Announcing Kelly Goodman Group
The KellyCare team is both enormously pleased and infinitely proud to announce that with the opening of our new KellyCare Clinic in Clarksville, Maryland, we are now uniting all of Kelly’s clinics under one unifying name: The Kelly Goodman Group Clinics. DON’T WORRY: if you’re one of our existing beloved patients, this change won’t effect your current clinic location (in Bethesda, Maryland or Washington, DC)
It all started with a vision for how healthcare could be: Personalized. Warm. An experience you felt enriched by and enjoyed, rather than something you had to endure. This concept was the driving force and the dream for Kelly Goodman, NP when she opened her first primary care clinic in Maryland. The idea caught on very quickly, especially when she added elite healthcare practitioners who shared her point of view, and patients who were gratified by their healthcare with Kelly’s clinics and were fast spreading the word around the Maryland and Washington, D.C. communities. Today, our clinics are consistently rated in the Top 10 by Yelp! For providing care that is conscientious of both our patients’ healthcare needs and their busy schedules, committed to making their healthcare experience enjoyable and worthwhile, and consistent in providing a customized, personal approach to the patient/healthcare provider relationship.
Our new Clarksville office is open and is ready to serve you! We offer a variety of healthcare services, including primary care, wellness care, walk-in appointments, and same-day appointments. We know how hectic your schedule is, and we strive to ensure that your health doesn’t have to be something that gets sacrificed because of time limitations in your daily calendar. We have designed this office to be a welcoming, friendly and appealing environment where you will actually enjoy the time you spend here. We always say we designed our clinics to be an office you won’t mind waiting in, even though you won’t have to!
Stop by and see us in our new Kelly Care location soon! And make sure to come back to this blog often for continued announcements about exciting things going on at the Kelly Goodman Group Clinics and also informative articles and videos about current healthcare topics and questions.
We hope to see you soon, Maryland and Washington, DC!
Kelly Goodman, NP
Hallucinations and healing
Ecstasy and mushrooms are being used by the medical and psychiatric community to help heal depression, anxiety, and PTSD. Both these substances have recently been approved for further studies of their ability, with highly trained support in a controlled setting with active therapy, to help patients who have not found relief elsewhere.
A story in the New York Times today discusses the use of psilocybin, also known as magic mushrooms, in patient’s whose cancer brought them to a desperate place of depression and anxiety. While the researchers are not clear on how this drug works exactly, the trials thus far show it is effective, and after only one dose when administered in a controlled setting by psychiatrist and a social worker in a session lasting 8 hours. There were two small studies and both reported success with patients in whom traditional treatment had not led to improvement. There are also studies being done to look at its role in addiction treatment and non-cancer depression.
A story linked to in this same article discusses the use of ecstacy, or Molly/MDMA, in treating PTSD (post traumatic stress disorder). We think of this in soldiers who have returned from war, but it occurs in civilians with the same triggers- either a single traumatic event or repeated traumas like abuse. It seems that while the brain is under the influence of this medication, it can finally confront the trauma that caused the condition and this trauma can be dealt with during a therapy session much like the one used in the psilocybin trials. The brain and body overreact in an inappropriate way to a given stimulus and can’t stop- to the point where it interrupts the person’s life. This can manifest in nightmares or panic attacks or other reactions that make daily living incredibly difficult.
While psilocybin is a natural substance, and MDMA was created in a lab, both seem to allow the patient to look at themselves and their experiences from a detached perspective and examine thoughts and emotions. Despite a number of treatment approaches including medications and psychotherapy techniques, there is none that hugely effective in treating PTSD and many other mental illnesses. The FDA is allowing these studies to proceed in hopes of offering a cure, in a relatively short course of treatment, for illness that is resistant to conventional therapies. Moving these drugs off the most restrictive DEA schedules is essential to conducting clinical trials, just like what needs to be done for marijuana (which I wrote about last week). I’m looking forward to a day when all medications that have the potential to be medically useful are allowed to be fully investigated in clinical trials.
Good news for Marijuana
Our November election offered good news for marijuana. Several states, including California, Nevada, Maine and Massachusetts, voted to legalize recreational marijuana, joining Colorado, Oregon, Alaska, and Washington State. Many more states have legalized marijuana for medical purposes- although the qualifying conditions vary by state. A total of 26 states, plus the District of Columbia, have approved this use and these states have been helpful for studying the effects of marijuana on patients as a group.
Overall the studies show that marijuana legalization decreases the deaths from opioid overdoses. Scientific American wrote a great article summarizing the recent studies on marijuana and opioid use. Marijuana (cannabinoids are the names of the chemical group) has been shown to decrease dependence on prescription opioid pills like Percocet and oxycontin and is a pathway for people to get off the dangerous drugs. As people become accustomed to an opiate, they require a higher dose for the same effect. Since these substances can be lethal, the dose required to relieve pain can near the lethal dose and lead to death. In 2014, 14,000 people died from unintentional overdose of prescribed opiates. Guess how many people died in 2014 from marijuana overdose? Zero, and that’s according to the DEA. Marijuana use does not lead to overdose and it is far less addictive than opiates or even alcohol or cigarettes. This is why so many states have passed legislation to legalize it. The hold up, in terms of wider use of cannabinoids in medicine, is with the DEA (Drug Enforcement Agency) which still classifies it as a drug with no medical use. With the Class I status it is difficult to procure the substance in order perform clinical trials. Since the pharmaceutical companies don’t stand to profit from marijuana there is no financial incentive for funding studies or money for lobbying the DEA. Currently, it is easiest to look backwards at data and plainly see how different symptoms or behaviors changed, how many fewer opioids were prescribed, and how many fewer people died when medical marijuana was available to patients. We are also starting to see the benefits of cannabinoids in treating not just pain or nausea, but also in helping with mental health issues as well, such as PTSD and depression. The use of cannabinoids for pain is so widespread now that the NFL is about to consider allowing their players to use cannabinoids for pain as so many ex-players have found relief from its use and have cut their opiate use.
Here in the District of Columbia, the use of medical marijuana is legal, as well as the recreational use by private citizens if it is not sold. Let’s hope the federal government allows states to keep the laws here in DC and across the nation. Let them also see the wisdom in correcting the DEA classification so that bigger studies can be performed and we can incorporate cannabinoids into everyday evidence-based practice.
Medical visit via videochat
We will soon be offering telehealth appointments for existing patients. As soon as the last few technical details are completed you will be able to schedule an appointment for a face-to-face video-chat visit using HIPAA compliant software. This is perfect for any type of visit or followup that does not require a hands on exam. When you’re too sick to come in to the office, or too contagious, we can see you through eVisit, which you can use on a computer or through the app on your phone or tablet. We can help you out with mental health concerns, with the stomach bug or influenza, with a urinary infection, a rash, pink eye, an allergic reaction,back pain, and many other common illnesses or follow up appointments. If you need to call us after hours for an urgent medical need we can direct you to sign in if we feel a telehealth visit is needed to properly treat you. You can choose to pay through insurance with just a standard office copay or you can pay out of pocket. We will still submit your prescription to your pharmacy or submit a referral to a specialist- just like a standard office visit. Just make sure you are somewhere you can talk privately!
Click here to go to our telehealth page on our website to read more about it and watch a video. You can click on the link there to be directed to our eVisit site. I recommend signing up now so that all you have to do is sign in when you are sick.
We are so pleased to be offering this to our patients and continuing to be collaborative and efficient in our health care practice.
Post-election anxiety?
So the reality of our recent election is setting in. No matter how you voted, there is a lot of uncertainty ahead in the next few months. If the trend continues, it feels like anything could happen in the home stretch of 2016. We have seen horrible violence both abroad and domestically, and some of it has been been perpetuated by our own citizens against fellow citizens. I’ve had many friends ask me not-so-jokingly if I’ve had an increase in requests for xanax. They have symptoms of insomnia, crying, displaced anger and intense muscle tension. They tell me they may be in to see me soon as a patient.
- An anxiety state defined by our medical coding is “Apprehension or fear of impending actual or imagined danger, vulnerability, or uncertainty” (ICD 10 code 2016-17 where ICD means International Classification of Diseases). While generalized anxiety disorder is defined as persistent physical symptoms of anxiety for 6 months, an anxiety state may be temporary. If this temporary state is interfering with your ability to live your life you may need some short term medical help. In a couple of weeks I imagine some people will meet the criteria for an adjustment disorder or even depression. Here are two definitions from the ICD codes that qualify a diagnosis of adjustment disorder- they sound pretty relevant right now don’t they?
- A category of psychiatric disorders which are characterized by emotional or behavioral symptoms that develop within 3 months of a stressor and do not persist for more than an additional 6 months after the stressor is no longer present.
- Social, psychological, or emotional difficulties in adapting to a new culture or similar difficulties in adapting to one’s own culture as the result of rapid social or cultural changes.
The bottom line is that if you are concerned about how you’re handling the turmoil of this year, especially with the recent election, please talk to someone about it. We want to help you and throw you a life preserver if needed.
Still smoking? Want to quit?
While fewer people are smoking nowadays, there are still plenty of people who smoke. It may be only when they are out with friends, or with family who smokes, or when they are extra stressed. Some people can stop for years but fall back into it quickly due to a big stressor in their life. We understand. Most of us need help with healthier coping mechanisms and can develop addictive behaviors (think food, alcohol, wasting hours on Netflix, or getting grumpy with our loved ones). But nicotine is an incredibly addictive chemical and it’s a behavioral habit. For this post let’s focus on cigarettes. The New York Times this week had an article reporting on a recent study that 28.6% of cancer deaths nationally are caused by smoking tobacco in some way. The rate varies on location, with a low of 21% in Utah and a high of 38% in Kentucky. There is also a big difference rates between genders with men significantly more affected than women. What are these 12 cancers that are directly related to cigarettes? Obviously lung, mouth and throat cancers. But also stomach, colon, bladder and even a type of leukemia. This study did not include cancers due to other types of tobacco like chewing tobacco which would add many more life altering and deadly cancers. How do we get these numbers to decrease? By implementing recommended programs in each state that help people stop smoking and prevent them from ever starting in the first place. The World Health Organization recommendations come down to three basics: prohibitive cost of tobacco products, no advertising, no smoking in public, and an engaged health system.
Here in primary care we can be engaged in finding out your smoking habits and helping you quit when you’re ready. We won’t shame you- promise- but we ask if you are ready to quit or reduce smoking. This upcoming cold and flu season is a great time to quit! Most people don’t have the urge to smoke as much when they’ve got a cold so take advantage of this fact and don’t resume your usual smoking frequency. Come in and see us as you may need antibiotics for your bronchitis (smoking changes the bronchi and lungs and encourages the growth of different types of bacteria) and we can discuss medications to stop smoking at the same time. Whether you’d like some accountability while you use the patches and/or gum from the drugstore, or you’d like to try Zyban or Chantix tablets to help reduce the cravings, we are here for you. People often tell us about some creative ways they have reduced or stopped smoking. They’ve had success with a transition to e-cigarettes, or cigars/cigarillos, or water pipes, to keep up the nicotine while they transition off the physical cigarette habit and then transition off nicotine slowly. Different studies have shown varying levels of success with this type of method, but only you know the method that may work for you. We’ve also had patients who found hypnotherapy incredibly helpful in as little as one visit.
Think about the factors that make quitting difficult or that have caused you to relapse in the past. Do you have a friend or family member to encourage you on the way? What has worked to help you reduce or quit in the past? Did you know you can start on a medication while still smoking? Starting on it for a few weeks prior to a quit date can ease a lot of the anxiety that goes along with quitting. And we will meet with you and support you through the ups and downs of the process for however long it takes. There are many methods to quit or reduce smoking so come in and see us at any of our Kelly Goodman Group Locations so we can find one that will work for you!
Breast Cancer- What’s Your Risk?
In honor of the end of Breast Cancer Awareness Month let’s talk about risks and screenings. When should you get a screening mammogram? At what age should you start? How often should you get one? Do you need an ultrasound or an MRI for further evaluation and how often?
These questions have different answers depending on whose advice you are looking for. All the groups that make official recommendations have their own particular guidelines for routine screening mammograms. They all agree on the risk factors though.
- Family history/ genetics
- Age
- Younger age for first period
- Older age for first childbirth
- Older age for menopause
- Breast density
- Use of birth control and/or hormone replacement
- Obesity
- Lack of exercise
- Alcohol use
- Radiation exposure
The most aggressive guidelines for screening are from the National Comprehensive Cancer Network. They recommend annual mammograms starting at age 40, and clinical breast exams. The most relaxed guidelines are from the US Preventive Services Task Force which does not even give recommendations for women with higher risk but only recommends screening mammograms every 2 years, beginning at age 50, and recommends against breast self-exam. The American Cancer Society recommends screening mammograms annually at 45 and decreasing to every other year at 55. The American Congress of Obstetricians & Gynecologists recommends annual screening mammos at age 40. All but the USPSTF recommend being aware of the feeling of your own normal breast tissue and having an annual MRI if the lifetime risk of breast cancer is calculated to be more than 20% based on family history.
How do you determine a woman’s lifetime risk of getting breast cancer? There are computer programs available that allow us to calculate that based on family history and the personal risk factors listed above. At your next physical exam we can determine if we need to calculate this risk, and at a followup appointment we can take the time to enter your personal and family data into a program that will give us a percentage chance that you could have breast cancer in the next 10 years and also the chances of developing breast cancer in your lifetime. These are sobering statistics (I have entered my own data and even with no family history of breast cancer my lifetime chances of developing it are 12%!). If your lifetime risk is 20% or higher you are entitled to see a genetic counselor and your insurance is obligated to pay for it, as well as an MRI (thank you Affordable Care Act).
Come in and let’s talk about your personal and family risk factors for developing breast cancer and make sure you are getting the appropriate screening to ensure your longest healthiest life.
STD boom!
Congratulations Washington, DC- your rate of syphilis is #3 highest in the US. As STD rates have continued to rise over the past few years, our area has the unfortunate distinction of having high rates of sexually transmitted infections. The latest report released this week from the CDC includes data on chlamydia, gonorrhea, and syphilis. Infections caused by HIV, human papillomavirus, herpes simplex virus, and trichomonas are not tracked in this report and CDC reminds us that the total number of infections shared through sexual contact is in fact far beyond the rates shared in this report. What is shocking is that HALF of all infections occur in people ages 15-24.
So how bad is it? Well the CDC tracks a lot of diseases, but chlamydia has now broken the record of highest number of any disease EVER REPORTED. It is easily treated with antibiotics. But here’s the problem- since many men and women never have symptoms, they don’t know they have been infected. The disease damages the reproductive tract which means women are at greater risk for ectopic pregnancy (life threatening) and that’s if they can get pregnant at all. Gonorrhea is increasing as well and is becoming resistant to antibiotics. Gonorrhea transmitted during oral sex can cause a sore throat and it can cause infertility in both men and women. Both chlamydia and gonorrhea can be “silent” and cause no symptoms, but when there are symptoms they are usually discharge, burning or pain in genital area and/or with urination. While the symptoms come and go, the infection does not resolve unless treated with antibiotics.
Syphilis sounds old-fashioned but it is definitely back and on the rise. It is cured with penicillin, but is often missed in its early stage. The first symptom of syphilis is a sore. This sore can be small, and since it is painless and can be inside the vagina or rectum people may not notice it. Or perhaps they notice it but think it is an ingrown hair, or shaving nick. If it’s on the mouth or lip they may confuse it with a cold sore or canker sore. It is important to be treated at this early stage, because the next stages cause symptoms like rash, flu like illness, hair loss, among others. Eventually the bacteria enters the brain and causes serious symptoms like dementia, paralysis and even death.
All of these infections can be passed on to a fetus in utero, or a baby through birth, and cause serious health concerns, and the pregnancy may end in miscarriage or result in premature birth. If you are pregnant or may become pregnant make sure you’re screened ASAP.
20 MILLION infections each year cost $16 BILLION (yes that’s a “b” in billion) in health care costs.
And that’s not counting the effects and costs of infertility and ectopic pregnancies that are caused by sexually transmitted infections.
Protect your fertility by getting screened for STDs every 6-12 months if you are sexually active. Come talk to us and we will give you a personalized recommendation based on your life. We are easy to talk to- even about sex- and can help you stay healthy.
Is bright morning light better than Viagra?
What if bright light for 30 min each morning could increase a man’s sexual satisfaction and even boost his testosterone levels? How much less Viagra would be prescribed?
We know that light therapy (using a lamp that that has the right wavelengths and strength) is an effective treatment for SAD (seasonal effective disorder). We are still in the midst of learning about light therapy and all of its potential. But knowing that most babies are conceived in June, when we have the maximum hours of daylight, there is a basis for looking into the effect of light on reproduction. A group in Italy studied a group of 38 sexually unsatisfied men and shared their results with the European Congress of Neuropsychopharmacology in September. This group of men had a mean sexual satisfaction score of 2/10 at the beginning of the study. After just 2 weeks of treatment with 30 minutes of 10000 lux light each morning, the mean score had increased to 6/10. In the control group, who was treated with filtered light, the mean score was 2.7/10. In addition to the subjective satisfaction score, the mens’ testosterone levels almost doubled. The retinohypothalamic tract (sunlight to retina to hypothalamus) is well established as the circadian rhythm pathway. Treating our brains with bright light at various times of day has different effects. Bright morning light helps us wake up, energizes us, and according to this study may improve a man’s sexual satisfaction and testosterone levels. Conversely, bright light at night, or even that from our phones and computers, can cause insomnia, make it hard to get out of bed in the morning, and affect our mood in a negative way. We’ll have another post about that soon, along with information about the types of lights needed.
This is a fascinating area of study. Be prepared to see more chronotherapy (time and light therapies) as they are non-pharmacologic treatments. That means they cost less, and have fewer side effects or interactions with medications, and they are helpful for mental health issues at the very least, if not more. Further, here at any of our Kelly Goodman Group locations we are open to discussing any complementary, integrative, or functional medicine treatment you would like to try.
Gluten-free diets are on the rise. Why?
If you’ve been looking at menus or walking through the grocery store, you’ve likely noticed more and more items labelled “gluten-free”. Why? Who is avoiding gluten and why are they doing it? Why was there a three-fold increase in gluten-free diets when there has been no increase in the medical diagnosis of related diseases?
In honor of National Celiac Awareness Day, we’re talking about gluten. Gluten is a protein found in grains- wheat, rye and barley- and helps give an elasticity to these flours in cooking and baking. These grains are found in breads, pastas, soups, cereals and other baked goods. People can be affected by gluten in a few ways.
First, some people have an immediate allergic reaction to wheat and/or another grain. This is a more obvious reaction and easier to diagnose by blood tests looking for antibodies and skin testing looking for skin reactions. These must be treated by avoidance of the grain. There are no medications or allergy shots for food allergies- yet.
Second, people can be affected by the gluten found in wheat, rye, and barley. This can be found in a serious autoimmune form known as Celiac disease or in a milder form called gluten sensitivity. Certain individuals, about 1 in 100 people, have Celiac, a genetic condition where the body attacks the small intestine when gluten is ingested. This can cause lifelong effects and increases one’s chances of having other autoimmune diseases. The only treatment is avoidance of gluten. Blood tests can be performed to help diagnose this disease. Gluten sensitivity is something we don’t yet have conclusive testing for, but studies have shown that people without Celiac can still have damage to their small intestines if they are sensitive to gluten. Therefore, these individuals should still avoid gluten.
Are you avoiding gluten, or limiting your intake? Is it for health or weight loss? Did you have fatigue, digestive or other symptoms that have improved since you went off gluten? Or are you being encouraged by a friend or family member to eliminate it for a month? If you have a family member with confirmed celiac, or if you have an autoimmune disease you should get tested for celiac before you stop eating it. The blood tests are accurate only when you are actively eating (or drinking) gluten.
Going gluten-free is much easier now than it was 16 years ago when a member of my family was diagnosed with a wheat allergy. We are happy to discuss these issues with you, do any appropriate testing, and manage any diseases that are found.