Covid-19 Vaccines – Should I Get One

Covid-19 Vaccines – Should I Get One

Here we are over a year later and unfortunately, COVID is still a major topic of conversation.  It saddens me for all of us that we still must talk about and worry about this unique virus.  I know we are all sick of it (pun intended 😀 ).  I am sure we all hoped that by this point, it would be behind us, and yet here we stand.  Given that we are in the midst of another “wave” of infections, I thought it was a good time to talk about where we are with the virus and give you my opinion and recommendations on the COVID vaccines that are currently available.

Inconsistent Messaging

I will start with the current surge in cases.  I share your frustration in the ever-changing narrative of which targets we are tracking.  In the beginning we tracked the number of deaths from the virus.  Then we started to focus on hospitalizations.  Now, most sources are looking mainly at cases.  This shifting in information can be confusing, misleading and scary.  It is poor messaging like this that breeds confusion, cynicism and distrust.  I have heard it from many of you and have expressed it myself.  I have tried to stay consistent in my messaging and have therefore stuck with monitoring hospitalizations in our state to gauge not only the incidence of new cases, but the severity of those cases, as reflected by the need for inpatient care.  Georgia has a great website to track this here.  For effect I am including the graph as of today (August 18, 2021): 

You can see the biggest spike was at the beginning of the year in January 2021.  You will also note that we are rapidly heading back to that peak now.  Unfortunately, several of you have been included in this spike of hospitalizations.  I had originally hoped that many of us would be able to fly under the radar by limiting our exposure and being smart and safe when going about the business of daily living.  It has become clear that this is not going to be the case.  I think the unfortunate reality is that we are all going to be exposed to this virus and its spike protein in one way or another, whether through getting ill or getting the vaccine.  I just do not see any way around it.  As this virus continues to mutate and spread it is only a matter of time before you will be exposed to it.  My fear, similar to what many of you have expressed, is that the exposure will lead to severe illness.

Fortunately, recent data has shown that there is a way to limit the severity of illness.  There is so much controversy and fear surrounding this virus and you all know me well enough to know that a lecture about why everyone should get the vaccine, either by choice or by force, is not happening here.  I think such tactics have been highly detrimental to our ability to come together and act freely for ourselves armed with the proper information.  The messaging from our political and medical establishment on the pandemic has been poor from the very beginning.  Throw in the hyper-partisan nature of our politics these days and you have a recipe for the chaos and confusion we have been experiencing this last year and a half.


The Take-Away About Vaccines

All that being said, I want to be clear about our stance here at Bianco Primary Care on preventing COVID-19 infection and the use of the current vaccines.  COVID-19 is especially dangerous for those who are obese (as defined by a BMI>30), age 70 or older, have diabetes, hypertension, or other chronic cardiovascular or pulmonary disease.  If you fall into one or more of these categories, you should get a vaccination if you have not already had a true COVID illness.  This will greatly reduce your risk of severe illness, hospitalization, or death.  The numbers on this are abundantly clear at this point.  I know there are breakthrough cases with the vaccine (we have seen lots of them) but the numbers indicate that those cases are much milder than the cases in those without the vaccine.

For the rest of you who do not fall into these categories, your risk of serious illness is much lower but there is still risk.  Given that, you should consider the vaccine to protect yourself to the extent that you can if you have not already had COVID.  I know many of you are skeptical of the vaccine given how new it is and how quickly it was brought to market.  I have shared that skepticism as I do with any new therapeutic in medicine without robust data on safety and efficacy.  We all have our anecdotes about someone who had a bad side effect from the vaccine as well.  The numbers are telling a story now however, and that story is that the vaccines are preventing more serious illness and death and have shown to be safe. I have looked at the data on all three vaccines and do not see any evidence of any significant numbers of side effects, including blood clots, infertility, etc.  With any therapeutic, there will be those who have some side effects.  The question then is do the side effects outweigh the overall benefit.  In this case the current data suggests the benefits of the vaccine outweigh the risks of side effects.

In summary:

  • If you meet any of the following criteria: age greater than 70 years, have obesity, heart disease, lung disease, high blood pressure, or diabetes, and have not already had COVID, you should be vaccinated.
  • If you are considered low-risk are otherwise healthy and have not already had COVID19, we encourage you to strongly consider getting vaccinated to help mitigate your risk of severe illness.

Our desire is always to do everything we can to keep you healthy.  We strive to do that in an open and honest way, giving you the best information we have, and allowing you to make the decisions that you deem to be best for you and your family.  We hope this article helps you in your quest for optimal health and for you to be your best self!!

 A Final Note

 As noted above the best protection against COVID and any other disease is to have healthy nutrition and fitness habits.  This has been lost in the arguments over masks and vaccines and social distancing, but it remains the best thing you can do for your health in the short and long term.  If you have not already started to build better habits, then I urge you to embark immediately.  We have a wonderful resource in our office with our Nutrition and Fitness expert, Kathryn Terry. She is fantastic and takes a personal approach to find the things that fit your lifestyle and family culture that can get you on the right track.  We have even created new membership options that include sessions with Kathryn to make it as easy as possible for you to take advantage of her expertise.  I encourage you to call the office (678-254-2333) or use our contact us form to set up a complimentary “meet the nutritionist” appointment.

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

Should I Exercise with Covid?

Should I Exercise with Covid?

It is hard to believe that we have suffered through an entire year of this COVID-19 pandemic, yet here we are.  Things are improving of course as numbers are down and continue to decline.  The good news about hitting the year mark is that we now know a lot more about the virus and its impacts on health and who is most susceptible to more severe illness.

We have had several questions surrounding COVID-19 and physical activity so I thought this would be a good way to address this issue.  I would like to divide our topic today into 2 categories: 1) Fitness and exercise prior to COVID infection and 2) Exercise after having COVID infection.

Will Exercise Help Prevent COVID-19?

Let’s start with physical fitness and its effects on health, in particular as it relates to COVID-19 infection.  It turns out that the more physically fit and active you are prior to contracting COVID, the less likely you are to suffer from more severe disease or require hospitalization.  I think we could argue that this just makes sense as we know this about fitness and any disease but nevertheless, there is some data that now confirms this.  Here is one example:

“ Although the clinical course of COVID-19 illness varies among athletes, (just as it does among non-athletes), on average, physical fitness appears to mitigate the severity of COVID-19 illness. As an example, in a retrospective study of 246 patients (59±12 years, 42 percent male, 75 percent Black) diagnosed with severe acute respiratory syndrome secondary to COVID-19 illness, hospitalization was found to be inversely related to aerobic fitness [4]. Baseline fitness in peak metabolic equivalents, based on exercise stress testing results obtained within the prior four years, were significantly lower among patients who were hospitalized (6.7±2.8) compared with those not hospitalized (8±2.4) (unadjusted odds ratio [OR] 0.83; 95% CI 0.74-0.92; OR adjusted for major risk factors 0.87; 95% CI 0.76-0.99).”  Source : 

The practical application here is that if you have not had COVID and are looking for things that you can do to mitigate your risk, look no further than an exercise regimen.  Things are more complicated with the pandemic and less access to gyms but that does not mean we should be sedentary. 

Spring is here with warmer temperatures and more sunshine so getting outside should be a given for all of us.  Walking or jogging daily will improve your fitness and well-being.  I will throw in that it will also increase your Vitamin D levels which have also been shown to be inversely related to COVID-19 severity. 

You should also mix in some weight training regularly which you can do at home with little to no equipment or at your local gym. If you need some guidance with that please consult a nutrition and fitness expert.

Should I Exercise with COVID-19?

Turning our attention to exercise after COVID-19 infection I will try to answer the questions of when and how much.  This advice, like that above, is also pretty intuitive.  The research we have points to being able to return to exercise after a week of recovery from symptoms. You want to give your body the time to heal before doing anything too intense or strenuous.

That being said if your symptoms are mild you can certainly get outside and go for a short walk.  Once you have given your body time to rest and recover you should ease yourself back into a routine.  You should expect that you will not be able to go back 100% right away and this is normal and natural and not a cause for concern.

“A concern among recreational and elite athletes during the COVID-19 pandemic is the impact of detraining. Several studies report that community lockdowns to prevent viral spread have had adverse effects on physical fitness. As an example, a retrospective study of Spanish students enrolled in 16 universities, and involving a total of 13,754 valid survey responses, described reduced moderate (-29.5 percent) and vigorous (-18.3 percent) physical activity during confinement and increased sedentary time (+52.7 percent) [9]. Multiple small, observational cohort studies report comparable declines in fitness among adolescents [10-13]. A small case-control study of children reported a substantial decline in the mean maximum oxygen uptake in a post-COVID-19 cohort compared with pre-pandemic controls (39.1 versus 44.7) [10]. Detraining is an important consideration for clinicians to address when providing guidance about return to play [14].”  Source: 

Listen to your body and try to find that balance of pushing hard enough to produce results without pushing too hard to produce injury.  If you are having chest pain or severe shortness of breath you should stop and seek a medical evaluation.  For the majority of you, I expect you to be back to your pre-COVID workouts within a few weeks of recovery.

I hope this helps clarify any questions you may have about COVID and exercise.  As always, if you want to learn more or be evaluated for your personal and individual situation reach out to us for an appointment.

If you are looking for more specific guidance on healthy habits, nutrition or a training regimen let us know and Kathryn Terry, Bianco Primary Care’s  Director of  Nutrition and Fitness will be happy to help you achieve your health and fitness goals.

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

Can Simple Healthy Lifestyle Changes Be The Cure?

Can Simple Healthy Lifestyle Changes Be The Cure?

One of the unique things about having a Direct Primary Care practice is the time it allows me to spend with patients and the feedback I get from them.  I also do a “meet the doc” appointment for potential patients to interview me and ask the questions that are important to them when it comes to finding a doctor.

The vast majority of patients are not interested in taking medications and make it very clear that they want to use them only as a last resort.  We all seem to inherently know that it is better to eat well, have a healthy weight, and exercise regularly.  And this is absolutely true!  I want to emphasize the importance of a healthy lifestyle and show that the benefits of getting those three things mentioned above far outweigh the benefits of taking medicine.

The American lifestye is not so healthy

Upwards of 85-90% of what is treated in a primary care office is lifestyle-related. Over 73% of Americans are overweight!!  That is just a staggering number.  It is not hard to see why that is the case.  First, technological advancements have made our lives more comfortable and effortless, and this is not necessarily a good thing.  The level of activity in an average day for a typical American is very low.  As an example of this, I would ask all of you with a watch that tracks your step how many you see on average.  I am willing to bet it is less than 10,000 and for many, it is less than 7,500.  Think about our ancestors from even 1 or 2 generations ago and about the amount of physical work they did in a day and we will quickly see why obesity is so prevalent.

The second factor of course is the advent of processed food and the increase in portion sizes.  We eat fairly high-calorie diets, especially for a population that is not doing much physical labor.  The end result of less activity and more calories is weight gain.  The end result of weight gain is inflammation, high blood pressure, high blood sugars, heart disease, stroke, arthritis, and more. All diseases most people take medications for that can have side effects and cost money!

Are medications the cure?

Considering the American lifestyle,  it is easy to see that in most cases medicine is just a band-aid to cover the underlying problem.  They can certainly help to make the measurables, like in blood tests or on scales better, but they are not getting to the root of the problem.  In contrast, getting your lifestyle in order improves the measurables and also eliminates the underlying condition making medicine unnecessary.

There is a large body of evidence that points to the benefits of losing even just 5% of your body weight with the benefits being dose-dependent, that is, the more weight you lose the better the measurables. Notice this is the first time I mentioned losing weight as a goal here as I do not want to focus too much on “going on a diet”.   I want to be clear that health and fitness entail making simple daily lifestyle changes that are steady and sustainable in the long term. The goal is not to lose weight quickly but to slowly and surely make small daily changes that become a healthy lifestyle of a balanced combination of good nutrition and sufficient physical activity.

If you think you are ready to make the changes and shed your medications or feelings of fatigue or a few extra pounds let us know and we will be ready to help.  We excited to help you be your healthiest and fittest self.  Set up an appointment to see me and to meet with our nutrition and fitness director, Kathryn, to get on the right path.

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

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.