April Showers Bring . . . Spring Allergies

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April showers + warming temperatures + early tree buds = increased suffering from spring allergies. If that happens to you or your family, begin now to prevent greater misery later.

Allergies Can Be Sneaky

I know. It’s been a long, cold winter. As the weather warms, we all like to get outside and at least think about opening our windows. But if you’re bothered by tree pollen, think again. Opening your windows might help you sleep more comfortably at night, but spring winds can bring tree pollen right into your bedroom causing you to wake with the sniffles.

And things might be getting worse. Botanists tell us that climate warming causes trees and other plants to pollenate earlier, in some areas up to two weeks earlier than just a few years ago. The nature’s spring pays little attention to our calendar. And this means that spring allergy season can last four months from March into June.

In the Northeast, I begin mowing my lawn in April. Grass pollen is also a problem then, and that lasts all the way through the summer. Flowers and weeds contribute their own pollen to the mix. For folks who suffer from such allergens, gardening might not be the best outdoor activity.

Don’t forget allergy triggers from winter either. Outdoors, spring winds can whip up molds and other debris that has lurked underneath the snow and in the soil. Molds and dust also accumulate in our homes during winter months. Spring cleaning is a worthy and helpful tradition! Pay special attention to bedrooms, floor coverings, and damp places in your living quarters.

How to Cope with Spring Allergies

To reduce the misery of watery eyes, runny noses, sneezing, coughing, etc., you can try the following measures:

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1.     Reduce direct exposure to tree, grass, and other pollens. If possible, keep windows closed and remain indoors especially at night. Use air conditioning to filter the air and change or clean filters monthly. Be especially careful on windy days, and keep an eye on your local pollen count (most weather apps provide this information).

2.     If you are allergic to molds, take it easy while cleaning up outside. If you work outside or do gardening, wear a NIOSH-rated N95mask. Also avoid walking in the woods during wet weather or when pollen counts are high.

3.     Control the presence of dust mites.

a.     Clean your sleeping areas thoroughly.

b.     Encase your mattress and pillows in allergen-proof covers (available online and in many bedding or department stores).

c.     Wash all bedding weekly in hot (at least 130ºF) water and dry on high heat.

d.     Replace wall-to-wall carpeting with non-fabric flooring.

e.     Remove as much upholstered furniture as possible.

f.      Vacuum with double-layered microfilter bag or HEPA filter installed.

g.     Use damp mop or rag to remove dust (dry rags merely stir up allergens).

4.     Rinsing or irrigating nasal passages can offer temporary relief from nasal congestion and other symptoms. NeilMed™ offers a wide variety of types for children and adults. (Tip: when using nasal washes, be sure to use only distilled water, warmed, to which saline-solution ingredients have been added. Otherwise, the rinse can cause pain.)

5.     To ease symptoms, consider the following medications.

a.     Antihistamines (available in pills, liquids, or nasal sprays; Benadryl™, Zyrtec™, Allegra™) to reduce runny nose, nasal congestion, and sneezing.

b.     Nasal corticosteroids (Flonase™, Nasonex™) for reducing all symptoms and blocking allergic reactions. Best if begun before symptoms emerge. May have side effects.

c.     Leukotriene receptor antagonists (Monteleukast™) useful in treating asthma and blocking effects of allergens.

d.     Decongestants (in spray, pills, or liquids) for relieving nasal stuffiness; can have unwanted side effects for persons with high blood pressure and might cause drowsiness.

6.     In instances of severe or chronic allergic reaction, it might be necessary to receive allergy shots (subcutaneous immunotherapy, or SCIT). This should be handled by a physician or allergist who can conduct appropriate testing to identify the specific allergen that is causing the reaction.

7.     If you take over-the-counter or prescription medications, it is wise to begin treatment a couple of weeks before your allergy season begins. Once symptoms have emerged, your body is primed to respond more readily to any allergy triggers.

Note: It is wise to consult a health care provider when using any medication.

Managing spring allergies can be tricky. At Kathy’s Urgent Care, we can help. We’ll diagnose your situation, offer tips for controlling exposure to allergens, and prescribe the correct medications to help relieve your symptoms. Remember: No appointment is needed! Just walk in, 7 days a week, and we’ll help you feel better.

Reduce Sugar for a Healthier Life

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“You are what you eat.” Simple. But most of us ignore the implications. As a physician, I see the consequences in my patients every day: obesity, type 2 diabetes, high blood pressure, high cholesterol, low energy, depression, unhealthy skin. All of these conditions and more are associated with poor nutrition, especially diets high in sugar and sodium. National Nutrition Month is a great time to begin eating healthy.

Caution: This post is intended for the general public. If you suffer from diabetes or cardiovascular disease, please consult your primary care physician about dietary restrictions and guidance.

Taking the Lifestyle Plunge

Seriously reducing the amount of sugar that you eat is not a fad. It is not a temporary “diet.” It is a change in lifestyle.

At first, you will encounter obstacles. Your own craving for sweetened food is strong. Oddly, eating less sugar will help overcome that craving. But early on, it will be a struggle.

Your friends and family might not be supportive or want to go along with such a change. But your well-being (and theirs!) depends on developing a more healthful approach to food.

The great news is that, if you lower your intake of sugar as I’m about to describe, you will feel much better quickly, even within a few days. Bearing in mind how much better you feel should help you overcome the obstacles that surround us all.

How to Avoid “Hidden Sugar”

Most Americans eat much more sugar than is recommended by wellness experts. Because of the added sugar that we don’t see, controlling intake of sugar is difficult. Many processed foods and beverages contain added sugar to improve taste, color, and preservation. Items containing added sugars include soda, sports drinks, fruit drinks (including fruit punch), flavored coffee, flavored tea, salad dressings, ketchup, dry mixes for baked goods, ice cream, sweetened yogurt, sweetened milk, syrup, cookies, cakes, most cereals, doughnuts, bagels, breads, sauces, candy, most snack foods, processed meats.

Most of us know this. But there can be some surprises. The next time you shop for groceries, take a look at the amount of sugar listed for a cup of raisin bran cereal. If a cup is 59 grams, the amount of sugar is about a third at 19 grams. That’s breakfast candy.  

Caloric sweeteners can be listed on food labels as agave syrup, brown sugar, corn sweetener, corn syrup, sugar molecules ending in “ose” (dextrose, fructose, glucose, lactose, maltose, sucrose), high-fructose corn syrup, fruit juice concentrate, honey, invert sugar, malt sugar, molasses, raw sugar, sugar, and syrup. Amounts are not always included. That’s why it makes more sense to refer to them as “hidden sugar.” And when you eat out, you never know what a restaurant includes in their menu items.

To avoid hidden sugar, my best advice is to cook your own food at home. Use fresh, unsweetened ingredients—fresh fruits and vegetables, unsweetened canned goods, fresh meats—as much as possible. Take a close, squinty-eyed look at food labels. If the amount of sugar listed creeps into double digits (10 or more grams) per serving, be careful.

Cooking at Home

It’s true that preparing your own meals at home requires time, imagination, and some expertise. But cooking at home is the best way to control what you eat in order to stay healthy. So how much time and energy is your health and that of your family worth to you?

These days, we rush to meet work or school schedules. That makes for unhealthy eating. Breakfast, for instance, is a sugar bomb for most people. Prepared cereals (except for plain oatmeal) are loaded with sugar. Most of us know this. But there can be some surprises. The next time you shop for groceries, take a look at the amount of sugar listed for a cup of raisin bran cereal. Assuming that a cup is 59 grams, the amount of sugar is about a third at 19 grams. That’s breakfast candy. Picking up a bagel, doughnuts, or a “healthy” muffin on the way to work will give you a sugar high that will sap your energy and good mood later.

Try something different for breakfast. To scrambled or fried eggs, add a serving of mixed vegetables. What? Vegetables for breakfast? Yes! Or for a quicker breakfast, add some unsweetened frozen or fresh berries (blueberries are good) to unsweetened, plain yogurt along with low-sugar or no-sugar granola for crunch. Delicious!

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The best lunch you can eat is the one that you make. Once again, beware prepared foods such as potato chips, prepared frozen entrees, and sandwiches that include sweetened condiments, prepared meats, and thick slices of bread. Substitute celery or carrot sticks for chips. Make a fresh salad, perhaps including some leftover chicken, along with a plain olive oil and white balsamic vinegar dressing. Or take a container of that soup that you had for dinner last night. Add a piece of fresh fruit instead of cookies. Perhaps most important, avoid eating lunch out at a restaurant or ordering a sandwich from your favorite deli—too risky.

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Planned right, dinners can be a time to unwind from a stressful day. If you are the one who is responsible for most of the cooking, ask another family member or your spouse to help out. They can chop those fresh vegetables that you brought home from the grocery store, and they can help clean up after eating your tasty food. While all of that is going on, conversation can flow.

A few tips for healthier dinners that do not skimp on flavor:

·      Maximize using green vegetables, cooked or in salads. The darker green, the better.

·      Steam vegetables, especially broccoli, carrots, asparagus, and green beans.

·      For better flavor, roast bite-sized vegetables (potatoes, broccoli, green beans, asparagus, brussel sprouts, butternut squash, zucchini, etc.) for about 25-30 minutes in your oven or toaster oven. Dribble lightly with olive oil and sprinkle with powdered garlic, black pepper, rosemary, thyme, or other spices (not salt) that pack a lot of flavor.

·      Try alternatives to white rice or potatoes such as brown or wild rice, sweet potatoes (baked or roasted), and cauliflower (can be a substitute for mashed potatoes).

·      Sauté meats and other foods as much as possible in olive oil.

·      Stir-fry is a great way to cook vegetables and small pieces of chicken or beef. Be careful to use low-sodium, low-sugar sauces or soy sauce.

·      Fresh fruit, low-sugar or no-sugar baked goods, or low-sugar frozen yogurt in small servings make good desserts. Save the regular ice cream and cakes for special occasions.

Plan ahead. When cooking dinner, prepare a little extra that can be converted to lunch the next day or the day after.

If you drink wine, beer, or other alcoholic beverages, reduce the amount that you consume. Instead of two glasses of wine, get by with one. Alcohol converts to sugar quickly and can wreck your attempts to eat healthier.

If you prepare more of your meals at home, you can divert money that you would spend in restaurants on high-sugar, high-sodium meals to healthier and better tasting food. Your lifestyle will change for the better.

How Much Sugar is Too Much?

The amount of hidden sugar in our food is astounding, sometimes surpassing the number of total calories that a person should consume in an entire day. The American Heart Association recommends that no more than half of a person’s daily discretionary calories (that is, calories above what is needed for daily bodily maintenance) should come from added sugar. For men, this amounts to about 9 teaspoons and for women, about 6 teaspoons. (On average, Americans consume about 20 teaspoons of added sugar per day.) Remember, added sugar is any amount above what foods naturally contain.

Unless you load up on high-sugar fruits or fruit juice (orange, apple, pear, etc.), you don’t need to worry too much about consuming only the sugar that is naturally present in most foods.

Some beverages, such as soda and sports drinks, contain so much sugar that they should be avoided completely. Lemon-infused water might be a good substitute. Even diet soda should be avoided since research shows that artificially sweetened drinks increase the craving for sugar and caloric intake.

Caution for persons on a gluten-free diet: Those who suffer from celiac disease or who have elected for other reasons to follow a gluten-free diet should guard against consuming too much hidden sugar. While avoiding foods containing wheat or other grains can reduce ingesting added sugar, merely substituting gluten-free for regular baked goods and other foods could result in increased consumption of sugar, which can cause weight gain and other problems. This is because many gluten-free products contain high amounts of sugar derived from rice, tapioca, and other sources. If you are gluten-free, read food labels closely and eat more fresh vegetables and other unprocessed foods.

Benefits of Less Sugar

You will receive many benefits from consuming less sugar, and many of them appear quickly.

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·      Lower blood pressure

·      Less risk of cardiovascular disease

·      Lower risk of type 2 diabetes

·      Improved mental alertness

·      Better energy throughout the day

·      Improved sleep

·      Less risk of Alzheimer’s disease

·      Reduced depression

·      Loss of excess weight (see your shoes again!)

·      Healthier looking skin

·      Reduced stress on the liver

·      Less craving for sweets and high-carb food

·      Lower inflammation

·      Fewer problems with knee and hip joints

We, at Kathy’s Urgent Care, want you and your family to enjoy healthier living. But remember that we’re here to help when you do encounter illness or injury. Contact us if you have any questions.

5 Urgent Care Myths Debunked

Have you noticed? Delivery of health care services is changing! When trying get the health care you deserve, when you need it, and at affordable cost, you might be confused by all of the options, including urgent care. Myths about urgent care have gone viral, preventing many folks from choosing the best alternative. As you decide what’s best for you and your family, don’t be hoodwinked by these common misunderstandings.

 

Myth #1. Urgent Care and Emergency Room Care Are the Same

While it is true that urgent care centers and hospital emergency departments both treat acute or urgent injuries and illnesses, persons who suffer from a truly life-threatening condition should go to an emergency room or call 911.

Urgent care centers treat most non-life-threatening injuries and illnesses, including broken bones, sprains, cuts, strep throat, bronchitis, allergic reactions, eye and ear infections, low back pain, headaches, nausea, and many more. Waiting times are nearly always shorter and cost is lower than with ERs.

The following chart of symptoms can help you decide where to get the most appropriate care.

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Myth #2. Urgent Care Staff Are Less Qualified

Be assured that all clinical staff at urgent care centers receive the same training as clinical staff in hospitals and family practices. A supervising physician is always present or on call. Other providers such as physician assistants (PAs), advanced practice registered nurses (APRNs), and medical assistants (MAs) must be credentialed and licensed according to state law.

Some urgent care centers also provide specialized clinical services such as orthopedic or pediatric care. When necessary, urgent care centers will refer patients to an appropriate specialist and will often arrange an appointment for a patient more quickly.

Myth #3. Urgent Care Costs More

In nearly all cases, treatment at an urgent care center costs less than at other locations. Because emergency departments must cover high overhead costs for sophisticated equipment and 24-hour staff, charges for ER treatment can be very high. This can be a problem especially if your health insurance plan carries a high deductible amount.

Urgent care centers accept most insurance coverage. Even if your plan carries a high deductible, your insurance will generally lower your out-of-pocket cost. If you have no insurance or choose not to use it, your urgent care center will usually charge a modest flat fee for treatment.

Bottom line: Urgent care fees are nearly always lower than emergency department or family practice fees.

Myth #4. Urgent Care Centers Only Treat Minor Ailments

While urgent care centers do treat minor ailments, the term “urgent care” can be misleading. Most urgent care centers also offer preventative health care such as screenings for disease, general physical examinations, and vaccinations (flu, MMR, Hepatitis, Tetanus, Diphtheria, Pertussis, Pneumonia, Polio, etc.).

Physical exams are offered for immigration, employment (DOT/CDL exams, drug testing, etc.), and school or sports requirements.  They also provide testing and treatment for STDs.

Urgent care centers usually have X-ray equipment and laboratories on site and can dispense routine medications.

Myth #5. Urgent Care Centers Don’t Interact with Other Health Care Providers

If you are concerned that your primary care physician won’t be informed about your urgent care visit, relax. Urgent care providers communicate regularly with family physicians, specialists, and hospitals. A complete record of your visit will be available to other providers as needed.

If there is any question about the nature of your care, the urgent care provider can contact your regular physician or specialist for consultation.

You can also rest assured that your health care privacy will be protected as required by federal and state law. Only other providers and your health insurance carrier(s) will have access to your records if necessary and as authorized by you.

Conclusion

As more health care options, such as urgent care, become commonly available, understand how to use them well for yourself and your family. Urgent care centers are conveniently located and are open on a walk-in basis during evening and weekend hours. For many non-life-threatening injuries and ailments as well as for preventative services at low cost, urgent care centers are your best choice.

For high quality health care that will meet your expectations, check us out at Kathy’s Urgent Care in Wethersfield or Rocky Hill, Connecticut!

The Flu Is Scary This Year!

You probably know someone—a family member, co-worker, or close friend—who has had the flu this year. If so, the chance that you will get the flu is very high. Halfway through the flu season, the CDC projects no end in sight.

Compared to the flu epidemic of 2014-15 when over 710,000 persons were hospitalized and over 56,000 people died in the U.S., hospitalizations are up.

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Figure 1. Source CDC

This year’s numbers are alarming because they represent the most serious cases, chiefly among children and the elderly. They also foretell a higher risk of secondary infections that can prove lethal. Visits to urgent care centers and other outpatient clinics have also skyrocketed.

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Figure 2. Source: CDC

Get a Flu Shot

The number one recommendation of authorities is for everyone (including children over 6 months of age) to get a flu shot. Several news outlets have reported that this year’s flu shot is not very effective against the H3N2 virus that is responsible for about 80% of cases. But even if an H3N2 infection is not prevented, the vaccine can still lessen symptoms and help prevent secondary bacterial infections.

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For more detailed information about flu shots, check out our previous blog post, 6 Myths about Flu Shots. Also check with your health care provider for answers to any questions or concerns you might have.

Know What Symptoms to Look For

If a person exhibits difficulty in breathing, a persistent high fever, dizziness or confusion, severe fatigue, or rapid heartbeat, seek medical attention. See a health care provider if an adult or child appears to get better and suddenly takes a turn for the worse since this can indicate a secondary infection.

Last week a patient walked into our clinic and asked if we were out of the rapid flu test. We replied, “Yes we are, but we don’t always use the flu test to determine if a patient has the flu.” This test—the “rapid influenza diagnostic test” (RIDT)—is more accurate in detecting flu in children than in adults. But as the CDC points out, it can produce either false negatives (indicating no flu when a patient is actually infected) or false positives (indicating flu infection when there is actually none). Such inaccurate results depend on the strain of flu and the severity of the flu outbreak. According to the CDC again, “Most people with flu symptoms do not require testing because the test results usually do not change how you are treated.” Bear in mind that health care providers see a lot of cases and are, therefore, very good at diagnosing the flu. That is why they often prefer relying on their own judgment.

Symptoms of the flu and the common cold can also be confused. For more information about the difference between them and about the flu in general, see our previous post, Cold or Flu: How Can I Tell the Difference?

Get Treatment for the Flu Quickly

Health providers usually administer anti-viral medications to patients diagnosed with the flu. The most common medications include

·      Oseltamivir (Tamiflu™), an oral medication

·      Zanamivir (Relenza™), an oral medication

·      Peramivir (Rapivab™), an injectable medication


These medications are not cures, but they can reduce duration and severity of symptoms. They are most effective if administered within 48-72 hours of the onset of flu symptoms.

If you are in doubt about whether you or a family member has the flu, get checked out quickly.

Don’t Mess Around!

So far, at least 53 children in the U.S. have died, and flu mortality rates for all age groups are climbing. The flu is a serious threat this year.

·      If you or your family members have not yet received a flu shot, get one! The sooner, the better since it takes a couple of weeks for the vaccine to become fully effective.

·      If you suspect that someone has symptoms of the flu, get them checked by a health care professional within a day or two.

·      Urge others to get flu shots in order to limit spreading the flu. This is a public health matter.

·      Be cautious in public places, and wash your hands often.

·      Stay informed.

If you have any concerns about the flu for yourself or a family member, come to Kathy’s Urgent Care so that we can help you. We’re open weekdays from 8am to 8pm and on weekends from 8am to 5pm.

What Will My Drug Prescription Cost?

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Such an apparently simple question does not have a simple answer. Let’s start with “whose cost.” The drug manufacturer’s? The pharmacy benefit manager’s (PBM, a “middleman”)? Your health insurance carrier’s? Your dispensing pharmacy’s? Your out-of-pocket cost? American society’s in general?

Consider Marcia who takes atorvastatin (generic form of Lipitor™) to manage her high cholesterol. A 30-day supply purchased through her Aetna health insurance plan at CVS recently cost $46. When she checked with GoodRx, however, she learned that a 90-day supply purchased for cash without insurance at a different pharmacy would cost only $18. More astonishing, the estimated full cash price with no discount coupon ranged from $29 at Costco to $392 at CVS and $439 at Walgreens. What’s going on here?

Prescription drug pricing is so complicated and so shrouded in mystery that it is difficult to tell why the price of a single drug varies so widely. Worse, if you have health insurance (and depending on other factors), you might actually pay more for a specific drug, like Marcia did, than if you had no insurance. And as more of the cost shifts to individuals (because of high deductible insurance plans, drug pricing practices, prescriptions for non-generic or more expensive drugs, etc.), your out-of-pocket costs can soar.
 

Are Drug Companies to Blame?

Nearly everyone has heard of the EpiPen price increase in 2016. EpiPen is an epinephrine auto-injector that delivers a precise dose to combat allergic reactions (such as to bee stings or certain foods). It is usually sold in packs of two (the second dose should be administered after 15 minutes if the first does not reduce anaphylactic shock) and is considered lifesaving for those who are susceptible to severe allergic reactions. The price of a two-pack in 2007 was around $100. After acquiring ownership of the drug, Mylan raised the price in 2016 to $609. Mylan has since made a generic version available at roughly half the cost of EpiPen. In either case, the medication expires after one year, making annual repurchase necessary. With high deductible insurance plans on the rise, out-of-pocket costs continue to be out of reach for many. Despite heavy criticism from members of Congress, former Mylan executives and employees, and consumers, Mylan has not lowered its price for the original EpiPen (see Outcry Over EpiPen Prices Hasn’t Made Them Lower).

Other alternatives, such as Adrenaclick™ (about $200) which also employs an auto-injector, are available. CVS has teamed up with Impax to sell a generic epinephrine auto-injector for about $109 for a two-pack.

Yet another alternative, Auvi-Q™, a redesigned auto-injector, is packaged with an audio recording to provide instructions about its use. Auvi-Q provides a link on its website for customers to download a form to be signed by their physician that will allow them to obtain the product through the company’s direct mail program for $0 out-of-pocket expense (to qualify, you must be insured and have a family income of less than $100,000). The list price, however, tops $4,777—an amount that will be charged to an insurance company and much more than EpiPen.

This rather extreme example shows that there is little control over what pharmaceutical companies can charge for their products. Most charge what they do simply because they can.
 

What About Pharmacy Benefit Managers (PBMs)?

Most people (like me until recently) have never heard of pharmacy benefit managers (PBMs). Such a name might lead you to think that they benefit all of us who purchase prescription drugs by negotiating lower prices. But that’s not what actually happens in many cases. PBMs (individuals or companies) are hired by insurance companies, large employee unions, and other institutions that offer prescription drug benefits to their members or clients. The PBMs negotiate pricing contracts with drug manufacturers. The process, however, often results in an increase in manufacturers’ list prices and includes a series of transactions that allows some PBMs to skim profits.

Here’s an oversimplified example of how the cycle typically works. Imagine that APEX is a drug manufacturer that makes NonAnx to control anxiety. RxBroker is a PBM company that has been hired by HealthIns, a major health insurance company. DrugSave is a large pharmacy chain.

  • APEX sets a list price for NonAnx at $3,000 per dose.
  • RxBroker proposes that HealthIns will approve NonAnx for coverage, but only if APEX pays a rebate of $1,500 off the list price.
  • APEX agrees to pay the rebate of $1,500 to RxBroker, and HealthIns lists the drug as approved.
  • RxBroker then tells DrugSave that HealthIns will cover the drug at $500 per dose.
  • (Patients covered by HealthIns would pay only $30 co-pay for a 30-day supply. DrugSave sets whatever cash price it wishes for non-insured customers.)
  • RxBroker (and maybe HealthIns) keeps the $1,000 difference between APEX’s $1,500 rebate and the $500 reimbursement due to DrugSave. (This is the skim.)
  • APEX raises its list price of NonAnx to $4,000 per dose to try to recover lost revenue from other institutional customers.
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For most PBMs, no one else knows how much the manufacturers’ rebates exceed what pharmacies charge customers for their prescriptions. This means that insurers and PBMs can quietly pocket the difference. That is why most of us find out what a prescription drug costs only when we go to the pharmacy counter to pay. That is also why some states are seeking ways to increase transparency in drug pricing.
 

What Can You Do?

If you are covered by a high deductible health insurance plan or if you lack insurance, consider taking the following steps.

  • Demand that your federal and state legislative representatives pass legislation that requires greater transparency in drug pricing. Rising prescription drug prices are generally not a partisan issue, and many states are beginning to address the matter.
  • If your insurance plan covers the cost of prescription drugs at least to some extent, contact your carrier to learn what your in-network or out-of-network cost will be. Ask if they have any discount plans.
  • Check with drug manufacturers to see if you qualify for discounts or other assistance.
  • Check with prescription drug discount services such as GoodRx or BlinkHealth for access to lower out-of-pocket prices. Contrary to what you might think, you might pay much less if you don’t use your insurance and take advantage of these programs.
  • Discuss the cost of your medications with your physician or other health care provider. Ask them to prescribe the lowest cost, effective medication possible (usually a generic drug). Surprisingly, many providers lack sufficient information to answer your question.

Individual responsibility for prescription drug costs is rising faster than any other area of health care. We all need to become more assertive in demanding information and transparency about drug pricing and the cost of health care generally.

At Kathy’s Urgent Care, we will be happy to discuss the cost of your prescription medications with you, and we pledge to prescribe or administer the lowest cost-effective medications possible.

My Throat’s Sore: Is It Strep?

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A bad sore throat awakens your child or you at night. Could it be strep? Before you jump to that conclusion, know what to watch for and check your symptoms.

Most sore throats develop from a common cold or the flu, both of which are caused by viruses. Strep is different: it is caused by a bacterial infection (streptococcus pyogenes). The good news is that antibacterial medications can work to treat strep. The bad news is that strep infections are highly contagious and can lead to severe complications, especially in children.

Symptoms to Look For

Having several of the symptoms below cannot determine whether you are dealing with a strep infection. Many of these symptoms accompany viral infections too. But watch for them anyway.

  • Quickly developing throat pain, usually within just a few hours.
  • High fever, (101.0° F [38.3° C] or higher for adults; 103.0° F [39.4° C] or higher for children).
  • White patches or pus on tonsils (back of throat).
  • Red spots on back roof of mouth.
  • Pain when swallowing.
  • Nausea (especially in children)
  • Swollen lymph nodes (in neck)
  • Headache, body aches
  • Rash
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These symptoms can also be consistent with non-strep infections. If you suspect a strep infection, you should go to an urgent care center or other health provider so that a quick diagnostic test can be performed. Using a cotton swab, the provider takes a sample from the back of the throat for testing. This rapid screen test takes about 5-10 minutes and is usually accurate. If, however, the test is negative but strep is still suspected, you will probably be treated with antibiotics anyway (we used to send a sample to a lab for further testing, but that practice has generally been discontinued).

Treatment

If strep is detected, a course of antibiotic medication is usually prescribed. Even if symptoms subside quickly, it is important to take all of the medicine as directed to prevent recurrence. Remember, it’s never okay to take someone else’s antibiotic, or to take an antibiotic prescribed for a previous medical episode.

Untreated strep infections can clear up on their own, but they create a high risk of rather severe complications.

Complications

Strep infections, left untreated, can spread to skin, sinuses, tonsils, blood, and ears. They can also cause the following severe conditions:

  • Rheumatic fever that can result in permanent damage to the heart, stroke, and even death (usually contracted by children age 5-15, but also by others).
  • Scarlet fever, usually appearing as a bright rash on the body (usually infects children, but is rather rare today).
  • Inflammation of the kidneys, a condition that can become serious.

Prevention

Strep throat infections are highly contagious and are usually passed from one person to another by direct contact, coughing, or sneezing. The number of cases increases during the fall to spring months, primarily because people are in closer contact with one another indoors. School children are especially susceptible.

Good personal hygiene—washing hands frequently (with soap for at least 30 seconds), covering the nose and mouth when sneezing or coughing, and avoiding direct contact with infected persons—are about the only ways to prevent getting or passing a strep infection to others. In addition,

  • Use hand sanitizer for the whole family if you’re on the go,
  • Refrain from using anyone else’s utensils,
  • Keep hands out of your mouth, and
  • Wash your dishes in hot, soapy water.

What You Should Do

If you or a family member has a bad sore throat with a high fever that came on suddenly, you should visit an urgent care clinic or other health provider to get checked. They can usually tell in a matter of minutes whether a strep infection is causing the problem, and they can help you feel better quickly.

In such a situation, feel free to walk into or call Kathy’s Urgent Care. We’re here to help you M-F, 8:00am – 8:00pm and on weekends 8:00am – 5:00pm.

Cold or Flu: How Can I Tell the Difference?

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Got the sniffles? Sore throat? Body aches and pains? Fever? You might be suffering from a cold or the flu. But how can you tell the difference, and what can you do about either one? Winter brings greater exposure to cold and flu viruses and, therefore, greater risk of infection. It’s important to know the difference and how you and your family can cope.

Cold vs. Flu

It is often difficult to tell whether you or others have a cold or the flu. As the following chart shows, however, differences in symptoms are often apparent.

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Treatment

Colds

Usually over-the-counter (OTC) or home remedies can relieve symptoms of colds. There are a wide variety of OTC medications to ease nasal congestion, coughs, and mild fever. But with all OTC medications, be sure to observe label directions and dosage limitations. Do not exceed dosage limitations for acetaminophen (over 59,000 persons were treated for overdosing last year). And do not give aspirin to children or teenagers, since doing so following a viral infection can result in Reye’s syndrome.

Sometimes gargling with salt water relieves a sore throat. A sinus rinse or irrigation can relieve sinus congestion and discomfort. (NeilMed® offers several OTC sinus rinse products (such as neti pots) that can help relieve symptoms for colds and allergies.)

Other home remedies include chicken soup which can have anti-inflammatory ingredients and can help relieve nasal congestion. Honey, sometimes with lemon, when consumed in tea or alone, can relieve coughing.

Above all, rest and drink fluids.

Flu

Many of the same OTC or home remedies that relieve cold symptoms can help also with flu symptoms.

Since the flu and possible complications are more serious, medical attention is frequently required. To relieve symptoms, physicians sometimes prescribe an antiviral drug:

·      Oseltamivir (Tamiflu™), an oral medication

·      Zanamivir (Relenza™), an oral medication

·      Peramivir (Rapivab™), an injectable medication

These medications are not cures, but they can reduce duration of symptoms. They are most effective if administered within 48-72 hours of the onset of flu symptoms.

If you are pregnant, are over 50 years old, have a compromised immune system, or have a chronic disorder such as diabetes, you should seek medical attention if you get the flu. Because of the risk of complications such as bronchitis or pneumonia, you should see a clinical provider within 48 hours of the beginning of symptoms.

Prevention

Colds

It is almost impossible to keep from catching a cold. The rhinovirus can be transmitted by airborne droplets from infected persons who sneeze or cough. It can also be transmitted by direct contact with an infected person or surfaces that such a person has touched. Basic hygiene, such a frequent washing of hands, and avoiding contact with infected persons or surfaces (such as doorknobs, countertops, railings) are the best preventative measures. In addition, try to avoid touching your own eyes, face, nose, or mouth if you encounter others who have a cold or you are in a public place.

Flu

To reduce the chances of getting the flu, use the same measures above that help to prevent catching a cold. Also, you should know that a cold cannot morph into the flu because colds and the flu are caused by two very different viruses.

Very important: The most effective way to prevent getting the flu is to get a flu shot every year. While experts recommend getting a flu shot by the end of every October, you can still get a flu shot in the late fall or early winter. Peak effectiveness begins 2-3 weeks after you receive your shot. For more information about flu shots, see our recent blog, Get Your Flu Shot Now!

If you or your family have questions about symptoms and whether you have the flu, come to Kathy’s Urgent Care so that we can resolve your concerns. If you do have the flu, we can help you feel better and avoid complications, especially if you visit us within 48-72 hours of the onset of symptoms.

Jingles Mean Shingles (Vaccine)

Holiday jingles can remind us to get vaccinated for shingles! I know, that’s cheesy. But if the title prods you to protect yourself or someone you know from getting a case of the shingles, it’s worth the lapse in good taste. Shingles affects many people, some with debilitating pain. About 1 million cases occur per year, and people who reach the age of 80 confront a 33% to 50% chance of contracting shingles.

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What Is Shingles (herpes zoster)?

Shingles is an infection by the same virus that causes chickenpox (herpes zoster). It causes a rash that develops into blisters on the face, neck, or torso (although it can affect other areas such as eyes, mouth, ear canal, genitals—areas that can lead to further complications) on one side of the body. Often preceded by a burning sensation and pain, the rash can be itchy and often quite painful. Fever and headache sometimes occur as well.

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For those who have had chickenpox, the virus lies dormant in nerve tissue, usually held in check by a person’s immune system for years. Starting about age 50 (occasionally, in younger persons as well) when a person’s immune system weakens or a person undergoes physiologic stress, the virus might express itself as a painful rash. The blisters usually scab over in 7-10 days and clear up in 2-4 weeks. Beyond those symptoms, some people develop severe, long-term pain (post-herpetic neuralgia or PHN) that can last for months or years. Antiviral medicines—acyclovir, valacyclovir, and famciclovir—are available to treat shingles and shorten the length and severity of illness. They should be taken as soon as possible after symptoms emerge. Some medications can also help relieve pain from PHN. In extreme cases, short-term prescription of opioids might be indicated.

Shingles, itself, cannot be transmitted from one person to another. But the virus can be passed by contact with active blisters to anyone who has not had or been vaccinated for chickenpox. Pregnant women (who can pass the virus to their fetus), the elderly, and young children who have not had or been vaccinated for chickenpox are especially susceptible. If you develop shingles, avoid contact with such persons until your symptoms disappear.

Vaccinations

If you have had chickenpox, getting vaccinated for shingles is the only chance you have of preventing the condition. The most common vaccine in use today is Zostavax (Merck). The Centers for Disease Control and Prevention (CDC) recommends that persons age 50 and older receive this vaccine. The CDC also recommends that persons who have had shingles receive the vaccine a few weeks after symptoms have disappeared. Zostavax is administered by a single injection that can be obtained at urgent care clinics or pharmacies.

In October 2017, the Food and Drug Administration (FDA) and the CDC approved a new shingles vaccine, Shingrix™ (GlaxoSmithKline), for persons age 50 and older. According to clinical trials, this new vaccine appears to be more effective than Zostavax™ It is administered by two injections two months apart.

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Conclusion

If you are 50 years of age or older, get vaccinated against shingles. Post-herpetic neuralgia (PHN) is a truly serious condition that can cause life-long pain and disability in many people. Even if you have had the Zostavax vaccine, consider getting the Shingrix vaccine since it is much more effective. You might experience a couple of days of discomfort, but that is minor compared to possible effects of shingles. If you decide to get the Shingrix vaccine, you will need to wait until early 2018.

If you have questions, contact your health care provider or call us at Kathy’s Urgent Care. We’ll be happy to respond to your concerns and to help you make the right decision.

What Will your Visit to the Doctor Cost?

What will be your out-of-pocket cost for your next doctor’s appointment? Unlike most other transactions, learning what a health care procedure will cost before you receive treatment is extremely difficult. Providers charge different prices. Health insurance plans vary. Various aspects of health insurance coverage are difficult to understand. And much of the confusion might be intentional to boost corporate profits. Public discussion of these issues often centers on “transparency of health care costs.”

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How Health Insurance Coverage Varies

Most of us are aware that the health insurance landscape has changed. Premiums have increased for people insured by their employers and for those who purchase insurance through the Affordable Care Act (ACA) exchanges. In addition, higher deductibles (the amount that an individual must pay out-of-pocket before insurance payment kicks in) and higher co-insurance (the percentage of health care costs for which an insured person is responsible) amounts have shifted more of the financial burden to individuals. This shift has focused our attention on how much or how little our insurance will pay for particular treatments.

Your insurance carrier can inform you about your deductible amount, your co-payment, your co-insurance rate, and specific details about which treatments are covered.

Insurance companies also negotiate varied rates of payment with different providers—what is called a contracted rate. Sometimes the amount paid by insurance companies to clinical providers could vary by several thousand dollars, ranging from $12,000 to $75,000 for joint replacement surgery, or $1,000 to $6,500 for cataract removal. If your deductible or co-insurance amounts were high, you could be faced with large out-of-pocket expenses, depending on which provider performed the service.

Insurance companies typically do NOT publish their contracted rates for clinical providers.

Because of contracted rates, insurance companies often pay substantially less than the full price that a provider would otherwise charge. This is true especially for providers who are listed as “in-network,” that is, who have negotiated specific rates with insurers. If a patient receives treatment from an “out-of-network” clinical provider, however, the amount charged by the provider could rise to a sum close to what uninsured patients would have to pay.

Insurance companies inform their clients about the differences between in-network and out-of-network payments, but charges assessed by out-of-network clinical providers can still be far above what an insurance company will pay.

Medicare and Medicaid establish fixed rates of reimbursement to clinical providers for specific conditions and treatments. Most providers accept these rates, but a small number of providers have opted out of accepting Medicare or Medicaid rates altogether. Further information can be found at the Kaiser Family Foundation website.

Why Providers Charge Different Prices

Clinical providers often add to the confusion by charging different amounts. Reasons for such differences among providers include the type of practice or institutional setting, the geographic location of the provider which might reflect drastic differences in overhead expenses, including the nature of the clinical staff and medical equipment that must be maintained.

Sometimes, providers’ fees differ because of the professional qualifications of clinical staff who actually conduct a procedure. Differences in overhead expenses are often reflected on your bill as a “facility fee.” Most providers will not itemize the details contained in their “facility fee.” These differences go far to explain why services rendered in a hospital’s emergency department or in their own urgent care centers are so much more expensive than when delivered by an independent urgent care clinic.

Because of such disparity among providers, it is always wise to check with more than one to see what they would charge for the procedure that you require. Some providers might be reluctant to give you such information, or they might claim that they cannot foresee what the final charges would be because they cannot predict whether complications might arise. You should therefore be prepared to make a decision based on an estimate of what the charges might be.

What Transparency Means

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Confused? You should be! Understanding the ins and outs of insurance coverage and the differences among providers perplexes even health care experts. But some insurers and clinical providers have begun to provide relevant information in simpler form. And some states have started to require greater transparency in health care costs and even to provide tools to help those who need care and help with paying for it. Here is what such transparency should mean:

  • Insurers and providers should provide accurate, relevant price information, including what is and is not covered by insurance.
    • Some insurance carriers—for example, Aetna and UnitedHealthcare—provide online tools to help their members find estimates for hospital costs and medical procedures.
  • You should be able to obtain information about quality of care and patient experience for different providers.
  • Your clinical provider should include considerations of cost when advising you about undergoing certain procedures or treatments. These considerations should include costs of referrals to other providers and procedures not covered by insurance. After all, crushing debt due to unexpected medical expense can be toxic!
  • Do not presume that higher price means better quality of care. For a list of several resources that you can use to check on quality of care, go to the Commonwealth Fund’s Quality Matters Archive.

Ask Questions

Of course, if you are confronting an emergency, there is no time to ask questions. Otherwise, do not be surprised by your health care bill. Take charge. Ask questions. Assume responsibility for your financial as well as physical well-being.

The Healthcare Financial Management Association (HFMA) has prepared a complete and useful guide in plain language for you to learn what questions to ask and how to ask them: “Understanding Healthcare Prices: A Consumer Guide.” Click here to download the guide free of charge (also available in Spanish).

At Kathy’s Urgent Care, we try to be as transparent as possible about pricing, payment policies, and insurance. For more information, check out our Payment Policies and Insurance page, or call us. We’ll be glad to respond to any questions that you have.

6 Myths about Flu Shots

Many people refuse to get a flu shot because they believe one or more misconceptions floating around on the Internet. Don’t let any of these myths keep you from getting a flu shot!

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1. Flu shots don’t work.
While it is true that flu shots do not keep everyone from getting the flu, effectiveness of the vaccine is rated by the CDC at about 60%. The flu is caused by several different viruses, and it is not possible to produce vaccines for all of them. Further, flu viruses mutate or change often and rapidly, compounding the difficulty. Finally, the vaccine becomes effective 2-3 weeks after the flu shot is administered, and some people catch the flu before then.

One other point to remember is that the primary goal of the flu vaccination program is to prevent an epidemic or pandemic, not to prevent every case of the flu. After all, we do not want to repeat the pandemic of 1918 when approximately 500 million people were affected worldwide resulting in deaths of 20-40 million in one year—the greatest natural disaster in world history. Further, even a modest reduction in flu cases helps to lessen the number of deaths among the elderly, chronically ill, and children. Even if you get the flu, perhaps from a different strain of the virus, you will probably endure less severe symptoms after having the shot.

2. Pregnant women should not get a flu shot.
Some have claimed that flu shots cause miscarriages or other health problems for pregnant women. No scientifically valid study supports that claim. In fact, the flu vaccine can protect both the mother and the fetus—a very important point, since children under 6 months should not receive the vaccine after they are born.

3. I should wait until later in the season to get a flu shot.
Many people put off getting a flu shot because they want the vaccine to last for the entire flu season. Research shows, however, that the vaccine is effective up to a year later which is plenty of coverage for a flu season that lasts from fall until May. No one can predict when outbreaks of the flu will begin. That is why medical authorities recommend getting a flu shot as early as mid-September.

4. I don’t need to get a flu shot every year.
Unlike many other vaccines, the one for influenza is changed every year to counter different or mutated strains of the virus. What worked effectively one year might not work as well the next. Scientists are working on developing synthetic vaccines that could be developed into a universal flu vaccine that would protect against all or most strains and could be administered by means of one dose for life. Until they succeed, however, we will need to get a flu shot every year.

5. People who are allergic to eggs should not get a flu shot.
Although the most widely used flu vaccines are manufactured by a process that uses chicken eggs, the amount of material derived from eggs is miniscule. Therefore, the CDC recommends that the vaccine is generally safe for those who exhibit allergic reactions to eggs. Such persons who are allergic to eggs should consult with their health provider before receiving the vaccine.

In addition, processes, such as cell-based and recombinant technology, that do not use chicken eggs at all have been developed and approved. These forms of the flu vaccine have been approved for use under the name Flublok® and can be administered to adults 18 years of age and older.

6. A flu shot can give you the flu.
No, a flu shot cannot give you the flu. That’s because all forms of the vaccine contain inactive forms of the flu virus.

Because the vaccine is not fully effective for 2-3 weeks, however, some people might get the flu shortly after receiving the shot. That experience probably reinforces this particular myth.

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Bottom line: Get a flu shot this year!

For more information about flu shots, check out my previous post, Get Your Flu Shot Now! If you have questions, call us at Kathy’s Urgent Care.

Athoured by Dr. Tom Brown.