Blood pressure is a measurement of the resistance in your arteries as your heart pumps blood through your body.  Blood pressure is measured using two numbers; the top number is termed the systolic blood pressure, and the bottom number is termed the diastolic blood pressure.  The systolic number is the measurement of the pressure in the arteries as the heart is pumping.  The diastolic number is the measurement of the pressure in the arteries as the heart is resting in between beats.  Hypertension is the term used to describe high blood pressure.   Blood pressure is considered to be high when it is 140/90 mmHg or above.  Most of the time, there are no symptoms of high blood pressure, therefore you may have high blood pressure and not be aware of it.  If left untreated, high blood pressure can lead to heart disease, stroke, and kidney disease.  Treating blood pressure to keep it less than 140/90 mmHg can help to maintain a healthy heart.    

Cholesterol is a fat that is found in the blood that your body needs to work properly.  Cholesterol is produced naturally by your body and also comes from the foods you eat.  Cholesterol measurements are divided into the “bad” cholesterol, or LDL, and the “good” cholesterol, or HDL.  Bad cholesterol builds in your arteries and becomes plaques that cause atherosclerosis or a narrowing of the arteries.  Good cholesterol helps to remove the bad cholesterol from the blood.  Dyslipidemia is any abnormal cholesterol measurement, most commonly high LDL (“bad”) and low HDL (“good”). Cholesterol is monitored through routine bloodwork.  Cholesterol is considered high when the LDL is greater than 130 mg/dL, and the total cholesterol is greater than 200 mg/dL.  As with hypertension, there are no symptoms of dyslipidemia.  If left untreated, dyslipidemia slowly causes damage to the blood vessels over years.  Treating and maintaining cholesterol below 200 mg/dL can help to maintain a healthy heart.

 Uncontrolled hypertension and abnormal cholesterol levels can lead to coronary artery disease, and ultimately cause a heart attack.  Coronary artery disease is the narrowing or blockage of the blood vessels that supply blood to the heart.  A heart attack occurs when a coronary artery becomes blocked, preventing oxygen from getting to the heart muscle.  The classic symptoms of a heart attack include chest pain or pressure; pain or discomfort in the arms, neck, jaw, or back; and shortness of breath.  Women typically experience more subtle symptoms including unusual fatigue, sleep disturbance, shortness of breath, indigestion, anxiety, weakness, cold sweat, or dizziness.  If you experience any of the above symptoms, it is important to seek medical attention.

There are many ways to promote a healthy heart.  In addition to monitoring and treating high blood pressure and high cholesterol, many lifestyle changes can protect your heart.  Following a healthy diet low in salt, getting regular exercise, maintaining a healthy body weight, quitting smoking, limiting alcohol consumption, and reducing stress all improve your heart health.  Prevention is the most important medicine when it comes to heart disease, so please schedule an appointment with any of our providers to have your blood pressure and cholesterol checked as well as to discuss your other risk factors for developing heart disease.

Rebecca A. Torquato PA-C

Bentz, Grob, Scheri & Woodburn Family Medicine

 Physical activity can be fun and doesn’t have to be done only in a gym.  Exercise can give your family the opportunity to spend time together by walking, hiking or bike riding and becoming healthier while enjoying the outdoors.

 Often we don’t know where to start when deciding to adapt a healthier lifestyle.  Assessing your fitness level is a good place to start.  You can do this by taking your pulse rate before and after a one mile walk, timing how long it takes to walk a mile, keeping track of how many push-ups you can do, how far you can stretch and measuring your waist circumference and body mass index.  Retake your physical assessment every 6 weeks and monitor your progress.

When designing a fitness program consider your goals, go at your own pace, and include different activities to create a balanced routine.  An exercise program should include aerobic activity that increases your heart rate, strengthening exercises and exercises that target your core areas; abdomen, lower back and pelvis.  A proper program should also include balance training, flexibility and stretching exercises.  Remember, a single workout does not need to include all of the above, but should rotate throughout the week. 

Becoming physically active is an important way to feel better, both physically and mentally.  As a general goal, aim for 30 minutes of physical activity each day, change your routine so that you don’t become bored and give up.  Most importantly, always check with your doctor before you start a new exercise program.

Michelle McGrath CRNP

Koman & Kimmell Family Medicine, A Divison of Genesis Medical Associates, Inc.

 As of January this year, Medicare began covering an Annual Wellness Visit (AWV), a new benefit resulting from the Affordable Care Act. The AWV takes place with one’s primary care provider, is covered once every 12 months after the first year of Medicare coverage, and has no deductibles, coinsurance or copayments.

Among other things, the Annual Wellness Visit includes the provider taking your medical history, a health risk assessment, an evaluation of your physical condition, and a screening for cognitive impairment, including depression. It also includes a personalized prevention plan, where the doctor develops a strategy with you to manage your health, including planning the preventive services and screenings you may need over the next 5 to 10 years. The plan helps you take advantage of Medicare’s preventive services, many with no cost-sharing. Also resulting from ACA, eliminating the cost-sharing for many preventive services covered by Medicare marks a major milestone in Medicare’s efforts to keep beneficiaries healthy rather than just pay for treatment when people are sick. Over 800,000 beneficiaries have used the AWV benefit as of June 2011.

The Annual Wellness Visit is different than the Welcome to Medicare visit. The Welcome to Medicare visit is for beneficiaries new to Medicare (see the FAQ below). Neither the AWV nor the Welcome to Medicare visit is a routine physical exam. Both provide you with an opportunity to talk with your doctor about your health concerns. In addition, while the AWV has no cost-sharing, if your doctor performs other services or orders extra testing not included in the AWV during the same appointment, the doctor may claim for those additional services and you may have a copay.

Key publications from Medicare.gov:

FAQ: Frequently Asked Questions

1. What does the Annual Wellness Visit cost?

You pay nothing out of pocket for this visit. However, you may incur a copayment or deductible expense if additional services are performed or ordered by your doctor.

2. When am I eligible for my Annual Wellness Visit?

After you have had Medicare Part B for more than 12 months. If you have had a “Welcome to Medicare” visit within the last 12 months, you must wait 12 months after your Welcome visit to schedule your Annual Wellness Visit.

3. How often can I have my Annual Wellness Visit?

You may have an Annual Wellness Visit once every 12 months.

4. What is covered during the new Annual Wellness Visit?

Your first Annual Wellness Visit will include:

Subsequent Annual Wellness Visits will include:

• measurement of weight, blood pressure, and other measurements deemed appropriate;
• an update to medical and family history;
• an update to the list of providers, suppliers, and medications;
• a review of the initial personal risk assessment;
• detection of any cognitive impairment;
• an updated screening schedule; and,
• a review and update of your list of referral services to help intervene and treat potential health risks.

6. Is the Annual Wellness Visit the same thing as an annual physical exam?

No. An annual physical is a much more extensive physical examination. In addition to collecting a medical history, it may also include: vital signs check, lung exam, head and neck exam, abdominal exam, neurological exam, dermatological exam, and extremities exam. The Annual Wellness Visit is not meant to replace your annual physical.

7. Will I actually see a doctor during the Annual Wellness Visit?

You will see your primary care provider which could be a physician, nurse practitioner or physician assistant. However, most of your time may be spent with an allied health profession, such as a nurse or medical assistant who will gather most of your medical history so that your physician can determine an appropriate preventive health screening plan.

8. What is the difference between the “Welcome to Medicare” visit and the “Annual Wellness Visit”?

• Medicare covers a one-time Welcome to Medicare Visit. (See below for what your provider will cover at this visit.)
• Medicare also covers an Annual Wellness Visit every 12 months. (See above for what your provider will cover during this visit).

9. When am I eligible for my “Welcome to Medicare” visit?

Medicare covers a one-time “Welcome to Medicare” visit within the first 12 months you have Medicare Part B. If you did not receive your Welcome to Medicare visit and have been with Medicare for more than 12 months, you are eligible for your Annual Wellness Visit.

10. What does the “Welcome to Medicare” visit cost?

As of January 2011, you pay nothing out of pocket for this visit.

11. What is covered in the “Welcome to Medicare” visit?

A “Welcome to Medicare” visit includes the following:

• A thorough review of health, education and counseling about the preventive services covered by Medicare and referrals for other care if needed.
• Establishing a schedule for a Medicare screening and preventive services you qualify for over the next 5 to 10 years.
• A review of a medical and social history with attention to risk factors for disease detection.
• A review of an individual for potential depression or other mood disorders.
• A review of the individual for functional ability and level of safety.
• An examination to include an individuals height, weight, blood pressure, visual acuity screen, measurement of body mass index and other factors as deemed appropriate by the examining physician or qualified non-physician practitioner.
• End-of-life planning, upon an individual”””’’s request.
• Education, counseling, and referral based on the results of the review and evaluation services described in the previous five components.
• EKG with interpretation and report.
• Hearing assessment.

12. Do I have to have my “Welcome to Medicare” visit before my Annual Wellness Visit?

No. You do nott have to have a “Welcome to Medicare” visit before getting an Annual Wellness Visit, but if you have the “Welcome to Medicare” visit, you willl have to wait 12 months before you can have your first Annual Wellness Visit.

13. What if I require further tests or screenings?

Medicare covers many screenings for people who are at high risk for certain diseases. During your Annual Wellness Visit, you and your doctor will decide what tests and screenings you need.

14. How do I schedule my Annual Wellness Visit or my “Welcome to Medicare” visit?

To help schedule your Welcome to Medicare visit or determine when you become eligible for your first Medicare Annual Wellness Visit, call your primary care physician.

Many lifestyle factors and medical conditions exist that pose a risk for developing osteoporosis, including but not limited to low calcium and vitamin D intake, tobacco abuse, decreased physical activity, female gender, diabetes, and rheumatoid arthritis. The diagnosis of osteoporosis is through the imaging study known as a DEXA scan, which measures bone mineral density in the hip and spine. The test results are reported with a score and categorized by normal, low bone mass (osteopenia) or osteoporosis.

Various treatment options are available based on patients’ individual score. First, is appropriate calcium and vitamin D intake. The current recommendation is 1200mg per day of calcium and 800-1,000mg of vitamin D. Regular weight bearing exercise, fall prevention, and smoking cessation are all lifestyle changes that patients can initiate on their own. If the diagnosis of osteoporosis is determined, then treatment with prescription medications is recommended. Many different prescription medications are currently available. Patients can take oral medications daily, weekly, or monthly, intravenous medications given once yearly or subcutaneous injections given daily or every six months. Healthcare providers can discuss the appropriate option for their patients depending on the patients’ risk factors as well as previous and current medication use. The goal for treating osteoporosis is to prevent further bone density loss and the prevention of hip and spine fractures.  If treatment with pharmaceuticals is required, it is currently recommended that a DEXA scan should be repeated in two years to evaluate effectiveness.

In the New Year, remember to schedule a yearly physical and if over the age of 65 for women or 70 for men, ask for a referral for a DEXA scan along with your referral for mammograms or colonoscopies!

Lara P. Trushel, PA-C

Schogel and Fardo Family Medicine

COPD is a term that includes chronic bronchitis and emphysema, which is caused primarily by smoking.  Symptoms include shortness of breath, cough, chest tightness, and wheezing.  Extreme weather changes can trigger exacerbations of COPD, which can result in hospitalization.  Breathing cold air can cause more tightening in a COPD patient’s airways and increase bronchospasms, making symptoms worse.  Also, in the winter months, there are more common cold and flu cases, which make COPD patients at a higher risk for developing lung infections, which exacerbates symptoms. 

Here are a few tips to keep healthy and to avoid COPD exacerbations triggered by cold winter weather. 

1. Quit smoking and avoid second hand smoke.  Talk to your healthcare provider for information regarding smoking cessation. 
2. Avoid dust and fumes.  You can check daily air quality levels and air pollution forecasts on local news programs and weather channels.
3. Get vaccinated.  Every COPD patient needs a yearly flu vaccine.  Also, COPD patients should be vaccinated with Pneumovax.  Pneumovax is given every 5 years.  Make sure you are up to date on your vaccinations.
4. Wash your hands frequently
5. Avoid others who have a cold or the flu
6. When outside in the cold weather, use a scarf to cover your nose and mouth to prevent inhaling cold air.

OF course, COPD patients are urged to use their medications, inhalers, and oxygen as prescribed by their doctor, physician assistant, or nurse practitioner.   Seek medical attention if you or a loved one with COPD becomes increasingly more short of breath especially during these cold winter months.

STACIE  LEY, PA-C

Singh & Dayalan Medical Associates

 The management of pain would begin in the acute setting. For example, the patient diagnosed with breast cancer would be provided with a multimodal analgesic regimen that has the goal of preventing and/or reducing the incidence of chronic pain. Factors that can be modified in the acute setting which have been associated with the development of chronic pain postoperatively include the length of time in pain prior to surgery, the coping ability of the patient, the type of surgery performed, treatment with radiation and/or chemotherapy, and adequate postoperative pain control. Nerve damage and subsequently chronic pain may develop after radiation and/or chemotherapy. The pain that may manifest following radiation therapy can appear month to years following treatment. Some studies have shown that up to fifty percent of patients will experience chronic pain post mastectomy. With appropriate treatment the pain that a cancer patient may encounter can be substantially reduced in eighty to ninety percent of cases.

 Another condition that may arise as a result of treatment utilizing surgery or radiation is Complex Regional Pain Syndrome (CRPS), formerly known as Reflex Systemic Dystrophy (RSD). CPRS is a condition in which the patient’s body overreacts to pain. This may be accompanied by skin color and temperature changes in the extremities, sweating differences, and extreme pain in response to non-painful stimuli.

 The best predictor of chronic pain following surgery is the intensity of acute postoperative pain. Our goal as health professionals is to help patients that have been diagnosed with breast cancer deal with all of the aspects of their pain, ranging from the acute postoperative to the chronic, and from nerve pain to CRPS. Options which may be utilized include medication management with opioid and non-opioid treatment, physical and occupational therapy, interventional procedures, and help with coping strategies. Our ultimate goal is to increase the quality of life by decreasing the pain.

 Maria Funair, PA-C

Singh & Dayalan Medical Associates

Behm Family Practice — providing flu vaccine from pediatrics to older adults (age 65+ who should receive high risk flu vaccine.)   Flu shots are given during regular hours of operation including Saturday hours.   Please call office for an appointment time — no walk-ins accepted.

Bentz, Grob, Scheri & Woodburn  — the Perrysville office offers flu vaccine every Tuesday and Thursday from 4:30-5:30 PM beginning September 27 through the month of October.   Will continue through November as needed.  Patient must schedule to receive flu vaccine –  no walk-ins accepted.

The Wexford office will offer flue vaccine starting Monday, September 26 from 8:00-12:00 Noon and Wednesday, October 5 from 1:00-4:00 PM.   It will also be offered October 10 from 8:00-12:00 Noon.  Additional dates will be added as needed.

Heck & Polinski — flu shot clinic scheduled for Monday, September 26 from 9:00-11:00 AM at their WestView office.  

Also available Monday through Friday at both the West View and Troy Hill offices.

Heyl Family Practice – Beginning the week of October 3, Wednesday morning starting at 9:15 AM; Tuesday and Thursday afternoons starting at 1:15 PM

Northern Area Family Medicine — Flu Shot Clinic begins Tuesday, Octoer 18 from 8:30-11:30 AM and 1:00-3:00 PM Monday thru Friday.  Evening and Saturday hours by appointment only.

Koman & Kimmell –  Please contact practice directly

Schogel & Fardo –        Please contact practice directly

Singh & Dayalan — Monday thru Friday 7:00-12:00 Noon and 1:00-5:00 PM.

Zillweger Medical Practice –  Please contact practice directly

If you have any questions specific to the practice at which you are a patient, please call them directly.

As the sunny days of summer gradually come to an end, the pools close, the scent of barbeque simmers away, and the daylight hours shorten, many people tend to feel down. What many people may not know is that a depressive mood that occurs at the same time each year, sometimes termed “ the winter blues,” may in fact be a condition called Seasonal Affective Disorder (SAD). SAD  is a type of depression that tends to occur mostly during the fall and winter months, when the daylight hours seem to shorten, and resolves as the warmer weather approaches. Another form of SAD occurs at the onset of the spring months and ends at the start of the fall; this condition is less common, and not as recognized as fall-onset SAD. Therefore, for most people with SAD, symptoms can start in September or October and run through April or May. But how do you differentiate SAD from the usual end of summer letdown…?

Anyone can get SAD, but it is more common in:

• People who live in areas where there are significant changes in the amount of daylight, and the daylight hours are shorter.
• Women.
• People between the ages of 15 and 55. It is less likely to develop the first episode of SAD as people age.
• People who have a close relative with SAD.

Medical professionals and psychiatric experts are not sure what exactly causes this condition,  but many theories have been drawn: The reduced sunlight may upset the sleep-wake cycle and other natural   body cycles such as the circadian rhythms.  The most supported theory has to do with the main mood-regulating neurotransmitter in the brain called serotonin. There is a decrease in activity of serotonin in  people affected by SAD. (similar to other forms of depression, IE major depressive disorder.)

The symptoms of SAD can be mild to debiliatating. The symptoms of Fall-onset SAD are similar to atypical depression, including increased sleep, and increased appetite, with specific cravings for carbohydrates, resulting in weight gain. Other symptoms include, feeling sad, moody, irritable or anxious, and interpersonal difficulties; there can be a loss in interest of the usual activities, called adhedonia. In contrast, spring-onset SAD symptoms are more consistent with typical depressive symptoms, such as weight and appetite loss, and sleeplessness.

If these symptoms do occur, it is important to visit your physician, physician assistant, or other health care provider.  These symptoms may or may not be an indication of a different depressive condition,  co-existing medical problem, or mood disorder, (especially if it occurs also at other times in the year). Your health care provider will help make this determination.

Light therapy has been shown to be the most preferred and effective treatment for SAD. Exposure to  light therapy should be scheduled (determined by the health care provider) beginning with 10-15 min sessions and increasing to 30-45 min sessions.  The two most common types of light therapy, include Bright Light Therapy, and Dawn Stimulation. Bright light therapy requires sitting in front of a  “ light box” for the timed sessions mentioned above. For the Dawn stimulation, a dim light appears in the morning and gradually gets brighter as the morning goes on, simulating a sunrise.

The duration of these treatments vary, depending on the response, and should be guided by the advice of the provider.

Other treatment options include, antidepressants, psychotherapy/counseling, positive support, and reassurance from loved ones that it will pass with time. Exercising regularly can also be helpful.

If you have questions or concerns about SAD, make an appointment to talk with your healthcare professional about what you can do to help yourself, or a family member who may be suffering from Seasonal Affective Disorder.

Heather Kasper PA-C

Bentz, Grob, Scheri & Woodburn Family Practice

For students entering college, it is important to make sure that they have received all of the required immunizations (per university requirements) and have considered a few additional immunizations.  Recommended immunizations include the Meningococcal vaccine, Human Papillomavirus vaccine, Varicella vaccine, and Hepatitis B vaccine.  The Meningococcal vaccine, better known as Menactra, helps guard patients against bacterial meningitis.  Recently, the CDC has changed the schedule on this vaccine.  In the past, it was a one-time immunization. Now, the CDC is recommending “boosters” between the ages of sixteen and eighteen for those patients initially vaccinated between the ages of thirteen and fifteen.

The Human Papillomavirus vaccine, “Gardasil,” prevents against certain strains of HPV, which can cause cervical cancer and genital warts in females.  This immunization also is recommended for males to reduce the likelihood of genital warts.  Varicella, better known as the “Chicken Pox vaccine,” is highly recommended in patients who have not had the varicella virus. The virus is highly contagious and normally requires a significant time away from school.  Lastly, the Hepatitis B vaccine is a three dose series that helps to protect against Hepatitis B (which can cause liver inflammation, infection, and failure). This is primarily transmitted by sharing dirty needles and often is contracted from piercing and tattoo parlors. Most teens have received the Hepatitis series and currently no additional booster is needed.

The pediatric immunization schedule remains the same from last season.  It is very important for parents or guardians of pediatric patients to schedule “well-child” visits with their health care provider to make sure they are staying up to date with the recommended protocol.

Prior to scheduling an immunization, please call the phone number on the back of your insurance card to confirm that the immunization will be covered.  The billers at your Genesis Division cannot determine what will be included within a patient’s insurance and ask that patients make this their responsibility to ensure covered care.

Vaccines have been developed to keep patients safe and healthy; however, they’re not effective or useful without your commitment to remain on schedule.  Those who have not been immunized, or refuse to do so, put themselves and others at a high risk for contracting theses “preventable diseases.”

Colleen M. Gavin PA-C

Bentz,Grob,Scheri & Woodburn Family Practice

 Anxiety is a feeling of apprehension of fear. You may not realize the reason for these feelings. There are four types of anxieties:

 Generalized Anxiety Disorder (GAD) is a common condition which can be genetic, a result of learned behavior/observation or because of stressful life situations. Symptoms may include: constant worrying or tension, difficulty concentrating, fatigue, irritability, problems falling or staying asleep or feeling “on the edge”.

 Specific Phobias are a type of anxiety disorder in which exposure to the feared stimulus may provoke extreme anxiety or a panic attack.  Common phobias are: blood, injections, certain animals (for instance, dogs or snakes), enclosed spaces, flying, high places, insects or spiders and lightning. Symptoms associated with this disorder include excessive sweating, problems controlling the muscles or actions, rapid heart rate or feeling weak.

 Obsessive Compulsive Disorder is an anxiety disorder in which people have unwanted and repeated thoughts, feelings, ideas, sensations (obsessions), or behaviors that make them feel driven to do something (compulsions). Often the person carries out the behaviors to get rid of the obsessive thoughts, but this only provides temporary relief. Not performing the obsessive rituals can cause great anxiety. Symptoms are obsessions or compulsions that are not due to medical illness or drug use or obsessions or compulsions that cause major distress or interfere with everyday life (i.e. washing your hands 100 times a day, flicking the light switch several times before leaving a room or counting to “50” before every task).

 Social Phobia is defined as persistent and irrational fear of situations that may involve scrutiny or judgment by others, such as parties and other social events. It may begin in adolescence and may be associated with overprotective parents or limited social opportunities. A person with this disorder may become overwhelmingly anxious and self-conscious in everyday social situations. They have an intense, persistent, and chronic fear of being watched and judged by others, and of doing things that will embarrass them. They can worry for days or weeks before a dreaded situation.

 Anxiety can be easily managed with the combination of medication and counseling.

 If you or someone you know may be suffering from an Anxiety Disorder please contact Licensed Professional Counselor, Mandy Kushner at Genesis Behavioral Health (412) 369-9940 to schedule an individual counseling appointment.

Mandy Kushner, LPC

Licensed Professional Counselor

Genesis Behavioral Health