Adolescent Care

Providing care to adolescents can be challenging because teenagers are often struggling to make decisions on their own. They are in the transition between being children and adults and often do not want advice. Our providers work to speak in terms that adolescents can understand about acute or chronic issues as well as education regarding preventive medicine. We provide comprehensive, primary care for adolescents ages 12 to 21. Some 10 and 11 year olds are treated if developmentally mature.

Services available include:

• Comprehensive physical exams and immunizations
• Urgent medical care
• Treatment for asthma
• Allergy shots
• Nutritional support and counseling for eating disorders
• Screening for complications associated with obesity
• Contraception counseling
• Pregnancy testing and referral
• HIV antibody counseling and testing
• Behavioral problems
• Learning disorders
• Attention deficit hyperactivity disorder (ADHD)
• Gynecological problems, including sexually transmitted diseases

We respect the privacy of your adolescent/teenager, so all discussion of care especially those on topics of STD’s, drug use, and birth control remain confidential. We do know, though, that it is very important to talk honestly about any risks associated with such behaviors.

Chronic Care Management

Medicare and Comprehensive Primary Care are committed to improving your healthcare within our practice and improving the coordination of your care with other healthcare providers. To reach that goal we encourage all our Medicare patients to schedule an Annual Wellness Visit and enroll in our Chronic Care Management Services¬ (CCM) — both covered benefits for Part B recipients! As always, we are dedicating to working with you and thank you for trusting us with your healthcare needs!

Annual Wellness Visits are good for your health, help ensure more of your health needs are met, and are highly encouraged by Medicare for all Part B recipients.

• Aligned with national quality measurement guidelines!
• No cost to Part B recipients – no copay, coinsurance or deductible!
• Allowed every 12 months – Comprehensive visit allowed during the first 12 months following Part B enrollment. Subsequent visits allowed every 12 months thereafter.
• Focus on illness prevention, detecting potential risks:
• Review past health status
• Illness prevention assessment
• Identifies your Circle of Care (healthcare providers, family members, and others involved in your care). You always retain the ability to direct us about what information may be shared!
• Current medications and medication management options
• Risk Assessments — fall prevention, behavioral health, home safety, nutrition, and more
• Not a traditional head-to-toe physical. Physicals are never covered by Medicare.
• Helps your CPC providers since Medicare now grades providers and reports grades nationally. Grades represent how well we care for your overall health, reach out to you, provide preventive services, and coordinate care with your specialists and family. Help us get an “A” and schedule your wellness visits each year!

Chronic Care Management Services (CCM) are provided to improve the management of chronic conditions and pays your provider’s office when we provide and document 20 or more minutes of additional care outside of a traditional office visit in a given month. This is good for you because we can do more than ever to help manage your chronic conditions, and hopefully prevent hospital and ER visits. And for the first time, our office can be compensated for providing these premium services. Here are some facts about the Medicare CCM service benefit:

• Services are designed to improve your overall healthcare and prevent illness.
• Available only to Part B Medicare recipients
• Must have two or more chronic conditions to qualify.
• Must elect to sign up to participate.
• Cost to you is only about per month (co-insurance) when at least 20 minutes of additional services are rendered and documented. No cost to you for months when less than 20 minutes of additional service is rendered.
• You may cancel at any time, if you change your mind or feel the service is not beneficial.
• Additional CCM services include, but are not limited to:
• Comprehensive yearly care planning
• Coordinating care with specialists, family and community resources (e.g. help arranging appointments, referrals, transportation, and more
• Telemedicine family conferences to help with advanced directives, review hospital and ER discharge instructions, and more.

If you have two or more chronic conditions and you are interested in receiving these premium services to help improve your overall health and prevent illness, talk with your provider or one of the clinical staff today.

Diagnostics

A diagnostic test is any kind of medical test that our providers order to be performed to aid in the diagnosis or detection of disease. We offer several diagnostic tests that can be done on-site at one of our locations for your convenience.

Our onsite diagnostic tests include:

• Lab Venopuncture
• Ultrasound
• Pulmonary Function Testing
• Pap Smear
• Echocardiogram
• Electrocardiogram (EKG)
• Vascular Screenings

Lab Venopuncture

In order to ensure quality collection of blood specimens, we partner with Foundation Laboratory at each of our locations to assist with the drawing of blood. Your blood specimens will then be analyzed for the specific ordered tests. Some tests share very precise and informative results for a specific condition, where others provide general information that may help to rule out a particular condition or disease. It is important that you understand each test that is being ordered and why. We encourage you to ask such questions while you are visiting your providers:

• What will this test measure?
• Why is this test being ordered?
• How reliable are the results of this test?
• When will the test results be available?
• How will the results be given (a letter, a phone call, online)?
• Will this test need to be done more than once?
• Does this test have any risks or side effects?
• How should I prepare for the test?

Ultrasound

Ultrasound is a type of imaging that uses high-frequency sound waves to look at organs and structures inside the body. Our providers use it to view the heart, blood vessels, kidneys, liver, and other organs. At CPC we perform ultrasounds with the Abdomen, Pelvic, Aortic, Arterial, Venous, Thyroid, and Carotid to assess for any abnormality. Ultrasound is used to help our providers evaluate symptoms such as:

• Pain
• Swelling
• Infection

This is a painless and safe procedure that is done while you lie on the exam table. A transducer probe covered with gel will be moved over your skin in the area that is being assessed.

Pulmonary Function Testing

If you are having difficulty with breathing or other symptoms, your physician may order Pulmonary function tests are a group of tests that measure how well the lungs take in and release air as well as how well they move gases such as oxygen from the atmosphere into the body’s circulation. This test is done with a spirometer, that measures how much air you exhale, and how quickly. Spirometry can evaluate a broad range of lung diseases, so serves as a good baseline test. To prepare for this test it is important to refrain from eating a large meal prior to the test nor smoke for 4-6 hours before the test. Your provider may order this test to help:

• Diagnose certain types of lung disease such as asthma, bronchitis, and emphysema
• Determine the cause of shortness of breath
• Measure whether exposure to chemicals at work is affecting lung function
• Check lung function before someone has surgery
• Assess the effect of medication
• Measure progress with a treatment being given

Pap Smear

This exam/test for women is a screening test for detecting cervical dysplasia, or precancerous changes. Cells scraped from the opening of the cervix are examined under a microscope. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina. Detecting this cancer early in women offers a better chance of a cure. This preventive procedure is generally painless and usually done during a pelvic exam. Your provider will position you on the exam table and insert a device called a speculum into your vagina. This allows for a better view of the cervical area to allow the provider to swab your cervix with a brush or cotton swab to collect cells from the surface. These cells are then sent to the lab for analysis.

Echocardiogram

An echocardiogram (also called an echo) is a type of ultrasound test that uses high-pitched sound waves that are sent through a device called a transducer. The device picks up echoes of the sound waves as they bounce off the different parts of your heart. An echocardiogram allows doctors to see the heart beating. It also shows the heart valves and other structures. This test may be ordered by your provider to help to diagnosis one of the following:

• Abnormal heart valves
• Abnormal heart rhythms
• Congenital heart disease
• Damage to the heart muscle from a heart attack
• Heart murmurs
• Inflammation (pericarditis) or fluid in the sac around the heart (pericardial effusion)
• Infection on or around the heart valves (infectious endocarditis)
• Pulmonary hypertension
• Ability of the heart to pump (for people with heart failure)
• Source of a blood clot after a stroke or TIA

Electrocardiogram (EKG)

An electrocardiogram (EKG or ECG) is a test that checks for problems with the electrical activity of your heart. An EKG shows spikes and dips in a line tracing that reflects the heart’s electrical activity. An EKG may be ordered by your provider:

• To check the heart’s electrical activity.
• To help find the cause of unexplained chest pain, which could be caused by a heart attack, angina or pericarditis.
• To help to find the cause of symptoms such as shortness of breath, dizziness, fainting, or rapid, irregular heartbeats (palpitations) that may be signs of heart disease.
• To find out if the walls of the heart chambers are too thick (hypertrophied).
• To check how well medicines are working and whether they are causing side effects that affect the heart.
• To check how well mechanical devices that are implanted in the heart, such as pacemakers, are working to control a normal heartbeat.

Vascular Screenings

Vascular disease may be present without any of the warning symptoms. A preventative screening test has been found to be a valuable tool to detect the presence of serious vascular disease. These screenings are painless and noninvasive that can find unsuspected conditions such as carotid disease or leg artery blockages, or aortic aneurysms. Symptoms of vascular disease can include: Stroke (numbness, weakness of face, arm, or leg, sudden confusion or trouble speaking, sudden difficulty walking, loss of balance, severe headache) Heart attack (chest pain or pressure, discomfort in one or both arms, back, neck, or shoulder, shortness of breath, cold sweat with nausea or light-headness) Aneurysm (chest pain and back pain) Peripheral Vascular Disease (PAD) (painful cramping in hips, thighs or calves when walking or climbing that stops when activity stops, discoloration of the foot, decrease in temperature of the lower leg or foot) Vascular screening is beneficial for those at increased risk for a given vascular disease.

You may be at an increased risk for Abdominal Aortic Aneurysm if you are:

• A man over 60 years of age.
• A woman over 60 years of age who also has at least one of the following: high blood pressure, high-cholesterol, high triglycerides, diabetes, heart disease, or am being treated with medication for high blood pressure or high-cholesterol.
• A man or a woman over age 50 who has a family history of at least one close relative with Abdominal Aortic Aneurysm.
• A man or a woman over age 50 and smoke currently or have smoked substantially in the past.

You may be at an increased risk for Stroke & Carotid Artery Disease if you:

• Have a history of stroke in my immediate family: parents, grandparents, brothers or sisters.
• Smoke currently or have regularly smoked in the past.
• Are over age 40 and have high cholesterol and/or high blood pressure or take medicine for high cholesterol or high blood pressure.
• Have coronary artery disease or have had a heart attack, stent, angioplasty, or by-pass surgery.
• Have lower extremity arterial blockages in your legs.

You may be at an increased risk for Peripheral Arterial Disease (PAD) if you:

• Are over 35 years of age and smoke.
• Are over 40 years of age and have high cholesterol, high tri-glycerides or high blood pressure or are being treated for one or more of these conditions.
• Have diabetes
• Have had a heart attack, stent or angioplasty, or bypass surgery.

Immunizations, Vaccinations, & Flu Clinic

Whether you need a flu shot, school vaccinations, or other inoculations, we are able to provide you and your family with the necessary immunizations necessary to maintain your health.

• Availability: We stock a wide range of vaccinations (from booster shots to tetanus shots to school shots).
• Quality of service: We administer vaccines according to the best practices established by both the CDC and the general medical field.
• Convenience: We have several locations for your convenience to get your immunizations and flu shots.

Flu Clinic

Our practice prides itself in providing you and your family members with the influenza vaccine. Influenza is a contagious disease that spreads itself amongst people throughout the United States. It is commonly spread by coughing, sneezing and close contact to individuals of all ages. Statistics have shown, though, that the risk of getting the flu is the highest in children. Symptoms of the flu include:

• Fever/chills
• Sore throat
• Fatigue
• Coughing
• Headaches
• Stuffy and runny nose
• Getting a flu vaccine in the form of an injection will not contain any live influenza virus, but is instead an “inactivated or recombinant” vaccine. A live attenuated influenza vaccine is actually given as a spray into the nose. It is recommended to get a flu vaccine every year, with the flu season generally occurring between October and May.
• You should not get an influenza vaccine if:
• You have any severe, life-threatening allergies
• You have ever had Guillain-Barre Syndrome

Preventive Healthcare

• Preventive care lets your doctor find potential health problems BEFORE you feel sick. It includes all measures to ensure wellbeing and prevent long term consequences from family history and/or disease.
• Preventive care can include immunizations, lab tests and other diagnostic testing, physical exams and prescriptions. All of these services help your doctor understand your symptoms or diagnose your illness. These visits focus on prevention and allow our physicians to work closely with you to plan for your future health.
• Below are the recommended vaccines with their recommended timings/frequency:

• Here are some of the recommended screenings for adults:

Women’s Health

Women have unique health issues.  These unique issues include pregnancy, menopause, and conditions of the female organs.  Also, some of the health issues that affect both men and women can affect women differently.  Our providers are qualified to care for these unique health issues that affect women.

There is so much to know about the woman’s body.  And as your body changes with time, you are bound to have questions you never thought of before.  You can come here to explore a range of women’s health issues.
Get help with decisions and common concerns on topics such as:

• Pap Smear
• Premenstrual Syndrome
• Headaches

Pap Smear

A pap smear is a diagnostic test for cervical screening that can detect potentially pre-cancerous and cancerous processes in the endocervical canal. This test is performed by opening the vaginal canal with a speculum during a physical exam, and collecting cells from the outer opening of the cervix of the uterus and the endocervix with a swab. The cells are examined under a microscope to look for any abnormalities. It is very important for each women to have a pap smear annually as part of their women’s routine visit.

What Causes an Abnormal Pap Smear

Abnormal cell changes in the cervix and endocervical canal can be caused by certain types of human papillomavirus (HPV), other types of bacterial or yeast infections, smoking, an impaired immune system, or menopause. These cell changes may go away on their own or can be successfully treated.

But, certain types of HPV have been linked to cervical cancer. It has been reported that with regular screenings and appropriate follow up care, death from cervical cancer can be reduced by 80%.

Premenstrual Syndrome

Premenstrual syndrome (PMS) refers to a varied collection of physical and emotional symptoms during part of a woman’s menstrual cycle. There are more than 200 reported symptoms of PMS including stress, anxiety, difficulty in falling asleep (insomnia), headache, fatigue, mood swings, increased emotional sensitivity, changes in libido, bloating, lower back pain, abdominal cramps, constipation/diarrhea, swelling or tenderness in the breasts, cyclic acne, joint or muscle pain, and food cravings.

The American College of Obstetricians and Gynecologists estimates that at least 85 percent of menstruating women have at least one PMS symptom as part of their monthly cycle. Most of these women have fairly mild symptoms that do not need treatment. Others (about 3 to 8 percent) have a more severe form of PMS, called premenstrual dysphoric disorder (PMDD).

The causes of PMS are not clear, but changes in hormones during the menstrual cycle seem to be an important cause. Some other possible causes include:

• Low levels of vitamins and minerals
• Eating a lot of salty foods, which may cause you to retain (keep) fluid
• Drinking alcohol and caffeine, which may alter your mood and energy level

Headaches

The menstrual cycle has a definite impact on the development of migraine headaches for some women. Approximately 50% of women have reported migraines associated with their menstrual cycle. A woman’s body has many biological changes that produce a widespread effect on their body. Some women are more sensitive to the fluctuations within the menstrual cycle. Studies suggest that migraine can be triggered by a drop in estrogen levels, such as those which naturally occur in the time just before your period. Often the migraine will occur anywhere between two days just prior to menstrual period onset through the first three days of menstruation.

There are no tests available to confirm the diagnosis, so the only accurate way to tell if you have menstrual migraine is to keep a diary for at least three months recording both your migraine attacks and the days you menstruate.

This will also help you to identify non-hormonal triggers that you can try to avoid during the most vulnerable times of your menstrual cycle.