Month: December 2016

Choosing Your Primary Care Physician

By Nathan Blake |12/19/16
Updated |7/3/17

When my partner and I moved from Virginia to Massachusetts, neither of us had any idea what we would do once we got here. Those days we were scraping by without: an apartment, jobs, state driver’s licenses, a local bank, and health insurance.

Fortunately we were able to cross off everything from that list within a month. But the last item — getting health insurance — was only the first step in health maintenance. I knew eventually I would want a medical professional I could trust to help me make my healthcare decisions, both big and small.

What I was needed was a primary care physician, or PCP.

What’s a Primary Care Physician?

Primary care physicians (also called “primary care doctors”) provide general medical services to specific patient populations.

A pediatrician manages the health of infants and children. Internists provide care to adults, diagnosing the nonsurgical treatment of diseases. A gynecologist specializes in pregnancy, childbirth, and the postpartum period. Each is a primary care physician, just with different specialties.

Why Are Primary Care Doctors Important?

PCPs, unlike many other health specialists, get to know their patients intimately and over a longer period of time. The ongoing nature of the PCP-patient relationship means the doctor can better assess what’s considered “normal” (and what isn’t) for each patient.

But those aren’t the only benefits of having a primary care physician.

The PCP often serves as a patient’s go-to medical resource. No more Dr. Google — with a primary care physician, you can talk about all of your health concerns with an expert you trust. It’s the primary care physician’s job to provide the patient with the very best care available, whether that care is in-house or through a referral to another specialist.

Primary care physicians and patients engage in what is called “continuity of care,” which means building a personal relationship that develops year after year. Keeping a close watch over a patient’s health allows PCPs to better intervene with disease prevention, patient education, health maintenance, and the diagnosis and treatment of both acute and chronic illnesses.

Lastly, the ease of access and communication involved with visiting a primary care physician is unrivaled. Longstanding doctor-patient relationships afford patients the opportunity to truly understand and participate in decisions that affect their health.

Once I settled down in Massachusetts, I knew I would need a primary care physician in my corner if I wanted to stay on top of my health. Turns out I had no idea how to actually go about choosing a primary care physician.

How Do I Choose a PCP?

Choosing a primary care physician is sort of like dating: there’s a large pool to choose from, and finding the right fit may take some trial and error.

Here are some tips I picked up that may help you find the doctor who best fits your personal needs. Let us know in the comments if they help!

Understand your insurance plan: Contact your health insurer or check your policy’s benefits to find out which doctors are considered “in-network.” Doctors in your insurers network will offer you discounted rates negotiated in advance by your health plan. Doctors considered “out-of-network,” on the other hand, often require patients to pay for their services up-front and in full.

It’s almost always a good idea to choose a PCP who is willing to work with your health insurance. We have an entire post focused on how to work with a doctor who doesn’t accept your health insurance.

Ask people you trustConsider asking for recommendations from friends, family, and coworkers. Most people feel more comfortable visiting doctors who have been recommended by someone they trust. Another benefit is that other people (or websites if you’re looking online) can help you pinpoint exactly what you want in a healthcare provider.

Are they male or female? Old or young? Laid-back or over-serious? The more you know about a doctor increases the chances that you’ll find one you like.

Keep an eye out for compatibilityMany patients schedule preliminary interviews with potential doctors to determine “fit.” Imagine the first visit as a trial run, and don’t rule out your gut-feeling.

Does the doctor explain things clearly? Do they listen without interrupting? Is the doctor relatable or more formal than your liking? Can you tell if the doctor prefers aggressive treatment or a more prolonged “wait-and-see” approach? All of these questions will help you in your search for a primary care physician.

Plan logisticallyIf you have a specific health condition like diabetes, you should choose a PCP who has specialized training or experience in endocrinology to receive the best care for your needs.

Other logistical considerations include the distance required to travel to the doctor’s office, schedule flexibility, and whether or not the doctor can understand you preferred language.

Make a list of your “wants” and “needs,” which you can then use to narrow down the list.

Know their availabilityNot all primary care physicians accept new patients. Even doctors with availability may have hours that conflict with your schedule. Some PCPs have dozens of patients, and those with more responsibilities require longer wait times to schedule an appointment.

Reach out to the doctor to get a better idea of their availability before you commit. You may be able to find someone who is a better fit for your schedule.

Check for qualifications:  A doctor is tasked with matters of literal life and death. Of course you’re not going to take advice from someone who isn’t qualified to give that advice. You want your health advisor to be an authority in their field, with an education and professional background that reflects expertise.

Check online or through the doctor’s office to see if the doctor is board-certified in the field(s) that you are visiting them for.

Are you ready to choose a primary care physician? Check out our “Doctors & Hospitals” category to browse resources we recommend for locating doctors online. Happy hunting!

Crohn’s and Colitis — Common but Misunderstood

By Nathan Blake |12/7/16

The first week of December marks the fifth annual Crohn’s and Colitis Awareness Week. These two conditions affect the digestive tracts of nearly 1.6 million Americans each year, although many more remain undiagnosed and deal with persistent pain and discomfort on a daily basis.

If you or a loved one has been diagnosed with either of these conditions, it is important to educate yourself about them in order to best manage the symptoms and reclaim a sense of normalcy.

What are Crohn’s and Colitis?

Crohn’s and colitis are among the most common forms of inflammatory bowel disease (IBD). IBD refers to a family of conditions that causes prolonged inflammation of parts or all of the intestinal tract. IBD and its various forms are known as invisible illnesses, referring to chronic conditions that impair a patient’s day-to-day activities yet show no outward signs.

Crohn’s disease is an inflammatory condition that can affect any part of the digestive tract from mouth to anus. The lining of the digestive tract becomes swollen and develops deep, open sores called ulcers, which can manifest in multiple areas including the esophagus, stomach, small intestine, colon, appendix, and in rare cases the skin and joints. Commonly, there are healthy portions of the intestine between inflamed areas that remain unaffected.

Ulcerative colitis is also an inflammatory disease, although its effects are specific to the superficial tissues of the colon and anus. With ulcerative colitis, ulcers develop on the inner lining on the large intestine. These ulcers may bleed and/or produce pus. Ulcerative colitis generally begins in the rectum and spreads upward to the first part of the colon.

Both diseases often appear gradually and then worsen with time, though many patients report periods of remission during which symptoms disappear for weeks or months. Periods of painful inflammation, on the other hand, are called flare-ups.

Common Symptoms of IBD

Because Crohn’s and colitis affect similar parts of the body, diagnosing these two diseases can be difficult. Their symptoms are often indistinguishable and can vary from person to person. Inflammation of the gastrointestinal tract often leads to the following symptoms, many of which are common for people dealing with Crohn’s or colitis.

• Diarrhea

• Rectal bleeding

• Urgent bowel movements

• Constipation

• Abdominal cramps/pains

• Fatigue

• Unintended weight loss

• Fever

• Night sweats

• Loss of appetite

What Causes Crohn’s and Colitis?

The intestine’s absorptive area spans over 4,300 square feet, making it the single largest surface in the human body, including the skin. Previously, diet and stress levels were implicated as the main determinants of IBD, but today they are seen as aggravating factors and not the actual cause.

While researchers are still unclear as to the exact causes of Crohn’s and colitis, many agree that they likely originate from a combination of factors.

Individual genes: People with a family history of IBD are 10 times more likely to develop the condition than those with no history.

Immune system: It is possible that Crohn’s and colitis appear in response to a viral, bacterial, or fungal infection of the intestinal tract, where the immune system produces an inflammatory response in the intestines to fight off the foreign agent(s). However, people with IBD often have inflammation even when no infection is present, leading researchers to believe that the patient’s immune system may be attacking the body itself. This phenomenon is known as an autoimmune response.

Environmental factors: Clinical and experimental evidence indicates that IBD may be associated with a range of seemingly unrelated environmental influences including cigarette smoking, diet, stress, use of hormones, vitamin D levels, and geographic/social status, among others.

Complications in IBD

Though these two diseases are rarely life-threatening, if left untreated, Crohn’s disease and ulcerative colitis can result in several serious complications deserving of immediate medical attention.

Fistulae: When ulcers extend completely through the intestinal wall, they create fistulae, or abnormal fusions between different parts of the body. The most common site for IBD fistula formation is the tissue surrounding the anus, where the fistula creates a connection between the rectum and the skin. Fistulae can occasionally become infected and form a life-threatening abscess—a localized pocket of pus—if left untreated.

Bleeding: Blood often appears in the stool of people with IBD, caused by inflammation, ulcer formation, and anal fissures. Some even pass blood alone in the absence of stool. Bleeding in the rectum is more common in ulcerative colitis than Crohn’s, but will vary depending on the area(s) affected.

Anemia: People with IBD have difficulties absorbing important nutrients from food, especially iron, which is absorbed in the small intestine (an area commonly affected by IBD). As a result, nearly half of people affected by Crohn’s or colitis do not receive adequate levels of vitamin B12, iron, and folic acid, all of which are necessary for the creation of new red blood cells. Patients with low levels of red blood cells develop anemia, resulting in headache, fatigue, chest pain, and weakness.

Treatment and Management

The goal in treating Crohn’s and colitis is to achieve and maintain remission, and mostly involves drug therapy to reduce the inflammation that causes IBD’s signs and symptoms. Immunosuppressants and anti-inflammatory drugs called aminosalicylates and corticosteroids have proven to be helpful in improving or completely stopping the symptoms of IBD. Biologics are a more recently developed therapy, created out of biological antibodies rather than chemical medications. Biologics also suppress the immune system but offer a distinct advantage in that they target specific proteins in the IBD patient rather than affecting the whole body.

However, there is currently no cure for Crohn’s disease, and ulcerative colitis can only be cured in the most severe cases when the entire large intestine is surgically removed.

Fortunately there are several ways that people with IBD can manage their symptoms. If you or a loved one has been diagnosed with IBD, consider the following strategies in conjunction with a physician’s oversight to help alleviate symptoms of the disease.

Manage stress: Many patients report an intensification of symptoms in times of stress. Consider adopting a meditation, yoga, or acupuncture routine to reduce symptoms, and get plenty of exercise, preferably daily.

Stay hydrated: Inflamed colons do not absorb water and electrolytes properly, resulting in diarrhea, increased bowel movements, and dehydration. Keep yourself hydrated with distilled water in order to combat this increased fluid loss, and monitor your urine to determine whether or not you are drinking enough liquids.

Limit “trigger” foods: Foods that cause flare-ups depend on the individual, but some are more commonly associated with intensified symptoms than others. They include fatty, spicy, and high-fiber foods; alcohol; coffee; carbonated drinks, nuts and seeds; raw fruits and vegetables; and red meat.

Get your vitamins: IBD flare-ups can negatively impact nutrition due to the increased bowel movements, loss in appetite, fatigue, etc. When the small intestine becomes inflamed, the body is unable to absorb nutrients from food. Coupled with a reduced appetite, IBD can easily lead to malnutrition. Patients can avoid malnutrition by eating smaller, well-balanced meals throughout the day. Your doctor may also recommend vitamin supplements as well.

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