Medicare's Annual Wellness Visit

Healthcare Reform was a hot topic in 2010 and continues to be as we start the new year!  There are many benefits introduced by the reform and one very important one that is set to start January 1^st, 2011 is Medicare’s new Annual Wellness Visit!  You may be asking yourself, “What is an Annual Wellness Visit?”   and  “Is it worth it for me to come in when I’m not sick?”- the answer to the second question is easy- YES!  If you want to know what an Annual Wellness Visit is, read on!

The Annual Wellness Visit  is Medicare’s answer to providing a preventive (or well check) visit with a few extras that research has found helps you live healthier, happier lives. AND IT’S ALL FREE for Medicare patients (if you have a Medicare Advantage plan, verify with your insurance provider that they too will cover your co-pay and deductible for Medicare’s Annual Wellness Visit)!  Prior to enacting this new law and benefit, Medicare did not cover the physical portion of a preventive visit and only covered certain screening tests.  More importantly, it did not give physicians and their patients a chance to sit down and talk about their general health, well-being and what the future may hold.  Now, by scheduling and attending your Annual Wellness Visit when you are not sick, you can get the following along with a wellness visit:

1. Measurement of individual height, weight, Body Mass Index (“BMI”) , blood pressure (“BP”), and other routine measurements as deemed appropriate, based on the beneficiary’s medical/family history;
• Measuring your BMI, blood pressure and other vitals gives us a quick picture of your current health.  We can tell if you are at risk for diabetes, cardiovascular disease and other health concerns just by a few simple, but vital, pieces of information.
2. Establishment of individual’s medical, family and social history;
• Knowing your most up to date family, medical and social history helps us determine if there are genetic or other reasons your risks may be greater than the average person.
3. A list of prescription medication;
• By reviewing your current list of medications, we can make sure you are not being prescribed too many medications or medications that have negative interactions with each other.  Our Athenahealth Electronic Health Record program will in most cases have a current list of medications if you have been getting them from a pharmacy and using your insurance.
4.  Establishment of a list of current providers and suppliers that are regularly involved in providing care to the individual;
• Knowing who else you are seeing and for what health issues allows us to better coordinate your care and get in touch with the right physician if we need to.
5. Detection of any cognitive impairment that individual may have (review of risk of depression, mood disorders, Alzheimer’s, etc.);
• A simple questionnaire helps us determine if there might be potential  mental health issues we should plan for while we can. 
6. Review of individual’s functional ability and level of safety;
• This will help us make sure that you are not in any danger of hurting yourself.
7. Establishment of a list of risk factors and conditions for which more intervention is recommended or is under way;
• Knowing and understanding the health risks you may be facing can save you the trouble of unnecessary visits to the hospital or even worse when it is too late.
8.  Personalized health advice and possible referral/follow-up for other covered preventive services such as weight-loss consultation, smoking cessation, diabetes management consultation; cholesterol management consultation, high blood pressure consultation, fall prevention and/or nutrition.
• Medicare realizes the importance of prevention and along with providing for a free Annual Wellness Visit, is also offering free services designed to help prevent, manage and reduce the most common health concerns for patients your age.
9. Establishment of a written screening schedule/checklist for the next 5-10 years as recommended by the United States Preventive Services Task Force;
• Knowing when to get proper screening is just as important as knowing what types of screening you may need.
10. (Not a part of the Annual Visit as of 1/3/2011 but it is a discussion we recommend you have with your primary care physician during your Annual Wellness Visit)Voluntary advanced care planning if desired (verbal or written information regarding the patients wishes in case an injury or illness  causes the patient to be unable to make health care decisions at that point)
• This is an important but often over-looked aspect of your health and well-being.  Knowing what you would like done, or not done, when it comes to important health decisions is good for your family, your provider and you.  Why wait until you can’t make that decision to have someone else make it for you?

Each year after your initial Annual Wellness Visit, your provider should follow up with you with another wellness visit where your list of medications, providers, risk factors are updated and your current health and well-being are re-evaluated.   If you can make your follow up wellness visit right after your Annual for the same day 12 months later, you won’t have to remember about making it later.  

What does this all mean for you/Why you should make an appointment for your Annual Wellness Visit?

A stitch in time saves nine.  This time honored adage has never been truer when it comes to your health and well-being.  Preventive medicine, that is medicine and services that help you from being sick or help you manage your current conditions so they don’t get worse, is the most important thing you can do to save your life, save your money, help your family,  and even help the overall health care system and the American economy.   For example, if during your Annual Wellness Visit, it is determined that you have or are at risk for Diabetes and then you take advantage of the free Diabetes Management services, you are more likely to control or not even get Diabetes.  Controlling or not even getting Diabetes can save you hundreds of dollars a month just in prescriptions.  We have had patients save over $500 a month by getting their Diabetes under control. If you don’t control your Diabetes and end up in the hospital because you need to be put on dialysis, your bill can be in the thousands.  That can be money in your pocket and money the hospital and government can save. 

Other benefits of getting your annual wellness visit and the yearly follow up are:

·         It’s an opportunity for you and your health care provider to discuss your health during a time when you are not in for a sick visit and therefore are not worried about  a how you’re feeling at the moment;

·         Planning out what visits you might need, based on your health condition and risk factors, in the beginning of the year can help you make sure you have the time to take care of the things you need to take care of;

·         It’s an opportunity have an open and honest discussion with family members (after your visit, you should meet with family members to discuss what you and your health care provider discussed during our annual visit such as your current health, risks, additional screenings that might be necessary, and what you would want done in case of an emergency);

·         IT’S FREE!

So make your appointment today!  You can call our office at 559-450-7299 to make an appointment or make an appointment request through the patient portal (go to www.avecinia.com, then click on “My Account” to access your patient portal).  When making an appointment, make sure you ask that it is for your Annual Wellness Visit (as long as you have not had your Welcome to Medicare Visit in the past 12 months or you are not new to Medicare within the past 12 months).  Your appointment will be for approximately 25-30 minutes (including time to fill out some questionnaires).  Although we have a list of your current medications, providers, family, personal and social history in our Electronic Health Record program, bring a list so we can confirm the information is accurate.  During your visit, you will be asked to complete a questionnaire that will become part of your Personalized Prevention Plane.  If you would like to fill this questionnaire out with the help of someone prior to the visit, just ask us and we can mail, email or fax it to you or you can download a copy from the Patient Portal under “Medical Forms” (the forms will be called Medicare Annual Wellness Visit Forms). 

 

We are excited that Medicare is offering this incredible, valuable opportunity for you without any cost to you! We highly recommend you make your Annual Wellness Visit appointment as soon as possible, or if your family member or loved one is with Medicare, have them make an appointment as soon as possible (or make it for them if you are their care taker).  See you soon!

For daily updates on news, information and more on health care and wellness, join avecinia wellness center's facebook page (facebook.com/avecinia) and follow avecinia on twitter (twitter.com/avecinia4health). avecinia wellness center is Fresno's premier integrative medicine and wellness center. We combine internal medicine and primary care with health management, weight management, acupuncture, aesthetics (Botox, Juvederm, Radiesse, Obagi and more) and massage therapy for a holistic approach to health. We use a robust electronic health record program and patient web portal to enhance our delivery of services and to help our patients reach their optimal well-being. To learn more, visit www.avecinia.com. If you are looking for a primary care doctor in Fresno or the Central Valley and would like to become a part of the avecinia family, visit our website and click on new patient registration. Let Dr. Unaiza Hayat and/or Ali Kunkel, MPA, PA-C, become your trusted guides. Our Aesthetic, Weight Management, Acupuncture, Health Management and Massage Therapy services do not require us to be your primary care physician. Learn more at www.avecinia.com We look forward to meeting you!

Top “Five” Fitness Tips For The Holiday’s!

Annie Malaythong- Health Coach Studio 108

Holiday season is here! With family gatherings and holiday parties filled with baked goods, foods and alcohol it’s hard to stay on track. Let’s face it; we all worry about putting on “winter weight.” But what exactly are we doing about it? It’s time to be realistic. It would be a shame for you not to enjoy your family and friends and all the goods. So, let’s set realistic health and fitness goals to keep you on track! Here’s to a healthy 2010 and to a better 2011!

1. Realistic Fitness Action Plan- Write out a “top 3” daily “Active To-Do” list to keep you feeling accomplished and productive with your fitness. Again, emphasize the “realistic.” If you currently are doing nothing for your fitness here’s an example:
1. Walk for 15 minutes today. (Anywhere)
2.  Stretch for 5 minutes.
3. Perform 3 different exercises that you are confident with.
2. Spice it up! Spicing up your workout can do wonders for your mind and body. Try doing something different. Studio 108 in Fresno offers unique classes such as Thai Budokon, Self-Defense Classes, Mind/Body/Stress-Free Yoga, or (30 minute) Express Cardio Intervals. If you’re not a group exercise person, try a personal trainer or a fitness specialist to mix it up. Mixing up your workouts and spicing it up will keep you motivated throughout the holidays and keep your body guessing. This will result in a longer fat burn
3. Easy on the Alcohol -Alcohol consumption packs on additional calories. Think of every 8oz alcoholic drink as roughly 30 minutes of additional cardio.
4. Understand your Calories IN vs. Calories OUT- Check out your BMR (Basal Metabolic Rate). The number of calories you’d burn if you stayed in bed all day. That number represents how many calories you need to consume just to maintain life without working out or being active. If your calorie intake is more than calories being burned, you are more than likely progressively gaining weight. Staying active is the key!
5. “Cheating” moderately- We all know sugar, sugar and sugar is the main ingredient for the holidays. If you can’t stay away or are tempted, try keeping your sugar intake to a minimum. A great trick is to fill up your sweets in the palm of your hand and limit choices to one “sweet palm” for the whole day. Example:

• “I have choices of apple pie, cookies, toffee, pumpkin pie, etc...”
• “I can only fit 2 pieces of toffee, and ½ of a pumpkin pie in the palm of my hand. I will limit my sweets to only these two options for the WHOLE day.
• “I will not attempt to stack, mash, crumble, combine or overflow my palm. For every additional serving of a “sweet palm” is another 1,000 calories which is roughly two hours of cardio for an average 150lb person. Or for every three “sweet palms” is one extra pound of pure body fat. “ * Eating balance meals focusing on macronutrients will avoid cravings and keep you feeling full longer.*

Moderation, balance and keeping active are key to a healthy you. Setting realistic goals, using some or all of the steps above, is a great way to start and stay on your fitness and well-being plan.  Share it with your family and friends so you don't have to do it alone!  Happy holidays and Happy New Year!

This blog was written by Annie Malaythong, Health Coach, Fitness Studio 108.  Annie is owns Fitness Studio 108 and was previously the Director of Fitness at Gold's Gym (Central Fresno).  Annie is a spokesperson and Nutrition Specialist for "Run For The Dream" Project Child Obesity Campaign, has been on KMPH 26 and KSEE 24 and can be seen beginning December 29th on MTV's "I Used To Be Fat".   avecinia wellness center works with Fitness Studio 108 to help our patients achieve their optimal well-being.  Our individual weight loss and management program incorporates fitness and nutrition provided by experts at Fitness Studio 108.  To learn more about avecinia wellness center and Fitness Studio 108's weight loss/management program, visit www.avecinia.com

avecinia wellness center is Fresno's premier integrative medical and wellness center. We combine primary care with health management, weight management, acupuncture, massage therapy and aesthetics to provide a holistic approach to your health and well-being.  We use a state of the art electronic health record program and patient portal (by athenahealth) to help deliver our unique services to our patients. Learn more by visiting our website at www.avecinia.com or "like" us at www.facebook.com/avecinia or follow us on twitter at www.twitter.com/avecinia4health

Healthy Holiday Eating Strategies

Thanksgiving, and thus, the holiday season is rapidly approaching! It’s an exciting time of family, friends, giving, and, oh yes, FOOD! Many start worrying about their weight and their waistlines, especially those who are working on lowering that number on the scale.

According to the National Institute of Health, the average weight gain during the holidays is only about 1 pound. That’s right, about 1. The problem is that most Americans don’t ever lose that pound of weight gain and it begins to add up over the years, increasing the risk for many chronic diseases.

Don’t panic. It’s important to recognize that you can enjoy holiday foods (it’s part of the fun!), but you want to stay balanced in the meantime. You don’t have to be afraid with a few strategies in mind:

1. Don’t attempt to diet and lose weight, instead try to maintain your weight. (This is a more realistic goal and will help you to feel successful through the holiday season) If you continue to lose weight, that’s great, and you can certainly continue to do so by maintaining healthy eating behaviors you’ve developed, but keep your expectations realistic.
2. Exercise to compensate for the extra calories you might be consuming, and to help relieve holiday stress. (This could be a walk with friends and family or outside playing with the kids)
3. Don’t skip meals, trying to “save up” for that big holiday meal. (This will contribute to ravenous hunger, causing you to overeat.)
4. Limit alcohol as much as possible. (A mixed drink can have as much as 500 calories per cup!) Calorie content of drinks:

• Beer: approx. 140 – 200 calories per 12 oz.
• 1.5 oz. shot of liquor: 115 – 200 calories
• 4 oz. wine: 60 – 160 calories
• 8 oz. margarita: approximately 400 calories
• 8 oz. egg nog: approximately 350 calories

5. Put your snacks & appetizers on a small plate instead of a large one and limit your trips to the buffet. Wait 20 minutes before getting another plate of food. (It takes 20 minutes for your brain to get the message that you are full.)
6. Take smaller bites and eat slowly. Try taking time to enjoy your food and the conversation with the people around you.
7. Substitute butter and margarine with plant sterol based products like Benecol and Take Control.
8. Try a healthy recipe for popular dishes such as Mashed Potatoes:

• 5 medium russet potatoes (medium white or red potatoes can also be used)
• 2 green onions, white and part of green, finely chopped
• 1/3 cup fat-free half and half (low-fat milk or whole milk can also be used)
• 1/4 cup fat-free or light sour cream
• 1 tablespoon butter (or no- or low-trans fat margarine or plant based sterol product)
• 1/2 teaspoon minced or crushed garlic (optional)
• Salt and pepper to taste

Preparation:

1. Pierce each potato several times with a fork and microwave the potatoes on HIGH until they are tender throughout (about 20 minutes depending on your microwave.) You can also bake or boil the potatoes until tender if you prefer. Let potatoes cool a few minutes.

2. Peel off skins (and discard) and add the potato flesh to a large mixing bowl along with the green onions, fat-free half and half, sour cream, butter or margarine, and garlic.

3. Beat on low speed until fairly smooth and blended. Add salt and pepper to taste.

Yield:

6 servings

Nutritional Information:

Per serving: 187 calories, 5 g protein, 37 g carbohydrate, 2 g fat (1.2 g saturated fat, 0.6 g monounsaturated fat, 0.1 g polyunsaturated fat), 6 mg cholesterol, 3.5 g fiber, 55 mg sodium (not including salt to taste).

9. Forget the “all-or-nothing” mindset. Instead, focus on “sometimes” and “for special occasions” to consume certain foods and beverages. Depriving yourself of special holiday foods isn’t a healthful eating strategy.
10. Remember that it is a holiDAY, not a holiWEEK! Make the special occasions special!

Have a Happy Thanksgiving!

This blog was written by Sunny Yingling, MS, RD.  Sunny is one of avecinia wellness center's trusted resources and we refer many of our patients needing diet and nutritional counseling to Sunny.  Sunny is a Professor of Nutrition at Clovis Community College and can regularly be seen on Central Valley Today on KSEE 24.  Sunny also works with our friends at Fitness Studio 108.  If you have any questions or would like to make an appointment with Sunny, you can email her at sunnymarie3@hotmail.com.

avecinia wellness center is Fresno's premier integrative medicine and wellness center and your partner in optimal well-being! We invite you to join us on facebook and follow us on twitter 

    

Health Care, Wellness and the Affordable Care Act of 2010

As the valley’s premier Integrative Medicine and Wellness center, avecinia wellness center is committed to your care and well-being.  As such, we are committed to helping empower you so you can make the best choices when it comes to your healthcare and well-being.  Your choice in health insurance should never effect your decisions about improving your health and well-being.  However, since the cost of health insurance is an important factor, it is vital for you to be well informed so you can make the best choice for you and/or your family. We hope the following information helps guide you towards better health and well-being.

In March of 2010, the President signed into law the hotly debated Affordable Care Act.  Whether you agree with the act or not, it is now the law and many of its provisions and benefits kicked in September 23^rd.  But they only apply to new plans, or plans that begin on or after September 23, 2010.   Here is a summary of these benefits, benefits to come and how they affect you (we categorize them by who they affect).  As always recommended, call your insurance provider, employee benefits manager, or a licensed Health Insurance Broker if you have questions about your plan.

For everyone:

•   Preventive Care
• Plans starting on or after September 23, 2010 will cover all your costs for a Preventive Care visit.  That means you do not have to pay a copayment, co-insurance or any deductible for preventive health services such as recommend screenings, vaccinations and counseling.  Keep in mind that coverage is only for in-network providers, and is only applicable if the preventive service is the primary purpose of the visit.  If the preventive service is in addition to other services, your plan may require to pay for the visit. If you have questions, please call your health insurance provider to verify which services are considered preventive and are free to you (i.e., you have no copay, co-insurance or deductible).  When making an appointment for a preventive service, make sure you inform your physicians at the time you are making an appointment that it is for a covered preventive service.  If you need to discuss any service or health issue outside what your health insurance plan covers as a preventive service, your provider has to submit that information to the health insurance plan and you may be billed for the visit because it is no longer considered a preventive visit.   
• An End to Pre-Existing Conditions for Children
•  Health Insurers cannot deny children (under 19 years old) health insurance because of preexisting conditions. A ban on adult discrimination will take effect in 2014.  That means if your plan went into effect after September 23, 2010 and in November your child is hospitalized because of a severe asthma attack.  Your new plan cannot deny payment for the hospitalization due to your child’s “pre-existing condition.”  Keep in mind that insurance companies are now reducing the number of children only plans. When looking for an insurance plan, make sure it covers your kids!
•  Coverage for young adults under the age of 26
• Under the Affordable Care Act, if your plan covers children, you can now add or keep your children on your health insurance plan until they turn 26.  This applies to your kids even if they are married or can get insurance from their employers group plan.  Your child does not have to be living with you or be financially dependent on you.   Keep in mind that you must enroll your children within the open enrollment period. 
• Doctor Choice & ER Access
• The Act helps preserves your choice of primary care physician within your health insurance plans network.  It also prohibits health insurance plans from requiring a referral before you can see a OB-GYN in your network.  Importantly, the Act prevents health insurance plans from requiring higher copayments or co-insurance for out-of-network emergency room services and it prohibits plans from requiring prior approval before seeking emergency room services from a provider or hospital outside of your plan’s network. Keep in mind that you will still be responsible for the difference between the amount billed by the out of network provider and the amount paid by your health insurance plan.
•   Insurance Cancellation
• Health Insurers cannot retroactively rescind (declare your policy invalid from the date you started your policy) your insurance policy for an honest mistake or missing information that has no bearing on your health.  That means if your plan went into effect after September 23, 2010 and you are later diagnosed with cancer, your health insurance provider cannot rescind your plan because you left out your hospitalization for a broken arm 6 years ago. Keep in mind that intentionally falsifying or misleading the insurance company still gives them cause to rescind your policy.  Your health insurance provider has to give you 30 days notice before it can rescind your policy so you can appeal the decision or find new coverage.
• Appealing Health Plan Decisions
• You now have the right to appeal your health insurance providers denial of payment, service or treatment.  If your plan upholds its denial, you have the right to ask for an independent review.  Keep in mind that your state may have additional rules/regulations that effect your appeal.  For more information in California, click here.
• Lifetime and Annual Limits
•  Lifetime limits on most benefits are prohibited on plans issued or renewed after September 23, 2010.  Annual Limit are being phased out as well.  No plan that begins after September 23, 2010 can set an annual limit lower than $750,000.  By January 1, 2014, no annual limits will be allowed on most covered benefits. Keep in mind that the ban on limits only applies to essential services.  Some plans may be eligible for a waiver if complying with the ban on the limit would mean a significant decrease in benefits or increase in premiums.

For Medicare:

• Preventive Care
• Medicare must now pay for 100 percent of the cost of annual physicals and other preventive care visits (see above for more information).
•  Seniors Receive “Donut Hole” Rebate
•  Seniors with Medicare prescription drug coverage that have reached their coverage gap in 2010 will get a 1 time tax free $250 rebate. Beginning in 2011, Medicare recipients will receive 50% off of covered brand-name drugs while in the “donut hole.”
•  Stronger Medicare Anti-Fraud provisions
• Visit www.stopmedicarefraud.gov to see how you can help curtail Medicare fraud.

For Businesses:

•  Small business tax credit for providing health insurance
• Small business with less than 25 employees may be eligible for a tax credit of up to 35% to offset the cost of providing health insurance to their employees.  If you are a small business owner, check with your accountant to see if you qualify or how you can qualify.
• Wellness Program Grants for Small Business
•  Small business with less than 100 employees may be eligible for grants to cover Wellness Programs that started after March 23, 2010.  Grants will be available in 2011.
• Early Retirement Reinsurance Program
• The Act provides $5 billion in financial assistance to employers and unions to help them maintain coverage for early retirees age 55 and older who are not yet eligible for Medicare.

To learn more about the provisions of the Affordable Care Act, visit www.healthcare.gov.  To learn more about Medicare, visit www.n4a.org.  
This video is a helpful summary

Choosing an Health Insurance Plan

If you are purchasing a health insurance plan on your own or your employer gives you the option to select from a variety of health insurance plans, visit the California Department of Insurance PPO Ratings to learn which plans had the best rankings. According to the Department of Insurance, Aetna PPO, CIGNA PPO and Health Net of California PPO rated the highest as rated by their members across a variety of standards.  As a practice, we have noticed that Aetna, CIGNA, and United Healthcare provide coverage for a wide range of services, have less administrative burdens, and are more consumer friendly and oriented than other health insurance companies.  You can also contact a licensed Insurance Broker who will help guide you through the insurance maze and help you find the plan that best fits your needs.  A broker will do this for you for free because they get a commission from the insurance company.  Overall, insurance companies pay the same amount of commission so a licensed broker should not be swayed towards one policy or another but should help you find the solution that is best for you.  If you are looking for a broker or have questions in general, contact Shane Moore at Valley Employee Benefits & Insurance Solutions.  He can be reached at (559) 325-2500 or by email at shane@valleyemployeebenefits.com.  If you have other questions, please call or email avecinia wellness center’s insurance specialist, Colette Vaquilar at (559) 450-7298 or billing@avecinia.com. Visit www.avecinia.com and "like" us at www.facebook.com/avecinia




For daily updates on news, information and more on health care and wellness, join avecinia wellness center's facebook page (facebook.com/avecinia) and follow avecinia on twitter (twitter.com/avecinia4health). avecinia wellness center is Fresno's premier integrative medicine and wellness center. We combine internal medicine and primary care with health management, weight management, acupuncture, aesthetics (Botox, Juvederm, Radiesse, Obagi and more) and massage therapy for a holistic approach to health. We use a robust electronic health record program and patient web portal to enhance our delivery of services and to help our patients reach their optimal well-being. To learn more, visit www.avecinia.com. If you are looking for a primary care doctor in Fresno or the Central Valley and would like to become a part of the avecinia family, visit our website and click on new patient registration. Let Dr. Unaiza Hayat and/or Ali Kunkel, MPA, PA-C, become your trusted guides. Our Aesthetic, Weight Management, Acupuncture, Health Management and Massage Therapy services do not require us to be your primary care physician. Learn more at www.avecinia.com We look forward to meeting you!

Massage Therapy

Massage therapy has a long history in cultures around the world.  In fact, references to massage appear in writings from ancient China, Japan, India, Arabic nations, Egypt, Greece (Hippocrates defined medicine as “the art of rubbing”), and Rome.

Massage became widely used in Europe during the Renaissance.  In the 1850s, two American physicians who had studied in Sweden introduced massage therapy in the United States, where it became popular and was promoted for a variety of health purposes.

Today people use many different types of massage therapy for a variety of health-related purposes. In the United States, massage therapy is often considered part of Complementary and Alternative Medicine (CAM), although it does have some conventional uses.

The term “massage therapy” encompasses many different techniques.  In general, therapists press, rub, and otherwise manipulate the muscles and other soft tissues of the body.  They most often use their hands and fingers, but may use their forearms, elbows or feet.

The Benefits Of Massage  

People use massage for a variety of health-related purposes, including to relieve pain, rehabilitate sports injuries, reduce stress, increase relaxation, address anxiety and depression, and aid general wellness.  Massage is useful for all of the conditions listed below and more:

• Alleviate low-back pain and improve range of motion;
• Ease medication dependence;
•  Enhance immunity by stimulating lymph flow—the body’s natural defense system;
• Exercise and stretch weak, tight, or atrophied muscles;
• Help athletes of any level prepare for, and recover from, strenuous workouts;
• Increase joint flexibility;
• Lessen depression and anxiety;
• Promote tissue regeneration, reducing scar tissue and stretch marks; 
• Pump oxygen and nutrients into tissues and vital organs, improving circulation;
• Reduce post surgery adhesions and swelling;
• Reduce spasms and cramping;
• Relax and soften injured, tired, and overused muscles;
• Release endorphins—amino acids that work as the body’s natural painkiller; and
• Relieve migraine pain.

 A Powerful Ally

Regardless of the adjectives we assign to it (rejuvenating, therapeutic) or the reasons we seek it out (stress relief, pain management), massage therapy can be a powerful ally in your healthcare regimen. Experts estimate that upwards of ninety percent of disease is stress related. And perhaps nothing ages us faster, internally and externally, than high stress. While eliminating anxiety and pressure altogether in this fast-paced world may be idealistic, massage can help manage stress. This translates into:

• Decreased anxiety;
•  Enhanced sleep quality;
• Greater energy;
• Improved concentration;
• Increased circulation; and 
• Reduced fatigue.

Furthermore, the emotional balance bodywork provides can often be just as vital and valuable as the more tangible physical benefits.

Consequently, the medical community is actively embracing bodywork, and massage is becoming an integral part of hospice care and neonatal intensive care units.

At avecinia wellness center, our approach to incorporating massage therapy into your health care and wellness is unique in Fresno.  Our highly trained therapists, Bethany Clague and Michael Greene work with our providers, Dr. Unaiza Hayat and Ali Kunkel, MPA, PA-C to coordinate care in instances where massage therapy is deemed useful. By incorporating massage therapy and coordinating care, you can be assured that you receive the best, specific care to match your needs. Make your appointment today to see either Beth or Mike. In September, a basic, 25 minute massage is only $30 (save $10).  

(Written by Michael Greene)

Back To School

As summer is coming to an end, many parents may dread what’s coming next: Back to School! More than wondering what back to school sale to go to first, most parents are concerned how to prepare their child emotionally and mentally for school and how stay healthy during the school year. By following the tips below, we hope to make back to school a happier, healthier transition for both parent and child!
Tips:

• Establish sleep and nutrition routines before school starts! Avoid difficult mornings the first week of school by setting bed and wake-up times a few weeks before school starts and gradually adjusting them to be earlier as the first day approaches. And make sure they start every day with a healthy breakfast such as whole grain, low-sugar cereals!

• Keep them going throughout the day with the right foods! Pack their lunch with colorful mix of fruits and vegetables. Apples, baby carrots, berries, grapes, pears are easy to pack and easy to eat and provide essential nutrients to keep them energized and ready to learn. Avoid sodas and sports drinks! One can of soda per day can add 30 pounds in a year.

• Help your kids know their school like the back of their hand! Visit the school in advance so children know where their classroom is. Give them a chance to meet their teacher, the school nurse, and other staff, if possible.

• Encourage communication! Encourage your child to talk to you about how they feel about going back to school. Practice listening to them (hint, pay attention to them when they speak the same way you would want someone to pay attention to you). When kids feel they are being heard, they are less likely to hide something from you, such as whether they are being bullied at school.

• Dealing with Bullies! Going back to school is never easy and having a bully to deal with can make it ten times worse! But you can help your child stand up to bullying by instilling them with confidence, help them make friends, encouraging them to communicate if they are being bullied and working with their teachers and school administrators to make the school a bully safe environment.

• A stitch in time saves nine! If your child has a chronic health condition requiring medication, such as asthma, diabetes, a food allergy, or any type of health care concern requiring special attention, contact the school nurse early to put a plan in place well in advance of the first day of school.

• August is National Vaccination Month! Immunizations, which are a very necessary part of the back-to-school routine, can be a little scary for kids, but you don't need to drag them kicking and screaming to the doctor's office. Ease kids' worries by talking with them about the health benefits of vaccines so they understand why the shots are important and are less anxious about getting them.
Here is a summary of vaccinations recommended by the CDC for school aged children: (www.cdc.gov/vaccines/events/niam/default.htm)

Children 4-6  (Click on the bold items to learn more about them)

• DTap (Diptheria, Tetanus, Pertussis)
• PPSV (Pneumococcal) - for pneumonia
• IPV (Inactivated Poliovirus)
• Influenza - for the flu
• MMR (Measles, Mumps, Rubella)
• Varicella for chickenpox
• Hepatitis A
• MCV (Meningococcal)

Children 7-18

• TdAP (for children 11-18) - for whooping cough
• HPV (for children 9-18) - HPV vaccine is also known as Gardasil
• MCV (Meningococcal) - for meningitis
• PPSV (Pneumococcal) - for pneumonia
• IPV (Inactivated Poliovirus)
• Influenza - for the flu
• MMR (Measles, Mumps, Rubella)
• Varicella - for chickenpox
• Hepatitis A
• Hepatitis B

Many of the vaccines listed above are available at avecinia wellness center. Call us at 559-450-7299 and speak with Jennie if you have any questions about immunization and vaccinations or would like to make an appointment.  As Fresno's premier integrated medical practice, we aim to provide our patients with total wellness.  If you have questions about stress management or how to help your kids cope with starting school, we are proud to refer our patients to Corinne Soares, LCSW.  You can learn more about Corinne on her blog here: http://therapistsdesk.blogspot.com/

We hope you and your family have a wonderful August and an exciting beginning to the new school year!

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Acupuncture

What is Acupuncture?
Acupuncture is a key component of traditional Chinese medicine that originated over 5,000 year ago. It is based on the belief that the body is viewed as a balance between two opposing forces known as the Yin and Yang. Vital energy call the “qi” circulates through twelve energy lines known as meridians. Each meridian is associated with a different organ system. An imbalance flow of the qi, therefore an imbalance between the Yin and Yang, throughout a meridian is the thought on how disease begins. The qi affects a person’s emotional, spiritual, physical and mental conditions.

Acupuncture typically involves penetrating the skin with thin, metallic needles that are manipulated by the fingers or by electric stimulation. The needles are inserted into specific points along meridian lines to influence the flow and restore balance of the qi. The unblocking of the qi allows the body to return to a balanced state and a healthy center. Most people feel a brief stinging or no pain and report feeling energized or relaxed from the therapy. There are over 1,000 acupuncture points on the body.

In 1997, acupuncture needles were reclassified from “experimental” to “medical” devices by the FDA. That same year, the National Institutes of Health released a consensus endorsing acupuncture for the treatment of a variety of conditions, such as pain relief and improved function for osteoarthritis, reduced post traumatic stress disorder and improved pregnancy rates following in vitro fertilization. The National Cancer Institute reports that acupuncture has shown many proven benefits for cancer patients. These benefits include improvement of the immune system response and reduction in pain, nausea and vomiting.

How Does Acupuncture Work?
There are many theories about how acupuncture works. Some of them include the following:
· Acupuncture stimulates the release of pain-relieving endorphins;
· Acupuncture stimulates circulation;
· Acupuncture influences the electrical currents of the body;
· Acupuncture influences the autonomic nervous system;
· Acupuncture influences the release of neurotransmitters, substances that transmit nerve impulses to the brain

Conditions Treated By Acupuncture
· Migraines and tension headaches
· Sinusitis
· Common cold
· Addictions (food, smoking, etc)
· Trigeminal neuralgia
· Meniere’s disease
· Tennis elbow
· Sciatica
· Arthritis
· Fibromyalgia
· Menstrual cramps
· Weight loss
· Low back pain
· Infertility
· Asthma
· TMJ
· Carpal tunnel syndrome

Is Acupuncture Safe?
Acupuncture is generally considered safe and adverse effects tend to be rare. Some people may experience dizziness, sweatiness and nausea or even lost of consciousness. However, these problems usually clear up on their own in minutes, without lasting harm to the patients. The National Center for Complementary and Alternative Medicine reports “there are fewer adverse effects associated with acupuncture than with many standard drug treatments used to manage painful musculoskeletal conditions.” While acupuncture is an extremely safe form of physical medicine, there are some contraindications and risks.

Precautions & Contraindications:
· Avoid blood vessels to prevent bleeding
· Points of the chest and back should be carefully needled to avoid injury to organs
· It is a contraindication to needle to abdomen of lumbosacral areas in a pregnant woman
Risks:
· Fainting
· Bruising
· Muscle spasm
· Bleeding
· Nerve damage
· Punctured lung
· Accidental injury to organs

Additionally, the National Center for Complementary and Alternative Medicine recommends that patients “do not rely on a diagnosis of disease by an acupuncture practitioner that does not have substantial medical training.” As part of Avecinia Wellness Center’s integrative approach to medicine and healing, we incorporate medical acupuncture with a variety of other healing modalities. Dr. Unaiza Hayat is one of the few Fresno based board certified physician who has been trained by the Pain Research institute in Medical Acupuncture. Each session is approximately 15-20 minutes and costs $65 for the first session and $40 for each session after (your insurance may reimburse, please speak to Colette for more information). We also offer Acupuncture for Weight Loss and Acupuncture for Infertility. Those programs start at $200. If you would like more information about acupuncture, please visit Avecinia Wellness Center’s website: www.avecinia.com and look under services for “Acupuncture” or call us at (559) 450-7299.

Skin Care

Skin Care
Your skin reflects your health. It is your body’s canvas and one of its most valuable assets. Good skin care and healthy lifestyle habits can help prevent many skin problems and delay the natural aging process. It’s the only skin you’ll ever get, so your daily habits mean everything. With proper skin care, your skin can stay fresh as you age. Follow the tips below and keep your skin healthy and glowing for the years to come.

Protect yourself from the sun
One of the most important ways to care for your skin is to protect it from the sun. Although sunlight helps your body make Vitamin D, which is important for good health, too much sunlight can be harmful. The sun emits ultraviolet (UV) radiation. Lifetime sun exposure can cause dry, rough skin, discoloration, age spots, freckles, wrinkles, moles and more serious problems, such as precursors to and/or skin cancer.

Understanding how the sun is damaging to the skin is important and worth knowing. There are main 2 types of UV radiation: UVB and UVA. Although both are contribute to the risk of developing skin cancer, UVB rays causes sunburns and UVA rays causes tanning and aging. Sun protection recommendations include:

•Avoid the sun between 10 AM and 4 PM. This is when the sun’s rays are the strongest.

•Wear protective clothing. Cover your skin with tightly woven long-sleeved shirts and pants. Shade your face by wearing wide-brimmed hats and protect your eyes with sun glasses that are UV-blocking. Dark colored clothing generally provides more protection than light colors. There is even special sun-protective clothing specially designed to block UV rays while keeping you comfortable and cool. This clothing will have a label listing UV protection factor (UPF) value on a scale from 15-50+, indicating the level of protection the garment provides. The higher the UPF, the higher the protection.

•Use sunscreen. Apply generous amounts of “broad-spectrum” sunscreen 30 minutes prior going outdoors and reapply every 2 hours or after swimming or heavy sweating. Use sunscreen that have a sun protection factor (SPF) greater than 15 and that have both UVA and UVB protection. SPF indicates protection against UVB rays only. “Broad-spectrum” protects against both UVA and UVB radiation, but, unfortunately, there is no standard system for measuring protection from UVA at this time. Products that contain titanium dioxide, avobenzone (Parsol 1789), zinc oxide or ecamsule are likely to be effective against both UVA and UVB. Remember to always check the expiration date on the sunscreen container to be sure that it is still effective. Most products are no longer effective after 2 to 3 years. Also, “waterproof” and “water resistant” products do rub off on your towel when you dry yourself, so reapply. We carry Obagi SPF 35 and Vivite SPF 30 sunscreen. Both offer UVA and UVB protection and are highly recommended. For a limited time, both are only $30. Don’t forget lip balm that contains SPF to protect your lips and apply sunscreen to your ears!

•Avoid tanning beds. The give out both UVA and UVB rays.

Take note that UV rays reach the ground throughout the year, even on cloudy days. UV rays passes through water, so even if you feel cool in the pool, you aren’t safe. Sunlight also reflects off sand and snow and increases the amount of UV radiation you receive, so be careful at the beach and in the snow.


Avoid smoking
Smoking contributes to wrinkles and makes your skin look older. Smoking decreases blood flow to your skin by narrowing blood vessels, depletes the skin of oxygen and nutrients and damages elastin and collagen. When these fibers breakdown, the skin begins to sag, stretch and lose its ability to go back into place. Smoking may contribute to wrinkles by the repetitive facial expressions of squinting your eyes and pursing your lips. If you already have fine lines developing, Obagi’s NuDerm system may help you combat them. Fine lines around the lips can be reduced with Vivite’s defining lip plumper. If you would like to quit smoking or know someone who does, make an appointment with Avecinia Wellness Center for our Smoking Cessation program.

Treat your skin gently
Properly cleanse your skin. If you wear makeup, be sure to remove all traces of it at the end of the day. Integrate a proper skin care routine into your day early. While you can’t replace the skin you have, you can nourish and pamper it to protect it for the future. The Obagi C-Rx System and the Vivite Vibrant System are excellent facial regimens we offer at the office.

Limit bath time. Long baths/showers and hot water remove oils from your skin. Use luke warm water rather than hot water when you bathe.

Avoid strong soaps that strip oil from your skin. Instead, use mild cleansers.

Gently pat dry after bathing with a soft towel and apply moisturizer when your skin is slightly damp for better absorption.

Manage stress
Uncontrolled stress can make your skin more sensitive and prone to acne breakouts and other skin problems. A healthy state of mind will aid in healthier skin, so take steps to manage stress. Set reasonable goals and limits, prioritize and scale back your to-do list and make time for activities you enjoy. If you do have breakouts or acne problems, try Obagi CLENziderm system; it is currently 25% off the regular price.

Eat a healthy diet
A healthy diet will help you feel and look your best. Eat plenty of vegetables, fruits, lean proteins and whole grains. Although the association of diet and acne is unclear, research suggests a diet low in fats and carbohydrates and rich in Vitamin C promotes younger looking skin.

Stay hydrated
You should drink 8 to 10 glasses of water a day to stay hydrated and to provide your skin with vital moisture from the inside.

The Basics to Weight Loss

The Basics to Weight loss
It takes a lot of effort and commitment to make healthier lifestyle changes, especially when it comes to eating habits and exercise. It is best to ease into new habits slowly. Overtime, this healthy lifestyle will help you look and feel better, not to mention have a healthier heart. A good place to start is with what you eat!

A well-balanced diet is one that delivers an adequate amount of calories while providing the maximum amount of nutrients. The body breaks down food to release energy and this process is called metabolism. Excess calories, more than your body uses, will be stored as body fat. An increased activity results in an increased metabolism. Unfortunately, the opposite is true. With decreased activity, increased food intake or both, your body will continue to store energy as fat, causing weight gain.
What to do
To lose weight, your intake of calories must be less than your body uses. A pound of fat is about 3,500 calories. To lose 1 pound of fat per week, you have to either eat 500 fewer calories or burn off 500 calories by exercise per day. A combination of the two is the best way to achieve this goal: cut 250 calories from your diet and exercise enough to burn off 250 calories. A healthy amount of weight loss is no more than 2 pounds per week.

Most people benefit if they eat small, frequent meals (about 5 to 6 meals) throughout the day, eating about every 2 to 3 hours. Eating breakfast is important and do not skip meals. Skipping meals may cause you to feel too hungry and overeat later in the day.
What not to do
Avoid fad diets. Most offer short-term changes and can lead to rebound weight gain. To get started on weight loss, keep a record of what you eat and how much exercise you get each day. You will be surprised on your habits. Find an eating plan and exercise regimen that works for you and slowly get comfortable with positive habits. Remember, good health comes from long-term effort and commitment.
Food choices
Eat a variety of colorful, nutrient rich fruits and vegetables. Frozen vegetable can offer a cost-effective choice without sacrificing nutrients.

Since fiber often makes you feel full, include an adequate amount of fiber in your diet. Fiber can be found in green leafy vegetables, whole grains, beans, fruit, nuts and bran flakes.

Eat three servings of low-fat or fat-free dairy daily. Milk, yogurt and cheese are good sources of calcium and Vitamin D.

Think of meat as a side dish. The serving size should be equivalent to the size of your palm or a deck of cards. Choose lean meats, skinless poultry and fish rich in omega-3 fatty acids.

Avoid consuming foods high in saturated and trans fats. These may cause in increase in LDL cholesterol (“bad” cholesterol) and increase your risk in heart disease.

Remember that some fats are beneficial to your overall health. These “good” fats are polyunsaturated and monounsaturated fats found in nuts, fish and low- or nonfat dairy products.

Avoid foods that are referred to as “empty calories.” These foods add lots of calories to your diet without having much nutritional benefit. Examples include soda, fruit drinks, fruit juice, sports drinks, energy drinks, sweetened tea and flavored or sweetened milk.

Canned foods tend to be high in sodium, so buy reduced-sodium or no-added-salt versions. Thoroughly rinsing canned beans can reduce the sodium content by 40%.
Healthy Tips on Dining Out
•Ask about low-fat choices
•Avoid fried appetizers or creamy soups
•Avoid high-fat items on salad such as cheese, bacon bits, croutons, chopped egg, olives and creamy dressing
•Make substitutions like steam vegetables, instead of french fries
•Ask for all butter, dressings and sauces to be left on the side; either omit or control how much you use
•Make sure your entrée is broiled, grilled, baked, steamed or poached instead of fried
•Order fresh fruit or sorbet for dessert instead of cake, ice cream or pie
•Removes the skin off poultry or visible fat from meat




For daily updates on news, information and more on health care and wellness, join avecinia wellness center's facebook page (facebook.com/avecinia) and follow avecinia on twitter (twitter.com/avecinia4health). avecinia wellness center is Fresno's premier integrative medicine and wellness center. We combine internal medicine and primary care with health management, weight management, acupuncture, aesthetics (Botox, Juvederm, Radiesse, Obagi and more) and massage therapy for a holistic approach to health. We use a robust electronic health record program and patient web portal to enhance our delivery of services and to help our patients reach their optimal well-being. To learn more, visit www.avecinia.com. If you are looking for a primary care doctor in Fresno or the Central Valley and would like to become a part of the avecinia family, visit our website and click on new patient registration. Let Dr. Unaiza Hayat and/or Ali Kunkel, MPA, PA-C, become your trusted guides. Our Aesthetic, Weight Management, Acupuncture, Health Management and Massage Therapy services do not require us to be your primary care physician. Learn more at www.avecinia.com We look forward to meeting you!