NeuCare EDU

Myth: The poison ivy rash spreads itself through oozing.

Fact: The rash, or discharge from the rash, does NOT spread itself to other areas of the body. The skin reaction is to a chemical called “urushiol” that is produced by the plant. Urushiol is a colorless, odorless oily substance that can stick to anything (skin, clothes, tools) and be spread around to different areas of your skin. Even the timing of that reaction after exposure can vary widely - sometimes by days or weeks - so it appears as though the rash is “migrating”.

Myth: I am allergic to “poison oak” or “sumac” but not “ivy”.

Fact: Poison ivy, oak and sumac are all part of the Toxicondendron genus of plants that produce the exact same oil, urushiol, that causes the rash. Actually, according to the local plant gurus poison oak and poison sumac are not natively found in the wild in Kansas.

Myth: I’ve never reacted to poison ivy in the past, so it’s safe for me to handle it.

Fact: We don’t fully understand why certain people react to poison ivy and other’s don’t. However, anyone can develop (or lose) the immune response at anytime in their life. I have seen many patients have their first poison ivy rash later in life despite dozens of previous exposures.

Myth: Only steroid shots or pills will get rid of my poison ivy.

Fact: Regardless of treatment, most rashes will last for 2-3 weeks. Steroids may help speed up that process by 1-2 weeks if started early. Systemic steroids (oral or injections) can be useful and needed in severe cases - especially if on the face or other sensitive areas. However, steroid skin creams can get the same amount of medication to the affected areas; and without the steroid circulating through the rest of the body.

Myth: Only the leaves of the poison ivy plant are poisonous.

Many women dread the eventuality of menopause - while others welcome it with open arms. In either case, the process of reaching the "end of monthly cycles" can be a rocky road. The timeframe directly before a woman starts menopause is called peri-menopause; which literally means "around menopause". 

The storm before the quiet

Many women in peri-menopause also experience hot flashes, difficulty sleeping, mood swings and other unpleasantries. Alterations in hormone levels are largely to blame for these menopausal-type symptoms.

To test or not to test?

Lab testing directly for "menopause" or "peri-menopause"  can be tricky and has many caveats. We know that post-menopausal women have very low levels of estrogen and high levels of Follicle Stimulating Hormone (FSH). Prior to several years past menopause, estrogen levels vary widely among different women (regardless of age) and even within the same woman depending on day and time - so it is generally not the best test to confirm menopausal issues.

This phase can start 2-10 years prior to actual menopause and occurs generally in women ages 35-55. The most common sign of peri-menopause is an irregular menstrual cycle. The timing and length of periods usually become erratic and unpredictable. Menstrual bleeding often becomes lighter, but sometimes - perhaps ironically - heavier and more frequent before stopping altogether. Diagnosing menopause and peri-menopause can typically be done with just a good health history and physical exam. However, a variety of medical conditions can have similar symptoms. Sometimes medical testing is needed to rule out any "other" suspected conditions.

A consistently "elevated" FSH is the most reliable lab marker of ovarian failure, the underlying cause of menopause. However, the FSH test is not without it's limitations. The timing of the FSH rise can be variable with respect to menopause; sometimes occurring years before or just around menopause in others. Also, FSH levels can vary widely within a single woman (even at the same time in a cycle), so they need to be repeated several times for confirmation.

Predicting menopause

For a variety of reasons, many women want to know when they are likely to start menopause. Family history of menopause (particularly first-degree relatives) is probably the best predictor currently available - especially if it occurs at a young age. Also, smokers tend to enter into menopause a few years earlier than their counterparts. Some health conditions and medications may also speed up the process.

In recent years there have been a few breakthroughs on using laboratory markers to predict the onset of menopause. The most recent advancement is a lab test called Anti-Mullearian Hormone. Several media reports have touted it as a predictor of menopause and for good reason. This test has been used for many years in fertility concerns, but just recently studied with respect to menopause. It has been found that a "low" AMH is a very good predictor of menopause occurring "in the next 5 years".

Medical management

I recently discovered an amazing online service called MyDirectives.com. If you are unfamiliar with the term 'Advanced Medical Directives', it is basically a legal statement regarding your personal wishes and preferences should you become incapable of making decisions about your medical care; particularly in an end-of-life situation. The most common example of this is the "Organ Donation" preference on your driver's license. Another commonly addressed aspect of an Advance Directive is a "Do Not Resuscitate" order  (or "DNR" as we in the biz say!) for people who wish not to have CPR performed should their heart stop. You can learn more about Advanced Directives with a great series of videos produced by this service. As with any legal document, completing a comprehensive and thorough Advance Medical Directive document can be a daunting task. Unfortunately, most people avoid doing so altogether because they don't have enough time or money (especially if an attorney is involved).  

​I inquire about existing Advanced Medical Directives upon all new member registrations and very few people (less than 10% based on my quick glance) have anything more than an Organ/Tissue Donation preference.  When I remember (which isn't nearly often enough), I encourage new patients, particularly those with chronic medical conditions or over age 50, to set up an Advance Medical Directive. However, I really didn't have a convenient and affordable resource for people to do so - until now. 

​MyDirectives.com is an online service that lets anyone create a legally binding Advance Medical Directive; simply without confusing legalese, online with great user interface AND for FREE! I personally created a Directive and it was a really painless, quick process. After creating your directives, it is obviously very important to share your document (wishes) with the people whom need to know. This is where MyDirectives.com is off-the-chart cool and cutting edge. You can share your Directives in a number of ways securely online with your family, friends or medical providers.

​In fact, they created a NeuCare portal for our members to complete their Directives so that they can be automatically shared with us and made part of their medical record. You can also use the code' neucare' to share your document with us.

If you have any complex questions about medical or legal questions about end-of-life issues, it is always wise to consult with your physician and/or attorney, but MyDirectives.com makes the initial process of creating and sharing an Advanced Medical Directive very easy; and did I mention free?

Welcome to NeuCare.net. Version 2.0 of our website has been an idea simmering in my brain for quite sometime; probably before finishing Version 1.0! While I have received many compliments on the style of our original website, it lacked clarity and cohesiveness of exactly how NeuCare works. I really think the new site nicely summarizes the basics of our version of Direct Primary Care on our SERVICES & PRICING pages.

In case you were wondering, I am NOT color-blind! One of my missions is to make primary health care easy for people; especially it's finances. We list all of our fees upfront and make things 'black & white' -- No decimals. No insurance coding gibberish. No hieroglyphics. I wanted the website to reflect that simplicity and transparency. 

​We have also greatly revamped the MEMBERS section of our website; including addition of a few new features, such as Refill Request and online Forms. I also have some other big ideas in this arena, so stay tuned.

The new website is also dynamic, so it will nicely format to any screen size or resolution - including phones and tablets. ​Members will now be able to easily send us messages, request visits & more from the comfort of their sofa on their iGadget.

Welcome to NeuCare.net. Version 2.0 of our website has been an idea simmering in my brain for quite sometime; probably before finishing Version 1.0! While I have received many compliments on the style of our original website, it lacked clarity and cohesiveness of exactly how NeuCare works. I really think the new site nicely summarizes the basics of our version of Direct Primary Care on our SERVICES & PRICING pages.

In case you were wondering, I am NOT color-blind! One of my missions is to make primary health care easy for people; especially it's finances. We list all of our fees upfront and make things 'black & white' -- No decimals. No insurance coding gibberish. No hieroglyphics. I wanted the website to reflect that simplicity and transparency. 

​We have also greatly revamped the MEMBERS section of our website; including addition of a few new features, such as Refill Request and online Forms. I also have some other big ideas in this arena, so stay tuned.

The new website is also dynamic, so it will nicely format to any screen size or resolution - including phones and tablets. ​Members will now be able to easily send us messages, request visits & more from the comfort of their sofa on their iGadget.

After gorging yourself during tomorrow's Thanksgiving meal you may be strongly inclined to take a nap. Your family will likely blame the turkey's high tryptophan content as the trigger of your deep slumber, but I would suggest interrogating your mashed potatoes before convicting the gobbler.

As flu season arrives (it’s officially here now) I am urging procrastinators to get vaccinated ASAP. People often cite negative personal experiences with the flu shot as a reason for declining my recommendation. The most common concerns I hear about the flu shot are “it gave me the flu” or “doesn't work for me.” Is that possible? And why does it not work sometimes?

The growing popularity of the Paleo Diet has been one of the most interesting diet fads in recent years. Based around Paleolithic (pre-historic human) hunter-gatherer food sources, the “caveman” diet takes eating ‘whole’ and unprocessed foods to the next level and makes amazing health claims. But is eating like prehistoric man for you?

Early in my medical training I envisioned myself as an old-fashioned family doctor. Marcus Welby, MD was well before my time, but he seemed like a good fictional role model for a naive student-doctor. (Especially considering Dr. Cox of Scrubs was my alternate choice.) After finishing my primary classroom studies, I was eager to leave the stacks of paper behind and to learn from real clinicians caring for real people.

After finding 2 ticks crawling on me recently I’m unofficially declaring it ‘tick season’. The unseasonably warm weather will likely help their populations thrive this year, but with a healthy dose of knowledge and preparation you can limit the health risks associated those nasty, godforsaken critters.