care physician go through each concern in an efficient manner? The current situation is leading to a tremendous about of physician burn out. According to helpguide.com the following are signs that are concerning for burnout:
Not sure about you, but as a physician, I can say almost every physician I know meets this criteria. The last bullet point definitely touches on the control insurance companies have on the care we provide. Healthcare is the only business in the world where a third party decides what the customer will get and for what price, regardless of what the physician advises. This leads to tremendous frustration for the patient and their physician. The average wait time to see your primary care physician is 2-3 weeks nationally. Moreover, the cost of medications and hospitalizations continue to rise. Finally, think about this: Do you understand everything that your insurance policy covers or not covers? We pay such high premiums for a product that we barely understand. Why do we allow this to happen? When we go out to eat, buy merchandise, or purchase any other service we focus on the details and know exactly what we are getting in return. Now that we are required to have health insurance by Federal law, we are mandated to go to the marketplace to purchase these confusing products. It is only after an illness, major surgery, or hospitalization that we realize what kind of a coverage or lack of coverage we actually have. Is it me or is this just crazy?! Primary care does not need to be expensive and for that matter, health care in general should not be so expensive. Furthermore, in my journey in building a practice to help my clients the most, I have partnered with some incredible companies. I have learned that medications, laboratory, and pathology do not have to cost so much! So, why the high premiums? Our vision at LiveActive Primary Care is for our clients to be worry free when they join. Every little service does not cost extra. We want your primary concern when you walk through our doors is, "I joined. Now let's take care of me." That attitude excites us! We will align resources with community partners at discounted rates to improve your quality of life. Direct primary care decreases our panel of patients to less 1,000 patients! Compare that to the average 2,500 to 5,000 patients in a traditional practice! This means more time for you! Benefits of direct primary care include:
My partner in our Health Suite 110 is an outstanding physician and a board certified Family Medicine physician. The two of us make a great team to provide you excellent care! Give us a try and we will be honored to be your personal physician for years to come! We hope to grow the Health Suite 110 with more physicians. We would love to have a "Med/Peds" physician - this is someone who is trained in Internal Medicine and Pediatrics. We are also interested in Family Medicine or Pediatric Medicine physicians. If you or know someone that is interested, please give us a call! We are so close to purchasing our space and next step is the complete build!! Contractors and our architect have put together some designs and we are moving forward with our vision to provide the best and comprehensive care possible. In the meantime, please do not hesitate to give us a call as we can make house visits until our clinic is built. We are also available to provide care at retirement homes, assisted living, and any independent living arrangement. So get started today and we will waive the home visit fee until our clinic is built! Call (913) 667-0787 or email us at info@LiveActivePC.com. How many of us can honestly say we have an advanced directive for health care completed for our loved one as early as their 65th birthday? I think a very few of us would nod our head yes. This includes me - well, I tried, but my dad is stubborn and this is a tough conversation to even bring up. So, I am in the same boat as the majority who struggle to have these conversations. Advanced Directive is defined as legal documents a person completes while still in possession of decision capacity about how treatment decisions should be made on her or his behalf in the event she or he loses the capacity to make such decisions. Advanced directives can be revoked orally by the patient at any time so long as they maintain decision making capacity. The most difficult question for patients and families is "which medical treatment is right for me?" The answer to this question will vary upon personal reflection of his/her own values and preferences. Clinicians play the role of guiding patients and families in reflecting on these questions. Thus, it truly is a team approach and should be approached in a systematic way. The easiest and most efficient way to go about doing this is to create a advance care planning process. What the heck is that? Advance Care Planning process (ACP) is an ongoing process where patients, families, and their healthcare providers reflect on the patients goals, values, and beliefs, discuss how they should inform current and future medical care and ultimately use this information to accurately document their future health care choices. In the most ideal situation, this is all done after exploring the patients and caregiver's knowledge, fears, hopes, and needs. When do we start this process? Anytime! Sooner the better. Several experts have advised the following:
Point here is - TALK ABOUT IT AS SOON AS YOU CAN AND IT IS AN ONGOING PROCESS. Death is natural and inevitable. We must become comfortable talking about it and sharing our thoughts with one another. What are the benefits of establishing a ACP? Randomized and prospective studies have shown the following:
So, can Dr. Ahmed help me with this and what benefit does LiveActive Primary Care offer me?
We all perceive life through a different lens. We are all human beings with our own personal limitations. Life has a definite start and stop time that never pauses in between for neither you or me. So if we all agree that our time is limited, does it not make sense to make the most of our time and enjoy each day? Why not live life to the fullest and a quality of life that is defined only by you alone? So, why not partner with a physician who is doing whatever they can to preserve that patient-physician relationship so that they can better understand you and be your partner in living a healthy, high quality, fulfilling, and most importantly... FUN life? Hope you found this post full of reflection and useful. Contact me if you want resources to this post or have any questions. Join our practice now! Our clinic will complete construction by early 2015 we hope. Take care and happy holidays to all! Enjoy your time with family and friends. Please remember to give your loved ones a nice big hug and remind those whom you love how much you love them at least once a day. Your internist, Dr. Ahmed 913-549-3884 info@LiveActivePC.com So, the past several months I have been losing sleep, working long hours, and traveling all across the state of Kansas. All this in hopes of creating one of the best best practices for my clients. I want people to come to my practice and simply enjoy their visit with their doctor. I hope to get rid of the old "Oh, no! I have to go to the doctor again!" Instead, I hope to stimulate a "YES! Let's go see Dr. Ahmed!" type of response. I thought I would share something that I found interesting in my practice set up so far - medications and laboratory do not have to be so expensive! Those of you who may know me, this dream all started from my frustration with the reality that most folks cannot afford their medications or their medical care, especially with the recent economic recession. The face of poverty and uninsured has changed over the years. I bet none of us can look around and predict who has or does not have insurance or means to afford health care. As I struggled to get the support and resources to establish a foundation, I came across this new model of delivering primary care. I started to discuss this with other physicians, got on the phone and reached out to physicians in California, Kansas, North Carolina, etc. It became clear to me that many physicians were in my shoes! I was not alone! This fueled me. I still was not certain if I wanted to take the plunge. I was out at lunch with an attorney and a broker. The theme of the lunch was "what the heck should Dr. Ahmed do with his life!" On one hand I love taking care of patients and on the other, I was being broken by the unnecessary red tape, protocols, and the difficulty in providing resources for my patients to follow through with our treatment plan because of financial barriers. That is when my delicious chicken sandwich became even more delicious! The broker yelled, "heck, why don't you just start your own practice! Why do anything else? You seem to be looking for ways to allow you to practice the way you want to practice." Those words changed my life. I am thankful for him. I am thankful for my attorney friend who later said, "I really was hoping you would start your own practice" after I made the decision to start my own practice. Life is really interesting. As I learn more ways to provide services for my future clients FREE of charge or at a cheap price, I am meeting people who constantly say, "This is a bargain!" I hope you will join my practice and enjoy the hard work we put in and will continue to put into providing you quality health care at low to NO cost to you! AtlasMD is a practice in Wichita, Kansas who is guiding us all along! Check out their saving that will be very similar to our savings come 2015! Your Internist, Dr. Ahmed
Did you know that the practice of internal medicine can be traced back to ancient India and China? In fact, the term Internal Medicine originates from the German term Innere Medizin. This term was popular in the 19th century and was brought to the United States from American physicians who trained in Germany in the early 20th century. The term Innere Medizin was used to describe physicians who combined the science of laboratory to patient care.
Internal Medicine physicians specialize in adult and geriatric medicine. So what defines "adult?" Well, nowadays that can be as young as 14 years old as kids are reaching adult weight of 50-70kg. In the past when I was in training we used to say anyone older than 16 or 18 years old. But, given the size of the average American, this definition has changed. I am comfortable seeing anyone who is "adult" weight. Therefore, I picked 14 years old as my starting age. You can twist my arm to see 13 year old folks... The American College of Physicians defines Internal Medicine as the following: "Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness." So our favorite question is "why?" This used to drive my parents crazy when I was young. I was that annoying little one that always popped his head up and asked "why?" It is a lot of detective work and we love looking at data and forming hypotheses. We do not zone in on one diagnosis, but have a list of possibilities and eliminate each one as more clinical information becomes available. I feel like this is being lost in today's "hamster wheel" medicine where everyone is rushed and the average exam time is 7 minutes. We treat ear infections, eye infections, headaches, post stroke care, post heart attack, high cholesterol, diabetes, adrenal issues, thyroid issues, copd, asthma, pneumonia, skin infections, depression, anxiety, any mental disorder, arthritis, urinary tract infection, prostate issues, trouble urinating, impotence, diarrhea, constipation, any gasterointestinal diseases, arrythmia, heart failure....I think you get the idea. If the illness is beyond the scope of internal medicine or a special procedure is needed, a referral is made to a specialist. We are skilled in suturing, skin biopsy, skin tag removal, cautery, joint injections, some do botox injections and liposuction, and various other small office procedures. In addition, the major skill is prevention and early recognition of disease or pathology. So, coaching clients through current guidelines for screening for breast cancer, colon cancer, heart disease, high cholesterol, and much more is critical in the care of our community. This is what excites me about my new practice! As a hospital physician I treated post stroke care, acute heart attacks, head bleeds, severe infections with multi-organ failure and all that was gratifying. But, there were some cases where I would sit with my head in the palms of my hands thinking, "if only she had an internist or the internist had more time in taking care of her, or her medications would be affordable...if only..." I'll be honest, I did cry at times for my patients because many times it is not their fault. The system has failed them and they suffered such a catastrophic event that will only cost the system and more importantly the individual significant dollars. Thus, prevention, wellness, and being a coach is as, if not more important, than treating an acute illness. So when people ask, "why do I need an internist?" I usually tell them, "well you can get one when you get terribly sick in the hospital with a large bill or you can get one now and prevent a catastrophic event if possible." More importantly, life is about building relationships. The sooner you find an internist you like and can partner with, the better you will feel and likely live healthier. Statistics show that people do better with a good support system regardless of what the issues they are dealing with - medications are not always the answer. Sometimes people just need to talk. In my model, I will have time to listen. Maybe the anxiety or panic attacks you are experiencing is because of an acute issue you are dealing with. Does it make sense to prescribe an anti-anxiety medication in 7 minutes of hearing your story or does it make more sense to listen and see if we can work out a solution together and only prescribe if needed? I argue that these quick visits are leading to unnecessary prescribing, imaging, and laboratory - this all drives rising costs for everyone. I have passion for science and am amazed at our progress. But I also understand that there are things in this world that we still do not understand. Sure, not everything is in our control. But, I believe with the knowledge and technology that we have today, prevention of disease and the management of disease is not only our responsibility but it will allow us to take care of each other. As I tell all care-takers, you have to take care of yourself before you take care of others. We have to be there for each other and more importantly be healthy when we stand together; or else we both fall. Living healthy does not have to cost so much nor should it be a burden. So, join my practice and let's do this together! Let's live life to it's fullest and I will be honored if I can be your internist in this journey we like to call life! Your Internist, Dr. Ahmed Picture a moment when you begin to develop an annoying cough. You carry on your day and try to take some throat lozenges to help soothe your sore throat. The following days, you begin to spike fevers and start to develop muscle aches and pains. Instead of calling a number where you are greeted by someone who says the doctor is free a month later, your call is answered by your doctor.
This doctor who knows you personally and talks to you. After listening to your symptoms, the two of you decide to meet at the clinic for an evaluation. You arrive at the office in complete misery. Once you get to the front door of the office, you think to yourself, "Oh no! I forgot my insurance card!" Alas, you realize, your doctor does not need your insurance card nor will they have to deal with asking your insurance carrier if this visit is covered. You are greeted by your doctor and immediately take a seat on the exam table. A strep test is done and a thorough exam is completed; all at no extra cost to you. Once the exam is done, you get your antibiotic at an extremely cheap price because your doctor has a in-house pharmacy where his savings are passed on to you. You smile at the thought of not having to worry about the big fat bill that would have come weeks later. A few days later, you are back to your full strength! Join our practice and become a member of LiveActive Primary Care! Make this story a reality for you! |
Author"He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all." Archives
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