End of Year Thoughts

As we wind down 2014 and look forward to the new year, a few thoughts come to mind. It has been a good year for me personally and for the our family medicine practice. Health care is changing and our practice and the people that work here are changing to adapt to it. We have been a Patient Centered Medical Home Practice for over 5 years now. We attested for Meaningful Use Certification for our second time. We have begun the transition to ICD-10 coding/billing readiness and are on-track for the October 1st 2015 deadline. We have done our PQRS reporting for Medicare for a second year as well. The affordable Care Act (aka Obamacare) has arrived and the walls are still standing... What the heck does all of that mean???

It means the practice of medicine has become more centralized. No longer can we function as an island of health care, disconnected from the hospitals and the insurance payers. No longer can you be an island of your own. It means your health is being monitored by other people so that we, as a population, can live longer, healthier, more productive lives. There is a sacrifice to be made. You are not just an individual who can take or leave health care. It means you are part of a greater whole. You are helping to take care of other people you will probably never meet...and they are taking care of you and your family too. You were paying for their health care long before Obamacare, you just didn't know it.  By not smoking and getting your vaccinations and eating healthy and getting out to exercise, you are not only helping yourself, but others. Policies are being made that will make it possible for generations of Americans to have basic health care and I think it's, overall, a good thing...but it means change, and that can be a little stressful. My word of advice for 2015 is, RELAX, because I'll bet there will be a 2016 too.

Happy Healthy New Year!
-Dr. Ronan and staff
www.lakelansingfamilypractice.com

Healthy Habits for Weight Loss Program

I'm very excited about our Healthy Habits For Weight Loss Program at Lake Lansing Family Practice. We are in week 2 of a 22 week program designed around Dr. Wayne Andersen's concepts for healthy living and weight loss www.drwayneandersen.com
This is our first group medical visit utilizing a team approach to address the health hazards of obesity within our practice. So often diet, exercise, and weight are mentioned as an afterthought when treating Diabetes or Heart Disease or even Arthritis, but rarely do we discuss it as the primary reason for an office visit. Our program utilizes a team approach which includes a Registered Dietitian, Nurse Practitioner/Program Director, Physician Medical Director, Health Coach, and Personal Trainer/Group Fitness Instructor. Initially meals are planned through MediFast www.lakelansingfamilypractice.tsfl.com but meal plans can be custom designed for each patient in attendance according to their fitness goals and nutritional needs. We had 14 people attend tonight and I hope we can keep the momentum up through all 22 weeks and beyond.
Nice job tonight Team!

Optimal Health

We will be offering our patients a 22 week program focused on weight loss starting in 3 weeks. Often times weight is discussed as an afterthought or in addition to and acute problem or multiple other chronic disease processes that we are trying to manage. I find that the weight and how it got to where it is now is the underlying problem leading to most of the other complaints during the visits.  We have decided to make weight its' own health topic and not lump it in with the Diabetes or the Hypertension or the Coronary Heart Disease or the Hip, Back and Knee pain.  The habits that led to the weight gain is what led to the acceleration of all of those other problems. Addressing them won't fix the weight.
Health is dependent on many things, some we can control and others we cannot.  We can choose to smoke or not smoke. We can choose the food we consume. We can choose to be active or not. You can't do much about age and genetics, but Lifestyle we can control.
The core foundation of our program is based on Dr. Wayne Scott Anderson's book, Discover Your Optimum Health.  It is a "guide to taking control of your weight, your vitality, your life."
22 weeks seems like a long path, but I'll bet that after doing something consistently for 22 weeks you will build habits that should last a lifetime.www.lakelansingfamilypractice.tsfl.com

Are you there yet?...hopefully, you have a long road ahead of you.

-Dr.Ronan

Check That Filter!

I noticed my furnace blower was a little noisy this morning while I was working out, so I turned off the blower and yanked out the air filter and... it was due for a change. With 2 dogs in our house we seem to need to replace these every month or two. I think not replacing these filters has led to a burned our motor at least twice for our household over the past 12 years. I usually buy about 3-4 at a time when I'm at Home Depot or the hardware store. Make it a routine to check these at home and at work (we have 4 furnaces at my office), so you don't go without heat or air conditioning this year.

Pet Therapy

This is my dog Max. He was in the clinic today due to family travel plans. One of my staff volunteered to take care of him and our other dog Josie over the weekend. My wife was coming in to pick him up at lunch time, so Max got to make patient rounds with me this morning. He's a pretty docile 13 year old dog who is very familiar with the clinic, unlike my younger lab/retreiver mix, who is a bit of a loose cannon. He kind of just follows me around and lays down in each room I visit. I always ask if patients are ok with a dog in the room before entering and if they prefer no dog, I park him outside the door. He likes to hit the pharmaceutical reps up for pats on the head and the occassional snack if they have any edibles. On vacation, I often miss bringing the dogs, since they are so much a part of our morning and evening routines. I think pets help kids learn how to care about other things besides themselves and to be responsible. I think being a dog owner has made me a better doctor in some ways. It is hard to watch him get old.
As Max says: drink plenty of water, walk a lot and get plenty of rest.

Food For Thought

Food For Thought  after the Holidays-

Well,we are just coming off the longest eating stetch of the year and I’ve noticed the gym is packed each night with post holiday New Years resolutionaries. I’ve talked to several dieticians and nutritionists over the years and the secret to losing weight is not in the exercise you do, but in the amount of food you eat. The ratio is 80 diet and 20% exercise. You will not exercise your weight off nearly as easily as you will calorie restrict your weight off.

That being said, I like to eat. I also like a good beer (good beer, not a lot of beer). We have always enjoyed good food and drink at family functions over the years, but I’ve noticed that a few tricks help keep the bulge off the holidays.

There is no magic food. All food contains calories. When you eat more calories than you need, you gain weight. When you eat fewer calories than you need, you lose weight. In order to lose a lot of weight, you need to consistently eat fewer calories than you need EVERY DAY for an extended period of time. You are what you ate last month/year.  Healthy weight loss is about 1-2 lbs per week. So, if you want to lose 30lbs, at 1lbs. per week, it’s going to take you 30 weeks or about 6 months. The good news is that this long period of time should do something transformative to you. It should nearly permanently change your eating habits so that you are not “dieting” anymore, you are just eating the way you eat to maintain a healthy weight.  The holiday eating is an exception, not how you live and eat normally. The other 48-50 weeks of the year is what you really are.

I don’t particularly like tofu, fish, wheat grass or cod liver oil, but there are plenty of lean healthy foods that I do like that I enjoy every day, and I keep my weight pretty well in check most of the time.

The book series, Eat This, Not That and Cook This, Not Than by David Zinczenko and Matt Goulding are great resources. I also like Clean Eating Magazine and refer people to their web site for affordable, delicious, low calorie-dense food.

Have some strawberries dipped in dark baking chocolate (South Beach Diet recommended) and enjoy a massage or pedicure instead of cheesecake. Go for a walk on a nice day. Watch a sports event while on a piece of home exercise equipment instead of the couch and try to drink one water for every beer or glass of wine you consume.

Don't do what you want to do in this cold...stay in!

With temperatures at -19 Fahrenheit this morning and a windchill at -33 F, it was downright painful to walk across the parking lot this morning. Over 15 inches of snow fell in our area over the past 2 days making driving difficult. My wife and kids kept wanting to use the day off of school and work to do "normal" winter activities, like go sledding, shopping, skiing, or go out for dinner, but I had to remind them and myself that the schools, banks, state government and my office were all closed for a reason...it was dangerous outside!
I plowed my driveway 3 times and when the temperatures dropped below zero, my hands turned red, swelled up and hurt that last time. I thought about doing more of the sidewalk or back porch, but thought better of it and went inside to warm up. My wife did go out to the grocery store the day before and stocked up on basics like bread and milk and eggs, so we had plenty of food. She wanted to do some shopping, but I told her that just because the driveway was clean didn't mean our street was and all the side roads were still pretty icy. Tow trucks were pretty busy, so if you needed one, you better be prepared to wait. The kids wanted to sled, but we chose to watch movies and eat popcorn instead. After being outside a couple of times, even the dogs knew being inside was the way to go. They just would not go out after a while. Funny how animal instincts are more dependable than people's.
Don't follow your instincts to go out, stay in and stay warm.

Power Loss, Inconvenient, But Not Life Changing

You don't know what you have until you lose it, right? Well, where we live the power went out for well over 60,000 households for about a week due to an ice storm. We lost our power for 5 days. Some people are still out after 8 days or more. We were fortunate enough to borrow a generator and wire a 220 volt line into our fuse box in the house, but many other people moved out of their homes for a week. The timing was bad, being the week of Christmas. Our Holiday party was relocated from our home to my parents down the road, who were, fortunately, not affected. Small inconveniences came up.  Alarm clocks didn't work. Cell phones were hard to keep charged. No home telephone or internet made it difficult to communicate with friends and family. Some friends and neighbors burst pipes due to the cold weather.
We've lost power for a day or two in the past, but rarely during the winter and rarely more than a day or two. It was a bit of a wake up call for us to have more candles, coolers, flashlights (with batteries) and firewood in the future. A back up generator of our own would have made the early going easier.
It's times like these that pull people together. Our neighbors around us were very generous as well as family offering a warm place to stay and extension cords and gasoline. It will be a Christmas we won't forget for quite a while.

Vitamins or Medicine?

Why so many people are willing to take supplements instead of their medication is hard for me to understand. Sometimes I have patients taking as many (or more) vitamins and supplements as they are medications. You get everything you need from a good and balanced diet. Vitamins can help plug a few holes, but do not replace good dietary habits. And vitamins don't fix Diabetes or Hypertension.  Diseases like Coronary Artery Disease (CAD) and Diabetes and Hypertension require medication, not vitamins and supplements. Medication plays a primary role in their management, while vitamins have a very limited/tertiary and unproven role in their management. I don't understand the general distrust of the pharmaceutical industry that the average consumer seems to have. Statins in particular have been villified by the media and lay people as causing more problems than solutions in the management of CAD, but several well designed and well controlled studies consistently show that lower Total Cholesterol, and LDL Cholesterol in particular, leads to less morbidity and mortality in adults. Controlling Hypertension with Betablockers, ACE Inhibitors and Diuretics leads to longevity, but people are still more willing to pop a vitamin C tablet in their mouths than take their Blood Pressure Medication. People are living longer than ever due to Vaccination programs, antibiotics and better medication for Diabetes and Heart Disease.  Vitamins are an unproven commodity, but we spend billions of dollars on then annually...buy more fruits and vegetables, Olive Oil, lean protein and drink more water.

Live well.
- Dr.Ronan

Your Are What You Eat

Who do you want to be this holiday season? The guy on top or the women below? Spend your calories wisely over the Holidays. Try adding some shredded vegitables to those recipes. Things like red onions, mushrooms and shredded zucchini add flavor without calories. Apple sauce and honey are good natural sweeteners for cakes and cookies. Wild Rice and Brown Rice go nicely with most meat dishes and don't forget about Qunioa and sweet potatoes!

Bon Appetite!

-Dr.Ronan

Read

I'm so proud of both of my daughters this summer for not letting their minds turn into mush. Both kids read several books over the summer, especially my 10 year old. Both kids also attended math and science camp too at our local university campus, Michigan State University. I know kids should play and swim and recreate, but reading is recreation in our family. Even my father and mother are both voracious readers in their 80's.

Who says people don't read books anymore?
Dr. Ronan

Paleo Breakfast

We were out in California and enjoyed the breakfast burrito at our hotel each morning. My wife came home and made up a Paleo Diet version of it that turned out pretty good. She cooks sweet potato fries in coconut oil until soft, then adds chorizo sausage and onions along with a couple of scrambled eggs cooked to completion. I added about 1/3 of an avocado to the top and just eat it out of a bowl, but you can wrap up in a low cal soft tortilla to go. This bowl is really breakfast for 2.
Beats a protein shake any day.

Eat well.
Dr.Ronan

Why do people stop their medication?

It's very frustrating to review lab work for someone and recommend treatment for either their cholesterol or sugars, start them down the correct path to health and find out months or even years later that they never did most, if not all, of what you told them they should do. I've read several studies stating that half of all prescriptions from a doctors office ever get filled and I thought that was ridiculous at the time, but now have come to the stark conclusion that is probably pretty accurate.
We took up a new initiative a couple of years ago to review a patient's medication list every time they come into the office. A lot of times people are annoyed that we don't know everything they are doing and state all their medications are the "same as the last time I was in." In reality, the list we have seldom reflects what the person is actually doing. They've stopped some medications because "they read somewhere that one was bad for them" or a well meaning friend or family member told them "not to take that one."
Sometimes, they "don't like to take so many pills" but one of my patients recently was discovered to have impacted his bowels with vitamins and supplements. He takes over 120 vitamins or supplements in addition to his medications each day.He felt this to be a more natural approach!!??!!
Most of these people don't thing twice to eating a hotdog or bratworst, soda pop or bag of potato/corn chips, whose ingredients I struggle to pronounce or comprehend... and I've taken Biochemistry and Chemistry in college and graduate school.

Most of my patients are simply eating and drinking themselves to death, not walking enough and not taking the 2-3 medications that would lower their risk of heart disease, strokes and kidney disease which are all know to be the leading causes of death in the United States. Don't worry, insurance companies know this and are already starting to cash in on your free will. They tell you that everyone will get insurance, but what they aren't telling you is that it's going to cost you A LOT MORE to be overweight, to smoke, to have high cholesterol, diabetes.  The more problems you fail to address, the more you pay and the older you get, the harder it will be to change.

I'm a doctor, but I'm a patient too, and I take my medication as directed, get my lab work done when ordered, try to eat healthy (chicken, green beans and some wild rice medley with skim milk after 45 mins at the gym). I know I'm not going to cheat death, but I'm hoping to put it off for a few more decades. My medication does not make me feel bad. I'll sleep better knowing my odds of a fatal MI are on my side tonight.

Live well.
Dr.Ronan

How to keep the pounds off on a vacation

This is my wife standing in front of our hotel's wine tasting parlor in Napa California. One of the things we struggle with during travel is keeping the pounds away when we are eating out and consuming wine or beer or whatever the locals provide. One way we battle the bulge is by taking a morning walk and then doing the same after dinner each night. We also try to split our portions and share. That way we get to try more things and not consume so much at each meal. Admittedly, I'm not very good at sharing my deserts. Most of our vacations are active, but you don't have to go over the top to enjoy yourself, stay safe and not put on 5 or 10 lbs that you'll regret next week.

Be healthy.
Dr.Ronan and family

Talk to your doctor online

Talking To Your Doctor’s Office Online...The Future Could Be Now

You can look up the balance of your checking or savings account online 24 hours per day 7 days per week. You can pay bills online. You can even order food and make reservations from a computer or smartphone. Why can’t you talk to your doctor’s office? Well, the answer is you can. Well, not all doctors offices. But, a growing number of physicians and physician offices are making themselves available to their patients online. This is done through what is called a Patient Portal. The portal is a password protected site designed to protect a patient’s health information from anyone seeing it other than authorized people. Usually a relationship with the doctors office must be established face to face before an online relationship can be connected as well. Patients still need to see their doctors periodically to maintain this relationship, but a lot of ordinary coordination of care and communication can take place between those visits.

I was intrigued by online medicine a  long time ago from several articles I had read in medical journals and finally committed to it after attending a conference where a 4 physician practice from South Carolina was using one successfully and really found it useful. I came back to my practice and did some research and contacted a pretty well established company to try.  We use a system from McKesson called RelayHealth.com and we’ve been using it for nearly 10 years. Not only do we message with our patients, but we also refill their medications so they don’t run out before their next appointment. We order  lab work prior to office visits so that the visit is more meaningful. We set up sleep studies or order x-rays and can refer people to specialists to expedite care. We even do webVisits, for patients who are unable to come in and have routine medical problems. This keeps our Emergency Department visit rate down and keeps me connected to our my own  patients.

I do lament that very few physicians choose to connect to each other via portals, or we could actually talk to each other about patient care as well. I’ve been asked, how do I have the time to message with patients and why would I want to do that. The answer is pretty simple, I don’t waste time, I save time. I’ve available to my patients even when I’m out of town on vacation, so I can take care of a lot of little things so that when I come home I’m not burried in messages. I can even do online webVisits when I’m not around for routine medical issues like poison ivy, sinus infections, diaper rash, influenza.  We manage well over 300 messages per month online. That means staff are not picking up a phone over 300 times per month! We schedule dozens of appointments that because people don’t wait on hold. If people do call the office, the wait time is quite a bit less. Best of all, our patient satisfaction surveys have been very positive about this system of care.

Your doctors office may already have this ability and you just have not been connected yet. Get connected.  Maybe they’ve thought about it but have not committed to it yet. Push them. Better health care starts with better communication. Let’s make a change.

Arthur J. Ronan, D.O. is a board certified family physician at Lake Lansing Family Practice in Lansing, MI

www.lakelansingfamilypractice.com

www.relayhealth.com

Get Out and Run!

My kids took part in a 1 mile Zoo Fun Run this past weekend. Many parents participated too. This was a great way to enjoy our local zoo here in Lansing, Potter Park Zoo www.potterparkzoo.com, and get some exercise in as well.
I was really impressed by the turn out. It was a great morning to go to the zoo, since the cool/crisp weather had the animals moving around and active.
The organizers did a great job entertaining the kids and lining them up. All were accounted for at the finish line.
I think it is a great idea to get kids into fitness at such a young age.

Garden Time

I finally got the garden in this weekend. We are trying to grow some of the foods we regularly eat from the grocery store and teach our kids how to take care of the plants. I've had great success growing rhubarb in the past at our old house but this yard has proven challenging for that one. It looks like I've finally found a plant that is producing and a good place for it in the yard.
We use a lot of Basil, parsley and rosemary, which are easy to grow. I've never had good luck with Cilantro, but I'm going to try again. Cucumber, tomatoes, zucchini and summer squash are all easy to grow and standard summer fair. You might be able to see all of the fending and netting around and over the garden area in the picture above. Just like no picnic is complete without ants, no garden is complete without critters. For a suburban area, our neighborhood is teeming with chipmunks, rabbits, berry eating robins and tomato worms. Trying to find an eco-friendly way to grow a few veggies in my back yard has given me new found respect for the farmers who grow hundreds of acres of this stuff.
Hopefully, the animals and bugs let me keep a little bit for myself and I'll talk about what I've done with it as the summer unfolds.
Eat Healthy!

Dr.Ronan

Going Paleo

Caveman Breakfast, I love it!!!

My wife recently undertook the Paleo Diet Cleanse and dragged me along for the ride. I've got to say, I'm not a diet person. I don't believe in fad diets, but one sniff of her breakfast one morning made put my vanilla protein shake to shame. This bowl of ham, sweet potato onions, avocado was fantastic.
The diet avoids dairy, gluten or bread, eggs, cocoa, caffeine and certain night shade veggies. The meals are planned out and pretty simple for most amateur chefs to pull off in about 10-20 mins. Many of the foods you can prepare for dinner and eat for lunch the next day. She lost 5lbs the first week and I lost 3lbs (but I did not give up my coffee or dairy). I'm actually excited for the next meal on the menu. If you want to shake things up, go Paleo and eat like a cave man for about 3-4 weeks to shake things up. I still think cavemen ate eggs. I wasn't there but it just seems to make sense.

I would not live on this, but my wife and I definitely want to incorporate some of this tasty food into our own daily habits.

Look it up.
www.paleodiet.com

Dr.Ronan

Patient Portals

For years I was asked if I would communicate with patients via email, but I was hesitant to open up that door for fear that what little personal time I have I would spend messaging patients. I read a few articles about it nearly 10 years ago and decided to give it a try. We enrolled to use a Patient Medical Record before we decided to use an Electronic Medical Record and the results have been mostly very positive. Just this morning I received a message from a patient of mine on vacation in Finland. He was having some eye problems and was worried he should come home.I advised him to be seen immediately over there and arranged for follow up when he comes home with a local ophthalmology group. In the past I've refilled medication for patients spending the winter out of state down south. I've managed some of my college students while off to school out of state. We've even been able to inform patients about their test results without having to bring them in. We manage about 300 messages per month via the portal and it's really cut down on office calls. Simple problems like sinus infections, poison ivy/rash, athletes foot, or urinary tract infections can be treated via Webvisits and then followed up in the office at a later time so the patient can get treated over the weekend instead of missing work or going to the Emergency Department for things that are not really emergencies. A simple experiment 10 years ago has improved care for over 1500 patients who are connected in our practice. Who would have thought I'd be giving medical advice in Finland today.
Take care.
Dr.Ronan

Avoid the White Plate

When I talk to patients/clients about eating healthy, I use an analogy called the White plate (Carbohydrates). This is NOT a White plate. This is a Green (Vegetables) and Brown (Protein) plate with a dab of White.  It has 2 servings of vegetables (broccoli and bok choy), about 8oz of flank steak and 1/4 cup of white rice. The drink is water.

This meal takes about 20 minutes to make and is under 700 calories. Even my kids like it. The more Green and Brown you put on a plate the longer it stays in system and the less you desire the White stuff.

The next time you go through a buffet line or are grabbing items for your lunch, just try to make it 3 parts Green and Brown and 1 part White and you'll be on the right path.