Daily Piece: Happy Halloween – Before You Grab A Yummy Candy Treat

You are winding down from a fun Halloween evening, You are tempted to grab some candy from your child’s treasure of yummy treats or the left over candies.  Stop…before you do, click below to check the carb content.  Moderation is key. My favorite is candy corn. What is your favorite candy?


Image result for halloween candies

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#halloween    #yummy     #candy

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Daily Piece: Caring for the Whole Person

Bill is one of my favorite patients as he is elderly gentlemen with a loving supportive family.  During his last visit with me, he shared his frustration of having the benefit of medical transportation to his dialysis appointments discontinued due to his “improved health.” As it turns Medicare discontinued this vital service for Bill because his health improved.  This is an issue because Bill also has dementia and can not remember how to get home from the dialysis center if he drives for his treatment.

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While I am a diabetes educator, I have the responsibility and privilege of caring  for the “whole” person as in Bill’s scenario.  Good news, after following up with his PCP, the paperwork is being processed for Bill to get his medical transportation to dialysis center back.

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#caring    #whole     #patient

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Daily Piece: Dig Deep and Break Through

It is tempting at times to give up when hitting a brick wall.  Today, I celebrated breaking through the brick wall.

Meet Sally a senior adult with Type 2 diabetes that I have been working with and supporting her in managing her Type 2 diabetes.  I have felt like I keep hitting that “brick wall” with Sally.  Today would be different.

I reviewed Sally’s chart when I arrived at office this morning.  At her last office visit, her blood sugar was over 500 mg/dL. Oh no, I thought.  She had been closer to target range prior to that office visit.  What was happening?  When Sally arrived for her visit, I checked her blood sugar and reviewed her blood glucose log (most values in 300 – 499 mg/dL range).  Oh no!  I assessed her abdominal area for any fatty deposits (lipodystrophy).  No fatty deposits.  I asked her to demonstrate how she injected her insulin. Spot on, no issues with insulin administration.  So I ask her about her 500 mg/dL blood sugar during last office visit. She states, “I ate a tomato sandwich without taking my bolus insulin.”  Ummm.  Now, I honestly did not see how that would cause such a glucose elevation. Keep digging!  Keep digging!  After doing a diet recall with her, the pieces of the puzzle still do not fit.  Ummm…what about beverages?  She only drinks orange juice when her glucose is low.  Turns out, she loves to drink an old fashioned Coke Cola.  She enjoys drinking her coke most every day.  The culprit for the significant glucose elevation..an old fashioned coke. After a bit of discussing and bargaining, Sally agreed to limit her coke to only when she had a low glucose.  Often times, we must dig, dig and dig to discover the obvious.

Image result for coke a cola

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#dig     #deep     #break #through

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Daily Piece: Navigating the OTC Aisle

Cold and flu season is upon us. Do you know how to properly navigate the OTC aisle to find just the right product you need?  Please  click below to learn more about how to navigate the OTC aisle.


Image result for OTC aisle

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#navigating     #OTC     #aisle

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Latest Blog…Millennials with an Affinity for Urgent Care Centers

In this blog, I am shifting away from my regular focus on diabetes to a broader healthcare topic which became of interest to me after reading a fascinating Washington Post article. The article focused on how people that live in large cities or move to new geographical locations on a regular basis are not developing long-term relationships with Primary Care Providers. In fact the article goes on to explain that many are utilizing Urgent Care Centers for their primary healthcare needs. And if you haven’t already guessed it – Yes, the Millennial Generation is leading this charge! …the “Disrupters of Value Based Healthcare!”

Value-Based System
The overall landscape for healthcare is the process of becoming a truly value based structure which emphasizes a variety of healthcare across the various stages of our life. Access to care is a crucial component of the value based system. Within this structure, the Primary Care Provider is viewed as the reliable medical adviser and coordinator of one’s healthcare needs. Also, Care Managers play an essential role in coordinating individual care for each patient, especially those who require complex levels of care. The Value Based System places a strong emphasis on avoiding high cost containers such as frequent emergency room visits for basic health care, as well as, attempting to avoid any duplicative care services between physicians.

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Disruption of the System
At the same time, disrupters within the network of healthcare are creating some challenges for the Value Based System. Consumers no longer feel they are at the mercy of the healthcare system, but rather they can take control and coordinate healthcare themselves. Advances such as telemedicine and patient portals enhance the care possible through a Value Based System. However, another disrupter, is the bust of urgent care centers, whether free standing or within pharmacies. These urgent care centers, if utilized for primary care, have the potential to create fragmentation in the “continuum of care” we find offered within the Value Base System.

Millennials, born between 1981 and 1996, want price transparency, convenience, and immediate care. They are not willing to wait a couple of days to see a primary care provider for an acute illness such as strep throat, flu, or scratched elbow. They have peeled away from the model of office-based primary care which they were accustomed to as a child under the care of a parent’s health insurance! The concern with this shift to an urgent care facility based healthcare plan lies in moving away from a one on one relationship with a Primary Care Provider. This can also fragment an individual’s healthcare and drive up overall healthcare costs.

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The Millennial generation is opting for retail clinics within pharmacies or other retail outlets, free standing urgent care centers, and online telemedicine sites. These all allow for convenience, transparency in costs since prices are likely posted, and provide digital connectivity. The Kaiser Family Foundation conducted a survey of 1,200 randomly selected adults and the findings indicated 26 percent of adults surveyed did not have a primary care provider Also, more specifically noteworthy is 45% of 18 – 29-year olds asked did not have primary care provider. While in an Employee Benefit Research Institute 2017 survey – only 33 percent of millennials did not have a regular doctor.

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Shifting to Address Disrupters
Primary Care Practices are hearing the Millennials loud and clear! The practices are responding and working diligently to attract and retain patients. How? Digital access has been incorporated allowing for online patient portals with ease in accessing their medical records, contacting their provider and making appointments with greater ease. These practices are adjusting their delivery model to incorporate additional providers, thus allowing for increase in patient capacity, incorporation of walk in patients, and urgent care clinics within many medical practices. The advantage of having the walk in or urgent care clinic within the primary care practice is the variety of care and treating the whole patient.

Reece’s Piece
I view change and adaptions within our healthcare environment to adjust to generational differences as positive. While I am certainly concerned with fragmentation and potential drivers of increase healthcare costs, I am thrilled to see Primary Care Practices transform to provide for the change demanded by Millennials. After all, we have come many light years since the doctor traveled to their patients’ home to provide care. Or have we? Home visit service is commonly offered by larger Primary Care Practices today. Like the rest of life, we come full circle. I encourage we proceed with great caution – we deserve the best healthcare!

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#millennials     #affinity    #urgent  #care

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Daily Piece: Annual Diabetes Eye Exam

After being in clinic today, my mind is fixed on the importance of getting annual diabetes eye exam.  If you are a person with diabetes, do you make getting your annual diabetes eye exam a priority? I have two young adults with Type 1 diabetes who I have worked with for a few years who are now experiencing eye related complications from years of having glucose values that have been far out of target range.  The silver lining is that they are now aware of the reality of their current situation and can turn the ship around. Get eyes exam, become informed and turn the ship around.

Image result for dilated eye exam

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#eye     #diabetes     #eye  #be informed

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Daily Piece: Now is the Time to Integrate the Diabetes Educator

While talking with the wonderful AADE Oregon Coordinating Body leaders on Thursday evening, I learned of Jessie Peterson, a diabetes educator, who is integrated into a primary practice, and all persons with diabetes seen in this practice have appointments with Jessie for clinical management, education and support. Shout out to Jesse!  It is time to move out of the silo of the education department into integration within outpatient primary care clinics.  Let’s integrate!


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#integrate     #diabetes     #educator  #primarycare

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Daily Piece: Ineffective Communication Makes for Frustrating Experience

As a healthcare professional, I tend to get in my groove when I am in clinic with a strong focus on patient care and effective communication.  I forget at times however frustrating it can be for patients, loved ones and caregivers when there is a complete lack of communication.

Today my husband and I experienced a very frustrating situation due to ineffective communication while at a specialist office visit and outpatient surgery center with my husband. He saw the specialist, and I listened attentively for the assessment and plan.  All was good. My husband and I were sent to check out clerk to schedule appointment for his outpatient surgical procedure. The clerk provided he and I with brief directions for a short walk to the outpatient surgery center around the corner to schedule his procedure.  Problem….he and I were NOT told that we would need to allow 40 minutes to “schedule” appointment for the procedure.  After the brief walk over to the surgery center, a receptionist “tosses” over a clip board with a stack of forms to complete.  She failed to explain that all of this “paperwork” had to be completed before meeting with another clerk who would enter in the information into the electronic health record then pass us off to the final person for scheduling the appointment.

A great lesson learned today (other than to avoid the particular surgery center in the future) for myself is to slow down and make sure that I am providing clear and effective communication with patients.

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#ineffective     #communication     #frustrating  #experience

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Daily Piece: Exciting New Guidelines…A Must Read

For my fellow diabetes educators and healthcare professionals, have you read the updated guidelines from ADA and EASD on the treatment of hyperglycemia in Type 2 diabetes? This set of 2018 guidelines are a refreshing update from the 2015 guidelines.  This update emphasizes individualized care for the person with Type 2 diabetes.  Please click below to take a few minutes to get up to speed. I promise that you will not regret it!


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#ADA     #EASD     #hyperglycemia #guidelines

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Being a Diabetes Educator Comes Out in Unexpected Settings

During dinner this evening at my husband twice year corporate leadership meeting, I had a couple of most interesting conversations.  One of my husband’s professional colleagues shared that he met a diabetes educator on his flight down to Atlanta.  He was excited to meet this educator  and understood the importance of the role of the diabetes educator due to his getting to know me over the last few years at these leadership meetings.

A dear professional friend of my husband shared how changing his diet to a focus on whole, non-processed foods and incorporating daily walks into his life has strengthened his battle against cancer.  Our diet (eating habits) and incorporating regular physical activity into our daily has the power to radically enhance our life and improve our overall health. I continue to strongly believe that our eating habits and physical activity are medicine.

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#diabetes     #unexpected    #settings

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