HAPPY HEART MONTH


February is National Heart Health Month and therefore it is the opportune time to review heart health.  Heart disease is not just a concern for males; it is the #1 killer of both males and females in the United States.  Heart disease is a generalized term that is used to define multiple conditions involving both the heart and the blood vessels.  Hypertension (high blood pressure) and dyslipidemia (abnormal cholesterol) are two of the most common conditions involving heart health. 

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



A NEW YOU!


Many of us make a New Year’s Resolution to lose weight and get in shape, but most of us are not sure how to go about doing this and eventually lose interest or become discouraged.  There are many health benefits of regular exercise, for example; it can help prevent weight gain or maintain weight loss, and it has a positive outcome on health conditions such as heart disease, high blood pressure, diabetes and elevated cholesterol levels.  Exercise stimulates various brain chemicals which in turn increases energy level and improve mood.  Increased physical activity also promotes better sleep, just be careful not to exercise too close to bedtime.

 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.



Understanding the Medicare Annual Wellness Visit


Frequently Asked Questions

 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:

  • routine measurements such as height, weight, blood pressure and body-mass index;
  • review of medical and family history;
  • establishing a list of current providers, suppliers, and medications;
  • a personal risk assessment (including any mental health conditions);
  • a review of functional ability and level of safety;
  • detection of any cognitive impairment;
  • screening for depression;
  • establishing a schedule for Medicare screening and preventive services you qualify for over the next 5 to 10 years;
  • other advice or referral services that may help intervene and treat potential health risks;
  • voluntary advanced care planning.

Subsequent Annual Wellness Visits will include:

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”?

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:

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.



OSTEOPOROSIS


 When adult patients visit their primary care physician or healthcare provider for their yearly physicals, often times their main focus is on their yearly lab work, mammograms, and colonoscopies. Many adult patients forget or do not think about the importance of screening for osteoporosis. Currently osteoporosis is the most common bone disease and approximately ten million Americans are diagnosed with the condition. The current recommendation for screening of osteoporosis is for all women of age 65 or older and all men age 70 or older.

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


November is a time to prepare for the holidays and gather with friends and family.  It is also a time when, especially in Western Pennsylvania, the weather changes from crisp cool fall temperatures to snowy, blustery Winter temperatures.  Many people do not look forward to this drop in temperature, and many medical conditions worsen as the weather become cooler.  One condition, in particular, is chronic obstructive pulmonary disorder, or COPD.

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