FOOD POISONING

For those who have ever had a case of food poisoning you know what a terrible thing it is! Especially when it occurs after a meal that you have spent money on! It is a complicated thing, like most things in medicine. This is a medical review of how your doctor approaches the problem.

Food poisoning is an illness that can cause nausea, vomiting, or diarrhea. The food can be contaminated with bacteria, viruses, or parasites.

Food can be infected by several means. One way would be by people who work with food who are sick and do not wash their hands. Another way is that the infected food is not washed properly or cooked enough. Another way is for one food product infects another food item.

Symptoms can happen right after a meal, days or even weeks later. Common symptoms include nausea, vomiting, abdominal pain, diarrhea that can be watery or bloody, and fever. 

Other symptoms can include blurry vision or dizziness.

If this should happen to you, be sure to drink plenty of water. Eat small meals that do not include a lot of fat in it. See your doctor for abdominal pain, if you cannot eat or drink, vomiting blood or having blood in the bowel movements, or if you have fever more than 100 degrees.

If you are younger (child) or an older adult, see your doctor sooner as kidney involvement may occur sooner.

Here are some helpful recommendations

• Do not drink unpasteurized milk or any unpasteurized products
• Wash raw fruits and vegetables
• Keep the refrigerator temperature at 40 degrees or colder
• Use precooked or perishable or ready to eat food as soon as possible
• Keep raw meat, fish, or poultry separated from each other
• Wash hands, knives or cutting boards after handling uncooked food
• Cook chicken eggs thoroughly until yolk is firm
• Never leave cooked food at room temp for more than two hours

For pregnant women

• Do not eat hot dogs, lunch meats or other delicatessen meats unless they are reheated until steaming hot. Microwave ovens may give uneven cooking
• Avoid spilling fluids from raw meat and hot dog packages onto utensils or other surfaces that you will come in contact with
• Do not eat refrigerated smoked seafood unless it has been cooked.

For more information, consult your health care provider.

___________________________________________________

Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
LIKE us at Facebook!
FOLLOW us on Twitter!

Men's Health Issue - PSA

What is PSA? PSA stands for prostate specific antigen, which is a protein produced by both normal and cancerous cells of the prostate gland. It is used as a screening test for prostate cancer; although this is met with controversy. It is also used to assess response to the treatment of prostate cancer.

The PSA value increases with increasing age because the prostate gland size increases. As a result, the normal reference range may be appropriate based upon a man’s age. This may help understand what a true normal or abnormal number may be and help avoid needless biopsies in older men.

It is also known that different races have different PSA values; black men in particular tend to have higher PSA values than white men without cancer. As a result, there is discussion that the PSA value should be race dependent. This is still unclear, but you can see the issues surrounding PSA values.

It is interesting that the higher the BMI (obesity) the lower the PSA values tend to be. This may be due to higher plasma volume. If that is the case, consider the importance of the rectal exam (o joy!).

There are some medications that lower the PSA value (5-apha reductase inhibitors). When on such meds (i.e. finasteride) the PSA interpretation need be adjusted. Some say any increase in PSA value while on these meds need to be evaluated.

Other medications such as the cholesterol lowering statins (ex: Lipitor) also appear to be able to lower PSA values. So maybe a two-fer? Lower cholesterol AND lower PSA? It appears promising, if you like statins.

What are other causes for elevated values? There are several major causes of elevated PSA values: BPH (benign prostatic hypertrophy (enlarged prostate)); prostate cancer; inflammation and trauma.

Of these, BPH is the most common especially for men over 50 years old. Simply put, bigger prostates produce more enzymes. Unfortunately, it is not that simple, as bigger prostates may also have pockets of cancer as well. In addition, treatment of BPH may lower PSA values. What to do? Work closely with your doctor.

Prostatitis is another common cause. As a result many physicians will treat an elevated PSA value with antibiotics for presumed infection than repeat the PSA after four weeks or so. This approach is also controversial as to its effectiveness; it is however the usual practice.

In regard to trauma, vigorous bike riding may elevate the PSA value as can a digital rectal exam. Although not proven, the blood test probably should be checked before the exam or after a time of biking abstinence.

Other methods for screening prostate? There is something called PSA density that you may hear about to more accurately predict cancer if you have an elevated PSA value. This is the volume of prostate as measured by ultrasound. The density would be the PSA divided by the volume. This is also controversial as there are different standards regarding the measurements with the ultrasound.

The approach that has gotten the most traction is something called PSA velocity, or the rate of change of the PSA over time and not so much the actual value. This velocity seems more related to the risk of death from prostate cancer.

So, PSA is a valuable tool for prostate cancer but is not specific for cancer. The use of PSA velocity or density has not proven of great use. Thus, the number of biopsies done is still too high. The value of checking PSA seems higher the younger you are (starting age 40-50).

What about Glycemia - Hemoglobin A1c

It has been known since the 1970s that glucose (sugar) can attach to proteins in the blood. If the sugar in the blood is high enough for long enough then the attachment of the sugar to the protein becomes permanent.

The demonstration that the development of microscopic complications in patients with type I diabetes can be slowed by treating high sugars led to the pursuit of measuring blood glucose levels, thus the development of the A1c test. In other words, when high sugars in type 1 diabetics were treated it reduced complications from developing and thus the need for the A1c test to measure.

The most useful test for measuring this phenomenon is called glycosolated hemoglobin, or the HbA1c. Red blood cells readily attach sugar molecules. Just as in the above scenario, the amount of sugar and the permanency of the bond is proportionate to the amount of sugar present in the blood. Since red blood cells only survive 120 days in the blood, the A1c is a measure of the average blood glucose over that 120 day time frame.

There are now many studies and plenty of data supporting the correlation of the A1c to diabetes control. In fact, the measure of A1c is now the means by which to diagnose new onset diabetes.

There are, however, sources of potential error related to the A1c values. This test is influenced by red blood cell survival. If a person has iron deficiency anemia or B-12 or folic acid deficiency the result of the A1c may be falsely high.

If there is a hemolytic anemia( blood loss) causing the marrow to produce young blood cells the A1c value may be falsely low.

If there is a hemoglobin problem such as sickle cell disease or thalassemia the values may also be off( high). Other problems such as a chronic disease state such as kidney disease may also give false values. Other issues that affect the A1c test includes: if you are on dialysis, taking erythropoietin or possibly of Black or Hispanic descent.

If the scenario exists where the A1c values are high but the blood glucose levels are excellent, I advise checking the before meals sugar as well as two hour after meals sugar and adjust medications appropriately.

Let’s consider the issue of high blood glucose values after meals for a moment. Optimal treatment includes changes in either nutrition or insulin regimen. For example, a large meal containing a lot of quickly absorbed carbs and low in fiber may cause a large post meal hyperglycemia. Changing the meal, eating less with each meal, eating more in between meals, increasing the amount of soluble fibers should lower post-prandial sugar level. Otherwise, using more premeal insulin of the short acting variety may be of benefit.

The level of A1c to help prevent complications for type 11 diabetes is clear: 7 %. This is based upon a large study called The United Kingdom Prospective Diabetes Study. For older patients is especial, care must be taken to avoid low( hypo) sugar reactions! That being said, it is very clear sugar values are directly related to future complications i.e. a one percent fall in A1c was associated with a 35% reduction in microvascular disease.

So,  follow up with your doctor to check your A1c level every 3 months if you are diabetic!

http://www.medindia.net/patients/calculators/bloodsugar-HbA1c-convertor.asp

___________________________________________________

Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
LIKE us at Facebook!
FOLLOW us on Twitter!

Obesity

As many are aware, obesity is a major issue in America and the problem is getting worse. More than 33% of Americans are obese ( defined as a BMI > 30 ). More than 64% of Americans are overweight (BMI>25).

It costs America approximately 100 billion dollars a year to treat obesity and the complications that arise from it. This is in addition to hidden costs, such as days missed from work and early death( less taxes).

There are several well documented health hazards with obesity, such as diabetes, heart disease, stroke, cancer, arthritis, liver disease, sleep apnea, and depression. The risks increase with the degree of obesity.

The most practical means of measuring obesity is the body mass index. This is calculated by dividing the weight in kilograms by the height in meters( kg/m).

BMI Categories :   25-29 overweight; 30-34 obese; 35-39 moderately obese; 40-49 severely obese; >50 super ( morbidly) obese.

Well, what to do? The hallmark solution will forever be diet and exercise, but for most people there has only been limited success and not for a lack of desire or effort. Surgery has come into medical community acceptance over the last several years due to studies showing the improvement in obesity complications.

Weight loss surgery (called bariatric from Greek word baros meaning weight) works by either malabsorption or restriction. Restriction procedures limit the amount of calorie intake by reducing the stomachs reservoir capacity or via creation of a blind stomach outlet. Gastric banding is a purely restrictive procedure. This limits solid food intake by restricting the stomach size as its only mechanism of action. The small intestine must then absorb nutrients. The weight loss with purely restrictive procedures is more gradual.

Malabsorptive procedures work by shortening the length of the small intestine. This is done by shortening of the small bowel or by diverting around it. Examples include jejunoileal bypass or duodenal switch operation. The weight loss can be huge, but the complications many such as protein loss or micronutrient deficiencies.

The famous Roux-en-y gastric bypass is both restrictive and malabsorptive. In this operation you are left with a small stomach pouch; however, the small bowel is rerouted favoring additional weight loss via dumping and mild malabsorption.

So, does surgery work? It does, especially for those with BMI >40. The mean weight loss percent of excess weight loss was 61%. Diabetes completely resolved in 77% and either improved or resolved in 84%. Also look at these results: high cholesterol improved 70%; high blood pressure improved 62%; sleep apnea resolved 86%; reflux improved as well as urinary incontinence. Because of these data, I am now a fan of weight loss surgery.

The amazing thing is that there is now data showing a decrease is overall mortality. The reduction of the complications of obesity reduces overall mortality by 29%. As always, if one can reduce BMI by diet and exercise this is the safest way. Otherwise talk to your doctor about weight loss surgery. There are several different types of surgery; an expert in the field will need be consulted.

Let’s review some of the indications for surgery intervention: Be motivated! Have a BMI>40. Or, have a BMI>35 with co-morbidities(other diseases or complications) such as diabetes, blood pressure, apnea, severe arthritis, heart condition etc. and having failed non-surgical programs.

The most common surgical technique is the laparoscopic gastric banding. The upper stomach is banded by a tight, adjustable soft silicone ring connected to an infusion port placed under the skin.

The port can be accessed with ease via a syringe and needle. The band is adjusted to deal with weight loss as well as nutritional issues. Data shows an expectation of about 40-75% weight loss at two years. But note! It is easier to cheat with the lap band! So, a comprehensive approach is needed as well as good motivation.

The decision to proceed with a surgery for obesity is a serious one as there are many potential complications. For this reason it is necessary to follow protocols.

We also have the BMI Calculator on our website. Check it out here: Eastside Family Health.

___________________________________________________

Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.

LIKE us at Facebook!
FOLLOW us on Twitter!

Non-Sciatic Sciatica

Piriformis Syndrome

This is an interesting disorder that is one cause of sciatica, other than a herniated disc in the low back. The sciatic nerve is compressed by the piriformis muscle causing an irritation of the sciatic nerve with numbness in the buttocks running down the lower thigh into the leg. When someone has these symptoms the biggest thing to rule out is a herniated disc of the spine.  So, if there is sciatica but no clear spinal signs, think piriformis muscle inflammation.

 piriformis distribution

What causes it?  In approximately 17% of the population the sciatic nerve passes through the piriformis muscle rather than underneath it. This is the supposed cause of this syndrome (non-disc related sciatica). Also anatomically, weak gluteal (buttock) muscles, which may occur with a lot of desk type jobs that involve much sitting( hip flexion with accompanying shortening  and tightening of the hip flexors). With weak gluts, other muscles have to compensate such as the hamstrings, adductor muscles( inner muscles of the thighs), and the piriformis. This results is hypertrophy of the piriformis with the resultant syndrome.

Other causes could include overuse injury such as strenuous use of the legs( anyone do the STP bike ride lately?) such as biking  or rowing. Also, runners, who engage in forward type of activities as well, are susceptible to developing  this syndrome. So, it is important to perform lateral (side) type of stretching to balance out the legs. If not properly stretched, the legs can develop overly tight adductors and out of proportion weak abductors. The piriformis muscle becomes large and sciatic nerve impingement is inevitable. The key is to keep the outside muscles of the hip, called abductors in proper stretch to take the strain off of the piriformis.

Interestingly, not only does the spasm of the piriformis cause sciatic nerve symptoms but the pudental nerve may also be irritated. This nerve controls the muscles of the bowel and bladder. The syndrome may present with loss of bowel and urine function as well as saddle anesthesia( numbness around the anus).

Some other potential causes of the syndrome include a falling injury, tight SI joints( sacro-iliac, or low back joints), over pronation of the foot, or sitting on a wallet.

How is it diagnosed?  Diagnosis is largely clinical, i.e. there not really any good or reliable imaging tests for this syndrome. Presentation includes pain in the buttock, back of the thigh and lower leg made worse with prolonged sitting, activity or walking.

What is treatment?  Treatment is conservative including avoiding such activities as running, biking or rowing for a while. Also, muscle relaxants , anti-inflammatories as well as physical therapy or massage to stretch and strengthen. If these do not work, see your doctor to consider an imaging study to rule out other pathology.  Treatment for weak abductors and tight adductors include stretching and strengthening of these muscles. It is possible to see results after just a few days.

                                                       the piriformis stretch

___________________________________________________

Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
LIKE us at Facebook!
FOLLOW us on Twitter!

The Case of the Jumping Legs: Restless Legs Syndrome

Do you have jumpy legs or legs that just need to move? Well, you may have a syndrome called restless legs (RLS). These are marked by a spontaneous movement of the legs. This usually only occurs at rest and are relieved by movement.  Sleep disturbance, such as sleep apneas, is commonly associated.  This is not the same as leg cramps.

Who has this?  This is a very common problem, as up to 15% of Americans have it. More women than men have it; the prevalence of RLS increases with age.  Sometimes it may occur in children and at times is misdiagnosed as growing pains.

What is the cause?  The cause is usually unknown; however, there appears to be a genetic link, in other words a family history. There is a hypothesis that the neurotransmitter called dopamine is associated with this disorder. In fact, this hypothesis is the basis of how we treat it with medicine. There is also an increased incidence of restless legs in patients with Parkinson’s disease.

RLS may also be associated with iron deficiency, chronic kidney disease, pregnancy, movement disorders, diabetes, varicose veins, and rheumatism. There is some association with low thyroid and obesity.

What are some of the symptoms?  Clinically, patients describe a sensation of crawling, creeping, pulling, itching, or stretching all deep in the leg rather than the skin. Pain is usually absent. Symptoms typically worsen at the end of the day and are maximal at night, usually within 15 minutes of getting into bed. In severe cases, symptoms may occur earlier in the day while the patient is seated. This makes sitting at a desk or meetings or in a movie theatre difficult. In milder cases, one  may be fidgety.

So, how do you diagnose RLS? Here are the criteria by the International Restless Leg Study Group: an urge to move when in bed or periods of inactivity( sometimes other body parts are involved as well such as the arms or even the entire body); the urge is partially or totally relieved by movement such as walking or stretching. Supportive criteria include family history or a positive response to RLS medication.

What is the treatment?  Some cases require the use of meds, but before that here are some these simple measures to try: stretching exercises of the posterior leg muscles before going to bed; use of iron replacement ( have your iron checked first); stop mental activating activities such as video games before going to bed; avoid caffeine; and lose weight. If these don’t work, there are some pretty successful medications your doctor can discuss with you.

Below is an example of stretching exercise to try:

Stand facing the wall, feet together, about two feet from the wall. Heels on the floor, lean forward to the wall, stretching the posterior leg muscles. Hold for 10-30 seconds. Repeat x5. Twice daily. 

___________________________________________________

Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
LIKE us at Facebook!
FOLLOW us on Twitter!

Abnormal Uterine Bleeding

What causes abnormal bleeding?  Abnormal bleeding from the uterus (anything not consistent with a regular menstrual cycle for a female) can be caused be a wide variety of things such as medications( contraceptives, blood thinners, steroids, antipsychotics, chemo, dilantin, some antibiotics, others), or benign growths such as polyps, thick uterine lining, fibroids; infections of the uterus; issues of the cervix such as polyps or endometriosis; cancer of the uterus or cervix; sexually transmitted diseases. There are many other causes of abnormal bleeding—it just depends on where the location is in the genital tract.

Age, sexual activity, pregnancy possibilities, ovulation, eating disorder symptoms, and if this is like a normal period are all other factors in determining cause.

For example, causes of abnormal bleeding in women between age 40 and menopause are usually due to growths, either benign or malignant.

For women between teenage and about 20, the causes are broken down based upon whether or not one ovulates or not. If you ovulate and bleed abnormally, the bleeding is usually cyclic only heavy or prolonged.  The cause is usually anatomic or physical such as a polyp, fibroid, endometriosis, cancer, or a foreign body. Hormone levels are normal in this circumstance.

What about bleeding outside of regular menstrual cycle?  Anovulatory means bleeding that occurs outside of ovulation, hence it is unpredictable. It is the most common cause of abnormal uterine bleeding. The cycle of when sex hormones are produced is off so bleeding is irregular (bleeding is a function of hormone interaction). The most common cause of this scenario is too much estrogen causing the lining of the uterus to become too thick, outgrowing its blood supply and eventually dying off. This causes irregular, prolonged and heavy bleeding.

So, what can cause a woman to stop ovulating? There are many possibilities such as: thyroid disorders, polycystic ovary syndrome, liver or kidney disease, endocrine disorders such as Cushing’s disease, eating disorders, intense exercise, stress, pituitary growths, tumors of the pituitary or brain and other things. The most common of these are stress,  polycystic ovary syndrome (PCOS)—comprised of obesity, abnormal hair growth, acne, and irregular periods., and abnormal exercise (too much of a good thing!).

For a teenager, ovulation is not always consistent. So, there may be episodes of no periods interspersed with times of heavy bleeding. This is because the hormonal axis in the body is still maturing. As always, make sure the person is not pregnant!

At the end of the day a biopsy of the lining of the uterus may be needed to help discern the cause of the bleeding. Most importantly, it is the way to rule out cancer.

What is the treatment?  Treatment is diverse from correcting the underlying problem to attempting to regulate the hormones with birth control pills to surgical intervention. As one can see, a health care professional is needed for cases of abnormal bleeding.

___________________________________________________

Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
LIKE us at Facebook!
FOLLOW us on Twitter!

Tic, Tac Twitch

Tics and twitches (medically called dystonia) are involuntary muscle contractions that result in a twisting or repetitive movement or abnormal postures. Examples would be a twisting of the neck or writer’s cramp or repetitive blinking of the eyes. The first time may have been triggered by an activity or event but over time the twitch becomes susceptible to less and less stimuli, even at rest. 

Most tics/twitches occur early in age but some may present older (more than 26 years of age). The abnormal movement can involve a body part such as a finger, or a leg or the trunk or even one side of the body. Some are inherited, some occur at birth (such as from brain injury), and others are acquired later on due to unknown reasons. It is interesting that the earlier the onset, the more likely it will present in the limbs (arms, legs) whereas older presentations occur in the neck, arm or face. 

Examples:

• Common types include: neck—spasms of neck and shoulders
• Blepharospasm—spasms of muscles around the eyes leading to involuntary eye closure and incessant blinking.
• Facial—jaw, tongue, or facial muscles spasm out
• Limbs—movements of the arm or leg
• Voice—a high pitch tremor nasally sound
• Occupational—writer’s cramp; typists; golfers spasm( the yips); and musicians mouth that twists including the jaw or tongue. Usually, when the activity is over so it the twitch. 

      Late onset twitch starts usually in the face, arm, neck. It rarely goes generalized. If so, further workup is definitely suggested.

There is good genetic linkage for early onset twitches and possibly with late onset.  If interested, ask for the DYT1 gene testing. Always have a doctor evaluate the twitch as it may be unusual and need further workup.

The main idea here is that a tic, a twitch or a dystonia is common and does not necessarily mean a seizure disorder. Tics in particular are usually accompanied by a sense of having to perform the tic and are relieved by doing it. A tic as well may be temporarily suppressed. The movements of these are also quite variable in comparison to a seizure. Also, there is a degree of suppression that can be achieved as opposed to a seizure.

___________________________________________________

Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
LIKE us at Facebook!
FOLLOW us on Twitter!

Prostatitis

What is prostatitis?  Prostatitis refers to inflammation of the prostate gland. Note, this is not cancer. It  is a very common condition affecting males over the age of 18. Prostatitis tends to occur in young and middle-aged males. The symptoms, though common are often not readily detected. Symptoms such as pain in the lower abdomen, perineum (area between anus and scrotum), testicles, penis, bladder pain, difficulty passing urine, and sometimes blood in the semen. Note that prostatitis  does not cause impotency. There are two major forms, acute and chronic.

Acute Prostatitis

What  are risk factors?  Acute prostatitis risks include trauma such as bike riding (Training for the STP (Seattle to Portland bike ride)?), horseback riding, dehydration, and sexual abstinence. It can also occur if one has a chronic indwelling catheter. Most of the occasions of acute prostatitis are caused by bacterial infections. 

What are the symptoms? The usual presentation is that of fever, chills, fatigue, pain on urination, pain in abdomen or lower, and cloudy urine. It is to be noted that these are similar symptoms for a bladder infection except for the fact that bladder infections are not common for males. 

How is it diagnosed?  Diagnosis includes the history as well as exam. The prostate typically feels swollen or “boggy”. The blood test called PSA( prostate specific antigen) may or may not be elevated. Treatment includes antibiotics. Anti-inflammatories also help to reduce the swelling. Antibiotics usually require four to six weeks to bring about cure. Rarely is hospitalization required. It is important to get treatment to help reduce the potential complications of chronic prostatitis as well as prostate abscess formation. 

Chronic prostatitis

Chronic prostatitis should be considered in men who have pain on urination and frequency but not the symptoms of acute prostatitis, those who have recurrent urinary tract infections for no obvious cause, and for those who have chronic bacteria in the urine.

What are the symptoms?  The symptoms of chronic prostatitis are more subtle than the acute phase. Patients may have no symptoms at all or may have some pain on urination or frequency, urgency etc. Exam may reveal a large prostate or be completely normal. Exam may also include prostatic massage, but this is not too popular.

What is the cause?  The cause is usually bacterial infection. Obtaining fluid should be attempted as it will greatly help choose the proper antibiotic. The coarse needs to be at least four weeks of antibiotics.

The take home message is this: if you have any of these symptoms, get it checked out, as the condition may lead to a more chronic state that may become recurrent.

___________________________________________________

Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
LIKE us at Facebook!
FOLLOW us on Twitter!

The Wild Wacky World of Insurance: Part One

Why should I have insurance?

1in·sur·ance

a means of guaranteeing protection or safety

The economy has stretched everyone these days.  Gas prices are a record high, food prices continue to increase and insurance premiums have done nothing but go up as well.  It can be tempting to just not get insurance at all, or to cancel.  However, all it takes is one illness that goes from bad to worse, and you’ll wish you had insurance.  We have an example for you.  But first, ever wonder, where did insurance come from?

 How does insurance work and what do all those terms mean?

When you join an insurance plan, you essentially enter into a contract with the plan.  Your physician also separately enters into a contract with your insurance plan.  That relationship between you, your insurance plan and your physician is what determines how much you pay for office visits, tests, and more. 

There are a lot of terms to know when dealing with insurance.  For some of the common terms, visit our blog on EOBs here http://blogs.eastsidefamilyhealth.com/2011/05/understanding-insurance.html

What’s the big deal about not having insurance?  I rarely get sick!

We all live in a world where accidents happen.  Germs are everywhere and we have no ultimate  control over how our body responds to everything it’s exposed to.  Sometimes we do silly things, like miss the potato and cut our finger instead.  Life is unpredictable.  Health insurance provides reassurance that when Murphy does come to visit, you have a way to get the care you need, and to be able to afford it much better than if you don’t have insurance.

Insurance premiums do continue to rise and it can sometimes be a strain on the wallet, but let me present it to you this way – I will let the numbers do the talking.

Say you wake up one morning, with right sided abdominal pain and you have no insurance.  Your doctor is great about giving a discounted rate for your office visits, but that does cost $75.00 when you arrive to the office (you have also called in sick to work, since the pain is so bad you are doubled over).

While there, the doctor tells you that you may have appendicitis.  The only way to know for sure is an ultrasound or CT scan.  Those tests range from $150-$1500.  If your physician checks your blood, so you’ll get a bill from the lab.  Tests there also have a range from $10 to $300, depending on how many and which tests.  Oh, and the CT / ultrasound confirms it – you have appendicitis!  You’re sent to the ER for hospital admission and surgery, lest you risk your life by not going.  The cost of the ER visit, the labs, the surgeon, assistant surgeon, anesthesiologist (assuming you don’t want to be awake during surgery), the medication you’re given, the anesthesia you’re given…. I think you get the idea. It sure does add up!

A case of appendicitis may run you at a minimum of $2-3,000 and depending on the severity, etc. could go all the way up to $20,000.  Now compare that to the cost of insurance….  Remember the opening definition for insurance?  “A means of guaranteeing protection or safety.”   While you cannot guarantee a life free of mishaps, at least with health insurance, you will can rest easy knowing you are protected financially.

Now, there are so many options for insurance plans.  Do not let the search for the perfect one be so daunting for you!  There are resources available and questions to help you in your search.  Look out for our next blog addressing what some of those are.

___________________________________________________

Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
LIKE us at Facebook!
FOLLOW us on Twitter!

So I was in a car accident but why do I need an attorney?

The story of a motor vehicle accident (MVA), or a car accident, as its most commonly called, usually starts out with something like this: So I was in a car accident but why do I need an attorney?

The story of a motor vehicle accident (MVA), or a car accident, as its most commonly called,  usually starts out with something like this:  “I was just sitting at the stoplight.” Let me tell you, though, the story does not always end well.  It usually ends with a damaged car, physical pain and a lengthy process of recovery.

A car accident can drastically change a person’s life.  Your schedule now has to accommodate doctors’ appointments, physical therapy appointments, massage and chiropractic appointments.  Sometimes, if the injuries are severe enough, there could be surgery and recovery time.  If that is not enough, you’ll have the stress and emotions that come with juggling your appointments and work,   and trying to go through “normal” life when even the way your body moves is anything but normal.  It can be daunting just dealing with all of that.  Now, add dealing with the car insurance company or companies and the other party, your stress level doubles and even triples.

All you want is for everything to be the way it was before the accident, right?  For your body to be made whole, your car to be made whole... Sounds simple enough.

Car insurance is meant to protect you and to bring you back to wholeness.  In another blog we looked up the definition of insurance which is a means of guaranteeing protection or safety.  It is meant to protect you in case of harm: physically, by providing compensation for healthcare and financially, by paying for your vehicle repairs.

Your car insurance is meant to be your advocate.  However, there are situations you may run into where you feel like things are not going well. The insurance company is trying to close your case and you don’t think it is time for that.  Or your injuries are more extensive than your personal injury protection coverage will pay for.  Will your car insurance agree to continue to pay for more treatment? Will the other party’s insurance?  How will you know if what they are saying and what you are getting is fair?  Are they thinking of what’s needed in the future or just  closing your case?  How do you know it’s time to close the case? Are you still in pain and still need medical care?  Do you have more questions than answers (like this paragraph)?

We understand this process can be daunting, frustrating, and time consuming but we want to see you through the process and come out as healthy as you can.  Sometimes, that means getting more help.

A lot of people cringe when they hear the word “lawyer” or “attorney”.  All sorts of preconceived ideas come to mind.  While seeing an attorney isn’t recommended at the beginning of a case, an attorney may be appropriate in cases with extensive physical injuries, a pre-existing injury is exacerbated by the accident, or when you come to a place where you are not sure if your car insurance or the other party are looking out for your best interests. 
Not all attorneys are created equal though.  A good attorney can be your advocate.  If you are concerned about your recovery or if your car insurance is looking out for you, talk to your physician.  Your physician may be able to refer you to a reputable attorney that they know and trust.

Confused about what to do if you’re in a car accident?  For more details, visit this blog: http://blogs.eastsidefamilyhealth.com/2011/03/what-to-do-after-auto-accident.html

___________________________________________________

Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
LIKE us at Facebook!
FOLLOW us on Twitter!

Supplements: To Take or Not To Take?

A myth commonly believed by many is that vitamins and supplements  make up for an unhealthly diet and lifestyle.   This is far from the truth as supplements are designed to supplement the diet .

Experts recommend eating a well balanced healthy diet and the use of supplements to fill in the gap.  Dr. Demetrius Albanes MD,  epidemiologist at the National Cancer Institute states “vitamins are safe when you get them in food, but in pill form, they can act more like a drug with the potential for unexpected and sometimes dangerous effects.”   We must be educated and aware that supplements taken in too high doses , such as the fat soluble forms of vitamin A, D, E, and K, can build up in the body and cause toxicity. Thus having an idea what the FDA recommendations of the upper and lower limits of vitamin and mineral doses is important in determining a supplement regimen.

I see many patients that are taking supplements on their own initiative or at the guidance of a provider and yet unaware how some of their supplements could be impacting their medical condition in a negative manner.   Therefore, it is important that the provider review a current list of medications and supplements  to identify any interactions and follow up with bloodwork to confirm normal values if necessary. 

A good supplement baseline to  get started for the young to middle-aged adult includes a multivitamin daily; Vitamin C 500mg daily as immune support therapy, not a treatment for cold viruses; Calcium 500mg up to two times a day depending on dairy food intake; and Vitamin D 1000-2000IU daily.  This may need to be adjusted depending on the patient’s diet and current levels which can best be determined in consultation with your primary care medical provider.

___________________________________________________________

Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
LIKE us at Facebook!
FOLLOW us on Twitter!

Hoarseness

Sounding hoarse lately? This refers to any change of voice. It can be higher, lower, huskier, or even breathless. This blog is to help think about the potential causes.

Voice is the result of interaction between the nose, mouth and a structure called the larynx.

Hoarseness can be caused by a number of factors. If the hoarseness is persistent it needs to be evaluated especially if there are no acute symptoms of infection or if has gone longer than two weeks. Tobacco use and alcohol are two worrisome coexistent risks for head and neck cancer. Unexplained weight loss, painful swallowing, difficulty swallowing or one-sided throat pain or ear pain needs to be evaluated.

Other causes of hoarseness include: acute laryngitis, chronic laryngitis, benign growths, cancer, nerve dysfunction, neurologic disease, or stress.

Acute laryngitis is common and self-limited condition lasting less than three weeks. This is usually due to a virus although can be bacterial. Laryngitis can also be caused by strain such as yelling or coughing resulting in bleeding from microtrauma.

Chronic laryngitis is typically due to irritants over time. Things such as acid reflux, fumes, chemicals, chronic voice strain, chronic alcohol use, chronic sinusitis, chronic post-nasal drip, or tobacco smoke. Some symptoms include throat clearing, heartburn, change of voice, sore throat, feeling like a lump in throat, or choking sensation. Asthma type symptoms may also present this way.

Normal Vocal Chords

As noted, there are benign growths that can occur on the vocal cords. Smoking can cause swelling of the cords called Reinke's edema resulting a husky low-pitched voice( sounds like a man). Polyps and nodules can also occur due to smoking, acid reflux or chronic vocal cord irritation.

This is Reinke's edema. Note the soft swollen irregular appearances (this was due to reflux).


Some may know of singer's nodes. This can be true but usually occurs with screamers. This is more common in women and children.

Now to the possibility of cancer. The vast majority of cancer is squamous cell. Major risk factors include alcohol use and smoking. This is usually heavy alcohol use such as up to 4-5 drinks per day. There are many other potential causes that have not been fully proved such as viruses, genetics and diet.

Cancer. Note the irregular appearing mass from the right vocal cord.

___________________________________________________

Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
LIKE us at Facebook!
FOLLOW us on Twitter!