Tag Archives: medical-issues

What To Do? Emergency Department vs. Urgent Care vs. Your Doctor’s Office

By: Jamie Harms, M.D.

Having an illness or injury often results in a good deal of anxiety and worry. You want medical attention and relief from your symptoms as quickly as possible. But where should you go to get the best, most appropriate and cost-effective care? The following are the most widely used treatment options and suggestions about when each might be best suited to meet your particular medical needs.

The emergency department:  Most emergency departments are part of hospitals, although there are free-standing emergency departments in Bowie and Queenstown. The ED is designed and equipped to handle serious or life-threatening emergencies.  It is always open, including nights, weekends and holidays. Patients are seen according to how sick or injured they are.   The most serious cases jump to the front of the line, even if they arrive later than everyone else.  Physicians in the ED are trained to look for life-threatening conditions, and the tests you will receive in the ED will help them decide if you have any of these.

The Emergency Department is the right place to go if you have a serious or potentially life-threatening illness or injury:  chest pain, sudden weakness on one side of your body, a new seizure, severe headache, persistent heavy bleeding, poisoning, or a large broken bone.

The Emergency Department is probably not the right place to go if you have a milder illness or a longstanding issue.  You are likely to wait longer for treatment. The Emergency Department doctors do not have access to your medical records.  Your visit will be much more expensive-as much as 4-6 times as expensive! Remember, they have to keep all that life-saving equipment available all the time. That’s great if you need it, but it’s just an extra charge if you don’t.

Urgent care centers:  There are lots of these in our area.  They often have extended hours, including evenings and some weekend hours.  They are designed and equipped to handle medical problems that need attention the same day, but are not life-threatening.  Patients are usually seen in the order they arrive, so your wait will depend on how many other people go to the Urgent Care Center at the same time you do.  Many Urgent Care Centers have X-ray and blood testing equipment.

An Urgent Care Center is the right place to go if you have a new illness or injury that occurs when your doctor’s office is closed: sprains and strains, painful urination, ear pain, severe cough or wheezing.

An Urgent Care Center is probably not the right place to go if your doctor’s office is open or if you have a serious or life-threatening condition. A visit to an Urgent Care Center is more expensive than a visit for the same condition at your doctor’s office. The provider in the Urgent Care Center does not know you and will not have access to your medical records. Urgent Care Centers are not equipped with life-saving equipment or providers trained to treat life-threatening illnesses or injuries.

Your doctor’s office:  No one knows you like your own doctor. Your doctor is equipped to treat many illnesses and injuries, and can arrange any testing you may need. Your primary care doctor has your medical records and knows your medical history. Patients are seen by appointment. Maryland Primary Care Physician offices reserve appointments for patients who need same-day treatment. Many MPCP offices have evening and/or Saturday hours for your convenience.  Call or check our website, www.mpcp.com, for a list of hours at your doctor’s office.

Your doctor’s is the right place to go if you have a new problem, such as sinus pain, ear pain or flu, cuts or other wounds, sprains or strains, cough, or a flare up of an old problem, such as back pain or migraine headache, or an ongoing problem that may require more testing or treatment, such as persistent stomach problems or joint issues.  You will pay the lowest copay at your primary care doctor’s office, and most times, you will be able to get an appointment the same day you call.

Your doctor’s office is the wrong place to go if you have a serious or life-threatening condition. If you need care in the next hour, go to the Emergency Department.

Don’t forget: Good communication is important to make sure you get good care. If you’re not sure what to do, call your primary care provider. Even when the office is closed, there is always someone on call who can direct you to the care you need. If you ever need to go to the Emergency Department or an Urgent Care center, take a list of all your medications and allergies with you. Let the staff know who your primary care provider is, and schedule a follow up appointment if needed.

Primary care quicker, less costly than the ER

A study by a New York health insurer claims 90% of conditions commonly seen in emergency rooms ─ like sinus infections, sprains and sore throats  – could be treated faster and at a lower cost elsewhere. Excellus BlueCross BlueShield reports that in 2013 emergency room visits in the state for these conditions were nearly 8 times more expensive than a primary care office, 3.5 times higher than an urgent care center, and 15 times costlier than telemedicine. Patients in ERs also had the longest wait times for treatment. The report concludes: “the best method of care for nearly all of these cases is for patients to see their primary care doctors.”

Important Facts About That Cough You Have

Cough is a frequent symptom seen in medical offices at this time of year. It can be a source of aggravation, frustration and anxiety for many patients. A cough falls into one of the following categories based on its duration: it can be acute, lasting less than 3 weeks; subacute, lasting from 3 to 8 weeks; or chronic, which lasts over 8 weeks.

The acute cough is mostly a result of upper respiratory tract infections and acute bronchitis. Most of the time, these are due to viruses and do not require the use of antibiotics. Fever may or may not be present and phlegm can be discolored. Pertussis, or whooping cough, is on the rise in the United States and may manifest by violent coughing and should be treated with an antibiotic. Approximately 15% of users of commonly prescribed blood pressure medications, lisinopril or zestril, may develop a cough, which usually begins within a week of beginning the medication. Treatment is stopping the offending medication and waiting 1-4 weeks for resolution, which you’ll want to coordinate with your primary care provider so you can get on an appropriate replacement medication. Lastly, pneumonia may also cause you to develop a cough. Depending on what incites coughing, therapy is supportive with cough medication, antihistamines, decongestants, antibiotics (if needed), and possible inhalers if asthma-like signs are present.

A subacute cough is most commonly a result of a prior upper respiratory infection. It can also be caused by asthma, postnasal drip, gastric acid reflux (even if heartburn is not present) or a primary lung disease. At this time, a chest X-ray should be obtained, especially for smokers or former smokers. Specific therapy is suggested depending on the cause.

Finally, chronic cough should be evaluated by requesting appropriate tests which may include sinus imaging, CAT scans, cardiac or gastroenterologic evaluations. A referral to a specialist may be needed.

If you or a loved one is suffering with a cough, particularly one that has lasted for more than 3 weeks, see your primary care provider, who can then determine an appropriate course of treatment.

 

Janice Rutkowski, M.D.Janice Rutkowski, M.D. is an MPCP partner and is certified by the American Board of Internal Medicine. She sees patients at the Arundel Mills office.

Can Botox for Migraines Help Me?

I began offering BOTOX® injections for chronic migraines at our Pasadena practice in December 2015. Since then I have treated a number of patients who have noticed significant improvement. One patient was having migraines almost on a daily basis, and 1 month after beginning treatment, has had only 2 mild headaches. Another patient I’ve been treating went from having 20 severe migraine headaches per month to 14 (8 mild and 6 moderate), and has not had to take prescription pain medications since her first Botox treatment.

BOTOX® is the only FDA-approved, preventative treatment that is injected by a doctor every 12 weeks for adults with Chronic Migraine (15 or more headache days a month, each lasting 4 hours or more). BOTOX® prevents up to 9 headache days a month (vs. up to 7 for placebo). BOTOX® therapy is not approved for adults with migraine who have 14 or fewer headache days a month.

Most insurances will cover BOTOX® as long as you meet the criteria for chronic migraine (see above) and have tried at least 2 chronic medications, such as beta blockers or other blood pressure medications, Topiramate, anti-depressants, etc. Even if you have experienced some improvement with these medications, you may still qualify for BOTOX®.

The most common side effect of BOTOX® is neck pain. Other side effects which may occur include dry mouth, discomfort or pain at the injection site, tiredness, headache, neck pain, and eye problems, such as double vision, blurred vision, decreased eyesight, drooping eyelids, swelling of your eyelids, and dry eyes. Serious and/or immediate allergic reactions may include itching, rash, red itchy welts, wheezing, asthma symptoms, or dizziness or feeling faint.

If you suffer from chronic migraines and want to see if this course of treatment might be right for you, you should discuss this option with your primary care provider. For more information please call our office at 410.255.2700, or visit the Pasadena office page.

 

Trang Pham, M.D.Dr. Pham is a Maryland Primary Care Physicians, LLC partner, is certified by the American Board of Family Medicine, and has been performing cosmetic BOTOX® injections since 2008.

How To Tell If You Have Heart Disease

If you have heart disease, you get chest pains, right?

Not all heart problems come with such clear warning signs. Coronary disease includes a number of conditions, which have different symptoms. Learn the symptoms and you’ll be better prepared to head off a dangerous health episode.

Coronary artery disease

Coronary artery disease develops when the arteries that supply blood to the heart become hardened and narrowed. This is often caused by build-up of cholesterol and other materials called plaque in your arteries. This build-up is called atherosclerosis. As it increases, it can reduce or block blood flow to the heart.

The most common symptom of coronary artery disease is angina or chest pain. People with angina describe it as a discomfort, heaviness, pressure, aching, burning, fullness, squeezing or painful feeling in the chest. It can be mistaken for indigestion or heartburn. Angina may also be felt in the shoulders, arms, neck, throat, jaw, teeth or back.

Coronary heart disease may lead to a heart attack. It can also weaken the heart muscle and cause heart failure or heart rhythm abnormalities (arrhythmias).

Heart attack

A heart attack occurs when blood supply to your heart is reduced or blocked, causing part of the heart muscle to die. Symptoms of a heart attack can include:

  • Chest discomfort ─ it can feel like an uncomfortable pressure, heaviness, squeezing or pain in the center or the left side of the chest
  • Discomfort radiating to the back, jaw, neck, and one or both arms.
  • Fullness, indigestion or choking feeling (may feel like heartburn)
  • Sweating, nausea, vomiting or lightheadedness
  • Extreme fatigue that can last for days, anxiety or shortness of breath with or without chest discomfort
  • Rapid or irregular heartbeats

Arrhythmia

Arrhythmia (heart rhythm problems) happens when the electrical impulses that regulate your heartbeats don’t work properly, causing your heart to beat too fast, too slow or irregularly. Atrial fibrillation is one type of heart arrhythmia. Symptoms of heart arrhythmia can include:

  • Palpitations ─ a feeling of skipped heart beats, fluttering or flip-flop sensation
  • Pounding in the chest
  • Dizziness or lightheadedness
  • Fainting or near fainting
  • Shortness of breath or wheezing
  • Chest pain
  • A racing or slow heartbeat
  • Weakness or fatigue (feeling very tired)

Heart valve disease

Heart valve disease occurs if one or more of your four heart valves don’t function properly. Birth defects, age-related changes, infections or other conditions can cause your heart valves to not open or close properly, or leaking which can cause blood to flow backwards into the heart chambers. Symptoms of heart valve disease can include:

  • Shortness of breath and or difficulty catching your breath
  • Unusual fatigue
  • Swelling in your legs, ankles, feet and abdomen
  • Fluttering, irregular or racing heartbeat
  • Dizziness or fainting

Heart failure

Heart failure is a condition in which your heart can’t pump enough blood to meet your body’s needs. Some causes include coronary heart disease, heart valve abnormalities, heart attack, diabetes and high blood pressure. If you have heart failure, you may experience:

  • Shortness of breath during activity or at rest, especially when lying flat in bed
  • A dry, hacky cough that doesn’t go away or wheezing
  • Rapid weight gain, as much as 2-3 pounds per day
  • Swelling in ankles, feet, legs and abdomen
  • Fatigue or lightheadedness
  • Rapid or irregular heartbeats

Pericarditis

Pericarditis is inflammation of the lining around the heart. It causes chest pain and accumulations of fluid around the heart. Causes of pericarditis include infections, injury and radiation treatment. Pericarditis usually begins suddenly and is short lived.

The most common symptom of pericarditis is chest pain, but it’s different from the pain of a heart attack. It may be sharp and located to the center of the chest. It gets worse when lying down, taking a deep breath, coughing or swallowing. Sitting up and leaning forward improves the chest pain.

Symptoms of heart disease aren’t always clear-cut, and it may be difficult to tell what’s really going on. If you are experiencing any of these symptoms, check with your health care provider. Or if they’re severe, call 911. It’s the fastest way to receive life-saving treatment.

David Jackson, M.D.

Dr. David Jackson, M.D., FACC is a MPCP partner and is certified by the American Board of Internal Medicine in both Cardiovascular and Internal Medicine. He sees patients in the Columbia Cardiology office.