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.

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 

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: https://asm.org/Press-Releases/2020/MMR-Vaccine-Could-Protect-Against-the-Worst-Symptom. 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.

How Deadly is COVID-19 And How To Avoid Getting It

How Deadly is COVID-19 And How To Avoid Getting It

The good news here is that the virus is not very deadly from an epidemiological standpoint. The overall death rate (including asymptomatic patients) is certainly less than 1%. That means if you get this virus you have greater than 99% chance of surviving!! I will take those odds😀. A word of caution: that is an average rate and those in certain “high risk” groups have higher rates. The high-risk groups include age over 60, those with obesity, diabetes, high blood pressure, heart disease, lung disease and high inflammatory markers (CRP or sed rate). In those cases, the rate is around 1.4%.   

The best news is that COVID-19 is rarely affecting our children and even more rarely do they get severe illness or death and many times less frequently than with the flu.  Recent studies have also shown that children are not spreading the virus from themselves to adults.

For most healthy individuals, if infected, you can expect 3-5 days of feeling miserable (flu-like symptoms) followed by recovery.  Certainly, those who are at high-risk could develop more severe symptoms, require hospitalization and have post-infection complications or even death.  Know where you fall in the risk continuum and take the appropriate precautions.

If you want to know if you are high risk and what extra precautions you can take, please read our article ” Am I high risk for sever case of COVID-19″

Of course the best course of action is to avoid getting infected with COVID-19. Here I address the four primary questions patients ask in that regard.

1) Do masks stop the spread?

The answer here is it all depends. If used properly and it is a quality mask, it can offer some protection for the wearer. There is a lot of discussion on this in the media and governments as well as businesses are requiring masks to be worn. A mask can help but is far from the 100% shield people have thought. For more details including studies addressing the effectiveness of masks, please read our article “Do Masks Stop The Spread of COVID-19”.

2) Can an asymptomatic person spread the virus?

While there is not yet a definitive answer from current research, it seems asymptomatic people do not spread the virus. There is evidence that a pre-symptomatic individual does probably have enough virus replication to “pass it on” but less so than someone with overt symptoms.

A pre-symptomatic individual would be someone who is infected with the virus, but 1-2 days before symptoms appear.  To be infected by such individuals it would require close and extended contact.  I know it sounds like what I said is just semantics but there is a real difference between asymptomatic (been exposed and develop antibodies but never have symptoms at all) and pre-symptomatic (the 1-2 day period before you start having symptoms).

We know that with all infections, the more virus in your body the more contagious you are. The more virus you have the more symptoms you have as well. If you do not have symptoms then that means you have a low viral load (your body is fighting the virus effectively enough to keep its population low).

Because we have no way to tell the difference between asymptomatic, pre-symptomatic and healthy individuals, the best practice is to avoid close and extended contact with others outside your home.  Wash your hands frequently and avoid touching your face or eyes.  If you are in the high-risk group, wear a mask if you are unable to social distance.

3) Does the virus live on surfaces?

Viruses do not normally live on a surface long enough to be a vector for spread and this coronavirus does not seem to be any different. While technically you may be able to find some virus on a surface in the lab for many days, it is not clinically relevant as it weakens quickly and is therefore not potent enough to cause illness.

In college, we tested this theory in the lab and I so vividly remember this experiment. Our whole class of 20 or so students put a glove on and then formed a line to each take a turn touching the doorknob to the classroom that our professor had expertly coated with germs!! We then took our gloves back to our station and ran a culture of what was on the glove. The first 20 students who touched the doorknob found germs on their gloves. However, the amount of germs on the first glove was vastly more than on the 20th glove.

So while technically the germs were on all gloves, practically only the first few gloves carried enough of them to get someone else sick.  The longer the time period between contamination of the door to the transmission to the glove, the less likely transmission and infection would occur, as the virus is unable to live long outside the body. This is why frequent hand-washing or sanitizing is so important, you never know where you are in the line—number 1 or number 20!

In short, in order to get the virus from a surface someone would have had to very recently coughed or sneezed and then touched that surface (gas pump, shopping cart, door handle, etc) and then you have to come along shortly behind them, touch the surface, and then touch your mouth or nose or eyes. This reaffirms the need to keep your hands clean and don’t touch your face while in public spaces.

4) Do gloves help or should I just wash my hands?

I do not think gloves help at all and are far inferior to a good hand washing or use of sanitizer. Gloves will pick up the virus the same as your bare hands but since you can’t wash gloves they are the perfect way to get yourself sick if you don’t change them constantly.

You are much better off just being diligent in washing your hands frequently or bringing hand sanitizer with you and using it after leaving stores or pumping gas, as examples.  If you do decide to wear gloves, remove them before touching any other surface (your car door, steering wheel, car keys, cell phone, purse) and sanitize your hands.  If you do not remove, dispose then sanitize prior to touching something else, then you have just contaminated your personal property and negated any benefit you might have received from the gloves.

 

Of course isolation is the safest way to avoid contracting the coronavirus, but that is simply not very possible in the world we live. With the information provided here, you should be able to live a fairly normal life and avoid getting Covid-19.  

 

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.

Do Masks Work To Stop The Spread of COVID-19?

Do Masks Work To Stop The Spread of COVID-19?

How effective masks are against COVID-19? This question seems to be a major topic these days with a lot of “experts” touting the effectiveness of masks and most major stores now requiring their use. The answer to me is “it depends”.

The “evidence” in favor of mask-wearing is not direct and has mostly been taken from computer models (which have been mostly wrong since the beginning of this pandemic). In medicine, we make treatment decisions, use new medications, approve new devices, etc. only after we have evidence in the form of the gold standard Randomized Controlled Trials (RCTs). The only one to date on masks was done in 2015 and is linked here: https://bmjopen.bmj.com/content/5/4/e006577.

In summary, this trial compared medical masks to cloth masks in healthcare workers. It was a “good study” in that it used more than 1600 subjects in a variety of healthcare settings. The conclusion, as you can see from reading the study, is that cloth masks are problematic to say the least and even medical masks were not near perfect. The study found that masks, even medical-grade masks, are not effective at blocking the virus from the wearer.

The coronavirus is less than 0.125 microns in size. For reference, 1 micron is one-millionth of a meter or 1/25,000 of an inch.  A cross-section of a single strand of human hair is 50 microns and the human eye can only discern to about 40 microns.  Masks (including N95 respirator masks) are only able to filter out 0.30 micron particles.  So, rather than being like a brick wall, most masks are more like a colander or sieve.  Some particles will get filtered, but many will pass right through.

I also want to address the trend I am seeing and that is to talk about wearing a mask to protect others. I understand this is said on TV and the internet frequently, but it simply defies logic and is not true. Masks provide protection to the wearer, hence the term PPE, which stands for Personal Protective Equipment. Dr. Shelley and I have practiced extensively in hospital settings and taken care of highly contagious patients with infections that are spread by droplets and the only people in these settings that wear PPE are the healthcare workers and the caregivers, never the patients. If a mask protected others then we would have been employing that in the hospitals but we do not and never have. Multiple studies show that droplets are not contained by masks.

In addition, most people do not wear their masks properly and leave their nose or mouth partially exposed. Also, many people are re-wearing their masks.  To control the spread of germs, the mask and gloves are meant to be a temporary barrier that are disposed of after use.  If you are wearing a mask and gloves to prevent the virus from getting into your body, then presumably that virus is located on the exterior surfaces of the mask and gloves after a single-use. 

If you remove the mask and store it in your purse or car, you have now contaminated your hands and any other surface that mask has come into contact with.  If you go on to reuse that mask, you again are touching a contaminated surface and run the risk of transmitting those germs to yourself or others.  We have seen many people leave the store, remove their mask and shove it into their purse, thus contaminating the entire contents of their purse which they will later touch while not wearing gloves. 

We have also seen people wearing gloves, leave the store and get into the car without removing their gloves.  Now the door handle, steering wheel and anything else touched with gloved hands are contaminated.

 

BOTTOMLINE: Masks provide some protection for the wearer of the mask.  If you are in the high-risk group for contracting COVID19 or for complications from COVID19, then you should wear a mask anytime you will be indoors, around more than 10 people and cannot stay 6 feet or more apart from others. 

 

Just remember, not all masks are created equal and most cloth masks are not very effective filters.  If you choose to wear a mask, do not re-use masks without sanitizing them first.  After removing your mask and BEFORE touching anything else, sanitize your hands.  For healthy, low-risk individuals keeping your distance, avoiding large crowds and frequent hand washing are all great ways to keep you safe from infection.

 

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.

What are IgG antibodies? How does this Covid-19 antibody test work?

What are IgG antibodies? How does this Covid-19 antibody test work?

When our bodies see a foreign invader (coronavirus in this case), our immune system mounts an acute/immediate reaction through IgM antibodies to eradicate the problem. Once the infection is gone the IgM antibodies are no longer produced and do not linger in the blood.

The body does, however, produce memory cells in the form of IgG antibodies. These memory cells are found in your blood as soon as 7-10 days after an infection. They patrol your blood and have only one job: look for that specific infection (Covid19 in this case) in the blood and if found, facilitate a much quicker response to the known invader so that the invader is not able to gain footing and cause infection.

These IgG antibodies are specific to each infection encountered or each strain of virus, as in this case. Many viruses mutate or change frequently and therefore have different strains each new season which makes fighting them tough because our bodies do not have specific antibodies to these newer, mutated strains (think common cold which is also a coronavirus or the seasonal influenza virus).

This antibody test detects the presence of Covid19 IgG antibodies in your bloodstream.  The antibody test requires a simple blood draw.

The antibody test is a new test, is it reliable?  If I test positive, does it guarantee I will not get infected with Covid19 in the future?

  • Medical research on this virus has not explained enough about what having these antibodies means as far as immunity goes. There is already evidence that Covid19 has mutated and has different strains so having detectable antibodies does not necessarily mean you are immune to the virus. 
  • Several community based epidemiological studies have been done (more coming including one being done currently in Fulton and Dekalb counties) and have given us some good preliminary information. This data shows that up to 50 times more people have been exposed to Covid19 than are reflected in the data we have had previously. This means the death rate will hopefully be much lower and closer to the same as the flu. The bad news is that those same studies show that only 3% to 4% of us have been exposed at this point. That means if we tested our entire practice only around 15-20 of them will have antibodies. 

 

Bottom line:  Knowing you have antibodies does not necessarily mean you cannot get re-infected with the virus.  We worry that the knowledge of having antibodies will create a false sense of security. Information about this virus and it’s testing is too preliminary to make the conclusion of immunity based upon positive antibody testing.  Regardless of test results, we strongly encourage you to continue with social distancing and frequent hand-washing.

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.