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Office Policies & Procedures | Staying Healthy | Cancer Detection | Curriculum Vitae

Office Policies and Procedures
	Most of our visits are by appointment. We do accept walk-ins on an emergency basis and will work you in as the need demands.
	If you feel that you cannot wait for or do not want to make an appointment, and it does not require you to be seen by me, we can call medication to the pharmacist as the case demands. Ask the receptionist for details.
	I respect your time and try hard to keep the appointments running on schedule, but each patient has different time requirements. I will answer every question about your problem and do my best to let you know how much I value you as a patient by the quality of time with you. Unfortunately, in working to achieve these high standards for my patients, we do get behind. You are welcome to reschedule if you have other pressing appointments. I will do my best to accommodate you.
	We reserve time each day to serve acutely ill people. Call the office upon opening at 9:00AM.
	If you feel you can only speak to me, please leave a message. I always return calls. Be patient, please. I may not be able to return your call until noon or later in the day after seeing my scheduled patients. Please be assured my staff also cares and will assist in any way they can.
	There is a 24 hour answering service for emergency phone calls.

Cancellation Policy

We ask for 24 hours notice for appointment cancellations. A “no show” charge will be billed to your account if we do not receive sufficient notice to cancel an appointment. In the case of a vasectomy or exercise treadmill test, the no show fee is increased due to the amount of time allotted for the procedure.

To Better Serve You

	My office staff is happy to make appointments and to obtain referrals for consults and testing. We do ask that if you make your own appointment, you give us at least 24 hours before your scheduled appointment in order for us to have the time to obtain the referral. It is better to be safe than sorry.
	You are responsible for knowing the requirements of your insurance policy such as needing a referral for tests or specialty consults. We will make every effort to adhere to their requirements, but ultimately responsibility is with you.
	Our default laboratory is Quest Diagnostics. We send all lab work, thin preps, and biopsies there unless otherwise notified. If your insurance company requires you to use another lab, it is your responsibility to notify us.
	Appointments are not required for blood work, blood pressure checks, and shots. The lab times available are 9:00AM – 11:30AM and 1:00PM – 4:00PM. Please be patient, we work you in as soon as possible.
	Any changes in your insurance coverage, phone number, address or employment, please notify us so we can keep your records current.
	We cannot guarantee your insurance will cover anything.
	We are happy to fill out FMLA papers once. Any additional changes will require a scheduled appointment.
	At the completion of your appointment, a copy of your bill is offered. Requests made later will be charged. We are here to provide you with the best possible services. If you have any question, please feel free to ask my caring staff or myself. Again, welcome to my practice!

Staying Healthy
All you ever wanted to know about Preventative Health but were afraid to ask.

Patients always ask me how I, as a doctor- always seeing people who are ill- keep from getting sick too. Well, I do get seasonal colds, and sometimes the new bug that hits town. But really there are a few simple things that everyone can do that will make a difference in their immune system and keep them healthy.

Definitions

Tests

Diabetes

People who are at high risk: overweight, family history, currently have hypoglycemia, or glucose intolerance, history of gestational diabetes; or who are symptomatic - frequent urination, frequent yeast infections, fatigue, vision changes, increased thirst, itching, weight changes should be tested with a fasting and a 1 or 2 hour glucose tolerance test- done in the office.

Those who are diabetic should strive for their ideal body weight, keep their HgB A1C below 6.0, keep finger stick blood sugars around 100, get yearly feet exams and yearly eye exams.

Heart Disease

This includes blockage of the arteries and high blood pressure. Both adversely effect the heart and your life. Blood pressure should be checked regularly at each doctor's visit and certainly with every yearly exam. Blood pressure may vary but 120/80 is a good average. Family history plays a huge role in blood pressure as does lifestyle, weight, and exercise. I'm unaware of any current recommendations for screening cardiac stress tests, but it makes sense to me if you have a family history, high cholesterol, high blood pressure, diabetes or any symptoms of chest pain, pressure, tightness, squeezing in your chest- get your heart checked.

Cholesterol

Recommendations keep getting lower and lower every year. If you don't know your good from your bad cholesterol, come in and see me. You need to! Your total cholesterol should be below 200. HDL's value, also known as "good" cholesterol will vary according to the age of the patient, but above 40 is good. The real culprit is LDL, aka "bad" cholesterol. An individual with no health problems should strive for an LDL below 100, but a patient with heart disease or diabetes should do everything to keep their LDL near 70. It only makes sense to me that everyone would benefit by keeping their LDL as near to 70 as possible. Studies show that babies and populations that have a low fat diet have LDLs near 70 which is why that has become the "goal". Always try to eat a well balanced heart healthy diet. We have free samples of these diets at the office; just ask! Our livers are just cholesterol producing machines. That's why even vegetarians and athletes can have high cholesterol. It is important to check bloodwork every year to track your numbers. In addition to diet and exercise you can also use Omega 3 fish oil and niacin to help lower your values. Studies also show that by adding a statin- crestor, lipitor, pravachol, etc... and lowering your cholesterol, no matter how low it is already, your risk of heart disease may be lowered by 1/3. Those are pretty good odds.

Hypertension

Also known as high blood pressure or the Silent Killer. High blood pressure can cause dizziness, headaches, blurred vision, neck pain, chest pain, blindness, an enlarged heart, kidney failure, an aneurysm, a stroke, and may cause no noticeable symptom at all. Ideally a blood pressure of 120/80 is the goal. Life style changes that you can do to help yourself are: get plenty of sleep- we need at least 8 - 9 hours each night; cut back on salt and sugar; avoid alcohol; avoid caffeine; avoid nicotine- smoking or chewing; if you are doing any sort of drugs, ie cocaine or meth- stop! that 's a very potent contributor to a lot of health problems including your high blood pressure; exercise, lose weight- even a few pounds can result in good blood pressure control; control the stress in your life- are your shoulders tight, are you always angry and snapping at people? Let's fix it.

Early Cancer Detection

Prostate Cancer
Digital exam of the prostate and an associated PSA should begin at age 50 and repeated yearly. If there is a family history, then it should begin about ten years before that family member was diagnosed, ie if a father is diagnosed with Prostate Cancer at age 52, his sons should begin screening tests at age 42.

Colon Cancer
Digital rectal exams at age 50, then yearly, hemoccult testing of the the stool at age 50 and then yearly, and if you are lucky to have an insurance that will cover it a flexible sigmoidoscopy at age 50, and then every 5 years there after. Again if there is a family member diagnosed with colon cancer, then screening should begin ten years prior to that diagnosis. And I would recommend a complete colonoscopy as opposed to a flexible sigmoidoscopy. There are several blood tests available to evaluate and follow colon cancer, CA199, and CEA, but they are not good screening tools.

Ovarian Cancer
This is a very difficult cancer to find early enough to do any good. Yearly pelvic exams, pelvic ultrasounds, and CA125 blood test are available. But none of these identify everything. Be aware of bloating, pain, pain with intercourse, abnormal spotting or bleeding, something that's "just not right" and family history.

Breast Cancer
Monthly self breast exam. No matter what recent studies may show about health care dollars in the third world, it is still a great idea. Everyone has lumps and bumps. You are looking for changes: nipple discharge, pain, growing or changing lumps, skin getting dimpled, a breast growing or changing in appearance, a lump stuck to the chest wall- anything that is different. Mammograms recommendations continue to be controversial. Mine are conservative: If there is a family history then 10 years before that relative's cancer was diagnosed, or at age thirty, whichever comes first. For the general public age 35 for their first screening mammogram. Then again at age forty. Every two years between 40 and 50, then every year after age 50. Some women with fibrocystic changes benefit from an additional test with ultrasound.

Lung Cancer
Stop smoking. There are no current recommendations. Yearly Chest X-rays are not cost effective for insurance companies. There are no blood test to screen for it and no insurance will pay for a bronchoscopy as a screening test.

Skin Cancer
Use sun block of at least SPF 15. There is no safe tan. Make sure that as part of your yearly exam your physician is checking you - all over- for abnormal lesions. If you see any moles or spots - new ones, old ones changing appearance- getting darker, larger, irritated, itching, burning, catching on clothes, bleeding come see me.