Achieving your goals in 2012- Resolutions to Success!

Setting goals- making a commitment to yourself this New Year!
Happy New Year!
When the ball drops on January 1, 2012, the resolutions begin! They usually begin with good intentions but end with promises for the following year. If you find it difficult to keep your new year’s resolutions, try these steps to help you reach your goal!
• Score goals! 

o What do you think of when you think about a goal? Can you picture a soccer player kicking a ball into a net, or the placekicker of your favorite football team scoring the winning field goal of the big game? Now think of our resolutions as goals and instead of dreading the thought of accomplishing your resolution, you can think of working your way to the goal and scoring! The mind is a powerful tool and how we think about things influences how we react to them. Think about how you feel when your favorite teams scores and wins? Wouldn’t it feel even better if you felt that way about yourself?

• Win-Win!
o An important aspect of “scoring a goal” is the immediate and recognizable satisfaction of achievement. Let’s face it, we are a nation of immediate gratification. Instead of fighting or bemoaning that reality, accept it and make it work for you. So when the placekicker scores, the points can make a real difference. So what are going to be your points? How about trying something like this: If your goal is to lose weight (i.e., win the game), your real goals are the things you do to “win!” Set up to jars. In one jar, place a dollar or two for every week you don’t drink soda. In the other jar, put a dollar or two (the “points” of each have to be the same) each week you have a soda. At the end of the year, see which jar has more. If the jar for weeks without soda has more, you get to keep all the money and spend it any way you want. If the jar for weeks with soda has more, you have to give all your money to an organization you don’t support or a person you don’t like. If your jar with soda is empty, guess what, you most likely lost weight too (you could lose 1 pound per week by cutting three soda’s out of your daily diet, that’s 52 pounds in a year, maybe more, especially if you got some exercise and controlled how much you ate).

• Can’t score goals without teamwork!

o Just like in football, soccer and any other sport, winning takes teamwork. Let your friends and family know about your goals. Find a motivating partner. Find someone that you can motivate as well so you both of have skin in the game. Or join a support group such as DiabetesFresno, Fresno's only free Type 2 diabetes support group open to everyone (meets the 2nd Saturday of every month at 11am at avecinia wellness center, call 559-450-7299 for more information).   Celebrate with your friends/support group/team when you “win!”

• Write your goals down, make a game plan!
o Your favorite sports team doesn’t win its games without a strategy, a game plan. Writing down your goals, and the steps you will take to achieve them, helps you visualize your achievement, gives you something to remind you of your goals, and helps you clear your mind because you don’t have to perpetually think about your goals. You can also use your written goals as a road map/checklist. It’s important that your goals be clear, and the steps that you will take to achieve your goal be doable/actionable. Use your written goals as a scorecard.
Use the worksheet below to help you track your achievements and reach your goals!

Although setting your achieving your goals sounds like playing a game, it is the most important game of your life because winning means achieving a better life for yourself. So January 1st the clock will start ticking, are you ready to win?

Goal tracking worksheet:

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!

Healthy Giving is Healthy Living

Ever wonder why it feels good when you give a little bit of something to someone else? Whether it’s a smile, a helping hand, your time or some money, the act of giving has a profound positive effect on both you and the person you are sharing with. So do something good for someone else and you just did something good for yourself! Saints, wise people, and religious leaders have all prescribed good deeds, charitable works and the act of giving unselfishly. Now science has the same prescription as well. In Oprah Winfrey’s Lifeclass Oprah Winfrey’s Lifeclass, 6 ways that giving can make a person healthy are discussed:

1. Simply contemplating generosity or giving was shown to boost protective antibodies in saliva;  
2. Connecting to people through active listening and speaking with self reference was shown to reduce the risk of heart attacks; 
3. Sharing in pain by reaching out to others in a similar circumstance actually reduces your pain;  
4. Most people think that you can catch more colds by hanging out with more people, but the opposite is also true. As long as you practice good cold season courtesy (keeping your hands clean, sneezing in your inner-elbow instead of on someone), studies show that being socially active can help you stay healthier. Volunteering is a great way to give back and be socially active; 
5. Did you know that giving love helps heal wounds faster? In a study, heals took a day longer to heal when couples argued; 
6. A soothing touch is good for you and a friend. A study showed that giving massages also reduces the stress hormone cortisol and alleviates anxiety and depression! 

So in reality, when you’re giving, you’re getting something more in return because your good health is your most valuable asset.

Another important aspect of giving is gratitude. Giving is the ability to share something you have with someone that does not have. Gratitude is the positive recognition of the ability to share or give. When you give, you can feel good, when you appreciate your ability to give, you can feel even better. A recent study conducted by the University of Texas Health Science Center reported that you can be 25% happier, healthier and more positive in general by simply writing down every night before you sleep 5 things you are grateful for. Being able to read this article, and sleep under a roof, are 2 things already. Try it and see how you feel in 10 weeks!

So in this holiday season and time of giving and gratitude, remember, good things happen to good people. When you’re giving and you’re thankful for being able to give and/or for the gifts you get, you’re getting more in return- a healthy, happy life!

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!

Medicare Open Enrollment and Advantage Plans

Did you know Medicare Open Enrollment is happening now through December 7th?  Do you have a Medicare Advantage Plan or wondering what one is? Medicare Advantage Plans are basically private versions of Medicare.  They sometimes cover more services than Medicare A and B, such as include Medicare Part D.  However, sometimes they do not cover all services provided by Medicare.

The Federal Government used to subsidize these private health insurance plans but the Patient Protection and Affordable Care Act is reducing this subsidy to save costs.  

One of California’s largest Medicare Advantage plans is pulling out of Medicare in 2012.

As of 2012, Freedom Blue Medicare Advantage Plan will no longer be available.  If you are currently covered through Freedom Blue, you should have been notified of the upcoming change and your need to choose a new Medicare Plan. The Open Enrollment period is October 15 – December 7, now is the time you can change your Medicare health plan and Part D coverage and/or return to Original Medicare. Coverage changes become effective January 1, 2012. We know this can be an overwhelming task and want to help you understand what this means to you.

Freedom Blue is a PPO plan, which means you select an "in network" doctor from a long list of providers.  You don't usually need a referral to see a specialist or an "out-of-network" doctor.   However, if you see an out of network provider, the PPO covers you at a lower rate than in-network and you will have a larger coinsurance or patient responsibility amount. PPO is the most flexible type of plan with the largest list of in network providers. 

With the termination of Freedom Blue, there will no longer be a PPO Medicare Advantage Plan available to Beneficiaries in Fresno County.  The options available are:

Traditional Medicare, you can use any doctors and facilities that accept assignment for Medicare.  Most doctors and facilities do accept Medicare assignment, such as avecinia.      

HMO, which requires you to use only doctors and facilities that are contracted with that particular HMO.  You generally need a referral from your primary care doctor to see a specialist.   Avecinia is not a contracted with any HMOs

HMO-POS,  similar to an HMO, you also have the option to receive some services from doctors or hospitals that are not in the plan's network, usually at a higher cost than a standard HMO plan. Avecinia is not contracted with any HMO-POS plans.

**Some Medicare Advantage plans offer Medicare prescription drug coverage, but other plans do not.    Don't forget to explore your prescription drug options.

    

These plans all have their pros and cons, and varying degrees of out of pocket costs.  Make sure that you educate yourself so you can choose the best plan for your health and your budget.  In our experience with Medicare and Medicare Advantage plans, we have found traditional Medicare the easiest to work with.  Traditional Medicare may not offer all the services some Medicare Advantage plans offer, but we have found that traditional Medicare is less likely to deny or request prior authorization for benefits it does cover. 

A great resource to help you better understand your Medicare choices is HICAP (the Health Insurance Counseling & Advocacy Group - http://www.cahealthadvocates.org/HICAP/).  HICAP provides free, objective information and counseling about Medicare.  The Fresno representative is Wayne McMillen at Clovis Senior Center.  Appointments can be made by calling 559-324-2750 (here’s a link to their October Newsletter with an article by Mr. McMillen: http://www.ci.clovis.ca.us/SiteCollectionDocuments/SeniorServicesDivision/October2011Newsletter.pdf)

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!

Preventive Visits (Physicals) and what it means for you!

The Good news about Preventive Visits/Physical/Well-Visits!

Have you heard the good news- “Preventive Visits” are 100% free to you! That sounds like great news doesn’t it?  It is, but it’s very important to know what “preventive” means so you can take full advantage of the opportunity.  The easiest way to determine what is a preventive visit (versus diagnostic) is to think of it as an information gathering visit to determine what your current state of health and well-being is and how it corresponds to other people of your age and gender. It’s best to do it when you are feeling well (thus the common moniker “well-visit”), you don’t have any current or new health concerns to discuss during the visit (thus no change in medication, no new prescriptions are given, no normal screening labs are ordered),  and /or no follow-up for a health issue discussed during the visit is scheduled.   For example, during your Physical/Preventive/Well-Visit, your doctor may notice that you are at risk for diabetes and have not been tested.  Your doctor then decides to test you. That screening/testing is part of your preventive visit.  However, if you are diabetic and you are at your Physical/Preventive/Well-visit and you are having complications due to your diabetes that are addressed by your doctor, that preventive/physical visit is now two visits: A physical/preventive visit and a diagnostic care visit where you will be responsible to pay a co-pay/co-insurance or deductible.   The same also applies if you are coming to your doctor and the doctor performs a routine screening related to the visit that may have been covered as preventive if you had come in for a preventive visit.  The screen is part of your diagnostic care and as such you will be responsible for the co-pay/co-insurance deductible for that visit.   So regular preventive care can help you stay well, catch problems early on, save you money and may be potentially life-saving.

So what can you expect during a Preventive/Physical/Well-Visit?

The rules for what is considered a preventive visit or part of a preventive visit and what isn’t are set by the Center for Medicare and Medicaid Services and your Health Insurance company.   As your health care provider, we are required to submit accurate health records indicating the exact reason for your visit and everything that was done and discussed during your visit. Each concern is grouped into a visit code and a diagnostic code.  That is how the different topics and health concerns addressed at your visit are organized into “preventive” versus “diagnostic” care.   Any attempt to not accurately account for everything puts you at risk and undermines our ethical obligations.  With that said, there isn’t a set rule as to how a Physical is conducted. Each doctor or practice will develop its own method of gathering necessary information (basically the purpose of a Physical) to see what is your current state of health and well-being.

Generally you can expect all, some or a variation of the following (courtesy of WebMD):

History: This is your chance to mention any complaints or concerns about your health. Your doctor will also likely quiz you about important behaviors, like smoking, excessive alcohol use, sexual health, diet, and exercise.  The doctor will also check on your vaccination status and update your personal and family medical history.

Vital Signs: These are some vital signs checked by your doctor:

·         Blood pressure: less than 120 over 80 is a normal blood pressure. Doctors define high blood pressure (hypertension) as 140 over 90 or higher.

·         Heart rate: Values between 60 and 100 are considered normal. Many healthy people have heart rates slower than 60, however.

·         Respiration rate: Around 16 is normal. Breathing more than 20 times per minute can suggest heart or lung problems.

·         Temperature: 98.6 degrees Fahrenheit is the average, but healthy people can have resting temperatures slightly higher or lower.

General Appearance: Your doctor gathers a large amount of information about you and your health just by watching and talking to you. How is your memory and mental quickness? Does your skin appear healthy? Can you easily stand and walk?

Heart Exam: Listening to your heart with a stethoscope, a doctor might detect an irregular heartbeat, a heart murmur, or other clues to heart disease.

Lung Exam: Using a stethoscope, a doctor listens for crackles, wheezes, or decreased breath sounds. These and other sounds are clues to the presence of heart or lung disease.

Head and Neck Exam: Opening up and saying "ah" shows off your throat and tonsils. The quality of your teeth and gums also provides information about your overall health. Ears, nose, sinuses, eyes, lymph nodes, thyroid, and carotid arteries are also examined.

Abdominal Exam: Your doctor can use a range of examination techniques including tapping your abdomen to detect liver size and presence of abdominal fluid, listening for bowel sounds with a stethoscope, and palpating for tenderness.

Neurological Exam: Nerves, muscle strength, reflexes, balance, and mental state are assessed.

Dermatological Exam: Skin and nail findings could indicate a dermatological problem or disease somewhere else in the body.

Extremities Exam: Your doctor will look for physical and sensory changes. Pulses can be checked in your arms and legs. Examining joints can assess for abnormalities.

Male Physical Exam

An annual physical exam for men might also include:

• Testicular exam: A doctor can check each testicle for lumps, tenderness, or changes in size. Most men with testicular cancer notice a growth before seeing a doctor.
•  Hernia exam: The famous "turn your head and cough" checks for a weakness in the abdominal wall between the intestines and scrotum.\
•  Penis exam: A doctor might notice evidence of sexually transmitted infections such as warts or ulcers on the penis.
•  Prostate exam: Inserting a finger in the rectum lets a doctor feel the prostate for its size and any suspicious areas.

Female Physical Exam

A woman's annual exam might include:

• Breast exam. Feeling for abnormal lumps may detect breast cancer or benign breast conditions. The doctor will also check the lymph nodes in the underarm area and look for visual abnormalities of the breasts.
• Pelvic exam: The pelvic exam allows examination of the vulva, vagina, and cervix. Routine checks for sexually transmitted infections are often done. A Pap test can screen for cervical cancer. 

Laboratory Tests

There are no standard laboratory tests during an annual physical. However, some doctors will order certain tests routinely:

• Complete blood count
• Chemistry panel
• Urinalysis (UA)

Unless symptoms already suggest a problem, these tests are unlikely to provide useful information.

A lipid panel (cholesterol test) is recommended every five years. Abnormal cholesterol levels increase the risk for heart attacksand strokes.

Physicals Should Emphasize Prevention

• At age 50, it's time to begin regular screening for colorectal cancer. People with immediate family members with colorectal cancer may need to be screened before age 50.
• For most women, age 40 marks the time to begin annual mammogram screening for breast cancer.
• Everyone should have their cholesterol (lipids) checked every five years after age 20, according to the American Heart Association.

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.  Make the appointment when you truly are well so the visit can focus on verifying your health and helping you manage your good health.  Check with your insurance company which other services are considered “preventive” and thus have no co-pay/co-insurance or deductible.  For example, most insurance companies are now fully covering a variety of immunizations such as: Hepatitis A and B, Flu, Herpes Zoster, Pneumococcal and more.  All you have to do is come in specifically for and only for a covered vaccination and it’s totally free to you (your health insurance will be billed and your health insurance carrier will cover your co-pay, co-insurance and any deductible).  The best way for you to know which services your plan considers “preventive” and free to you is to call your insurance company and ask. Visit avecinia’s list of  health insurance companies it is contracted with to find your insurance company’s website/contact information.  Generally, the preventive services listed under the Affordable Care Act will be covered services.  Take advantage of this great opportunity to save money and save your life today!

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!