The Blood Pressure Basics

The Blood Pressure Basics

Hello everyone!! I hope you are having a great week!!  Today I would like to address a very common problem in Internal Medicine, Hypertension a.k.a., High Blood Pressure. 

What is Hypertension?

Hypertension puts a  strain on your arteries and heart, and can restrict blood flow to and from other body organs. This can lead to heart disease, stroke, kidney disease, and other problems. 

When your heart beats or contracts, it pushes blood through the arteries. This force creates pressure on the arteries. This is called systolic blood pressure ( The top number).  When your heart relaxes, between beats, the pressure in the arteries is called the diastolic blood pressure (The bottom number). 

What Do the Numbers Mean?

The answer here depends on which society guidelines you reference as there are some slight variations in terminology used.  For our purposes today we will call normal blood pressure 130/89 or less on average.  High blood pressure is 140/90 or higher.  There is some gray area about whether 130-140 is normal or pre-hypertension but suffice it to say that under 140/90 is generally safe.

Which is Better? Office Or Home Readings

Here at Bianco Primary Care, we rely heavily on what you get at home.  In the office, we check your blood pressure as a screening and if we find it to be high here, we will ask our patients to begin a home monitoring regimen.  There is a medical condition called “white coat hypertension” and home monitoring helps us know if the number in our office is real or just nerves.

Blood Pressure Machines Vs Manual Readings

Although we use the manual technique here in the office, most automated machines work very well.  If there is any doubt we have our patients bring their machine to the office and cross check them with a manual reading.  You can pick up a home monitoring device at almost any pharmacy or online.

Will I feel it when I have High Blood Pressure? 

There is a common misconception if you have high blood pressure you will experience symptoms such as nervousness, sweating, difficulty sleeping or feel flush. The truth is that high blood pressure is largely a symptomless condition. If you ignore your blood pressure because you think symptoms will alert you to the problem, you are taking a dangerous chance with your life. It’s always better to have it checked by your doctor at regular visits.   

How Is High Blood Pressure Treated?

Like with most things we treat we usually start with a thorough look at your lifestyle habits and work to make improvements in your nutrition and get you on a sensible exercise regimen. Medicines also play a role and are determined based on each individual’s specific circumstances.

I hope this helps clear a few things up about high blood pressure.  We are happy to talk with you about this topic in more detail.  We also have a Nutrition and Fitness expert on staff to help with the lifestyle changes that can help you achieve optimal blood pressure. 

Is it time for an affordable Primary Care Doctor who knows you and you can reach when you need them? In-office, text, phone, email – No insurance required.

What Do Cholesterol Numbers Mean?

What Do Cholesterol Numbers Mean?

Having your cholesterol checked is part of the standard annual labs that we all get every year. It gives important insight into your health. But what does it really mean?  What should my numbers be? Do I need to take cholesterol medicine?  I want to take a few minutes to talk about this lab test and dispel a few misconceptions about how to interpret it and what “good numbers” look like.

Total Cholesterol, HDL, LDL and Triglycerides

To start, let’s talk about the main markers used in a standard “lipid panel”.  Lipids are the fats or fatty substances in your blood. Lipids are measured and categorized as Total Cholesterol, HDL, LDL, and Triglycerides.  As the name implies, your Total Cholesterol is the combination of all your cholesterol both good and bad (HDL + LDL + 20% of Triglycerides).  HDL is your “good” cholesterol (think H for Healthy) and helps to clean your arteries.  LDL is your “bad” cholesterol (think L for Lousy) and is the primary lipid implicated in vascular disease (heart attacks and stroke).  Triglycerides are a measure of free fatty acids and are not as directly correlated to vascular disease but are affected by the amount of fried foods, processed foods, and alcohol we take into our bodies.

Undertsanding the Numbers

When you get your lab report in front of you, there are normal reference ranges listed, which vary slightly from lab to lab, but generally indicate the Total Cholesterol should be less than 200, HDL to be more than 40, LDL to be less than 130 (some labs list as low as 100) and Triglycerides less than 150.

The clinical application of the results, however, is not as simple as just looking at lab reference ranges.  One simple example is to say that your LDL is nice and low at 115 but your HDL is super high (a good thing) at 85.  Once you add in the 20% of Triglycerides you will easily be over 200, but only because your good cholesterol is so high.  In this case, a Total Cholesterol of over 200 is not a bad thing at all.

This becomes even more nuanced when discussing your LDL or bad cholesterol.  As long as your LDL is less than 190 (as the vast majority of us) then we have to look at your potential other risk factors for heart attack and stroke to guide whether you need medicine to lower your numbers.

Most of the other risk factors we control, at least to some extent, and include smoking, high blood pressure, and diabetes.  The one risk factor we cannot control is age.  The extent of your risk factors determines how aggressive we need to be in lowering your LDL or in deciding to leave it alone.  As we do here at Bianco Primary Care, your doctor may run a few advanced labs to assess cardiovascular disease risk.

This basic understanding of the numbers of a lipid panel will let you know how much and what kinds of fat you have in your blood. The good news is getting and keeping these numbers in the healthy range is often a matter of diet and exercise. But can also be controlled through a variety of low-cost medications.

Is it time for an affordable Primary Care Doctor who knows you and you can reach when you need them? In-office, text, phone, email – No insurance required.

What You Need To Know About Inflammation

What You Need To Know About Inflammation

Inflammation is a hot topic today and seems to show up everywhere when discussing health.  We are bombarded by advertisements that tell us to eat certain foods or take certain supplements to “reduce inflammation”, and all this information can be overwhelming.  In this post I want to share what you need to know about inflammation:  1) define what inflammation is, 2) explain where it comes from and 3) discuss why you should care about it in regard to having good health.

What Is Inflammation

Inflammation is the result of the body’s immune response or defense against injury, infection or allergy.  The first point to make here is that inflammation is a natural response.  The immune system causes increased blood flow to a certain area of the body or to the whole body depending on the offending agent.  This increased blood flow brings white blood cells and chemical toxins.  This is, of course, a good thing if you are sick and trying to fight off infection or if your body encounters are allergen. Thankfully, this type of circumstance is infrequent for the vast majority of us. 

Where Does Inflammation Come From 

Inflammation is a problem when it becomes a chronic condition outside of an infection or an allergic response.  This happens when our bodies are not healthy and is a reaction to the stress on our organs from being overweight, eating the wrong foods, having uncontrolled blood pressure or blood sugar, smoking, etc.  Notice I said overweight and not obese above.  You do not have to be “obese” (defined as BMI >30) to be inflamed.  If you have belly fat then you more than likely have inflammation.  This unnatural amount of inflammation can lead to more severe health problems.

Why You Should Care about Inflammation

As part of our patients’ annual screening labs we check a marker of inflammation called CRP-HS.  This test tells us the amount of inflammation you have in your body. If you have elevated levels then you are at risk for a host of diseases including heart attack and stroke and even a severe case of COVID-19. Yes CRP has been found to be a risk factor for more severe cases of the novel coronavirus.  This makes sense because we now know that COVID-19 causes damage and death through an overreaction of the immune system (inflammation) and not necessarily only the virus itself.

Knowing your level of inflammation through testing is an integral part of routine health maintenance and can help you know your risk of systemic disease.   This can then be used to assess what needs to be done to reduce your level of inflammation.  Particularly at this time, this is the best way to assess your possibility of having a more severe case of COVID versus a more mild case. 

Drs. Shelley & Michael Bianco

Get your inflammation assessed and strategies to reduce it today! We work with you to get and keep you healthy. Were here when you need us,  personalized care, and affordable plans 

Certified Nutrition Specialist and Fitness Trainer Joins Bianco Primary Care

Certified Nutrition Specialist and Fitness Trainer Joins Bianco Primary Care

In the effort to provide the best health care to its patients, Bianco Primary care has recently brought on board Kathryn Terry, a Certified Nutrition Specialist and Personal Trainer, to be the Bianco Primary Care Nutrition and Fitness Director. Proper nutrition and fitness are key components of treating the whole person so patients can get healthy and maintain optimal health. 

Recently, Bianco Primary Care Office Manager Eileen Smith interviewed our Nutrition and Fitness Director Kathryn Terry about her nutrition philosophies, reasons why she’s so excited to be a part of the practice and what patients can expect.


Eileen: Kathryn, we have so enjoyed having you as part of our practice for over a month now. What has you most excited about being part of the Bianco family?

Kathryn: Honestly Eileen, it is the ability to work with our patients by treating the whole person. By having their blood work prior to seeing them, and for some patients even years of bloodwork history- which is so valuable. I also have records of current medications/ past medications and diseases already notated, which helps save me time and gives me an idea of some factors affecting the patients’ metabolism before I even speak with them.

Eileen: How do patients benefit from seeing you in this primary care setting specifically?

Kathryn: Beyond having health history detailed, I now get to work hand in hand with their primary care doctor and work towards getting them off medications. We all get to take part in and see the lifestyle transformation that Dr. Shelley, Dr. Mike, and I all want them to have.

Eileen: Absolutely. Now, you said lifestyle transformation. What do you mean by that?

Kathryn: It means helping our patients achieve changes that will last. The framework we discuss and habit changes we build on are meant to be adaptable for the rest of the lifetime. Gone is the mentality of a 30 day fix when you’re feeling low, just to gain it all back after the holidays. Gone is the mentality of comparing yourself to “so and so’s” diet because you heard it worked for them last year. This is a lifestyle transformation that we work on together, and it is personal.

Eileen: Well that sounds different. So is there isn’t just one specific diet, that you have all your clients follow?

Kathryn: No, we step away from all the different “diets” that you see in the media and talk about a way of eating that is sustainable and works best for each client, in the present. Diets are not sustainable. Now I have seen plenty of people shed 10’s to even 100 lbs following a specific diet, but I have also seen them gain it back when life changed or when a roadblock was thrown in their way because they didn’t know how to eat when NOT following that diet. The lifestyle change that I will embark on with each client is designed to help them think and plan around these roadblocks.

Eileen: I really love how you just explained that. Can you share a little bit about the types of clients that you specialize in working with? Is it all weight loss?

Kathryn:Thank you, and sure! I actually work with a variety of clients. I have clients who are looking for weight loss yes, but I also have clients who are looking for weight/ muscle gain, and people in between. I’ve worked with many athletes in the past looking to fuel themselves appropriately for competition, and also helped the everyday mom planning for a family of 5 on little time and a limited budget. I truly have a wide range of experience in this field, and if anyone even has a question on if I could help them or not, please reach out!

Eileen: That sounds great, Kathryn. Now to my understanding you are also a personal trainer too right? Tell me about that part of your background.

Kathryn:Yes, I am a NASM Certified Personal Trainer and Corrective Exercise Specialist, inspired by my enjoyment of being physically active and sharing that passion with others. I decided to dive deeper into corrective exercise when I discovered through my experience that the injuries that so many people tolerate long-term and write-off for old age, simply are a result of moving incorrectly. This is where my “Type-A/ fix it” mindset plays as a strength, and allows me to see to the true root of someone’s problem. I then fix the pain or weakness through specific exercises, rather than non-immediate unnecessary surgery or medication.

Eileen: That sounds like a neat niche that some of our clients could really benefit from. Can you do any of that here at Bianco Primary Care without a gym?

Kathryn: This has been a tricky thing to figure out, if we are being honest. We have decided to offer three options for helping our members with their fitness. First is a simple workout routine. If someone would like guidance on what to do to help lose weight, gain muscle, train for a specific sport and/or gain endurance, or rehab a specific injury I can create a detailed plan month by month, to help take the guesswork out of their programming.

Eileen: So does that involve meeting with you in person at all?

Kathryn:Technically twice. It could be virtually nowadays, but I will meet with the member once to discuss their goals, talk about injury history, learn about what exercises equipment they have available, etc… Then we will meet once more to go over their plan I have created to make sure everything makes sense that I have included and the goals appear doable.

Eileen: Got it. So what do you offer beyond the workout design? Anything in person?

Kathryn: We do, we also offer virtual training for ½ hours and full hours, and in person training for full hours where I go to the client and train them in their home or at an outdoor space. This would be for those who need the extra guidance and accountability through the process of achieving their fitness goals.

Eileen: That sounds great Kathryn. The last thing I want to wrap up with is a question. There is so much conflicting information out on the internet from bloggers, influencers and coaches alike. If you had to tell our members one piece of advice to help them stay healthy, what would it be?

Kathryn: Wow, ah, honestly, it would be to not model your health journey after someone else’s. We all have so many different factors affecting our metabolism- things we can and can’t control- so why would you try to control your pieces to look like someone with a different genetic make-up, height, age, or even different gender than you? What research and time has told us is that a healthy diet, and physical activity leads to better overall mental and physical health. Here at Bianco Primary Care I hope to break down more walls of confusion and help each client personalize their long term, lifestyle plan.

Personalized Nutrition Plans
Personal Fitness Training

Is it time for an affordable Primary Care Doctor who knows you and you can reach when you need them? In-office, text, phone, email – No insurance required.

Am I “High Risk” For A Sever Case of COVID-19?

Am I “High Risk” For A Sever Case of COVID-19?

Those individuals that are at higher risk for worsened symptoms, complications or death are those that are age greater than 60 years, those with obesity, high inflammatory markers (CRP or ESR), heart disease, lung disease (including smokers), diabetes and high blood pressure. If you are in one of these groups then you should be extra careful.

What extra precautions should “High Risk” people take?

Be extra vigilant about washing your hands frequently when you are out in public, wear a mask if you will be indoors and unable to social distance, and avoid gatherings of more than ten people. From a long-term perspective, I must mention that those risk factors (outside of age) are usually reversible with lifestyle changes.

If you have one of the reversible conditions, let this be a wake-up call to the seriousness of not taking care of yourself properly. Do not continue to procrastinate making a change to improve your health. Now is the time!! 

If you would Like to learn more about the spread of COVID-19 and steps to avoid it, please read out article, “How Deadly is COVID-19 And How To Avoid Getting It”.

Are there medications I can take to Lessen the symptoms if I get COVID-19?

We do not have a specific treatment for COVID-19 but there are things we can do to help with symptom management and disease progression.  An option for the short term is the MMR vaccine. Yes, the vaccine for measles, mumps, and rubella could help to lessen the symptoms of COVID-19. Getting a vaccine activates two parts of our immune system.

One part of the immune response creates long-term specific immunity to the specific disease we are being vaccinated against (i.e. if we are ever exposed to Measles, our body will be prepared to fight it off with previously created antibodies).

The second immune response, however, is not specific but creates a generalized surge in our immune function that can be used to help stave off the inflammatory response to foreign invaders in our bodies.  It is this second part that stands to help fight against COVID by reducing the inflammatory response, which we have seen to be the issue in severe cases.

COVID produces a major inflammatory response in susceptible individuals, leading to severe complications and potentially death.  Here is some information on this cutting edge research: If you fall into the high-risk category, we can write you an order to get the vaccine at your pharmacy.

What About Hydroxychloroquine? 

While we do not have a specific treatment for COVID-19, there are things we can do to help with symptom management and disease progression.

For those of you in the high-risk category, I think there is compelling evidence that a combination of Hydroxychloroquine + Azithromycin + Zinc if started within 4-5 days of symptoms will lower your risk of death or debility.

We have created a protocol, so if you get sick let us know right away and we will get you tested and get you started, if appropriate.

A final word on this: this combination is not preventative and can be dangerous so please do not ask for or take these medicines unless you have confirmed COVID-19 infection and are in a high-risk category.




Now is the time to have an affordable Primary Care Doctor who knows you and you can reach when you need them? In-office, text, phone, email – No insurance required.