Is Hormone Therapy safe?

2023-03-27T14:22:32+00:00March 23rd, 2023|Adults, Direct Primary Care, Family Medicine, Health Care, Uncategorized|

What’s the deal with Hormone Therapy? Is it safe?

After the Women’s Health Initiative study done in the early 2000s that demonstrated an increased risk of cardiac events, strokes, blood clots and breast cancer was terminated early, many believed HRT to have more risk than benefit. The number of women taking HRT dropped from 20% to 5% nationwide. One of the flaws in the study was that the women enrolled were over 60y old. For women 50-59years these risks are slightly increased but no where near as drastic as the original study.

The answer to safety is not an “all or none” proposition. HRT is not “good’ or “bad.” As with any treatment, the benefits and risks must be weighed for each individual woman. Remembering that menopause is a chapter in life and not forever helps. Discussing “how long” these symptoms will last or when and which ones warrant treatment is a conversation to have with your physician.

Hormone Replacement Therapy (HRT) is not a panacea for the changes that occur in menopause throughout the body. Often there are better medications to treat a lot of these specific changes. For example, it is not generally recommended to try to prevent osteoporosis with HRT. Additionally, we would not treat mood disorders that become unmasked during this transition period with HRT.

There are so many symptoms… which ones warrant consideration for HRT?

  • Severe vasomotor symptoms occurring every hour or two and disrupting daily life (not responsive to behavioral/lifestyle modification)
  • Vasomotor symptoms that are interfering with sleep
  • Vaginal atrophy or Urinary Dysfunction

Who might be a candidate for HRT?

  • In general, women who are less than 60 and less than 10 y from menopause.
  • Women without a history of heart disease, stroke, blood clots, or breast cancer.

Isn’t HRT just pills?

  • Not all HRT is created equally and there are numerous different modes of delivery for Estrogen.
  • Pills by mouth can decrease testerone affects on hair loss and acne, while patches have a lot less risk of blood clots and stroke than pills.
  • Vaginal symptoms alone are best treated with cream or rings that produces only local estrogen exposure.
  • All women with a uterus taking estrogen will need to get progesterone in pill form or as an IUD as well to decrease risk for endometrial cancer.

What about “bioidentical” hormones?

  • Bioidentical hormones just means they have the same molecular structure we produce naturally. Estrogen patches and prometrium are FDA approved bioidenticals that are prescription medications.
  • People often refer to compounded formulations as bioidentical hormones… with compounded formulations there is not a lot of safety data and no regulation.

At Roots Health DPC we use the NIH Breast Cancer Risk Assessment Tool (NCI) to assess risk for breast cancer. We assess for risk for cardiovascular disease as well when we discuss HRT treatment options so that patients can make informed decisions.

Not all HRT is equal and topical treatment options do not have the same systemic system side effects as pills and may be just as effective. A great resource for patients is NAMS (North American Menopause Society).

Are you looking for a physician who has time to discuss all your options with you? We are enrolling a limited number of new patients and would love to hear from you today.

What you need to know about HOT FLASHES

2023-03-20T13:54:27+00:00March 20th, 2023|Adults, Direct Primary Care, Health Care|

HOT FLASHES: What you need to know.

Hot flashes are the most common menopause-related symptom, affecting over 75% of women in midlife. Let’s discuss triggers, symptoms, and treatments. The most Frequently Asked Questions.

What is going on during a hot flash?

The small blood vessels near the skin surface are dilating, which causes heat release and flushing. So why does this even happen? As estrogen levels drop, changes in the hypothalamus in our brain cause dysfunction of the natural internal thermometer. The feeling of warmth results from inappropriate peripheral vasodilatation with increased blood flow to skin. Perspiration results in rapid heat loss and a decrease in core body temperature below normal. Shivering may then occur as a normal mechanism to restore the core temperature to normal.

What provokes hot flashes?

Hot flashes can last anywhere from 2-4 minutes and commonly occur related to these situations:

  • Drinking hot liquids (coffee, tea, hot water)
  • Drinking alcohol
  • Eating spicy foods
  • Taking a hot shower
  • When stressed, excited, anxious
  • When overly physically active
  • When overdressed or wearing tight-fitting clothes
  • As a side effect of some medications

It is important to know that hot flashes and/or night sweats can be indicative of other diseases (carcinoid, pheochromocytoma, POTS, certain cancers).

Does your doctor’s office feel like a place where you can talk about any symptoms you are experiencing and get answers to the questions you have? If you are searching for a physician that takes time to listen, Dr. Diaz is accepting a limited number of new patients at Roots Health DPC.

When to consider hormonal treatment.

In general, if the symptoms are happening every hour or two and interfering with your functioning or if the symptoms are interfering with sleep, we recommend speaking to your physician about hormonal options available.

Next week we take a deep dive into Hormone Replacement Therapy… the good, the bad, and the ugly.

If you appreciate the information and want to make sure you don’t miss our weekly newsletter… let us send it to your inbox… for free and for fun. Don’t miss another episode of “Mondays with your MD”

Prediabetes Screening

2023-02-13T15:40:42+00:00February 13th, 2023|Adults, Diabetes, Direct Primary Care, Family Medicine, Health Care|

What is the best way to screen for Prediabetes and What Can I do if I have prediabetes?

Prediabetes is a diagnosis that gives us the opportunity to avoid developing diabetes and any of the complications that accompany it. I often refer to this as a warning sign… like the red “check-engine” light that comes on when your car needs servicing. Looking at the diagnosis as an opportunity to improve our health can dramatically shift our response to a new diagnosis and the actions we take.

Diagnosis

There are multiple available tests that are used to evaluate for prediabetes and diabetes. If a blood test shows that your blood sugar is higher than normal but not high enough to be called diabetes, it is called “pre-diabetes.” The most commonly used tests are:

  • One test measures glucose after fasting.
    • Impaired fasting glucose consistent with pre-diabetes is between 100-125 mg/dL.
    • Diabetes is diagnosed with a fasting glucose of 126 mg/dL or higher.
  • Another test, Hemoglobin A1C, measures how much glucose has attached to red blood cells and provides a view of your blood sugar levels over the past three months. This test does not require fasting.
    • An A1C value of 5.7 percent to 6.4 percent is classified as prediabetes.
    • An A1C value of 6.5 percent or higher is consistent with diabetes.

Knowledge gives you the power to advocate for your own health and well-being. Never miss another “Mondays with your MD.”

What can I do if I have pre-diabetes?

If you have pre-diabetes, you can make lifestyle changes to lower the chance of developing diabetes. Here’s what you can do to prevent Diabetes:

  • Eat a healthy diet – Try to eat a diet with lots of fruits, vegetables, and low-fat dairy products, but low in meats, sweets, and refined grains. Basic principles of healthy eating, portion control and counting carbohydrates will serve you well.

     

  • Weight Loss- If you are overweight, trying to get to a healthy body weight can help. Losing 5 to 10 percent of your body weight can lower your risk a lot. Your doctor can help you find healthy ways to do this.
  • Physical Activity: be active for 30 minutes a day – You don’t have to go to the gym or do heavy exercise to get a benefit. Activities like walking, gardening, and dancing can all help improve your health.
  • Quit smoking – If you smoke, talk to your doctor about how to quit. People are much more likely to succeed if they have help when quitting.
  • Consider medical interventions –You might try a medication to lower your chances of developing diabetes, especially if lifestyle changes aren’t helping enough. One drug that is often recommend in these cases for persons with prediabetes is metformin. You can discuss this option with your doctor.

Uncontrolled diabetes is a serious disease with complications that include kidney failure, limb and vision loss. The diagnosis of Prediabetes is an opportunity to change the trajectory of your health and wellness journey. Educate yourself and ensure you are working with a doctor you trust to answer all of your questions, all of the time.

YOUR TIME is valuable – Mondays with your MD

2023-03-15T13:38:23+00:00December 4th, 2022|Adults, Direct Primary Care, Families, Family Practice, Health Care, Membership|

YOUR TIME is the most valuable resource you have. Give yourself the gift of TIME.

You work hard to balance time between your career and your family. When one of your own has a health concern that “pops up” or just needs to be scheduled …. trying to figure out the how, where, and when to get the issue addressed can literally take hours, and even days, from your routine.

I get it. I’m a working mom and I know what it is like to balance work and family, to “carry” the mental load, and then…. to put “one more thing” on your plate. My job is to take that stress off your plate.

“My son has a sore throat and fever…. I have placed a call to his doctor’s office and am waiting for a call back….”

When you have medical concerns, the last thing you want is to pile on more stress. Let me help! My patients reach out to me, their physician, directly via text at any time of day. They get answers to the questions they have about their health immediately and can take the next steps and get back to their busy lives.

“My daughter cut open her foot. Do I take her to urgent care or ER and wait to be seen?”

No one has time to wait around for a return call from the doctor’s office for advice. You don’t have to sit in an urgent care with other contagious sick people waiting to be seen… then go back again the following week because you picked up a virus in the lobby while waiting. We take care of this without the wait!

“I am experiencing a constant feeling of being tired… but I just put off going to see the doctor because it is so hard to get an appointment and the visit takes up half my day.”

Let us make going to the doctor as easy as booking a time that works perfectly for your schedule. We even offer telemedicine so you can get care wherever you are. If you are visiting us, there is no waiting in a waiting room. Ever!

THIS IS NOT too good to be true!


Ditch the Healthcare Hassle. Give yourself the gift of Time!

Get all the health care needs for your family met with ease and grace. We know how valuable your time is and that is why we are making health care easy for families: one mom at a time.

Come and see how Direct Primary Care works….schedule a free initial consultation with us today and get all your questions answered.

YOU DESERVE BETTER CARE

What is a Sinus Infection? – Mondays with your MD

2022-11-28T19:51:24+00:00November 28th, 2022|Adults, Colds and Flus, Direct Primary Care, Health Care|

This cold and flu season, I am getting a lot of questions about sinus infections.

So today, we are reviewing which treatments work best.

What is a sinus infection?

The sinuses, air-filled pockets in bones of the face, form the top part of the respiratory tract. A sinus infection occurs when the tissue in the sinuses swells and leads to a buildup of mucus, pain, and discomfort.

Viruses cause 9 out of 10 sinus infections in adults. Here we discuss symptoms and treatment options for Viral Sinus Infections.

Common symptoms:

Pain or pressure in your sinuses
Facial pain is a common symptom of sinusitis. You have several different sinuses above and below your eyes, as well as behind your nose. Any of these air-filled cavities can hurt when you have a sinus infection. You may feel pain in your forehead, on either side of your nose, in your upper jaws and teeth, or between your eyes

Tenderness in the face
Your face may also be tender to the touch due to the built-up pressure. This tends to occur at the bridge of the nose or under the eyes, and can occur on the forehead and cheeks.

Runny nose and postnasal drip
When you have a sinus infection, you may need to blow your nose often because of nasal discharge. This discharge comes from your infected sinuses and drains into your nasal passages. The discharge may also bypass your nose and drain down the back of your throat causing irritation or sore throat. This is called postnasal drip, and it may cause you to cough. It can also cause your voice to sound hoarse.

Sinus headaches
Persistent pressure and swelling in your sinuses can give you symptoms of a headache. Sinus pain can also cause earaches and pain in your teeth, jaws, and cheeks. Sinus headaches are often at their worst in the morning because fluids have been collecting all night long.

What can I do?

Most cases of acute sinusitis get better on their own. Self-care techniques are usually all you need to ease symptoms. In general, antibiotics are not needed and do not help symptoms (as it is usually caused by a virus anyway).

Consider the following options:

1. Pain medication
Over the counter anti-inflammatory medications such as ibuprofen can provide relief of headache, facial pain, and sore throat if they are not contraindicated.

2. Intranasal steroid sprays
These reduce inflammation and decrease swelling in nasal passages. This can be particularly helpful for patients with allergic symptoms as well. Commonly we use fluticasone nasal spray.

3. Decongestants

These are typically Pseudophedrine or Phenylephrine. They can relieve congestion and pressure but may cause a rebound effect when stopped. There are contraindications for some patients with high blood pressure and other risks.

4. Nasal Irrigation
Using a neti pot with sterile intranasal saline is highly recommended for most. These generally provide safe and effective temporary relief.

Signs that you should seek care

Consult your doctor if you have:

  • a high persistent fever (>102F)
  • symptoms that have lasted for more than 10 days
  • symptoms that are getting worse
As always, it’s recommended that you check in with your physician when you are sick for a personalized diagnosis and treatment plan to best suit your individual needs.

Are you looking for a physician who is always available and easy to reach that will answer all your health care questions? Reach out today to schedule your FREE initial consultation with Dr Diaz. Space is limited

Mondays with your MD – Open Enrollment is Here

2022-11-12T02:13:13+00:00November 5th, 2022|Adults, Copays, Deductibles, Direct Primary Care, Family Practice, Health Care, Membership, Prescription Costs|

The THINGS you DID NOT EVEN THINK to consider this Open Enrollment…..

How can I keep my costs low AND receive high quality accessible health care?

Every year we pay more for insurance while less and less is covered. When we attempt to use our insurance it is cumbersome and inconvenient at best. We have all experienced the frustration with the amount of time it requires to obtain what we need for our health and get it covered by insurance. Today we cover the basics and empower you to make decisions that will give you the most cost-effective way to obtain the high quality health care you deserve

The Jargon

Premium: the amount you pay every month for health insurance.
Deductible: the amount you must pay before you can get any services covered by your insurance in a calendar year. A few Caveats to the deductible: Not everything counts towards your deductible. Premiums and copays generally don’t count. Some plans have separate deductibles for prescriptions.

Copay: a fixed amount you pay for a covered expense (visits, procedures, medications, etc)
Out-of-pocket maximum: the most you might have to spend for covered services in a given year. This number is important to understand!
HDHP is a High-deductible Health Plan (HDHP): these plans offer lower monthly premiums and allow you qualify for a Health Savings Account (HSA)
HSA is a Health Savings Account: A type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses.
Health Share Plans*: this is not an insurance product and offers much lower monthly premiums with low initial unshareable amount (similar to a deductible). *A cooperative where members “share” medical costs. They cover catastrophic needs (hospital stay, surgery, ER visit, etc) but are not insurance products.

What your typical open enrollment conversation is missing!!!

Smart consumers determine their out of pocket projected cost for the year and choose a high deductible plan to save on monthly premiums. Savvy consumers understand the relationship between premiums and deductibles and keep costs low by determining the most cost-effective way to lower their out of pocket-expenses over the course of the entire year.

REMEMBER HEALTH CARE DOES NOT NEED TO BE EXPENSIVE.

Direct Primary Care: The impossible Made Simple and Transparent.

Direct Primary Care (DPC) removes insurance companies from the physician-patient relationship and provides the vast majority of health care services through a low monthly fee (like a gym membership). Patients skip the hassle of traditional insurance-based care. They get more time with their physician with same day and next day appointments… all without copays or hidden fees. DPC can produce tremendous savings on out of pocket expenses when patients work with their DPC physician to find the most cost-effective appropriate health care. The enormous savings on medications, labs, and imaging often exceed the annual cost of membership.

Can you imagine if you could have easily accessible high quality health care with access to your doctor whenever you needed it AND pay less out of pocket? Have a cough and fever but dont want to go to the urgent care? ….. skip the line and the copay! Urinary tract infection while on vacation out of state?…. no problem we got you covered.

“Dr Diaz is accountable and easy to reach. I feel well taken care of and trust I am in good hands.“ – M.C.

M.C. saved 97% on her bloodwork.
Imagine getting 97% OFF… you read that right! This patient had labs with Roots Health DPC and paid $29.57. The same patient had the exact same labs billed (for the same tests) at a price of $901.24 through the same lab.

At Roots Health DPC we get it. Your health and wellness are our main goal and we are here to support our patients as they make decisions that will affect their well-being.

Open enrollment only comes once per year… make the most of it and choose the best plan to meet your health care needs.
Its your money.
Its your healthcare.
Its your choice.

If you want to learn more about how direct primary care can help you achieve your health care goals and save you money, sign up for our free guide:
“Better Healthcare for a Fraction of the Price”

Mondays with your MD – Breast Cancer Warning Signs (Part 3)

2022-10-31T19:17:54+00:00October 31st, 2022|Adults, Direct Primary Care, Health Care|

The 5 signs of Breast Cancer

Breast Cancer Screening is for women without symptoms. However, if you notice

any symptoms of breast cancer you should see your doctor for an evaluation

promptly regardless of when you were last screened.

The warning signs of Breast Cancer

1. If you notice a lump that feels firm or fixed in the breast or underarm area
2. Swelling, warmth, redness or darkening of the breast skin
3. Change in the size or shape of the breast including dimpling or puckering of skin
4. Nipple retraction or change in position of nipple
5. Discharge from your nipple

 

Although the vast majority of breast cancers are found through abnormal mammograms, up to 30% of breast cancer patients present with a mass that occurs between mammograms.

This is part THREE of a THREE part series on Breast Cancer Awareness.
Read more here
Part One – Prevention
Part Two – Screening

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Mondays with your MD – Breast Cancer Awareness Month!

2022-10-17T23:16:13+00:00October 16th, 2022|Adults, Direct Primary Care, Family Medicine, Health Care, Public Health|

October is Breast Cancer Awareness Month

Many of us have been touched by breast cancer- perhaps through a personal diagnosis- or by a family member, friend, or colleague diagnosed with this disease. Breast cancer, after all, is the most frequently diagnosed cancer and leading cause of cancer death in women. Please join me over the next few Mondays to discuss prevention, screening, and warning signs.

Education is Key for Prevention

Do you know the risk factors associated with an INCREASED risk for breast cancer?

  • Hormonal factors can influence your risk for breast cancer. Higher levels of endogenous estrogen and hormonal combined estrogen/progesterone replacement has been associated with increased risk of developing breast cancer.
  • Reproductive factors associated with a higher breast cancer risk include earlier onset of menstruation, not giving birth or having first child later in life, and a late menopause.
  • Family history and genetic mutations. The risk of breast cancer is affected by the number of first-degree female relatives diagnosed with breast cancer and the age at which they were diagnosed.
  • The highest breast cancer risk occurs among White women (although it remains he most common cancer among women of every major ethnic/racial group).
  • Alcohol consumption is associated with a higher risk of breast cancer.
  • A higher BMI in postmenopausal women is associated with increased risk for breast cancer. 

Do you know how to DECREASE your risk for breast cancer?

  • Breastfeeding. For every 12 months of breastfeeding there is an approximate 4% reduction in the relative risk of breast cancer.
  • Increased physical activity at all ages lowers risk.
  • Dietary factors may modify breast cancer risk although data is limited. Eating a low-fat high fiber diet with plenty of fruits and vegetables is recommended.

This is part ONE of a THREE part series on Breast Cancer Awareness. STAY TUNED. Next week we will review breast cancer screening options and recommendations.

 

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Mondays with your MD – Telemedicine: Back to the Future

2022-07-11T13:33:18+00:00July 11th, 2022|Adults, Direct Primary Care, Family Practice, Health Care, Telemedicine|

Reminiscent of a time where patients could receive medical advice by simply calling their doctor on the phone….telemedicine, popularized with the pandemic, has always been a structured integral part of Direct Primary Care (DPC). Virtual care has been shown to increase access to health care and lead to improved health outcomes when utilized correctly.

Telemedicine

Telemedicine allows for an ongoing dialogue between patients and physicians about shared health goals and decision-making. This improves adherence to the medical plan of care by providing a platform for a collaborative approach to health, where chronic conditions can be managed.

Telemedicine provides flexibility for scheduling and eliminates barriers between physicians and patients. Follow up appointments are made easier by removing travel times, childcare concerns, and time off work.

Virtual consultations can prevent unnecessary in-person referrals to specialists and lead to shorter waiting times to see specialists.

Telemedicine has always been a structured integral part of (DPC). When patients have an urgent care need or a follow up concern from previous visits, DPC physicians are able to quickly troubleshoot those problems with patients and determine the best course of action for each individual.

Mondays with your MD: What is Direct Primary Care?

2025-08-04T17:32:37+00:00June 10th, 2022|Direct Primary Care, Family Practice, Health Care, Membership, Urgent Care|

People ask me all the time…. What is Direct Primary Care?

Focused on your health.

In a traditional fee for service primary care practice, doctors are paid based on how many people they see, number of tests they order, or type of procedures they do. This leads to our current system of rapid visits with many tests and quick referrals. Many times doctors cannot take the the time to really listen, or think about what is best for your health from the patient perspective. In the existing system, doctors are not reimbursed for emails or phone calls and this creates a system where it becomes difficult to speak to your doctor outside of a harried office visit that you may have been waiting a long time for.

In direct primary care, instead of paying for each visit or procedure, you pay a monthly fee. This monthly fee frees the physician from the model that promotes productivity over quality and allows your physician to focus on you and what you really need. This leads to more time with your doctor when you need it and convenient easy access outside the doctor’s “office visit” by phone, text, email, etc.

The doctor you call. The doctor you trust.

Direct primary care doctors are dedicated to provide the high-quality unhurried care that is essential for your wellbeing and ongoing maintenance of your health. You can see your direct primary care doctor for all routine and preventive services like checkups as well as urgent care and chronic care management. Many times having this relationship with your physician and the access it provides, can save you visits to more expensive venues like the urgent care, hospital or emergency room.

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