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.

Get Your Flu Shot Now!

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Intro – Get a Flu Shot!

Flu season looms! Get your flu shot before the end of October to protect yourself and others throughout the season that can last until next May. If you don’t have time to read the rest of this blog post, STOP READING! Just go get your flu shot. Kathy’s Urgent Care in Wethersfield and Rocky Hill, CT. No appointment necessary.

Who Should Get a Flu Shot?

According to the Centers for Disease Control and Prevention (CDC), everyone over the age of 6 months should get a flu shot.

·      Pregnant women are especially at risk and should be vaccinated. The flu vaccine also protects their unborn fetus from the flu—an especially important consideration, since children younger than 6 months should not receive a flu shot.

o   The American Congress of Obstetricians and Gynecologists (ACOG) stated in September, “Influenza vaccination is an essential element of prenatal care because pregnant women are at an increased risk of serious illness and mortality due to influenza. In addition, maternal vaccination is the most effective strategy to protect newborns because the vaccine is not approved for use in infants younger than six months.”

·      Children from 6 months to 18 years of age should get a flu shot. Children who receive their first vaccination will require two shots, 28 days apart. The CDC recommends against receiving a nasal spray vaccination.

·      Persons 65 years of age and older usually have weaker immune systems and should get a high-dose shot that protects against 4 strains of flu virus. They should also get a pneumococcal vaccination to protect against serious strains of pneumonia, since the elderly account for 85% of deaths due to flu and complications from pneumonia.

·      Anyone with a compromised immune system is especially at risk for the flu and should be vaccinated.

Note: Persons who are allergic to any component of the vaccine (for example, eggs), who had a severe allergic reaction to the vaccine in the past, who have had Guillain-Barré Syndrome (also called GBS), or who are not feeling well should discuss with their health provider whether they should receive the flu vaccine or what type of vaccine might be appropriate for them.

When Should You Get a Flu Shot?

For the 2017-18 flu season, the answer is simple: NOW! It is impossible to predict just when a flu epidemic will begin, but there will be one and it is likely to be severe. The vaccine takes 2-3 weeks to become effective. Therefore, the CDC recommends getting your flu shot before the end of October.

What Kind of Flu Shot Should You Get?

There are different types of flu vaccines that have been approved by the FDA for general use. To keep things simple, you should be aware of two main alternatives:

·      Most children and adults can get a trivalent shot—one that protects against three major flu viruses.

·      Persons 65 and older should get a high-dose, quadrivalent shot—one that protects against an additional flu virus strain and in a higher dose because of their declining immune system.

For more complete answers to this question, please consult the “Frequently Asked Questions” page on the CDC website.

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What Are the Side Effects of a Flu Shot?

You cannot get the flu from the flu vaccine. Some people, however, might experience mild side effects that include soreness, redness, or swelling at the injection site. About 1-2% of those receiving a flu shot will experience a low-grade fever.

Rarely, more serious side effects result from an allergic reaction to one of the ingredients in the vaccine. Symptoms can include difficulty breathing, swelling around the eyes or lips, hives, racing heart, dizziness and high fever. If you develop any of these symptoms, seek medical attention.

Remember, you cannot get the flu from a flu shot. Because the vaccine takes 2-3 weeks to become effective, however, you can get the flu after you have had a flu shot. Further, since the vaccine is not effective against all strains of the flu, you can still get the flu from a strain against which you are not immunized. In those cases, your experience of the flu will probably be milder.

More about other questions will appear in a later post. If you have concerns about yourself or a family member getting a flu shot, call us at Kathy’s Urgent Care. We’re here to help.

Authored by Dr. Tom Brown

6 Ways to Cope with Fall Seasonal Allergies

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Along with colorful autumn leaves, fall brings sneezes and runny eyes to many of us. For some, fall allergies are more bothersome than spring allergies. The primary culprits causing fall allergies are pollen, molds, and dust mites. But don’t just suffer! There are steps you can take to minimize allergic reactions.

What Causes Fall Allergies

Ragweed pollen causes more allergic reactions than anything else during fall months. (These reactions are often called “hay fever” despite their having nothing to do with hay and do not cause a fever.) If you are allergic to pollen during the spring, you have about a 75% chance of also reacting to ragweed. During warm days and cool nights in August through October, wind scatters the pollen nearly everywhere in North America. Pollen levels peak around midday and especially during warm, dry weather. Although rain removes the pollen from the air, dry winds can spread it for hundreds of miles.

Inhaling ragweed pollen can result in allergic rhinitis—a condition that produces runny nose and eyes and causes sneezing. Some symptoms resemble those of a cold. The pollen can also be ingested when certain foods are eaten raw. Bananas, melons, cucumbers, zucchini, beans, celery, and some fruits often carry ragweed pollen. Cooking usually removes the problem, but not always. Orally ingested pollen can result in swollen mouth and throats as well as, rarely, vomiting, diarrhea, or even anaphylactic shock.

Molds are another major trigger of fall allergies. Most of us are aware that molds grow in warm, damp places in our homes. But during the fall, those piles of autumn leaves that kids like to jump in are usually filled with mold spores. The spores can be kicked up by autumn winds or by raking. Even walking through the woods or a park where leaves have fallen can expose you to mold spores. Symptoms resemble those caused by ragweed and can sometimes be severe.

Dust mites present a third fall allergy trigger. They are too small to see without a microscope and are difficult to control. Although they live and are active year-round, turning on our heating systems in the fall forces dust and the residue from the mites into the air. Since dust mites feed on the dead scales of human skin, we encounter them most often in bedding, carpeting, and upholstered furniture. Symptoms, again, resemble those produced by ragweed.

Allergy or Cold?

Many of us have trouble determining whether we’re suffering from a cold or an allergic reaction, especially since some of the symptoms are similar. Remember, though, that allergies are caused by allergens—substances that trigger an autoimmune response in our bodies—while colds are caused by viruses. The following chart can help you distinguish them.

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What You Can Do

To prevent allergic reactions and to treat symptoms, try the following:

1.     Reduce exposure to ragweed and other pollens. If possible, keep windows closed and remain indoors. Use air conditioning to filter the air and change or clean filters monthly. Be especially careful on dry, windy days.

2.     If you are allergic to molds, avoid raking leaves. If you must rake or blow leaves, wear a NIOSH-rated N95mask. Also avoid walking in the woods or other places where leaves have fallen.

3.     Control the presence of dust mites.

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

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

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

d.     Remove as much upholstered furniture as possible.

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

f.      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 will 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.

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

Remember also that children returning to school in the fall often encounter high levels of allergens. School buildings that have been unused during summer months are usually filled with dust and mites—major allergy triggers. Be sure to monitor your children’s health during these months.

Managing fall 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.

Authored by Dr. Tom Brown

Don't Eat the Potato Salad

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Don’t eat the potato salad . . . unless you know it’s safe! The end of summer, Labor Day outings, final days at the beach—all occasions for cookouts, picnics, and beach parties with family and friends. Unfortunately, they are also occasions for getting a stomach bug from improperly handled or stored food.

To keep yourself and others from getting sick, take a few moments to review what causes “food poisoning” and some food safety tips.

Foodborne Illnesses

The following organisms commonly cause foodborne illness or “food poisoning”:

  • Norovirus. Many persons have never heard of this virus, but it affects over 5 million people per year. It leads to inflamed stomach and intestines and results in stomach pain, nausea, vomiting, and diarrhea. Proper hygiene after using the toilet or changing diapers and safe food handling will prevent most infections.
  • Salmonella. This bacterial infection causes abdominal cramps, diarrhea, and fever, usually within 12-72 hours. Most people recover without medical treatment, but sometimes severe diarrhea requires treatment or hospitalization. If the infection spreads, it can cause death. Very young, elderly, and immune-compromised persons are most at risk for severe infection.
  • Clostridium perfringrens. This bacterium causes about 1 million infections per year. Diarrhea occurs 6-24 hours after infection, but usually without vomiting or fever. Symptoms last about 24 hours, and most people recover without medical treatment. Very young or elderly persons can experience more severe symptoms that require treatment.
  • Campylobacter. This bacterium causes diarrhea (sometimes bloody), abdominal cramping, and fever 2-5 days after exposure. Symptoms last 1-2 weeks. If infection spreads to the bloodstream, usually in immune-compromised persons, it can become life-threatening.
  • Staphylococcal aureus. The staphylococcal bacterium produces toxins that cause vomiting, nausea, abdominal cramping, and diarrhea within 30 minutes to 6 hours of exposure. Since the toxins are resistant to heat and salt, they can survive cooking. Infections typically occur in foods that people handle but do not cook (sliced meat, puddings, pastries, and sandwiches). Contaminated food does not smell or look spoiled.
  • Escherichia coli (E. coli). Most E. coli bacteria are harmless or even beneficial, but some cause diarrhea (sometimes bloody), abdominal cramping, vomiting, urinary tract and other infections. While most infected persons get better in 5-7 days, some strains of E. coli cause a life-threatening condition that requires medical attention. If you have diarrhea that lasts for more than 3 days or is accompanied by high fever, blood in the stool, or so much vomiting that you cannot keep liquids down and you pass very little urine, go to an urgent care clinic or other health care provider.
  • Listeria monocytogenes. This bacterium causes a serious infection, Listeriosis, that is especially dangerous for pregnant women and persons over 65. Although there are only about 1,600 cases per year, the mortality rate for those infected is about 16%. Foods most at risk for contamination include unpasteurized dairy products (especially soft cheeses), raw sprouts, and melons. Persons at high risk should probably avoid these foods.

Most of the time, foodborne illnesses will not require medical attention. But young children, elderly persons, and anyone whose immune system is compromised can develop more severe infections and symptoms that can become life-threatening.

Basic Food Safety

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Clean, Separate, Cook, Chill. This should be the mantra of every person who handles, prepares, and cooks food. Heed these four rules and you will eliminate nearly all foodborne illnesses from your life. It’s really that simple.

Still, a few specific tips will make safe food handling easier and more effective.

Potato Salad, Eggs, and Dairy

While potato salad serves as a primary example, other salads that include mayonnaise, eggs, and dairy products need special attention.

  • Keep prepared salads cold—that means 40ºF or cooler—in the refrigerator or ice chest until they are served.
  • No more than 2 hours (1 hour if surrounding temperature is 90º or higher) after serving, these foods should be chilled again. Remember, many bacteria thrive in warm, moist environments.
  • Even better, place serving dishes or pans for these foods on a bed of ice while they sit out.
  • If these dishes sit out more than 1 or 2 hours (see above), throw the food out! Better safe than sorry!
  • Rinse all produce under running tap water before using or packing it in a cooler.

Chicken, Beef, Pork, and Seafood

Favorites for outside grilling, raw meats require special handling.

  • Use separate cutting boards for animal products only, and wash these surfaces often with warm, soapy water.
  • When handling raw meats, wear disposable, vinyl gloves that you discard before touching other surfaces, utensils, or food.
  • If gloves are not available, wash your hands thoroughly (at least 20 seconds) before and after handling raw meat.
  • Marinate meats safely in the refrigerator. If you want to use some of the marinade as a sauce, reserve a portion ahead of time and separate from raw meat. Never reuse marinade that has been in contact with raw meat.
  • Cook food thoroughly (see chart), and use a meat thermometer to check (you can’t always tell by looking).
  • Keep cooked meats hot while serving. As with cold foods, do not let cooked meats sit out more than 1-2 hours.
  • Never use platters, dishes, or utensils that have touched raw meats to serve food after cooking unless such items have been thoroughly washed. Not heeding this rule is a major cause of cross-contamination and illness.


Cleanliness and Storage

Keeping yourself, dishes, utensils, and preparation surfaces clean, while storing food properly, will prevent most foodborne illness.

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  • Wash your hands for at least 20 seconds in warm, soapy water and before, during, and after handling food. Handwashing after handling raw meat, but before touching other food, utensils, or surfaces, is especially important.
  • Similarly, clean food preparation surfaces—countertops, cutting boards, refrigerator shelves—often. Be especially careful to avoid cross-contamination from raw meats on such surfaces.
  • A consensus seems to be building to avoid antibacterial soaps. There is little evidence that they help prevent bacterial infection, and some evidence that they might contribute to antibacterial resistance.
  • Use separate cutting boards and other surfaces to prepare raw meats and keep them separated from surfaces on which fruits and vegetables are prepared.
  • Consider using disposable paper towels for cleaning food preparation surfaces instead of sponges that can harbor nasty bacteria. If you use sponges, keep them as clean as possible and toss them in the trash often.
  • Also consider using disposable vinyl gloves for handling raw meat. Toss them in the trash before touching other utensils, surfaces, or food.
  • Store raw meats in leak-proof containers and separate from vegetables and fruits.
  • Store fruits, vegetables, meats, eggs, and dairy products properly, usually at 40ºF or lower. (Yes, eggs in the U.S. should be refrigerated.)
  • Do not thaw meat on the counter. Meat should be thawed in the refrigerator or, more quickly, in a microwave oven (follow instructions). If left on the counter to thaw, raw meat quickly becomes a site for bacterial growth.

Be safe this Labor Day and on other occasions when you cook out! Your family will thank you for being fussy about food safety. If, despite your best precautions, you or others become ill, monitor the symptoms. If diarrhea is severe and long-lasting or if vomiting prevents ingestion of fluids, seek medical attention.

And remember, we at Kathy’s Urgent Care are here to help. If you live or work near one of our two convenient locations, just walk in. We’re open 7 days and evenings every week.

Authored by Dr. Brown. 

About Those Sports Physicals

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If you are a parent of a student who wants to play or try out for school sports, you need to be aware of required health screenings and physical examinations. Most schools require all participants or would-be participants in any form of sports activity to submit the results of a pre-participation physical examination. This must be done every year.

The State of Connecticut is no exception. The Connecticut Interscholastic Athletic Conference (CIAC) requires completion of their Pre-Participation Physical Evaluation form by the student, his or her parent(s)/guardian, and a licensed physician.

The Pre-Participation Physical Evaluation

The physical evaluation consists of four major parts.

History

The student, with the help of his or her parent(s)/guardian, should complete this section prior to taking the form to a physician. Questions focus on the following general areas:

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  • General health history
  • Heart health questions about the student and family
  • Bone and joint questions
  • Specific medical questions

If any question is answered “Yes,” an explanation must be provided on the form or a separate sheet. Circle any question that you cannot answer so that you can discuss it with the physician.

Supplemental History for Athlete with Special Needs

This section provides an opportunity to identify any disabilities, visual or hearing impairment, allergies, use of special equipment, etc. There is also a section that allows identification of any past physical or medical difficulties.

Physical Examination Form

This section is completed only by the examining physician. It addresses the following areas:

  • Questions about mental and physical well being
  • Use of tobacco, alcohol, and drugs
  • Medical examination of vital signs, musculoskeletal condition, and general fitness

The bottom of the form asks the physician to clear the student for all sports without restriction or without restriction but with recommendation for further evaluation or treatment. The physician may also withhold clearance for all sports, some sports, or in order to evaluate further.

The original copy of this form is retained in the physician’s office and can be amended at any time.

Clearance Form

The clearance form summarizes the conclusions of the physician regarding whether the student is cleared for all, some, or no sports activity. There is also a section to identify allergies and other emergency information.

Important Reminder: Submitting a Pre-Participation Physical Evaluation form for sports activity does not fulfill the requirement of submitting a regular Health Assessment Record as required by your school. Be sure to check with your school for specific policies.

Having a Pre-Participation Exam

Many families ask their regular physician or pediatrician to complete this examination. During the crush of back-to-school activities each year, obtaining an appointment in time is often not possible. In that case, or if you do not have a regular health care provider, go to an urgent care center.

When you go for your exam, please observe the following steps:

  • Download, print, and fill out your portion of the Pre-Participation Physical Evaluation form.
  • Reserve an examination time at the clinic if possible.
  • Bring your completed form with you.
  • Bring your student’s health insurance information and ID.
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If you live near one of our clinics in Wethersfield or Rocky Hill, CT, come to Kathy’s Urgent Care. We perform many of these examinations every year, and we can help you with any questions that you might have. We also treat minor sports injuries.

Authored by Dr. Tom Brown

Our clinics are open 7 days a week. Just call to reserve a time or walk in at your convenience. Our contact information is available on our website at www.kathysurgentcare.com.

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