Open House 3/29

Looking forward to hosting an open house this weekend, Saturday March 29th, to show off my brand new beautiful office! It’s going to be a beautiful warm day, so while you are undoubtedly already out and about in Harford County, come stop by between 11am and 2pm to say hello! You can bring family and friends, grab a snack, enter a raffle, peruse the office, and enjoy the art gallery of local work that is now my hallway! Opening Slack Family Practice and bringing direct primary care to Harford County has been a dream come true. The response in the community has been so supportive, which is really not surprising at all. People are ready for a change in healthcare, ready to embrace direct patient and physician communication, and eager to shrug the constraints, hidden charges, and frustrations of the typical insurance based system. The flexibility, personalization, and laid back nature of direct primary care is refreshing and welcomed. So if this is something you have been considering, or a new concept that you would like to hear more about, come chat on Saturday! I look forward to seeing you there!

Shout Out to PT!

I had a lovely lunch with my neighbors at Drayer Physical Therapy! I find many reasons to refer patients for physical therapy as a first line treatment. It’s a great way to approach various conditions without using medications, thus avoiding the potential for medication side effects and interactions. Most people are probably aware of physical therapy for orthopedic issues - things like tennis elbow, sprained ankles, rotator cuff tears etc. But PT offers so much more!

One common medical issue I refer for physical therapy is vertigo - see my other post about BPPV. Vestibular therapy is quite successful in replacing misplaced crystals. I also use physical therapy for acute treatment of migraines with a technique called dry needling. Pelvic floor physical therapy addresses urinary incontinence issues. I learned the therapists at Drayer can do splinting, orthotics, and even measure for custom DME like walkers and wheelchairs.

Physical therapists do an excellent job of assessing patients, creating treatment plans, and educating about home routines and self care. They can help address acute pain, manage chronic issues, and (my favorite!) teach preventative measures. The group I met today is clearly passionate about patient care, and I plan to take full advantage of this close resource!

Day Light Savings

Time to Spring Ahead this weekend! I know, I don’t look forward to it either - no one likes losing an hour of sleep. But looking on the BRIGHT side, we do get some extra time in the sun. Soak up some extra sunlight Sunday morning, preferably combined with some physical activity like taking a walk. Both the light in the morning and the exercise will help you fall asleep better that night, despite the time difference.

If you are very sensitive to disturbances in sleep schedules, start now - try going to bed 15 minutes early each night leading up until Saturday. This might help out with kids too!

Be extra strict with your sleep hygiene right now - avoid caffeine in the afternoon, eat dinner at least a few hours before bed, and limit your screen time as well.

Luckily most devices that tell time update automatically these days, but for anything that doesn’t, especially like bedside alarm clocks, change the time as you are going to bed Saturday to avoid confusion when you wake up.

Mostly though, keep in mind that day light savings is just another signal that SPRING IS ON THE WAY!

Lymphedema

Lower leg swelling is a common concern brought to primary care doctors. While leg swelling can be a sign of other underlying disorders, such as blood clots and heart failure, it is also commonly caused by lymphedema. Lymphedema is an accumulation of fluid and/or adipose tissue as a result of an issue with the body’s lymphatic drainage system. Often the underlying issue is from damage from something like an injury, surgery, cancer treatments, or lymph node removal, but other times the cause is genetic, hereditary, or simply unknown.

The swelling with lymphedema generally starts slowly and progresses. At first it is usually ‘pitting,’ which means the kind of swelling you can poke with your finger and see the finger mark remain. As the swelling progresses and becomes more chronic, it may no longer be pitting but rather measures as an increase in circumference of the extremity. Often the swelling is asymmetric, with one leg or arm measuring bigger than the other.

Sometimes patients with lymphedema complain of a heavy sensation in the affect limbs, with aching discomfort and stiffness. Depending on the degree and duration of swelling, rashes and other skin lesions can develop. Others are primarily bothered by the appearance. Either way, treatment options are available! Exercising the affected limbs helps to prevent swelling from getting worse. It is also recommended to wear compression garments, including with exercise. I have also had patients see great results going to a lymphedema center, where a specialized physical therapist does manual lymphatic drainage massages.

If you are having concerns about lower leg swelling, definitetly make an appointment with your doctor! Your PCP can help rule out the more dangerous threats, and then guide you towards the best way to manage going forward!

Weekend Warrior Exercise

Often when I counsel my patients on exercise recommendations from the American Heart Association, I am met with a scoff and an eye roll. It’s not because my patients don’t want to exercise - most people readily acknowledge how much better they feel, both mentally and physically, when they get into a regular exercise routine. Rather, the response comes as a skeptical ‘sure, I totally have time for that’ reflex. Trying to find 30 minutes in a day between commute, work, helping the kids with homework, transporting to various sports and after school activities, figuring out dinner, prepping for the next day, and finally getting to that load of laundry that has sat in the washer now for so long it needs to get re-washed (just me?) is daunting if not impossible.

The good news is that recent studies show that meeting the goal of 150 minutes of moderate physical activity per week over 1-2 days offers similar health benefits compared to spreading that exercise out over 5-6 days! Doing this pattern of exercise that concentrates physical activity into one or two days on the weekend is known as a weekend warrior workout. An example might be an hour of cardio Saturday morning - running, biking, swimming - with a strength training session later in the day - body weight exercises, pilates, weight lifting etc. Then on Sunday, 30-60 minutes of activity like hiking or tennis, followed by a light activity such as yoga.

Rather than stress about trying to squeeze in a work out on a packed week day, thereby counteracting the stress relieving benefits of exercise, plan out a weekend warrior workout! Mix up your work outs to keep them interesting, and choose activities that you enjoy for the positive reinforcement. If you are just starting an exercise routine after a long hiatus, start light and gradually increase intensity over time. Remember that about 80% of your exercise should be done at a light or moderate intensity. If it hurts to exercise, you might be doing something wrong or just need to pull back the intensity for a bit! Remember to stretch, remember to hydrate, remember to refuel with healthy foods, and of course remember to have fun!

Now get moving this weekend!!

Dealing with Dry Skin

I always find this part of winter to be tough - once Valentine’s day comes and goes, it feels like we should be turning the corner towards spring, yet the cold lingers, and we often get hit with one more snow or ice storm. Typically this time of winter is marked for many by dry skin. Hands are often hit the worst, as we are constantly reminded to keep up with washing and hand sanitizer to avoid the many circulating illnesses, on top of exposure to the cold and dry climate.

Dry skin is irritating, itchy, sometimes painful. Like most conditions, prevention is much more successful compared to treatment. Don’t wait for your skin to be cracked and bleeding before starting a good moisturizing routine! I recommend thick creams or ointments, such as Cetaphil, Eucerin, Aquaphor, and good old Vaseline. Avoid harsh and overly perfumed soaps - again I like Cetaphil for cleaning. It’s best to lather on moisturizers right after getting out of the bath or shower, and keep up with applying at least twice a day.

For stubborn or symptomatic (itchy/irritated) areas, over the counter 1% hydrocortisone can be used without a prescription and can offer relief, though often stronger, prescription strength steroid creams are required for a short time. If you think this might be the case for you, reach out to your direct access primary care for help!

Influenza

Most of you probably already know, but there is A LOT of illness going around right now! My older son was recently diagnosed with Flu A, and he was one of about seven absences in his 4th grade class this week. Thankfully, albeit very reluctantly, he gets his flu shot every year and so his course was fairly mild. He complained of body aches, sore throat, headache, sinus congestion, and had a temp around 99 - 100 for a couple of days. Despite this, he was able to enjoy two days on the couch watching Netflix with just enough misery to also get spoiled with gatorade, blankets, and cuddles.

There are treatment options available for the flu, which help to lessen the severity of symptoms and shorten the course of the illness. The key to these medications being effective, however, is to start them early in the course of your symptoms. If you think you might have the flu, it’s worth going to urgent care (or much better yet, your direct access primary care!!) to get tested sooner rather than later. This is doubly important if you have other conditions that put you at risk for a rough go of it with the flu - things like asthma, diabetes, heart disease, COPD and more.

With such high rates of respiratory illness circulating right now, take extra precautions. Wash your hands often, wear a mask in crowded places if you are vulnerable, and stay home if you aren’t feeling well!

Weight Loss Medication at SFP

Now that my physical office space is up and running, I have also begun offering weight loss management, including medications! Initially I planned on offering this service to non-members, but I have learned that my primary care upbringing has made it difficult for me not to get involved in all aspects of a patients healthcare. When patients start taking GLP-1 medications like semaglutide and tirzepatide, they quickly find that they work - weight loss happens fairly efficiently. With those changes, there are often adjustments that need to happen with chronic medications like blood pressure medications or cholesterol medications. Side effects need to be managed, blood work needs to be followed, and counseling on nutrition and exercise is essential. This is why I decided to only offer weight loss medication to SFP members - those I am already seeing for primary care.

However, I recognize that joining SFP is not necessarily low cost, though I do feel it is high value. Still, in order to make the prospect of doing both affordable, I am offering access to medication at a significantly lower price. Many weight loss clinics in the area charge about $115 per injection of semaglutide or more. When considering the discounted price of the medication that I am able to offer, combined with the price of membership spread out over 52 weeks, the overall cost of both would still be cheaper - about $110 per injection!

So if you are thinking of starting a weight loss journey, reach out to learn more about the benefits of doing a program through direct access primary care! Not only will you be able to start these highly effective medications, but you will have access to email, text, or call your doctor should any questions or concerns arise. And that is not limited to questions/concerns regarding the weight loss medication - you would have the full benefits of direct access primary care, such as management of chronic conditions, preventative healthcare, and easy access for any urgent care needs. Get started today!

Coronary Artery Calcium Scoring - What is it, and who should have it done?

Coronary Artery Calcium (CAC) Scoring is done by a CT scan of the heart, looking for calcium plaque build up in the coronary arteries. This is a screening test, which means it is done on people who feel well - no chest pain, no problems breathing, no known heart disease. However, it is not a test that is recommended for everyone.

I find this test most helpful in patients who are at a higher risk for heart disease based on their cholesterol results or family history, yet aren’t certain they want to start taking a statin medication (such as Crestor, Lipitor). In these patients, having additional data to gauge heart disease risk helps in making the decision on how aggressively to treat.

There are some potential down sides to getting this test done. For one, a CT scan exposes a patient to radiation (though a small amount, about the same as a mammogram). Further, though the scan is intended to evaluate the heart, it will show the entire chest. This brings the risk of incidental findings, which I and most doctors dread, because it often leads to unnecessary testing, procedures, and cost. This is one reason why it’s always important to think critically about ordering tests. One good question to ask is, will this test change what I plan to do?

So if you have high cholesterol or other risk factors for heart disease, talk to your primary care about your personal risks and benefits of Coronary Artery Calcium Scoring!

First Week Down!

We are wrapping up the first week at SFP! On Monday this week we spent the day hanging and decorating and organizing, as well as last minute electrician fixes, but since then we have had a steady stream of in-office appointments and I am loving it! I say ‘we’ now because I am thrilled to have brought on my office manager, Melissa. We worked together for many years before SFP, and like riding a bike we are seamlessly into our routine of patient care.

The office has come together beautifully, and I look forward to hosting an open house with date TBD. Part of the reason I am waiting to set a date is because the Harford County Art Society is allowing my office to be a satellite location for local art work to be displayed and purchased! I want to be able to showcase their work during the open house, so I am waiting for that installment before setting a date. Still, the office is open so if you are a part of the SFP family reach out for an appointment. If you are interested in becoming a member, please do the same!

As I have said before, every patient interaction I have further reinforces my decision to adopt the direct access primary care model. This is even more true with seeing patients in the office. I love that visits are unhurried, more relaxed, and comprehensive. I’m looking forward to catching up with even more patients next week!

How Often Do I Need A Pap Smear?

January is cervical cancer awareness month, so today I want to talk about updated guidelines for pap smears. These updates are really not new (2012 for ACS, 2018 for USPSTF, 2021 for ACOG) but I still find that patients are surprised when I tell them they no longer need a pap smear every year. Some patients even push back, worried that something will be missed if a pap smear is not done every year. However, studies have shown that testing every 3 years results in similar rates of cancer detection compared to testing annually. Further, testing annually leads to about triple the number of downstream interventions like colposcopies and surgical procedures. So essentially, testing every year leads to more invasive tests/procedures without actually detecting more cancer!

In women aged 30-65, testing for HPV with the pap smear can be done instead of just doing a pap smear. With this co-testing method, paps only need to be done every 5 years. HPV is the virus that causes cervical cancer. There are several variants of HPV, and the test can detect the ones that are highest risk to cause cancer.

Pap smears can be stopped at the age of 65, if there has been adequate prior screening that has been negative. Some prefer to continue screening longer, through age 74, assuming a healthy population with a life expectancy of at least 10 years. High grade abnormalities on pap smears are actually rare in the older population of women who have had previously negative screening. If screening history is abnormal, unknown, or incomplete, then it’s best to continue to screening.

As with anything, my approach is always to have a discussion with patients about risks and benefits. Keep in mind, these are general recommendations for a healthy and low risk population. If you have conditions that place you at higher risk, such as HIV or long term immunosuppressive therapy, or a history of abnormal pap smears, then there are different recommendations to follow.

As a direct access primary care physician, I offer routine GYN care including pap smears and HPV testing if indicated.

First Mammogram - Check!

I got my first mammogram done today! I am slightly behind schedule, compared to when most women start routine screening mammograms, but I would not say I am delinquent. The recommendations for breast cancer screening for women vary, with some organizations (American Congress of Obstetrics and Gynecology, American College of Radiology, United States Preventative Services Task Force) advising a start age of 40, and others (American Cancer Society, American College of Physicians) suggest age 45 or even 50.

The discrepancy comes from weighing risks vs benefits of mammography at age 40-49. Younger women who are pre-menopausal have denser breast tissue, which makes the images taken with mammography difficult to see and interpret clearly. This tends to lead to the need for call backs, with requests from the radiologists for more images at different views to try and determine if they are seeing something of concern or not. That question of a potential abnormality often leads to even more additional testing, like ultrasounds and biopsies. All of this can cause a lot of anxiety in patients, as well as increased medical spending and exposure to risks associated with invasive procedures.

On the flip side, if mammogram screenings are not started until later in life, there is a potential that cancer can be missed. And breast cancer is so well publicized now, it feels like we all know someone - personally, professionally, celebrity - with breast cancer. So most women scoff at the idea of missing a breast cancer and are ready at 40 and a day to get started.

My approach with patients is always to have an open discussion about risks and benefits to determine when the right age to get started with mammograms is for them. For all of my patients going for their very first mammogram, I make sure to let them know how common it is to receive a call back, to try and offset some of the anxiety that this can trigger. In addition to the likely denser breast tissue reducing visibility, there are no prior films for comparison. In the future, a baseline mammogram is used for comparison and helps to reduce the need for more images.

In reality, the process of getting a mammogram was no big deal. Shout out to Advanced Radiology in Aberdeen! I had a great experience this morning. The new facility there is beautiful, the appointment was quick, and the mammography tech was cheerful, offered clear instructions, and even shared with me the same warning about call backs that I do with my patients! Fingers crossed I won’t need to go back for more images, but if I do, I would definitely return there.

So if you have been dragging your feet on getting a screening test done, there is no better time than now to reach out and get something scheduled! With direct access, making appointments to discuss preventive care is easy and seamless, so get started today!

NAD+ boosting Supplements - Are They Legit?

I recently did a deep dive on a supplement for a patient, and thought I might share what I found on my blog as well. I think it highlights what is typically found in regards to clinical trials done on dietary supplements - in short, the trials are usually small in number, with few participants and short study times, making it hard to draw any significant conclusions.

This particular supplement is Nicotinamide Riboside (NR), which is given to boost nicotinamide adenine dinucleotide (NAD+) levels. Declining levels of NAD+ are seen with aging and thought to be related to or possibly cause the associated ill effects of aging such as decreased energy, weight gain, loss of muscle mass etc. Supplements containing NR or other NAD+ boosting agents claim to essentially be the fountain of youth. Tempting to believe, of course. And in truth, the studies are showing some promising findings that should result in more study, though after doing this research I am far from ready to buy in. Here’s what I found:

There have been about a dozen studies on using oral Nicotinamide Riboside to boost NAD+ in humans.  Like a lot of studies done on supplements, these were all really small trials, so talking about 10-40 people in the various trials.  A few of them were the more robust randomized controlled placebo blinded type that we like to see, but most were not.  And most of the trials were short, ranging from 1 week on the supplement to 20 weeks.  About 3/4 were done on healthy or overweight populations, and the rest were targeting specific diseases like Parkinsons or heart failure.  Reassuringly, all of the trials showed that taking 250mg - 2000mg per day was safe.  Almost all of them also showed that taking the supplement did increase NAD+ levels.  Unfortunately, the studies weren't able to show any improvement in things like weight, blood pressure, muscle function or insulin sensitivity.  They were able to show improvement in mitochondrial function and reduction in inflammatory markers and other cellular level processes, so that's really promising, but these changes were typically only found in the studies done on a population with a health condition, rather than the general healthy population.  Further, those cellular changes didn't translate to any meaningful clinical outcomes, meaning despite the microscopic tests showing results, there was no improvement in blood pressure, weight, physical function etc.  

SO.  My take away from all that.  The supplements are likely safe, at least in regards to the NAD+ boosting elements.  And they hold a lot of promise - just because the trials to date have not shown that they can improve clinical outcomes does not mean that they don't work, it just means further study is needed.  Like I said, only a few trials and all in a small amount of people for a short amount of time.  But there's also nothing in these studies that warrant the boasting and price tag of these supplements. 

If you want to look at the studies yourself, you can get into the weeds here.

Regardless of whether or not you choose to try a supplement, make sure you continue to focus on healthy lifestyle and habits. And always discuss over the counter medications and supplements with your PCP - as a direct access PCP, I now have the space to do these deeper dives. I love that I get to learn along with my patients, and become more informed when making recommendations in this regard!

*Snow Falls*

Now that winter is officially here, we finally have some potential snow in the forecast. It’s only an inch or so this afternoon with possibly more on Monday, though I feel like our ability to predict the weather is rather unreliable. Still, best to be prepared!

In terms of my primary care practice, I think about two main things with snow in particular. The first is falls. With snow comes ice, and with ice comes lots of chances for slips and falls. I particularly worry about this in my older population who are at higher risk from complications. A seemingly benign slip on ice could result in a serious bone fracture. The best prevention is to avoid hazardous situations - if you do not have to go out in the snow and ice, then certainly stay home! For those that do need to venture out, pre-treat sidewalks and driveways with salt, wear supportive and comfortable foot wear, and take your time walking.

The other thing I observe with snow is an increase in visits for back pain - not from a slip and fall, but rather from shoveling snow! Consider shoveling snow an exercise, and prepare by warming up your body with a few stretches first. Rather than bending at the waist, picking up the snow, and twisting to throw it, try to push the snow instead as if your shovel were a snow plow. When you do need to lift the snow, keep your back straight, bend with your knees, and move smaller/lighter piles of snow each time to prevent straining and injuring your back. Rather than twisting and throwing, walk your small load of snow where you want it. Take frequent breaks, especially if you start to feel discomfort!

Generally I love snow, so I hope we do get a few inches this week. But if we do, remember to stay warm, stay vertical, and stay safe!

*New Year Resolution*

As we move through the holiday season, and 2024 comes to an end, we all start looking towards a new year and a fresh start. With this comes the tradition of making a New Years resolution. Many people like to center their resolutions on self improvement, with health often taking a central role.

Obviously as a primary care doctor I encourage this! And I do think it’s important to articulate a goal, both what you hope to achieve and just as importantly, why. As you go through the year, coming back to your “why” is a great way to refocus when behaviors and habits start to stray.

But just as important as stating a goal and having a ‘why,’ is creating a plan. This is where I can help! Starting a membership with Slack Family Practice is a concrete step towards realizing your health goals. It’s an investment in yourself, your future, and your health. As a direct access primary care physician, I can partner with you to tackle your New Years resolution and all your healthcare goals.

Become a member of SFP, and experience a new approach to healthcare. Relieving the burden of insurance companies allows for a seamless, transparent, accessible way to improve your health. Reach out now to schedule a complimentary visit to learn more about the practice, direct access primary care, my approach to healthcare, and more!

Tips for Healthy Holiday Travel

As many people are preparing to travel for the holidays, I want to share a few tips to staying healthy while on the road!

First, be prepared! Make sure you are packing your medications, and keep them in their original pill bottles. If you usually make a weekly pill dispenser, that’s fine to do for your trips as well, but make sure to have a complete and up to date list of your prescription medications also. This way, if you happen to need urgent or emergent care while away, you have a list of your medications at the ready to share. On that same medication list, include your primary care’s contact information. As a direct primary care physician, I definitely want to know what’s going on with any care you might need while away.

During your trip, be proactive when it comes to preventing DVTs. DVTs are blood clots that can form in the deep veins of the leg from prolonged inactivity. If you are flying, stand and walk up and down the aisles when it’s safe. At your seat, you can pump your calf muscles by raising your feet up and down on your toes while sitting. If you are driving, take several breaks at rest stops to stretch your legs. With both forms of travel, wear compression stockings - this will help prevent leg swelling.

Plan ahead when it comes to nutrition. If you are following a certain diet, whether for managing a chronic condition or trying to prevent one, diets while traveling are challenging. Typically the options are high in salt and fat and ultra-processed foods. If you can, pack a cooler with healthy snacks and lunches rather than stopping for fast food. If this isn’t possible, opt for healthy items as best able - for example, rather than getting a burger, go for the grilled chicken.

Holiday travel can be quite stressful because of high traffic, so have a few quick breathing techniques or meditations at the ready to help you stay calm and maintain your holiday spirit. Again, because of all around higher traffic, germs will abound! So carry a hand sanitizer, wash your hands when you can, and wear a mask if you aren’t feeling well.

I hope everyone has a safe, fun, and healthy holiday break!

Patient Empowerment With Direct Access Primary Care

I recently heard direct access primary care described as offering patient empowerment, and I love this. Historically, patients would contact their physician directly for their needs or concerns. Over the years, the need for administrative staff has significantly increased - trying to get payment from insurance companies requires an entire department of dedicated employees! With the growing number of people required to run an outpatient office, the distance between the doctor and the patient grows as well. When I was a resident, there was not a robust portal messaging system set up. In medical school, we were still on paper charts! With this set up, it was near impossible for a patient to reach me. Interactions were only initiated on the physician end, or after receiving a message that had been passed through so many different people it entirely lost its original meaning like a true game of telephone.

With the development of portal messaging, there suddenly became a way to speak, albeit non-verbally, directly to your doctor. However, because medical practices are at the mercy of insurance companies, there is no way to bill for an interaction that happens via portal or email. So rather than being able to embrace this open line of communication, we had to limit it as much as possible. Healthcare systems even started putting a limit on the number of characters that can go in a text box to discourage patients from using it! And I certainly don’t judge other physicians for shunning communication via portal messaging. It was not too long ago that I was chugging through 20 patients a day in the office only to find 50 more patient messages waiting for me in my inbox. It was this, in large part, that le d to my decision to leave and start a new kind of practice.

What I love about direct access care is, as the name suggests, direct access! It’s wonderful that patients reach out to me directly - no red tape, no automated robo calls, no distorted or lost messaging as it passes from person to person and department to department. This model does empower patients to be in control of their health. Rather than limit a text box, a member of my practice is free to write me an essay, a daily newsletter, a journal entry, a passing thought, anything! I am here for quick questions, advice on over the counter medications, nutrition recommendations, exercise ideas, medication questions, and anything else health related. We can prioritize preventative care, and tailor health recommendations around specific personal needs and values.

All of this is achieved with transparent pricing. Rather than surprise bills, variable deductibles, and additional charges, direct access models offer consistent membership fees. Being more involved with your physician, and specifically having access to timely care, has been shown to improve health outcomes which lowers healthcare costs in the long run. If you are tired of never being able to speak to your doctor, never getting an appointment when you need one, and having your concerns brushed off or minimized, then explore making a change to direct access primary care with Slack Family Practice!

Stay Active Against Dementia

Dementia is quite brutal for all involved. Watching a family member deteriorate, caring for a parent, experiencing early signs, fearing the onset in your own future and so on. There are so many things to cover when addressing the topic of dementia, but today, as is my theme, I want to focus on prevention.

One reason I love emphasizing prevention is because it allows you to take action in advance. Dementia can be such an overwhelming disease process to face, and because there is a genetic component, it can leave one feeling hopeless and fearful. But knowing there is something proactive that can be done is very empowering. And it’s just that - activity - which is the mainstay of prevention for dementia. When considering dementia, it’s important be active: physically, mentally, and socially.

Here again are more benefits of exercise and physical activity. While studies have not proven that exercise improves cognitive function, many observational studies have seen that the higher one’s physical activity is, the lower one’s risk of dementia becomes. It might not be that there is a direct correlation between exercise and lower rates of dementia, but more that exercise reduces those health conditions which lead to dementia. One type of dementia, vascular dementia, is caused by damage to the blood vessels that supply the brain. This damage is a result of things like high blood pressure, high cholesterol, and high blood sugar. But it’s not just vascular dementia cases that are reduced with controlling risk factors. Reducing risk factors for dementia by 10-25 percent could prevent up to half of all diagnoses of Alzheimer’s disease! So by focusing on lifestyle interventions - diet, exercise and more - you will not only help to control health conditions like high blood pressure and diabetes, but you will also be reducing your risk of having a heart attack, a stroke, or developing dementia.

Staying mentally active is very important, particularly for older adults. It’s important in retirement to find ways to stay mentally challenged. Consider taking a class at the community college, or getting involved with a volunteer organization. Avoid falling into a trap of watching day time TV - higher rates of TV watching are actually associated with higher rates of dementia. Instead, work on a puzzle, read a book, and do the daily New York Times games (why does my husband always beat me at Connections? Why?!?).

Social isolation is another huge risk factor for dementia. Some of my suggestions for staying mentally active will help address this as well! We are fortunate to live in a very active community here in Harford County. There are lots of opportunities to be social, join an interest group, volunteer, and stay busy. The senior center is a great place to check off many of these boxes - there is a fitness center, exercise and dance classes, and fun DIY projects, all for free!

If you have concerns about dementia, either because of family history, becoming forgetful, knowing you have risk factors etc, then take action now! At Slack Family Practice, I can work with you directly to identify risk factors and create a plan to keep you healthy. So start today!

Local Trends in Respiratory Infections

The Maryland Department of Health recently sent me an update of trends in respiratory infections, which certainly reflects what I have been seeing in our Harford County community. COVID and Flu infections remain low, though in previous years we have seen a post-holiday spike, so don’t let your guard down! Infections that are currently on the rise include Pertussis, RSV, and Mycoplasma Pneumoniae.

Pertussis is ‘whooping cough’ and most seriously affects infants. The good news is that there is a vaccine for pertussis which you are probably familiar with - Tdap! The Tdap vaccine not only prevents tetanus, but diptheria and pertussis as well. Infants are not able to get a vaccine for pertussis until they are 2-3 months old, but if a Tdap is given during the 3rd trimester of pregnancy, they benefit from passive immunity. If you are going to be around young kids this holiday, make sure you are up to date with your Tdap, which is given every 10 years.

RSV stands for Respiratory Syncytial Virus, and similar to pertussis is a significant illness in infants and children. RSV infections can also be severe in older adults, and thus a vaccine is available for those 75 and older, or 60 and older with other risk factors for severe infection. Associated conditions that put people at higher risks for complications from RSV infection include lung disease like asthma and COPD, diabetes, heart disease, liver or kidney disease, and conditions that cause one to be immunocompromised.

Mycoplasma pneumoniae is a bacteria which causes ‘walking pneumonia.’ The term ‘walking pneumonia’ is typically used to describe pneumonia that is less severe and might not interfere with one’s ability to do regular activity. This bacteria is naturally resistant to the antibiotics that are typically used to treat pneumonia. We often think of mycoplasma pneumoniae when someone has been diagnosed with pneumonia but isn’t getting better as expected with typical antibiotics. There is not a vaccine available for Mycoplasma, so lean on other preventative measures like hand washing and coughing into your elbow etc.

I know many kids in the county have had mycoplasma pneumoniae infections, my sons included. My youngest had the typical course, starting with a fairly high fever to about 102-103, and a cough which lasted for a few days before we went to his pediatrician. She diagnosed him with pneumonia based on his symptoms and his exam, and started Amoxicillin. After 3 days on the antibiotic, he was still having fevers and started having more respiratory symptoms. He has asthma, which is a risk factor for more severe respiratory infections, so we took him to the ER when his pulse ox dropped and his respirations increased. There he had a chest xray which confirmed pneumonia, and they were able to do a nasal swab that tested positive for mycoplasma. His antibiotics were switched to Azithromycin, and he was back to his typical trouble making within a day!

Talk to your doctor or your pharmacy about your vaccine history to make sure you and your family are fully protected this winter, so you won’t miss out on any holiday celebrations and/or trouble making ;)

Reflections on Direct Access Primary Care

Since I started my direct access practice just over 4 months ago, I wanted to give an update on how things are going. My initial focus has been growing my practice. Because of the way healthcare systems write physician contracts, I was unable to tell my patients about starting my own practice, or have a discussion about benefits of direct access primary care. My goal with writing this blog and posting to facebook is to let people know where I am, what I am about, and how I approach primary care in this new model.

As my patients have started to find me, and new patients are reaching out as well, I have been able to start shifting my focus to my passion - caring for patients. Every time I have a patient interaction, it has been very reaffirming that I made the right choice in starting this practice. I love that I get more time with my patients. I feel like I am able to make a more meaningful impact. I have been able to personally arrange several specialist referrals, coordinate the response to critical results, and make new diagnoses which I have time to explain, counsel, and create a personalized plan to address.

I feel available for my patients, both physically (I can be reached directly by phone, email, text, and portal messaging) but also and maybe even more importantly, mentally. When I am talking with a patient, I don’t feel pressure to wrap things up because I am behind and have 4 people in the waiting room getting agitated. Instead, I feel relaxed and attentive. I don’t hesitate to ask a few probing follow up questions to see if there are more concerns that should be explored, as opposed to skirting sensitive topics because there just isn’t time.

I truly believe this model of direct access primary care is best for patients and best for physicians. I wish that insurance companies would recognize the value of preventative care, but more often than not they only look to cover services AFTER things have gone wrong. So I don’t think insurance companies will start offering to cover annual membership fees for direct access any time soon. But if you are able to invest in this model ($1860 per year, which breaks down to $155 per month), then I know you too will find it refreshing, beneficial, and well worth it! So as we move through this holiday season and into the New Year, think about how you can start focusing on your own health and well being. Try a membership with Slack Family Practice, and explore healthcare as it should be!