The Importance of Sleep

Fatigue and poor sleep is a common topic that comes up in primary care. Good sleep is crucial to staying healthy and feeling your best. Sleep can affect as aspects of our life including weight loss, mood, performance, and concentration. Poor sleep can increase your risk for heart disease, obesity, high blood pressure and stroke. For example, not getting enough sleep can increase your body’s hormones that cause hunger.

There are a number of causes of poor sleep, but some of the more common causes are: Sleep apnea, poor sleep hygiene, sleep disorders (such as Restless Leg Syndrome), and stress/anxiety.

Sleep apnea

Sleep apnea is a common cause of fatigue. Factors that can increase your risk for sleep apnea are excess weight and enlarged tonsils. Common signs of sleep apnea are snoring, daytime fatigue (even after getting a full night’s sleep), napping during the day, and headaches (especially in the morning). If you think you may have sleep apnea, you should consult with your doctor. It can be diagnosed through a sleep study (which can sometimes even be done at home) and treated with a CPAP machine. In some cases weight loss can also help to improve symptoms.

Sleep Hygiene

Sleep hygiene is a crucial part of getting good, restful sleep and staying healthy. Some important tips for sleep hygiene are:

• Adults should get 7-8 hours of sleep each night

• Avoid bright screens for 30 minutes to an hour before bedtime (i.e. TV, phone, computer)

• Avoid caffeine before bedtime

• Exercise regularly

If you suffer from chronic fatigue or poor sleep, it’s important to see your doctor for a thorough evaluation to see what could be going on. Getting good sleep is an important part of wellness.

Having trouble getting your abs back postpartum...it could be Diastasis Recti

If you are having trouble getting your core and abs back in shape it could be Diastasis recti (DR). DR is most common in women after pregnancy, but it can affect men and children as well. According to the Cleveland Clinic, Diastasis Recti occurs when the rectus abdominis muscles (six-pack ab muscles) separate (usually during pregnancy) from being stretched. For some women this will go away on its own but for others it may persist. DR is very common and present in around 60% of people.

Symptoms of Diastasis recti include:

• A visible abdominal “pooch” that won’t go away

• Weak abdominal muscles

• Difficulty lifting heavy objects

• Low back pain

• Pelvic or hip pain

• Urine leaking with coughing or sneezing

• Constipation

How is it diagnosed?

It is best to see your doctor (either your Obstetrician or Family Doctor) if you are concerned you may have Diastasis recti. They can help to diagnose it and determine the severity.

How is it treated?

Diastasis recti can usually be treated or at least improved with certain exercises as well as pelvic floor physical therapy. It is very important to find a physical therapist experienced in treating pelvic floor and DR issues. Some traditional “core” exercises can actually make DR worse, including crunches, sit-ups, planks, etc, so it’s important to talk to your doctor and physical therapist about what exercises you can and can’t do. Your doctor can help you locate the right therapist for this. It’s also important to avoid lifting heavy objects and to properly support yourself when you sit up. If therapy doesn’t work, DR can sometimes be corrected with surgery.

Developments in Weight Loss Medications

Weight loss is a common topic in our clinic, especially around the beginning of the year. The New Year is a great time to start fresh with a clean slate and work towards your health and weight loss goals. But weight loss is a complicated task that requires a well rounded approach for success. That approach includes fueling your body with clean eating/nutrition, moving daily and incorporating physical activity, attending to your emotional and mental well-being, and sometimes adding weight loss medication to help overcome food cravings, hunger hormones and low metabolism. This is why it is critical to find a physician that will work with you on all aspects of weight loss to help you reach your goals and maintain them. Weight loss medications are often necessary to achieve those goals. There is nothing wrong with taking weight loss medications (as long as you don’t have any contraindications that prevent you from doing so) just as there is nothing wrong with taking blood pressure or thyroid medication. Obesity and overweight are medical conditions that should be treated with a well rounded approach just like any other condition. However, it is important to find a doctor that is experienced with various weight loss medications and can help you determine which one is right for you.

There have been exciting developments in the weight loss world over the last few years. One of the developments is the rise of GLP-1 agonists such as Semaglutide (Wegovy) and Liraglutide (Saxenda). These medications not only can help patients to feel fuller longer and stave off food cravings, they also affect how your body processes sugar and carbohydrates. Another exciting new development in the weight loss world is a capsule called Plenity which helps patients feel full before eating meals so that their portion sizes are smaller. And there are several other medications that we still prescribe when indicated which have been around for years and are effective including Phentermine and Contrave.

Your doctor should take into account your other medical issues, past medical and surgical history, other medications you are on, cost, etc when determining which medication is right for you. Just like with any weight loss plan you must make sustainable nutrition, activity and lifestyle changes while taking the medication to prevent weight regain. Our weight loss and metabolic resent program at Impact Health DPC in Ennis is a physician guided multifaceted approach that includes guidance on nutrition, exercise, lifestyle, emotional well-being and weight loss medication when appropriate. It is a comprehensive program that includes:

• Monthly visits with our board certified weight loss physician

• Medical grade body composition measurements to track your progress

• Lab panels every 3 months to track markers of health and progress

• Guidance on nutrition, physical activity, lifestyle and emotional well-being

• Monthly Lipo B or B12 injections (when appropriate at discretion of physician)

More information on our weight loss program can be found by clicking here or by calling 972-846-4800

You can sign up for our program today by clicking here

In addition, ask about our telemedicine program for those that live 45+ miles from our office*

*Must be within the state of Texas. Due to state regulations, we are not able to prescribe any controlled substances such as Phentermine via telemedicine

TMJ Pain

Temporomandibular Joint Disorder/Dysfunction or TMD is a fairly common disorder characterized by pain and dysfunction of the joints and muscles of the jaw. Signs and symptoms of TMD include:

• Pain in the jaw or cheek

• Locking of clicking of the jaw, especially with eating

• Chronic ear pain

• Headaches

• Teeth grinding

Some people may not even know that they have TMD until they are told by a dentist that they have signs of grinding their teeth.

There are a number of treatment options available for TMD including:

• Medications (such as anti-inflammatories or muscle relaxers)

• Mouth guards

• Physical Therapy

• Botox injections

If you think that you may have TMD, speak with your doctor about your symptoms and treatment options. We do offer Botox injections for TMD here at Impact Health DPC as well as other treatment options. For more information contact us today.

Information, comments and posts on this site neither constitute medical advice, nor reflect the opinions of any organization. Dr. Sjogren always recommends checking with your physician if you have any medical needs or concerns.

Diabetes Prevention and Treatment

Are you struggling with Type 2 Diabetes or Prediabetes?

According to the CDC, 34.2 million Americans have Diabetes and 88 million American adults have Prediabetes. Symptoms of Diabetes or Prediabetes/glucose intolerance can include:

• Fatigue

• Excessive thirst

• Frequent urination

• Weight gain or weight loss

• Irritability

• Frequent infections

At Impact Health Direct Primary Care, I help patients prevent the progression to diabetes and control their diabetes through nutrition, physical activity and medication management. We utilize some of the latest monitoring and treatment options including continuous glucose monitoring to help our patients achieve optimal health. In addition, if you have been diagnosed with Prediabetes, it does not always mean that you will develop Diabetes. We can often prevent the progression to Diabetes through nutrition, exercise and medication (when appropriate). I am passionate about helping patients to achieve optimal health and wellness. Contact us to see how we can help!

The Importance of Preventative Care

As a primary care physician, I feel it’s very important to educate patients about preventative care. I encourage everyone to talk to their doctor regularly about their preventative care plan and what they can do to maintain optimal health. Here are a list of a few of the preventative screenings that you should discuss with your doctor (there are too many to list here so this list is not all-encompassing):

• Mammogram (Breast Cancer Screening): The age to start screening mammograms depends on your personal risk factors as well as family history, but in general the American College of Obstetrics and Gynecology recommends that average risk women begin screening mammograms between the ages of 40-49 and repeat them annually or biennially. Of course, some women with certain risk factors or family history of breast cancer should begin earlier (talk to your doctor to determine when it’s right for you to start getting mammograms).

• Pap smear (cervical cancer screening): The US Preventative Services Task Force recommends that women begin cervical cancer screening at age 21. The screening interval depends on the type of screening done as well as a woman’s previous pap smear results.

• Colonoscopy (Colorectal cancer screening): The American Cancer Society recommends that people of average risk should start colorectal cancer screening at age 45. People with certain risk factors or family history of colorectal cancer may need to start earlier than this (discuss your specific situation with your doctor).

• Lung cancer screening: The US Preventative Services Task Force recommends yearly screening for lung cancer with a low dose CT scan for people ages 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years.

• And more: there are several other preventative screenings and measures available including (but not limited to) osteoporosis screening (bone density), diabetes screening, prostate cancer screening, abdominal aortic aneurysm screening, Hepatitis C screening, etc.

Your particular risk factors as well as which screenings are indicated for you should be a regular discussion with your primary care physician. Shared decision making between the patient and the physician is so important in all aspects of healthcare, including preventative care. Also, if you are uninsured, don’t let cost be a barrier to getting the appropriate screenings that you need. At Impact Health Direct Primary Care, one of our goals is to help patients find affordable options for their healthcare needs. We can help you to find the best prices for screenings as well as discuss cost effective alternatives when appropriate.

If you’re looking for a physician to be a partner in your health, contact us today!

Information, comments and posts on this site neither constitute medical advice, nor reflect the opinions of any organization. Dr. Sjogren always recommends checking with your physician if you have any medical needs or concerns.

Seasonal Allergies: They're Nothing to Sneeze At

Seasonal allergies (or Allergic Rhinitis) are a common topic that we encounter in primary care. Seasonal allergies are typically due to allergens in the environment such as weeds, grasses and trees. Symptoms of allergic rhinitis can include sneezing, runny nose, postnasal drip, and itchy eyes. Some people experience allergies only during certain seasons, but others can experience them year round. There are a number of treatment options depending on the severity of the allergies, including oral antihistamines and steroid nasal sprays (as always, you should consult with your doctor about your specific symptoms and treatment plan before beginning something new). Also, using an air filter in your home and keeping floors vacuumed regularly can help. In some cases, immunotherapy such as allergy shots or sublingual allergy drops may be necessary. Sublingual allergy drops (or Sublingual Immunotherapy) are a treatment option for allergy sufferers in which the drops are applied under the tongue, gradually helping your body to tolerate whatever is causing your allergies. We are excited to offer Sublingual Immunotherapy to our patients through Allergy Choices. Contact us to learn more about this customized treatment.

Information, comments and posts on this site neither constitute medical advice, nor reflect the opinions of any organization. Dr. Sjogren always recommends checking with your physician if you have any medical needs or concerns.

Gut Health: Prebiotics and Probiotics

Gut health typically refers to the status of the bacteria in your gastrointestinal (GI) system. Our GI system contains both “good” and “bad” bacteria (our gut microbiome), but sometimes the number of good bacteria can get too low. There’s ever-evolving research on how the gut microbiome can affect your health (including weight and obesity).

Prebiotics vs Probiotics

Prebiotics are substances found in fiber that essentially feed the “good” bacteria in your GI tract.

Probiotics are live bacteria that are considered “good” bacteria because they can aide in the health of your digestive system. They can be found in Probiotic supplements or naturally in foods such as yogurt, Sauerkraut, Kimchi, or Kombucha tea. There are various types of probiotics and some people may have allergic reactions or contraindications to probiotic foods and supplements, so be sure to discuss with your doctor if they are right for you.

Why Gut Health is Important

Gut health has been shown to have a role in various conditions including: irritable bowel syndrome, antibiotic associated diarrhea, inflammatory conditions, atopic dermatitis (eczema), and even obesity. Talk to your doctor to see what steps you can take to optimize your gut health.

Click here to read more on this topic from Harvard.

As with many things in life, taking probiotics are not entirely without risk. Some people may be allergic to certain foods or supplements or may have pre-existing health conditions that preclude them from taking prebiotics or probiotics. As always, you should consult with your doctor before starting something new to see if it is right and safe for you.

Information, comments and posts on this site neither constitute medical advice, nor reflect the opinions of any organization. Dr. Sjogren always recommends checking with your physician if you have any medical needs or concerns.

Direct Primary Care: A Modern Healthcare Solution

Many people have been affected by COVID-19 in a number of ways, and some of the most common things we are hearing is that people have either lost their jobs (and in turn have lost their health insurance) or they are putting off their healthcare needs because they are avoiding doctors appointments. Now, more than ever, patients are turning to direct primary care to meet their healthcare needs. Here are some of the reasons why:

• It’s affordable: Whether or not you have health insurance, direct primary care is a cost effective option. The low cost monthly membership fee covers all visits in our office with no co-pays, as well as call/text/video chat with your physician. In addition, most procedures we can do in the office are included and our patients have access to low cost labs. Many patients’ deductibles continue to climb year after year, so they find it more cost effective to save health insurance for bigger things such as hospitalizations, surgery, and specialist care and utilize direct primary care for their primary care needs. Direct primary care is also very valuable for those who can’t get health insurance. In addition to the costs savings of the services performed in our office, we are very cost conscious and can help you “shop” around for the best prices when you need services outside of our office (such as imaging, specialist care, etc). Healthcare costs have become so complex and we feel that it is part of our job to help you navigate the healthcare system.

  • Example: A patient calls (or texts) the doctor in the morning that they think they have a urinary tract infection. They discuss the symptoms and decide to schedule an appointment for that afternoon when the patient gets off of work. The patient is seen that afternoon and a urinalysis is done in the office showing a UTI. The doctor sends a prescription for an antibiotic to the pharmacy, which the patient picks up that afternoon. The patient was able to get care that worked around their schedule and the best part is it was included in their monthly membership fee (no additional charge for the visit or the urinalysis). The only extra cost they incurred was for the antibiotic prescription at the pharmacy.

• It’s convenient: Because we have a smaller patient panel than many doctors’ offices, we are usually able to see patients for same or next business day appointments, so you’ll be seeing your physician who knows you and your medical history. We also space out our appointments so that they’re not rushed and you’re also not usually waiting in the waiting room.

• It’s accessible: Your physician will be available to you by phone/text/video chat so that you can receive care when you need it. If you have a concern you can text your doctor directly. We also offer telemedicine visits so that you can receive care for most things from the comfort of your home.

• It’s personalized: Our patient panel size is smaller than many practices in order to provide personalized care. Our appointments are not rushed and we want to spend time addressing your concerns and questions. We take a holistic approach to medicine so it’s important to have the time to discuss various aspects of a patient’s life that can be contributing to their health.

• It works for small businesses too: The economic impact of COVID-19 has made it increasingly hard for businesses to provide affordable health care options for their employees. Direct primary care is an affordable way for employers to provide primary care to their employees.* DPC has been shown to improve employee satisfaction, retention, and health while lowering overall costs. Our clinic offers special pricing for businesses with 5 or more employees enrolled. We also have a new virtual-only option for businesses. Click here to learn more about DPC for businesses.

Let us show you the benefits of direct primary care! Contact us to find out more.

*Direct primary care is not health insurance. Please discuss tax and legal requirements for your business with your accountant and/or attorney.

The Importance of Exercise

The benefits of physical activity are numerous. Healthy nutrition and exercise are some of the most important ways that you can take care of your physical and mental health. In this article I’ll go over both the benefits of staying active and various strategies to incorporate more physical activity into your lifestyle. As always, you should talk to your doctor about your specific situation, medical conditions and any limitations you may have before starting a new exercise routine.

Benefits of Exercise

• Weight loss: if you are working on losing weight or maintaining weight loss, exercise can help you accomplish those goals. You’ve probably heard the phrase that “you can’t out-exercise a bad diet” and it’s true that both nutrition and exercise are important components of a healthy lifestyle, so be sure that your diet is also on point. Two important ways that exercise helps with the weight loss journey are: 

  • It helps to preserve muscle mass: As you lose weight, you usually lose both fat and muscle. Of course, you would prefer that a majority of the loss be fat and that you preserve as much muscle mass as possible. When you incorporate exercise (especially resistance or strength training) it helps build and preserve that muscle as well as burn fat.

  • It helps to maintain your metabolism: As people lose weight, their resting metabolism often slows down to compensate, which is one of the many reasons that people plateau when trying to lose weight (I plan to write a separate blog post about weight loss plateaus and will expand more on this). Exercise can help to improve your resting metabolism and overcome plateaus.

• Preserve muscle mass with aging: As we age, we typically lose 3-5% of our muscle mass per decade starting in our 30’s (especially if we are inactive). Exercise (especially resistance or strength training) can help slow or prevent this. In addition, maintaining or building muscle mass helps to prevent fractures and osteoporosis.

• Improved mood: Exercise causes a release of endorphins which helps with mood and energy levels. Many people who exercise regularly report improvement in their mood.

• Helps to reduce risk of chronic diseases: Exercise can help improve many other medical issues as well as prevent chronic diseases. According to the CDC  physical activity can reduce your risk of conditions such as Type 2 Diabetes, Heart Disease, and many types of cancer, among other things.

Incorporating Physical Activity Into Your Routine

According to the CDC, adults should get “at least 150 minutes of moderate-intensity aerobic activity every
week, plus muscle-strengthening activities at least 2 days a week”. Talk to your doctor about your specific situation, medical conditions and any limitations you may have before starting a new exercise routine.

Resources for exercise routines/workouts:

• If you’d like to exercise at home, there are an abundance of free and paid resources available online for exercise guidance including: Youtube, hundreds of workout apps (both free and paid), or online exercise databases such as this one from the American Council on Exercise. If you don’t have much experience with exercise or feel uncertain about the techniques, it may be a good idea to work with a personal trainer until you feel more comfortable.

• If you’re looking for more structured guidance or someone to make sure you’re doing your exercises correctly, consider working with a personal trainer. They can help you to get started and also develop exercise routines for you to follow based on your specific goals.

If you’re looking for medically supervised weight loss, contact us as Impact Health Direct Primary Care for more information about our weight loss services or click here to find out more. We’re very passionate about helping patients to achieve a happier and healthier lifestyle that is sustainable long-term.

Information, comments and posts on this site neither constitute medical advice, nor reflect the opinions of any organization. Dr. Sjogren always recommends checking with your physician if you have any medical needs or concerns.

How To Maintain A Positive Outlook In The Face Of COVID-19

COVID-19 sent a shock through our country, our economy and our healthcare system. It can be difficult to maintain a positive attitude with all of the uncertainty surrounding the future. But there are some things that you can do to help maintain a healthy and positive outlook:

• Keep a routine: Maintaining a routine can help you to feel some sense of normalcy. Try to go to bed and wake up at your usual time. Eat a healthy breakfast. Go over/create a to-do list for the day or the week to keep yourself organized.

• Catch up on your reading: It’s tempting to binge watch your favorite TV shows, but try to balance TV/screen time with reading a good old fashioned book. You can even start a virtual book club with your friends or family.

• Learn something new: Now is a great time to acquire a new skill. You can watch TED talks or even take a free course on Coursera.org

• Keep moving: Exercise is extremely important for mental well being. Many companies are offering their apps or videos for free during this time. For example: Peleton is doing a 90 day free trial of their workout app which includes a ton of workouts you can do at home.

• Relaxation techniques and Mindfulness: With the uncertainty surrounding the future, make sure you take time to relax and reduce stress. On that note there are many apps out there that can help you with guided meditation (ex: Calm app). Yoga is also a good way to reduce stress. Free yoga videos can be found on YouTube, etc.

• Stay connected: It’s important to stay connected with family and friends. Plan virtual events via Google Chats, Zoom, FaceTime, Skype, etc.

• Hone your cooking skills: Now is a great time to try out new recipes. There are endless recipes available online. Pinterest is a great place to find recipes. Several of the meal delivery kit companies also have their recipes available for free online (such as Home Chef or Hello Fresh).

• Self care: Most importantly take care of yourself and your body. Eat healthy, get plenty of sleep, remain physically active, and do activities that bring you joy!

If you need a new doctor or even a one time virtual visit, we are here for you at Impact Health DPC. We make healthcare simple and we are currently offering virtual video visits.

COVID-19 Updates

Case numbers

As of today, Texas has had 21,944 confirmed cases of COVID-19 and 561 deaths from the virus. Ellis county has reported 135 cases and 4 deaths from COVID-19.

Testing

There are various types of tests for COVID-19. The PCR test (which is typically done with a nasopharyngeal swab) remains the most reliable test for detecting active infection in an outpatient setting at this time. There are other tests called serology (or antibody) tests that are available in some areas but are currently being evaluated by the CDC for their accuracy and reliability. So far, these tests seem to be better at detecting past infection as they test for antibodies to COVID-19 which typically take the immune system 1-2 weeks after infection to develop. It is not yet known whether antibodies to COVID-19 will confer long-term immunity, but the CDC is currently working to determine this.

Precautions

Here are some precautions that you can take to help protect yourself and those around you:

• Clean your hands with soap and water for at least 20 seconds

• Avoid touching your face, eyes, nose and mouth

• Try to maintain a minimum 6 foot distance from other people

• If you do need to go out for groceries, etc…wear a face mask (such as a cloth face mask)

Summary of Governor Abbot’s recent executive orders

On April 17th, Governor Abbot released 3 executive orders regarding COVID-19. Some of the items in these executive orders include:

• Certain retailers will be allowed to re-open using a retail-to-go model

• Texas schools will remain closed for the rest of the academic year

• The creation of a Strike Force to open Texas (made up of medical experts and community leaders) which will guide the re-opening of Texas.

• Loosening of certain restrictions on surgeries

At Impact Health we are continuously staying updated on COVID-19 news and information. We will do our best to keep you regularly updated on developments. We are primarily utilizing telemedicine for visits in order to keep our patients safe and healthy. I want to personally thank the community of Ennis for all of their hard work in keeping each other and our city safe and healthy. Keep up the great work Ennis! We WILL get through this!

Diets and Weight Loss: Developing a Lifestyle

Posted by: Dr. Kara Sjogren

As we enter the first few months of the new year, many of us want a fresh start when it comes to our goals—including weight loss. There’s so much conflicting information out there it’s hard to know what is best. People often ask me “Which diets work best for weight loss?”. The answer to that is complex but really it comes down to what is a lifestyle that you can sustain rather than just a fad diet that you can follow for a set period of time. When people set their minds to lose weight they often look at the short term and pick a diet that they think will give them the best/quickest results. However, they often forget to consider the long term sustainability of what they are embarking on. In fact, losing weight and gaining it back (or “yo-yo dieting”) can actually be detrimental to your health and your metabolism. This is one reason why picking a “way of eating” or lifestyle is far more beneficial in the long term than just “dieting”. A number of factors go into selecting the best way of eating for each person including their specific health issues, schedule, meal prep time, dietary restrictions, food likes and dislikes, etc. It’s a good idea to discuss all of these things with a weight loss physician and/or nutritionist to come up with the best eating style for you. In the end, incorporating more nutritious/whole foods and less processed foods is the key to any healthy diet. In addition, obesity medicine specialists are learning that there is so much more complexity to weight loss (and maintaining a healthy weight) than the old “calories in, calories out” model that we used to follow. A calorie is not just a calorie and, in fact, different sources of calories can affect us and our metabolism in such different ways. In addition there are many other factors that affect weight loss and weight maintenance including exercise, sleep, stress, mood, etc.

Here are a few tips for other lifestyle changes that can aid with weight loss and weight maintenance:

1. Incorporate strength training into your exercise routine: Many of us hit the treadmill or elliptical hard at the start of the new year to kick start our weight loss; however, adding in strength training even 2-3 times a week can help improve resting metabolism, bone strength, and weight maintenance. Of course it’s a good idea to consult with your doctor first to make sure you are healthy enough to do strength training and that you don’t have any restrictions. It’s also a good idea to meet up with a personal trainer if you have not done strength training before or are unsure how to use equipment.

2. Hydrate: Water is essential to many of our body’s processes including the metabolism of fat. Not drinking enough water can hinder weight loss efforts. The amount of water you need daily depends on several factors including your age, gender, and other health issues you may have. It’s important to talk to your doctor about how much water you should be getting daily.

3. Sleep: Studies show that inadequate sleep can hinder weight loss. Adults should aim for around 7-8 hours of sleep each night. One way to improve your sleep is to avoid screens (such as TV’s, computers, phones) for at least 30 minutes before bed. If you feel that you are getting adequate sleep but still don’t feel well rested in the morning, talk to your doctor to see if there may be something else going on (such as sleep apnea, restless leg syndrome, etc).

We’d be happy to help you with your weight loss journey here at Impact Health Direct Primary Care. Check out our website to learn more about our weight loss program.