Life today moves at a frenetic pace, between appointments and meetings and errands, it’s easy to forget to make time for lunch let alone to make time for your health.

Even if you appear to be perfectly healthy, taking care of yourself is the one item on your ‘to do’ list you can’t afford to ignore.

In addition to a sensible diet, getting regular exercise, and working to limit stress, regular doctors visits are an integral part of a healthy lifestyle.

This is where primary care comes in. In addition to treating chronic conditions like arthritis, depression, and anxiety disorder, primary care doctors can help you prevent preventable diseases by considering your overall health.

Working at hospitals and urgent care centers, I see patients coming in every day with life-altering complications due to preventable diseases. The hardest part of being a doctor for me is watching a person’s health affect his or her livelihood due to a preventable disease.

The key to preventing preventable diseases is early detection. This is what a consistent relationship with a primary care doctor can help you accomplish. Unlike specialists or doctors you see only sporadically, a primary care physician can take a holistic approach to your overall health. That means not just helping you out when you get a cold or the flu, but recognizing what symptoms and diseases you are most at risk for and helping you to identify behaviors that will allow you to avoid them.

A primary care doctor can consider the health of your whole being, and help you plan for a long life as your ‘best self.’ The most rewarding part of my job is helping to prevent diseases, but I can’t do that when I only see patients who are already sick.

Simplicity Wellness provides the continuity of care and holistic approach of primary care straight from our urgent care center. Now scheduling appointments Wednesday and Thursday from 8:00 to 2:30, call and schedule your appointment today.

Simplicity is proud to sponsor the race which benefits students of Kinhaven preschool in the Ballston neighborhood of Arlington.

The race will start at Bluemont Park and stretch along the W&OD bike trail “out and back” course.

Cash awards to the top three finishers and special prizes for stroller and barefoot/Five Finger runners.

Don’t miss out on the chance to spend the day being active with your family for a good cause. Register online today.

A woman living in the U.S. today has a 1 in 8 lifetime risk of being diagnosed with breast cancer. The second most common cancer among women, breast cancer accounts for nearly 1 in 3 cancers diagnosed in women in the United States.

According to the American Cancer Society (ACS) the high rate of breast cancer diagnosis can be attributed to longer life expectancy, menopausal hormone use, and rising prevalence of obesity.

Although there are no measures that can be taken to directly prevent cancer, obese cancer patients have about a 30% higher risk of death compared with those who maintain a healthy weight.

Research has shown that exercise during and after treatment can improve outcomes. For this reason, the ACS created the following list of guidelines for nutrition and physical activity:

1. Maintain a healthy weight throughout life

• Balance calorie intake with physical activity
• Avoid excessive weight gain throughout life
• Achieve and maintain a healthy weight

2. Adopt a physically active lifestyle.

• Adults should engage in at least 30 minutes of moderate to vigorous physical activity, above usual activities, on 5 or more days of days of the week; 45 to 60 minutes of intentional physical activity is preferable
• Children and adolescents should engage in at least 60 minutes per day of moderate to vigorous physical activity at least 5 days a week

3. Eat a healthy diet, with an emphasis on plant resources

• Choose foods and drinks in amounts that help achieve and maintain a healthy weight
• Eat 5 or more servings of a variety of vegetables and fruits each day
• Choose whole grains over processed grains
• Limit intake of processed and red meats

4. If you drink alcoholic beverages, limit your intake.

• Women should drink no more than 1 drink per day (or 2 per day for men)

In addition to the active lifestyle detailed above, early detection of breast cancer greatly reduces the risk of death.

Early detection can also lead to a wider range of treatment options. These options include less aggressive surgery (for example, a lumpectomy as opposed to a mastectomy) and less aggressive adjuvant therapy (treatment following surgery e.g. chemotherapy, radiation therapy, biological therapy).

Early detection can be accomplished by monthly self-examinations beginning at age 20. This should be supplemented with examinations by your doctor every 1-3 years.

After age 40 women should undergo annual mammograms and continue monthly self-examinations.

Breast cancer typically produces no symptoms when the tumor is small and therefore the most treatable. For this reason, it’s important for women to follow recommended screening guidelines.

If you feel a lump, know that benign breast masses are fairly common, but you should still get the lump checked by your doctor as soon as you can. If caught early, breast cancer can be cured with treatment.

Food allergies are on the rise in the United States. The most common foods that cause allergic reactions are peanuts, tree nuts, milk, eggs, and shellfish.

The symptoms of an allergic reaction range from mild–rashes, hives, itching and swelling– to severe–trouble breathing, vomiting, loss of consciousness and even death.

Peanut allergy is the most common cause of death due to food allergens.

It affects approximately 2% of the population. For some people with peanut allergy, even tiny amounts of peanuts can cause a serious reaction.

This can make it really tough for an allergic child to lead a normal life, and causes parents of children with allergies to live in fear. There is no cure for peanut allergy, so the only option to keep these allergic children safe is strict avoidance.

Unfortunately, it is not enough for a child to be taught to avoid peanuts and peanut products themselves, because these products are so prevalent in our diet children can easily be accidentally exposed to peanuts through contact with other children and their foods.

These kids with allergies will have the best chance for a happy, safe, normal school experience if communities are willing to work together to help keep all children safe.

What can you do to help?

• Consider eliminating peanuts and peanut butter from your child’s diet until 3 pm weekdays. It might help you broaden your child’s palette, and it could quite literally save a life. One great option is to use peanut butter alternatives for school. Alternatives that are highly rated for taste include Wowbutter, Sunbutter, IM Healthy soybutter and almond butter.
• If you can’t eliminate the peanut butter or peanut-based snacks, please teach your children about the importance of washing their hands and face (and brushing their teeth if possible) after eating them. Our kids are going to touch each other when they play, and these small actions can greatly reduce the risk of secondary exposure to children who are even sensitive to skin exposure.
• Look for school snacks that do not include peanuts. The “trace amounts” warning that is almost ubiquitous is far preferable to actual peanut ingredients.
• Obviously, we all have to be careful at home. Never feed another child without knowing their allergy status, and never take your child for a play date without informing the parents if your child has an allergy.
• Talk to your child about peanut and other food allergies and how scary they are for a child who is allergic. It’s a great opportunity to build empathy – and to help your child think about how their behavior affects others!

Our “allergy parents” do everything they can to keep their kids safe. They are faced with a life-threatening problem that they need the help of those around them, many of them strangers, to tackle. If you are fortunate enough to not face this threat yourself, imagine how you would feel if it was your child, and know that these parents will be forever grateful for your help and first in line to return in kind.

It does take a village, so let’s all do our part to keep all of our children healthy!

Have you had a headache recently? Headaches are especially common among women and an acute attack can range from annoying to completely debilitating.

While some headaches are caused by the daily stresses of life, some are more serious and require your attention. The following is a quick guide to help you tell the difference.

1. Differentiate between tension headaches and migraines.

Tension headaches: These usually develop after a long stressful day. They are characterized by a dull steady pain. The feeling is often described as a tight band around the head, usually affecting both sides, occasionally spreading to the neck or shoulders. These headaches are usually non-throbbing.

Migraines: If you have ever had a migraine, you know it. Migraines are characterized by throbbing on one side of the head and are commonly associated with sensitivity to noise and light. You may also experience nausea or vomiting, visual symptoms, or tingling in the extremities prior to onset. Migraine sufferers often have a family history of similar episodes. Many people suffer from both migraines and tension headaches, and it is possible to experience a combination of the two

2. Understand the three tiers of treatment for migraines.

Preventive lifestyle changes. While there are common triggers, I recommend that my patients keep a diary of their own possible triggers whenever they develop a migraine. This helps them eliminate their personal triggers without becoming overly dependent on medication. These include caffeine, alcohol, tyramine and nitrates contained in food, monosodium glutamate, too much or too little sleep, menstruation, missed meals, weather changes, high altitudes, flickering or glaring lights, and fatigue.

Acute abortive therapy. First-line therapy is to abort an attack with over-the-counter anti-inflammatory drugs like ibuprofen, naproxen, aspirin, or a combination drug with acetaminophen, aspirin, and caffeine. When these options are insufficient, I will prescribe a serotonin agonist (more commonly known as triptans), dihydrooergotamines, or a butalbital-containing agent. These drugs have been shown to be effective, but are associated with more side effects and are not tolerated by all patients. Anti-nausea medication often helps in patients with complicated migraines.

Preventative medication. If patients are getting migraines more than once a month, and they last for three days or more per month or are complicated, I recommend preventative therapy. The most studied of these are beta-blockers (commonly known to treat high blood pressure), amytriptyline (an antidepressant), and some anti-seizure drugs (although side effects are more common). The best option is individualized to the patient. Keep in mind that preventative medication may take two to three months before a clinical effect can be appreciated.

3. Know when to be concerned.

If your headache develops after prolonged reading, computer/television use, or driving: A vision check and new glasses may be in order.

If you develop a fever, stiff neck, have a sudden onset of a severe headache, or a headache that is uncharacteristic of headaches you have had in the past.

If you have jaw and temple tenderness, confusion, weakness, vision changes, or other sensory deficits.

If you develop a new onset of headaches during pregnancy, or after the age of 50.

If your headache seems atypical to you, do not hesitate to immediately seek medical attention.

4. Get familiar with how to avoid headaches.

It can be tough to keep headaches away, especially if you have a tendency to get them, so be careful of the medications you take.

In fact, when pain relievers are being used more than twice a week, headaches can actually increase in frequency and lead to a cycle of daily headaches. If this is a concern, preventive therapy should be considered.

Unfortunately, a lot of patients are unaware of the rebound affect associated with frequent use of many of the migraine medications. Drugs that can cause rebound headaches with withdrawal include ergotamines, triptans, and butalbital, as well as medications that contain caffeine.

Getting inside your headache

• Common headaches:
  The most common culprits are tension headaches, migraines, medication over-use, and rebound headaches.
• Secondary headaches:
  These are more rare, and associated with an underlying cause such as sinusitis, masses, infection, or intracranial bleeds. Pay attention to these, for they need appropriate, and often emergent workups.
• Cluster headaches:
  Also rare, and actually more common in men, these headaches are characterized by a short, sharp pain. They are usually limited to one side of the head, and frequently are associated with tears or a runny nose that is limited to the affected side. These headaches occur in clusters during certain periods of the year, with clusters lasting anywhere from a week to several months. While some benefit from oxygen therapy, treatment is similar to that for a migraine.

Medical Director

Simplicity Urgent Care

Having worked in emergency rooms from DC to Boston, I’ve watched thousands of patients without life-threatening problems wait for hours before being seen by a doctor.

Seeing this happen over and over again made me wonder: Why did so many people end up in the ER who didn’t have to be there?

So I began asking my patients why they chose an emergency department over other sources of health care.

Based on their feedback, here are the top three reasons patients choose go to the ER:

1. They don’t have a relationship with a regular medical doctor.

As the health-insurance market has become more competitive, businesses have started to change insurance companies more frequently to maximize the benefitsfor their employees. When this happens, employees receive new insurance cards, and if the current primary-care doctor does not participate with the new insurance company, employees have to find a new doctor. Unfortunately, this situation is common.

As many people have discovered, finding a new doctor requires overcoming several hurdles. If you have a new primary-care doctor, then you need to schedule a new-patient visit, but those are typically scheduled several months in the future. When you have an acute problem, obviously you can’t wait several months until after the new-patient visit — you need care now.

The population of Washington, DC is by nature transient; inhabitants frequently move for new jobs and new opportunities. When you arrive in a new area, finding a new doctor isn’t always high up on your list of priorities — until you get sick. Then once again, you are looking for a new doctor who can’t see
you immediately.

2. They have a regular doctor, but he or she has no available same-day appointments, even for acute illness.

Primary-care doctors are in high demand, and they fill their days with appointments to see as many patients as possible while in the office. In the past, doctors would leave space open on their schedule to accommodate sick visits. With the current state of health care, however, these free sick-visit spots are becoming scarce.

When you call a primary care doctor, the front desk staff assesses the doctor’s availability, and typically reports that the doctor has no spots available to see you today. The receptionist is then trained to refer you to an emergency department or to let you find care on your own.

3. Their health concern requires more care than what a doctor’s office can provide — such as procedures, X-rays, and on-site lab tests — but doesn’t need the full armamentarium of a hospital-based emergency department.

With technology playing such an important role in health care, medical treatment often requires X-rays or procedures such as laceration repairs and casting. Since technology is expensive and can only by justified if the doctor’s office uses it frequently, many physicians choose to refer the patients who need technology elsewhere rather than purchase it themselves.

The sites that have the technology are now limited to hospitals and specialists’ offices, which use it mainly to care for the own patients.

Here’s another solution: Simplicity Urgent Care

These responses not only intrigued me — they gave me an idea.

Because many of the ER patients I spoke with said that they would rather go elsewhere because of the high expense and long wait times at emergency rooms, but few options were available that would fit their needs at that particular time, I decided the time was right to establish an urgent care center in Arlington, VA.

In early 2010, I joined forced with my friend and fellow ER doc Dr. John Maguire, the medical director for three of INOVA’s freestanding emergency rooms in Northern Virginia, where he oversees more than 75,000 patient visits annually.

And on November 22, we opened the doors of Simplicity Urgent Care, a new solution that we believe will satisfy the needs of our patients and referring physicians.

Keeping it simple

Dr. Maguire and I know that finding top-notch health care can be complicated, and the last thing patients want to do when they are sick is navigate a complex structure. Actually, the same holds true when they are well.

That’s why we focus on making every visit efficient, and most importantly, simple.

Our center offers on-demand care with a lab, a digital X-ray machine, and a room equipped for procedures previously only performed in the hospital emergency department. At Simplicity Urgent Care, we believe it’s important to have this technology on-site because it allows us to better care for our patients and expand the scope of conditions we can treat.

And unlike many retail health-care clinics, a doctor sees every patient at Simplicity Urgent Care.

We know that life can be busy, complicated, and stressful. At Simplicity Urgent Care, we know healthcare doesn’t have to be. Register online today to experience the difference.

It always seems to happen at 6 p.m. You left your happy, healthy baby at the daycare center in the morning, and by the end of the day you have a cranky baby with a runny nose, cough, and a fever. You immediately think “Where did this come from, and what should I do about it?”

Since your pediatrician’s office is closed for the day, and you know you can’t wait until morning to see a doctor, should you take your child to the emergency department or urgent care center? Or are you overreacting?

As a parent of four children and a pediatric emergency physician, I can see both sides of the dilemma. Here are some thoughts to help you handle the situation.

1. First and foremost, it is never wrong to take your child to the emergency department at any hour. As an Emergency Room doctor by day, I can tell you that is what we are there for. Trust your parental instincts. If you feel that something is wrong, head to the ER or urgent care center — because you know what’s best for your child.

2. Once you get there, here’s what you can expect: With children and fever, pediatric emergency physicians break children up into three groups: 2 months and under, 2 months to 6 months, and 6 months and above.

• The grouping is based on the number of vaccinations the child has received, with the older children having enough protection against the Strep and H Flu and the younger ones at increased risk of contracting these bacterial illnesses.
• For this reason, if your child is 2 months and under with a rectal temperature of 100.4 or greater, the baby automatically gets a comprehensive work-up and spends the next two days in the hospital for observation.
• For children who are 2 to 6 months, the child will receive a work-up; however, if the lab results are normal, the child can go home with close follow-up with their pediatrician in the morning.
• For children who are 6 months and above, the work-up will depend on the child’s symptoms and how sick the child looks to an experienced pediatric provider. Don’t be surprised if your doctor does a complete physical exam, feels that a virus causes the fever, and sends you home with no antibiotics. This is standard — and good medicine — because it decreases the chances of allergies, diarrhea, and antibiotic resistance in your child.

3. About fever. Another question I am frequently asked is how a parent should handle a high fever. Worried parents often want to know, “If my child’s fever skyrockets to 104, what should I do?”

• I always reassure parents that a relatively high fever in a small child is not harmful because raising the body’s temperature is its method of fighting off infections. In some countries, in fact, doctors do not advise using ibuprofen or acetaminophen because they want to let the fever take its course.
• In the United States, we advise taking antipyretics (Tylenol or Motrin), which knock down the fever and keep both the children and their parents happy. I usually advise parents to stick with Motrin over Tylenol (and do not alternate) because a dose of Motrin lasts for eight hours while Tylenol only lasts for four hours. If your kids are anything like mine, my wife — also a doctor — and I try to avoid the medicine battle at all costs, so we minimize the frequency of giving medications.
• When determining the proper dose of Motrin, be sure to administer the dose base on your child’s weight — not their age. By using the wrong table it’s easy to under-dose the medication, and even a small amount under the required dosage based on weight will render the entire dose ineffective.

Here are some rules of thumb for administering Motrin:

• If your child is 22 pounds, give 5 mls (1 teaspoon)
• If your child is 33 pounds, give 7.5 mls (1 and 1/2 teaspoon)
• If your child is 44 pounds, give 10 mls (2 teaspoons)
• If your child is under 6 months, do not give Motrin and discuss treatment with your pediatrician, ED physician, or urgent care physician.

4. What should you do when your child has a cough? Know that a cough is a very common symptom associated with fever. It is frequently part of the viral syndrome — but it can also be a sign of pneumonia.

How can parents tell the difference? It can be difficult, so here’s my algorithm for determining which child I will order a chest X-ray on (to determine if the baby has a pneumonia). Note: While these criteria aren’t hard-and-fast rules, I find them helpful for finding pneumonia in children and at the same time helping us not over-order tests.

• Does the child look good? (Yes, he or she is sick, but you know when your child looks like something is wrong.)
• Is the child breathing well? If not, their oxygen saturation may be low.
• Has the child had a fever and cough for more than three days?
• If you answered “no” to the first two questions, and “yes” to the last one and you think your child has pneumonia, contact your pediatrician immediately or head to the ER or urgent care center.

5. Assuming your child does not have pneumonia, the next question parents ask is: “So what should I do about this cough?”

• First, I reassure parents that the cough isn’t hurting the child after I have done an exam and found the results to be normal and the child’s oxygen saturation to be normal.
• Second, the short answer is that there is no good medicine for a cough. The over-the-counter cough and cold medications are for children 6 years and older as advised by the FDA.
• The reason that they are contraindicated for children younger than 6 is because they are ineffective and have caused adverse outcomes — but mainly in children under 1 year old.

While there are no great or quick ways to alleviate a cough, I suggest that parents put a vaporizer in the child’s room, especially in the cold, dry winter.

And don’t count out old-school remedies such as mixing in a little milk with honey. In addition to reassuring parents that a cough won’t hurt their children, I tell them just to keep an eye on it for any symptoms of pneumonia (see above).

As always, feel free to contact me with questions: john.jones@simplicityurgentcare.com.

Chest pain is one of the most common complaints we see in the emergency departments that I manage here in Northern Virginia. Typically, the patient looks up at me with big, scared eyes and asks, “Am I having a heart attack?”

I always wish that it were easier to tell, but despite medical advances, we are often unable to answer the question during the initial visit.

Here’s why:

1. Chest pain is a very difficult symptom to pin a diagnosis to because it can be a sign of several other problems, including a broken rib, a blood clot, pneumonia, or a tear in the aorta, among other conditions.
2. That’s why most physicians make a diagnosis based on the patient’s medical history. For instance, we know that if the patient smokes, has high cholesterol, and has a family history of heart disease, he or she is more likely to have a heart problem than a healthy triathlete.
3. Physicians are trained to create a differential diagnosis, which is a list of the possibilities that could be the cause of the symptoms. With chest pain as the presenting complaint, our first concern is ruling out something that is life threatening before making a diagnosis.

Women and diabetics

There are two groups of patients that will commonly have unusual symptoms when they are actually having a heart attack:

Women:
Heart disease is a big threat to women’s health. Believe it or not, statistics show that about 267,000 women die of heart attacks each year — six times more than those who die of breast cancer.

The reason it’s such a big threat is that women who are having a heart attack often have atypical complaints, such as shortness of breath, nausea and / or vomiting, and back or jaw pain. They also experience flu-like symptoms, fatigue, extreme weakness, light-headedness, and cold sweats.

In addition, heart attacks tend to occur in women about 10 years later than they occur for men. About 82 percent of female heart attack patients are 55 or older. They also tend to have high blood pressure, high cholesterol, and/or diabetes (see more on that below). And they are likely to be smokers, overweight, and lead a sedentary lifestyle.

Unfortunately, women are often less likely than men to believe they’re having a heart attack, so they delay seeking emergency treatment. Obviously, this is a lethal combination and one that needs to be paid more attention to. Women with the risk factors listed above need to be diligent about chest pain and seek treatment immediately.

Diabetics:
Another group of patients that have atypical complaints when they are having a heart attack is diabetics. In fact, if I had a nickel for every diabetic patient who is having a heart attack with no chest pain, but is complaining of significant nausea, I’d sure have a big pile of nickels.

That’s why physicians must be masters of pattern recognition, and be able to see outside the “normal” patterns to minimize the possibility of missing the tough case.

Signs of a heart attack

Chest pain that is related to a heart attack or other serious heart problem is very often associated with one or more of the following:

• Pressure, fullness, or tightness in your chest
• Crushing or searing pain that radiates to your back, neck, jaw, shoulders, and arms, especially your left arm
• Pain that lasts more than a few minutes, goes away and comes back, or varies in intensity
• Shortness of breath, sweating, dizziness, or nausea

Chest pain that isn’t related to a heart problem is more often associated with:

• A burning sensation behind your breastbone (sternum)
• A sour taste or a sensation of food re-entering your mouth
• Trouble swallowing
• Pain that gets better or worse when you change your body position
• Pain that intensifies when you breathe deeply or cough
• Tenderness when you push on your chest

If you think you are having a heart attack:

1. Call 911 and the EMTs will take you to the nearest emergency department. While urgent care centers are great for a lot of things, the emergency department is where you want to be if you are having a heart attack. Please do not drive yourself to the hospital, unless you have no other choice, as your condition could worsen and you risk putting yourself and other drivers in danger.
2. Once at the ER or urgent care center, explain the problem and expect to be seen immediately.
3. In most cases, an EKG will be done quickly. This recording of the electrical activity in your heart is the first screen for heart attack. It also identifies patients that need to have other heart-related procedures done, including an angioplasty, where the clogged blood vessel is opened with a balloon.
4. Unfortunately, a relatively small percentage of patients have EKG changes when they are having a heart attack or angina. So an EKG is not always helpful. That’s why doctors will also ask to draw blood to look for cardiac enzymes, which makes it easier to quickly identify the problem.

Questions? Don’t hesitate to contact me at john.maguire@simplicityurgentcare.com.