Transcriptions
Dr. Sanders: Hi, Dr. Sanders of Voyage Direct Primary Care. Today I wanted to talk about colds. It’s cold season right now, it’s in the middle of February, and we’ve got a lot of people out there with runny noses and congestion and sore throats and all that stuff and I want to talk about today what common recommendation that I have to folks that get colds, and then how to kind of avoid other things and whatnot.

So, number one: cold. You have the typical head congestion, lots of mucus, lots of mucus. Things you can do with that mucus, I like to do 1200 mg of mucinex, plain mucinex, just gyphenicen. There’s a lot of combo meds over there, and you don’t often need all the different various combinations. Those just add lots of side effects to your stuff and make you feel groggy and sometimes really dizzy and funky, so just plain mucinex, 1200 mg twice a day. Mucinex breaks up the mucus, makes it more like water, so doesn’t pull in your sinuses or in your ears or in your lungs, and predispose you to “opportunistic infections,” we;ll talk about that in a minute. 

The other one is sudafed if your blood pressure will tolerate that, another reasonable thing to do. Again, plain sudafed, it will dry up the mucus in your nasal terminix so you don’t create as much mucus and I just like those two medicines, honestly. There’s dexomethorphan, Sudafed DM, again that’s a cough thing, I like people to cough. Certainly if there’s a cough that’s keeping you up at night and all that then maybe you can add some of those things, but honestly there’s things I can add to your regimen that will be better than that stuff anyway. 

So, opportunistic infection. The average cold lasts three to seven days, usually. So that’s very common and you’ll eventually kick it, lots of water, lots of rest, lots of fluids and sudafed and mucinex, and most people just kind of, the virus will run its course and your immune system will kill it. However, sometimes that mucus pools, and it will pool in your sinuses, and it will pool in your ears, it might even pool in your lungs and will create what’s called and opportunistic infection. That’s when I want to hear from you. 

So if you’re past that seven day mark, and you’re having ear pain or you’re having sinus pressure, again past the seven day mark, so I’m ten days in and I’ve got this sinus pressure. Now you have a sinus infection. Well what about in the first three days and I get sinus pressure? Well that’s all viral, lots of mucus and it’s still pooling in your sinuses and causing pressure, but the chance of that being bacteria are much less. If you’re past that seven day mark and it’s starting to hurt, then yeah you probably got an opportunistic bacterial infection. Also you can have pneumonias in that same time frame. Kids get otitis, maybe like an ear infection, very very commonly as an opportunistic infection as well.

So be on the lookout for those as well, and I think that’s it. Dr. Sanders with Voyage Direct Primary Care, trying to teach the masses and talk about colds today. Thanks, bye.

The post The Common Cold: Symptoms and Remedies appeared first on Voyage Clinics.

WINTER 2019 INFLUENZA                                                                                                                                       

Influenza is in full force this winter.  I’ve already seen it tear through one of our families.  Their 10-month-old got very sick, and it even put the father in bed for 3 days.  Influenza is like a cold on steroids!  Symptoms include:  body aches, fevers, chills, fatigue, headache, sore throat, runny nose. Children can sometimes have vomiting and diarrhea as well.

WHAT’S THE BIG DEAL?                                                                                                                                                        

Influenza can cause serious complications, including:  pneumonia, respiratory failure, hospitalization and even sometimes death.  These complications are especially common among infants, elderly, and people with chronic illnesses (diabetes 1 and 2, heart disease, lung disease, etc).

In medical school, my microbiology teacher told me, “Of all the bacteria, fungi, parasites and viruses you’ve learned about, there is one that scares me the most…” (dramatic pause while we all tuned in) “…Influenza!”  He went on to explain genetic shifts and drifts and how, if a significant genetic change to the virus occurs (one that people’s immune systems aren’t familiar with), it could cause massive complications.

This has occurred a few times over the years; the most significant genetic mutation was the Spanish flu of 1918.  This pandemic was the deadliest in recorded history.  It infected an estimated 500 million people worldwide—about one-third of the planet’s population—and killed an estimated 20 million to 50 million victims, including some 675,000 Americans.

HOW TO PREVENT INFLUENZA?                                                                                                                                   

The CDC recommends flu vaccinations each year to decrease the spread and severity of disease.  Flu vaccinations can be given to people starting at 6 months and older, depending on age and health status.  Vaccinations help the body’s immune system become familiar with influenza so that if it encounters the virus, it can fight it off quickly and easily.  If you’ve been vaccinated and “catch” the flu, you’ll experience fewer and less severe symptoms than you would otherwise.  If you’re vaccinated, the flu will probably feel like a regular cold (lasting 2-3 days) instead of knocking you completely out of commission for 10 days.

Sometimes influenza mutates to a different strain than the one to which you were immunized.  This happened two years ago when the predominant strain of influenza was not consistent with the vaccine.  Those who were vaccinated and contracted the flu did get sicker that year than they had during years where the vaccine hit the target, but it still helped somewhat.

Does the flu shot actually cause the flu?  No!  This is a common misconception.  It can, however, give you slight flu-like symptoms for a few days.  I got mine last week, and I had a sore shoulder for a couple of days but that was about it.

WHAT IF I CATCH THE FLU?                                                                                                                                               

First, we have to decide if it will be beneficial to test for it.  You should consider testing if:  you are pregnant, have small children, or are elderly.  You should also consider testing if you have a serious medical condition or are immunocompromised (type 1 diabetes, emphysema, COPD, asthma, heart failure).  If you’d like to be tested for flu, you can come in to Voyage DPC for a $30 test (with membership).  There are many pharmacies who offer the test as well.

If you suspect that you have contracted the flu, the earlier you come in for testing, the better.   If you get tested and require treatment with Tamiflu, it is helpful to get the medication onboard as early as possible (first 48 hours).  If you are not at high risk for flu complications but you live with someone who is (elderly, infants, pregnant women, people with chronic disease), you may want to get tested as well.  This will allow us to consider preventive treatment for other family members who are at high risk.

VOYAGE DIRECT PRIMARY CARE                                                                                                                                     

At Voyage DPC, we are fixing healthcare. We are happy to help with your influenza needs.  We are available for same-day or next-day visits.  We also offer osteopathic lymphatic treatments and adjustments shown to mobilize lymphatics and optimize your immune system.

We hope this post has been educational for you.  We love to teach and help other optimize our members’ lives and wellness as we help them navigate healthcare.

Enjoy the Journey!

John Sanders,D.O.                                                                                                                                                                   Family Physician

The post Influenza is here 2019 appeared first on Voyage Clinics.

“FIGHT NIGHT”

Let’s talk about it.

You only get one brain and it’s darn valuable. Some high schoolers in my area have been having “fight nights.” They put on boxing gloves and throw haymakers until someone gets knocked out. They create a mob-mentality with all the high schoolers in a circle egging them on, further jacking the situation.  Then they often post it to social media.

TRAUMATIC BRAIN INJURY:
At 10:30 pm Last weekend I got a call. One of my patient’s sons was involved in a fight night and was knocked out cold. The father and I spoke and he said he was “pretty bad” and asked if I could help. I did a house-call to check out the situation. The poor kids brain was severely concussed. He was severely agitated, confused, and stuck in a 30-45 second loop mentally. He would repeat himself and always end up confused and angry. These are classic symptoms of a severe concussion to the frontal lobe of the brain. Neuro exam was otherwise intact. I advised them to head to the ER as this was one of the worst concussions I had ever seen. They said they couldn’t afford an ER visit at this time. I’m certified in Advanced Trauma and Life Support and I’ve worked in an ER but I didn’t have a way to scan his brain for a bleed. I decided on frequent neuro exams and something to calm him down. I collaborated with the local ER physician who agreed with my plan and understood the situation. I sent Mom to a 24 hour pharmacy and we were able to get the him calmed down finally at 1:30 am. I watched him closely over the next 72 hours with frequent neuro exams to ensure he wasn’t bleeding in his brain. He gradually recovered mental clarity over the next few days.

This kid could have died. Let’s put a ban on fight nights and keep these kids safe.

At Voyage Direct Primary Care we go above and beyond the current healthcare system and help families access old-school family medical care. ???? It’s also important to point out the strains the current healthcare system (with it’s copays and deductibles) is putting on families. I’m glad it all worked out and I was able to help them but this could have went sideways pretty easily.  At Voyage DPC we are striving to fix much of what’s wrong with the current system by providing a high level of availability, transparency, and affordability.  We believe the families deserve great family medical care.

**this picture is a dramatic re-enactment of a face blow. It’s not real**????

*Posted with permission*

The post Fight Night and Traumatic Brain Injuries appeared first on Voyage Clinics.

Transcription:
Dr. Sanders: Dr. Sanders of Voyage Direct Primary Care here to talk about a couple of muscle groups that are important to stretch. Number one is your pecs. Pecs affects your posture a lot. Our pec muscles are these muscles here, they move our shoulders forward and they can often lead to this phenomenon with our posture. So we have to stretch our pecs, we often forget to stretch these guys. Stretch our pecs, pull our shoulders back, our chin down to avoid that cervical neck problems that I see in a lot of people.

So pec stretch, here it is. Make sure you go at about 90 degrees, turn your body, you feel that nice little stretch here. I like to go up 45 degrees from there, and I like to go down 45 degrees from there, and that gets your full nice pec muscle. Make sure you get both sides, both sides.

Next, piriformis. These are your three P’s: pecs, piriformis and psoas. So your next one is your piriformis, you may have heard of sciatica, low-back pain. This is often caused by a tight piriformis. It’s one of the muscles in your glutes, it’s right here in your butt. So to stretch it, do a figure four. You’re sitting down and you just have a figure four look. I like to go towards my knee for 15 seconds, towards the middle for 15 seconds, towards my foot for 15 seconds. Do each of those three times, both sides. Towards your knee, towards the middle and towards your foot. You should feel a nice stretch in your butt, it’s going to really avoid that low-back pain in that piriformis, sciatica issues that a lot of people have. If you already have sciatica, do this stretch, it’ll help a ton.

Next, psoas. This is my favorite stretch. You may have seen Nacho Libre, this is one of my favorite poses on that movie. Nacho does this action, boom. So, make sure that your hip isn’t open. You close your hip down, your pelvis is forward. You take a nice, long stride out, and you just stretch. You’ll feel it stretch right in this region right here. So get both sides, do a nice lean forward and get that psoas. 

Why is your psoas stretch so important? Your psoas, this muscle here, controls your pelvis. So if it’s tight, your pelvis will often tilt like this, it’ll tilt back like this if it’s too tight. So we want to stretch those guys so we can maintain a nice good, even pelvis and avoid that low-back sprain or strain that you’re going to set yourself up for with tight psoas muscles.

So, again: piriformis, pecs and psoas, the three P’s. It’s a good stretch regimen to do every day. Thanks.

The post Psoas, Piriformis, and Pec Stretches appeared first on Voyage Clinics.

Transcription
Dr. Sanders: Hi, I’m Dr. Sanders with Voyage Direct Primary Care. Today we’re going to talk a little bit about skin health. There’s two categories of skin cancers out there that your doctor should be looking for. One is pigmented and non-pigmented. In other words, one is dark and one is basically skin colored.

The non-pigmented ones are no big deal, the pigmented ones can become melanoma, and it’s a big deal. I like to use this device here, it’s called the dermascope, can you see that pretty well? It allows me to take a microscopic look at any moles or any suspicious dark legions that I see, and kind of just tell more information about it. 

Make sure that you go to your doctor at least annually for a skin exam. If you have a family history of melanoma you should go maybe more frequently than that. Again, Dr. Sanders of Voyage Direct Primary Care

The post Skin Exams with a Dermascope appeared first on Voyage Clinics.

Transcription
Dr. Sanders: Hi this is Dr. Sanders from Voyage Direct Primary Care. Today I wanted to talk about skin cancers, there are two main categories of skin cancers. You’ve got the pigmented and the non-pigmented skin cancers. This means the dark ones and the non-dark ones. The pigmented ones are the major ones that we’re mostly concerned about, that would be the melanomas of the world. Melanoma, you have your A. B, C, D, Es of Melanoma: asymmetry, irregular borders, lots of color in it, diameter greater than four millimeters, and evolving or changing.

If you have a dark skin legion that’s manifesting any of these things, you want to definitely get those looked at. One of the benefits of Voyage Direct Primary Care is that I have negotiated pricing on the pathology piece, so I can do the incision in my office and we can send that to pathology typically with insurance it’s about $250, with us it’s about $70, so that’s fantastic savings there.

The non-pigmented skin lesions are going to be scarnel cell and basal cell carcinoma. While they sound scary, they’re not very scary. They’re just disfiguring, so the sooner the better you detect them, but they don’t metastasize to all parts of your body and cause death and things like that like melanoma does. 

I hope this helps you understand skin cancers better. Voyage Direct Primary Care, I’m Dr. Sanders.

The post Different Types of Skin Cancer appeared first on Voyage Clinics.

Transcription
Hi I’m Dr. Sanders with Voyage Direct Primary Care. Today we’re going to talk about vertigo. My sweet wife Shauna woke up this morning and the whole world was spinning on her. When she wakes up she’s laying on her side, and she gets up quickly, rolls over and touches her alarm clock, and she threw off some of the crystals in her inner ear called the cochlea, and she gave herself a bad case of what’s called Benign Parasichsmal Provisional Vertigo. It’s just what it sounds like, it’s benign so it’s not a huge deal, but it can make you feel really bad. So she’s had symptoms of…

Shauna: Dizziness, vertigo, I feel like I’m going to fall over when I try to walk someplace especially, it gets worse. When I move my head in different positions and sometimes I’m nauseous as well.

Dr. Sanders: So I wanted to show you a quick maneuver that is curative a large percentage of the time. So let’s go through that real quick.

So you just have them sitting up, and then you have them kind of quickly lie back, and turn their head towards me and extend their neck, and you kind of support their neck in that endeavor. So let’s go ahead and go through it, go ahead Shauna. 

So you support their neck as they lay it back and I’m holding her neck up, and often it will bring on a sense of dizziness, sometimes they’ll throw up so definitely have a barf bag ready. And you’ll see her eyes will start to twitch, and it gives her a real bad sensation of dizziness.. If you can see her eyes twitching there. And that just re-calibrates those stones in her inner ear, and so the goal is to shift them in a place that’s more functional so she doesn’t have the vertigo as bad.

So I usually hold them there until their symptoms go away, have they gone away?

Shauna: Yep

Dr. Sanders: And then I’ll have them sit back up, and then sometimes even sitting back up causes the symptoms to get worse as well.

Shauna: Yep, I don’t think my eyes are twitching but I’m definitely feeling a little dizzy.

Dr. Sanders: Okay, and then so usually it’s one side that’s affected, I’ll take them to both sides and just see which side is the worst and I’ll do it several times to that one side.

That’s it, this is Voyage Direct Primary Care, I’m Dr. Sanders helping people muscles through vertigo. If you have symptoms of imbalance or proprioception loss or different things like that, it could be other things as well, so if you do have an episode of a vertigo spinning-type sensation, make sure you talk to your doctor about it. There are several different things it could be as well. Thank you and thanks for listening.

The post Treating Vertigo Attacks appeared first on Voyage Clinics.

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Common Cold vs. Strep vs. Flu

Transcription
Dr. Sanders: Today I want to talk about the common cold versus strep versus flu. So let’s talk about flu and the common cold first. The common cold is runny nose, sometimes watery eyes, sore throat, and that’s about it. Kind of the common head cold. Influenza is going to be similar symptoms but just profound. So you’ll have a fever often, you’ll get really sick, you’ll feel a lot of fatigue. A common cold can sometimes make you have some body aches and those things, it’s a nonspecific finding. So just think of influenza as a common cold really, really on steroids, so just really, really severe.

Now, let’s talk about the common hold, which will give you a sore throat, inflamed tonsils, a redness in the back of your throat, lots of mucus and coughing and all of that versus strep. Strep is one that you don’t want to miss, you got to treat that, you can get rheumatic fever, you can have heart valve, you can have kidney disease, you can have joint disease from non-treated strep, so we want to definitely detect that. It’s offered for free as part of my membership in Voyage Direct Primary Care. A rapid strep test, we can do that any time we want to.

So, what’s the difference? Well, strep is going to cause sore throat, fever, sometimes a tummy ache and a headache. But the thing that’s real kicker for strep is going to be the they don’t have the mucus, they don’t have the cough, they don’t have the nasal congestion or all of that other stuff. Does it mean that you can’t get a cold on top of a strep, no it doesn’t mean that. And in fact, I’ve almost gotten fooled on that before. As a whole, if you have a cough and you have lots of mucus and you have a sore throat, chances are it’s not strep. If you have a sore throat and a fever and a tummy ache and no cough, no mucus, chances are it’s strep and you have to get tested. 

So just to help you kind of parse through that a little bit, Dr. Sanders with Voyage Direct primary care.

Additional Information on Strep Infections In the USA

According to the CDC, the United States sees 14,000–25,000 cases of invasive group A strep disease each year, and 1,500–2,300 deaths from it. The CDC also estimates that the country has several million cases of mild group A strep infections, and 11,000–13,000 cases of severe group A strep infections, with 1,100–1,600 deaths. 

Key Points

• Preliminary 2023 data indicate the number of severe infections caused by group A Streptococcus (group A strep) reached a 20-year high.
• Currently, less severe infections are also at high levels throughout the country, as is typically seen from December through April.
  • (https://www.cdc.gov/groupastrep/current-activity.html)

Prevention Tips

Now that we’ve talked about the differences between the common cold, the flu, and strep, let’s touch on a few more important points. One thing people often ask is, “How can I prevent these illnesses?” Well, good hygiene is key. Wash your hands frequently, avoid touching your face, and try to stay away from people who are sick. For the flu, getting an annual flu vaccine is highly recommended, as it can significantly reduce your chances of getting sick.

When to See a Doctor for Flu, Strep, “Colds”?

Another question that comes up is, “When should I see a doctor?” For a common cold, you usually don’t need to see a doctor unless your symptoms are severe or prolonged. Rest, fluids, and over-the-counter medications can help manage symptoms. However, if you have a high fever, difficulty breathing, or symptoms that are getting worse instead of better, it’s a good idea to seek medical advice.

For the flu, because it can lead to more serious complications, it’s wise to see a doctor if you have significant symptoms like a high fever, severe body aches, or fatigue that doesn’t improve after a few days. Antiviral medications can sometimes be prescribed to lessen the severity and duration of the flu if caught early.

As for strep throat, if you suspect you have it based on the symptoms we discussed—sore throat, fever, tummy ache, no cough or mucus—it’s important to get a rapid strep test. If it’s positive, antibiotics are necessary to prevent those serious complications like rheumatic fever or kidney issues.

Treatment Options

Lastly, let’s talk a bit about treatment. For a common cold, focus on symptomatic relief. Hydrate well, use saline nasal sprays, throat lozenges, and rest as much as you can. For the flu, rest and hydration are also critical, and your doctor may prescribe antivirals if needed. For strep, antibiotics are the cornerstone of treatment, and it’s crucial to complete the full course even if you start feeling better quickly to ensure the infection is fully eradicated and to prevent complications.

Overall Health

Remember, keeping yourself healthy also means taking care of your overall well-being. Eat a balanced diet, get regular exercise, and ensure you’re getting enough sleep. These steps can help boost your immune system and keep these illnesses at bay.

Recap

So, to recap, good hygiene, knowing when to seek medical advice, and following the appropriate treatments are key in managing and preventing these common illnesses. Stay healthy, and don’t hesitate to reach out if you have any concerns or need further information. Dr. Sanders and Voyage Direct Clinics, Direct Primary Care pioneers, wishing you well!

The post Flu -vs- Common Cold -vs- Strep Throat appeared first on Voyage Clinics.

People often ask me the difference between an Doctor of Osteopathy (D.O.) and a Medical Doctor (M.D.). We have similar training in many ways. D.O.’s practice medicine alongside M.D.s in hospitals across America. While I am board certified in Family Medicine, I also trained in osteopathic musculoskeletal manipulations, which allow me to complement traditional medical treatments, thus optimizing wellness and healing. I offer patients a more holistic approach to health and wellness.

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