4 Warning Signs of Sleep Apnea

Posted on April 9, 2018December 1, 2022 by cara

Sleep apnea affects up to 22 million Americans in one of its three main forms: obstructive sleep apnea, central sleep apnea, or complex sleep apnea. Obstructive sleep apnea is when the tongue closes the airway. In central sleep apnea, the airway is free, but the brain refuses to signal the muscles to allow breathing. And complex sleep apnea combines both situations. In all forms of apnea, the brain attempts to at least partially trigger breathing after a minimal break. Up to 25% of children, including infants, suffer from pediatric sleep apnea as well. If ignored too long, sleep apnea can lead to serious complications including diabetes, heart attack, and stroke. Of course, the right treatment can reverse all concerns. But what are some warning signs of sleep apnea?

Dry Mouth in the Morning

Xerostomia is the medical term for the sensation of dry mouth. This can be caused or due to a number of issues including medications, vitamin deficiencies, and serious health issues. But more often, dry mouth is due to sleeping with your mouth open. While there may be various reasons for that sleep apnea is among the most common. When you have trouble getting enough air during sleeping hours, the mouth opens in response. So waking up parched may be a sign of sleep apnea.

Painful or Stiff Teeth and Jaw

Bruxism is the term for grinding your teeth and it’s usually brought on by stress. Teeth grinding can occur at any time, but it’s most prevalent during sleeping hours. It also becomes habitual quickly. When teeth grinding is combined with other apnea signs, the condition is likely due to the apnea. If you have stress, strain, stiffness or pain in the teeth and jaw and it’s not for an obvious reason, chances are you grind your teeth. Fortunately, your Red Bank dentist has some simple and effective solutions for bruxism. But taking away that sign isn’t a cure for sleep apnea.

You’re Always Tired or Continuously Yawning

The human body needs REM (Rapid Eye Movement) sleep to refresh and renew. But breathing fluctuations cause the body to be forced into a lighter stage of sleeping so it can remind the muscles to work correctly. When this happens regularly, the result is often grogginess and irritability. However, changes in appetite and difficulty concentrating may also occur. Your alarm clock may show “proof” you got your full eight hours of beauty rest, but if you’re yawning and tired most of the day, chances are you haven’t gotten close to that amount.

You’re a Loud or Noisy Sleeper

Snoring is often the most obvious sign of sleep apnea, but not all snoring is equal. However, if your snoring is loud, jagged, and seems to have a “sawing” edge, it may be apnea-related. This snoring may become loud enough to wake you up or it may cause relationship issues as it continually wakes up your partner. Even if you don’t snore, loud or regular gasping during sleeping hours may occur as your body remembers to breathe. These common warning signs of sleep apnea should be taken seriously, but a simple and effective cure could be as close as your Red Bank dentist. Give us a call when you’re ready to sleep easier.

Over 40? It’s Never Too Late for Lumineers

Posted on April 9, 2018April 26, 2020 by cara

Poor dental hygiene and care not only leads to premature aging, but it can also lead to several potentially serious health issues. According to the American Dental Association (ADA), just a few generations ago, middle age was associated with serious tooth loss for most Americans. Fluoride, better dental hygiene, and more dental care options helped slow and even reverse that trend in many states. But still today by the time women, specifically, reach the age of 40 or 50 serious changes in their teeth occur. Top teeth become shorter while the bottoms lengthen. Gums begin to recede, and bone density weakens, leaving the jawline to shift and often concave inward. But it’s never too late to get the smile you deserve. In fact, your Manhattan cosmetic dentist can give you a brand new smile in just two visits thanks to Lumineers.

Lumineers Correct Multiple Dental Concerns

It’s no secret dental work can be quite expensive and nerve-wracking, especially if you need to correct multiple issues individually. Cosmetic dentistry is specifically meant to provide aesthetic solutions to improve your smile and overall dental health. Gaps, chips, cracks, and deep stains are some main reasons people opt to visit a cosmetic dentist. And there are plenty of options to correct each issue. However, if you have several at once, Lumineers can easily cover and correct them all simultaneously.

Lumineers Are Non-Invasive and Reversible

Traditional porcelain veneers are somewhat invasive because the dentist needs to remove a small amount of enamel from each affected tooth. This ensures the porcelain shells affix properly to the teeth. As such, local anesthesia and numbing agents are often required as well. That’s not an issue with Lumineers. While porcelain veneers are around the width of a contact lens, Lumineers are around half that width. The thinner shells are easier to affix and require no anesthesia or medication. That translates to no potential medication side effects and no unexpected, unnecessary, or painful recovery issues. And because no enamel needs to be removed during the treatment, Lumineers can be reversed or removed if the patient changes their mind down the road or opts for another dental solution.

Lumineers Are Efficient and Convenient

Lumineers are digitally created and constructed, so the patient can see exactly how they’ll look once the treatment is completed. Made of Cerinate porcelain, Lumineers are only about 0.2 millimeters thick, so there are no concerns regarding discomfort or a bulky appearance. And just like traditional veneers, Lumineers allow you to get a beautiful new smile in just two visits.

Lumineers Are Durable

Don’t let the thin construction of Lumineers fool you. They’re far tougher than they may look. The special dental-grade porcelain and chemical composition help to resist leakage and cracking better than traditional porcelain veneers. And as for durability, with proper care and maintenance, your Lumineers may easily last around 20 years which is actually longer than the average lifespan expectations of traditional veneers. Give your Manhattan cosmetic dentist a call when you’re ready to see if Lumineers are right for you.

Wedding Ready: Top 3 Cosmetic Dentistry Procedures Before the Big Day

Posted on April 9, 2018April 26, 2020 by cara

Every marriage-bound couple dreams of a flawless wedding day, but getting there can be quite the adventure. There is no right or wrong way to plan your perfect day, but the average wedding in America costs around $28,000. That includes food, entertainment, and all the incidentals to capture your dream day in the hearts of everyone in attendance for hopefully the rest of your lives. Whether you’re the bride or groom, all eyes will be on you at one point or another… and for years to come thanks to the wedding photos. However, all the planning, hopes, and dreams for that one special day can be crushed in an instant the second the photographer tells you to say cheese. Your Manhattan cosmetic dentist can help ensure your smile is as ready for the big day as you with one of the following procedures.

Professional Teeth Whitening

Anyone can pick up a home whitening kit just about anywhere nowadays. But while those shiny boxes make huge promises, few actually deliver on those. Home kits are designed as one-size-fits-all solutions, but since everyone’s different how can that work? In fact, since boxed home kits only deliver one to two shade differences on average, you may feel the need to repeat the process over the course of several months just to notice any real difference at all. That, however, can lead to other problems such as weakened enamel, sensitivity, and mouth sores. Professional teeth whitening, however, is custom designed to fit the needs and desires of each patient. Just a one-hour appointment with your Manhattan cosmetic dentist can lighten, whiten, and brighten your teeth up to 8 shades. And the results last for far longer than over-the-counter options.

Invisalign

The average engagement lasts 14 months before the nuptials take place. That’s plenty of time to get your teeth picture perfect. While traditional braces may be off-limits for multiple reasons, Invisalign may fit the bill. Invisalign is the clear solution to several moderate orthodontic correction needs, including gaps, misaligned teeth, and bite issues. In many cases, Invisalign takes less time to complete the corrections than traditional braces. And unlike the metallic option, Invisalign is practically invisible and offers far more freedom. So even if you’re still in mid-treatment by the time of your wedding day, go ahead and eat those gooey treats or wedding cake. And smile freely without worrying about your dental progress being the highlight of the day.

Porcelain Veneers

If you’re in a hurry and can invest in a quick smile makeover, porcelain veneers can make you ready for your close up in just a couple dental visits. Porcelain veneers are the celebrity secret for perfect smiles, and they can easily be yours as well. The wafer-thin porcelain shells are custom-designed and fitted to ensure a natural, seamless appearance that will leave your guests wondering if you were born with perfect teeth. Porcelain veneers are an irreversible procedure as some enamel needs to be removed to affix the shells. But they’re a quick solution, generally requiring just a couple visits. And when taken care of correctly, they can last well over a decade without any major issues. Call your Manhattan cosmetic dentist when you’re ready to get the perfect smile for your big day.

Engagement for good health outcomes!

Posted on November 24, 2014April 26, 2020 by Daria Massimilla

What is Patient Engagement?

“No blockbuster drug can make a difference if a patient doesn’t take it,” noted Donald W. Kemper, Founder and CEO Healthwise. To get the patient to “take the med”, the patient must believe that taking it is something they want to do. Engagement moves the patient towards such action.

Patient engagement is helping patients take a more active role in self-managing their disease. Providers can better engage patients by establishing a person-centered not patient-centered partnership, as this encompasses the whole person and their life — their body, mind, spirit, family, and full health community. Person-centeredness is needed if we truly want to be able to set up a positive partnership with that person to improve their health. Nurses play a central role in engaging patients by facilitating the provider-patient communications and emotional disclosure. More definitively, engagement occurs when the provider or health coach spends time exploring what is most important to the person and allow them to choose their own course of action on whatever health concern they wish—through inquiry, personal discovery and accountability.

Why is it Important?

Patient engagement is the key to improving quality, efficiency and health outcomes. The absence of engagement is associated with preventable deaths —a shocking 40% of deaths are due to changeable lifestyle factors. Half of all patients do not follow physician referrals, and most (75%) do not keep their follow-up appointments. ¹ These factors are related to behaviors, and are maladaptive behaviors that can be unlearned and replaced by new healthy behaviors that will prolong life. We know that changing behavior is hard, but entirely possible through focused attention by the patient that is supported and guided by a trained provider or health coach.

Not long ago, when a patient refused treatment they were called “non-compliant”. Within this paternalistic framework, physicians would tell patients what to do and were expected to adhere to that unilateral advice without having any opportunity to question or redirect. They might have even felt uncomfortable questioning authority. We now know that this can no longer be an excuse to not fully engage people in their care. When a provider demonstrates commitment to the patient and is caring and understanding, the result is an increase in their engagement in the relationship and their health goals .² In fact, the way providers now interact with and motivate patients is touted as the new 21st century healthcare breakthrough. A growing body of evidence clearly shows that providers who engage with their patients achieve significantly improved clinical outcomes. ³ Furthermore, health care organizations that emphasize patient engagement can improve productivity and patient satisfaction. ⁴

Patient engagement is evolving from a perk to an necessary part of healthcare practices, academia, and government. Major health reform initiatives are zeroing in on patient and family engagement. These include Accountable Care Organizations (ACOs), Patient-Centered Medical Home (PCMH), and CMS Stage 2 Meaningful Use of the EHR Incentive Programs, and. In 2014, Stage 2 Meaningful Use will require providers to allow for increased patient and family engagement, electronic transmission of medical summaries, e-prescribing and lab results, and rigorous health information exchange so they can receive incentive payment ⁵.

How to get buy-in from your patient:

Make it easy to connect with their doctor: deploy an online patient portal that provides access to medical records, lab and other test results, appointment scheduling, registration, educational resources, and online bill payment. Compliance with ICD-10 and Stage 2 Meaningful Use, and other mandates is essential.
Empower your patients: provide an effective space for the client to develop new insights into their own health and to create a specific plan to reach their goals. The client is responsible and held accountable for taking action on their plan. A health coach can effectively motivate and support the patient’s health behavior change. Coaching can elicit internal motivation and connect health goals to life purpose, increasing the chance the new behavior will be maintained.
Bridge care to technology: A growing number of companies use cloud-based and patient monitoring technology to obtain complete and timely medical data. For example, Philips uses salesforce.com to help improve patient engagement in its new cloud-based telehealth platform that focuses on medical device and data interoperability. It compiles data gathered from electronic medical records, home-based monitoring equipment, and personal devices such as Apple’s HealthKit. The process compels both providers and patients to work together in using these data to design an dynamic personalized care plan that works best for them. This has already seen success in Banner iCare of Arizona a pioneer accountable care organization (ACO). As Marc Benioff, CEO of salesforce.com observes:

”We have entered a new transformative era for healthcare, and technology is enabling the industry to connect to, care for and engage with patients and each other in a profound new way…We are creating an open health platform and ecosystem to benefit everyone that cares about one of the most important issues of our time.” ⁶–Eric Wicklund

References:

1 Anand K, Parekh, “Winning their trust”, N Engl J Med 2011: 364:e5June 16, 2011

2 Duke Integrative Medicine

3 James, J. “Patient Engagement.” February 2013. Health Affairs/Robert Wood Johnson Foundation. Available at: http://www.rwjf.org/en/research-publications/find-rwjf-research/2013/02/patient-engagement.html

4 http://www.athenahealth.com/knowledge-hub/patient-engagement/what-is-patient-engagement.php#sthash.cZwrhnWg.dpuf

5 http://www.cms.gov/eHealth/downloads/eHealthU_EPsGuideStage2EHR.pdf; http://www.athenahealth.com/knowledge-hub/patient-engagement/what-is-patient-engagement.php#sthash.cZwrhnWg.dpuf

6 Patient engagement: The unifying link in telehealth. August 20, 2014 | Eric Wicklund – Editor, mHealthNews; http://www.mhealthnews.com/news/patient-engagement-unifying-link-telehealth

What is a Health Coach and why do I need one?

Posted on October 31, 2014April 26, 2020 by Daria Massimilla

Our current health care crisis shows that despite the top dollar spent on health care and technological advances, chronic diseases are on a steep rise. The rate of diabetes rose by 50% in the last 30 years and will double again by 2050. Heart disease kills 1 American every 37 seconds; and 1 of every 3 Americans is obese. These are related to unhealthy lifestyle choices. We know how hard it is to make and keep healthy behaviors, and our health system is not set up to help them address the complex factors impacting these lifestyle choices. Physicians have under 10 minutes to talk to their patients, only enough time for crucial medical recommendations. Recommendations or information alone is insufficient incentive or resource for actual behavior change. Physicians also are not trained to engage patients in health behavior change and patients often do not expect to participate in their own care. This phenomenon of people not feeling motivated or empowered to direct their own care is called low patient engagement and activation. Our healthcare system is missing a healthcare professional available with expertise in health behavior change and the skills and the time necessary to provide patients with the opportunity to discover their own direction, motivation, and support in reaching their goals. To help meet this need, health coaches are trained to help people develop their individualized care plans focused on healthily lifestyle changes.

Why would I ever need a Health Coach?

Health Coaches can understand your story. Each of us has a unique story about our personal journey through life; we might also have a mission or purpose, a dream to fulfill. Somewhere along the way, you or your loved one (or patient) was derailed off the path, disrupting the balance in your life. This might have been due to an accident, stressor or life-changing event, or just bad luck. Such events might not manifest initially, but may over time fester into maladaptive coping skills (i.e. smoking, drinking, overeating, or other addictive behaviors), discouragement, a sense of loss of control and possibly even a dependency on others. Regardless of the specific cause or effect, you are where you are now…And now, you might be suffering from a chronic condition that has you and your loved ones overwhelmed. You might feel at a loss of where to turn for help. Hospitals and rehab facilities treat your problem when it flares — but this feels just too little, too late. Your primary care doctor sees you for check ups, tests, and referrals for specific problems— but might not be able to take the time to probe deeper into all the challenges you face and why those things became challenging in the first place. Who is there to see you through the time spent at home between visits, when you are resorting to the usual remedies that aren’t the type of cure you need?

What is a Health Coach?

An Integrative Health Coach works in a dynamic partnership with clients to help them achieve and sustain optimal health and vitality. Our clients are living with conditions like cancer, heart and lung disease, cancer and diabetes. Since most of these conditions are affected by lifestyle choices, research has shown that health coaches help such clients with lifestyle behavior change within a holistic framework of health. Significant improvements in dietary, exercise and weight management, and medication compliance behaviors were found in these studies. The key elements to success were goal setting, motivational interviewing (which is part of health coaching), and collaboration with health care providers (Olsen JM, Nesbitt BJ).

Integrative health coaches work with the Wheel of Health, developed by Duke Integrative Medicine, to examine the areas that influence their health. The areas include: relationships, personal/professional development, exercise, environment, spirituality, nutrition, and mind-body connection. Health coaches empower clients by building on their strengths in any of these areas so they can achieve the change they desire. Together, they design a care plan that allows the client to work at their own pace. The process takes time, sometimes up to six months with weekly face-to-face meetings or teleconferencing. Regardless, your health coach will see you through the day-to-day, when you are home, to gently guide you back on track to the healthiest YOU!

Olsen JM, Nesbitt BJ. Am J Health Promot. 2010 Sep-Oct; 25(1)e1-e12. doi: 10.4278/ajhp.090313-LIT-101.

http://www.dukeintegrativemedicine.org/about-us/wheel-of-health

Telehealth Is the Future Now

Posted on October 16, 2014April 26, 2020 by Daria Massimilla

What is Telehealth?

“Telehealth is the integration of telecommunication systems into practice of protecting and promoting health, while telemedicine is the incorporation of these systems into curative medicine” (World Health Organization, 1997)

How is it used?

First used successfully in the military to provide care for wounded soldiers in the field, telemedicine is expanding not only within the government but spilling over to the private sector. You can guess what’s driving this enormous change in how we deliver care — the pressure to cut costs! The move towards telehealth is also prompted by Obamacare pressures to improve quality, reduce ER visits and readmissions, and allow for better access to care by the elderly, disabled and rural residents.

Patients who find it hard to visit a doctor or specialist can now teleconference their office for personalized medical advice…from the comfort of home. When heart failure patients are remotely monitored on a daily basis for any subtle changes in weight or vitals, their doctor will be alerted immediately and will make timely adjustments in their diuretic and blood pressure medications to keep them from returning to the hospital with fluid overload. Providers can push text messages to clients needing a daily nudge with their diet and exercise regimen and help them stick to an exercise and diet plan they designed with their providers. This technology is an excellent way to deliver patient-centered care. How many times has a simple injury or infection been ignored because it was a hassle to see the doctor, only to have it explode into a fulminating painful medical emergency? With monthly prepaid contracts with the primary doctor, people will be less likely to delay seeking help and more inclined to fire-off a text or video call to their provider that is covered in their plan.

Real-time communication using online voice and video interactions or “teleconferencing” allows providers to conduct consultations and deliver care, health education and health coaching at a distance. Providers can also gather real-time data from patients through store-and-forward imaging, streaming media and remote wireless devices that detect subtle day-to-day changes in their physical and mental states.

Patients and providers can save a lot of time and money engaging in this electronic information exchange. They use a variety of platforms that suit the needs of both provider and client, such as smartphones, mobile apps, cloud-computing, tablets and laptops. For $49 per cyber visit, people seeking medical advice on common symptoms like coughing or on how to better manage their chronic illness can quickly access a doctor 24/7. To enroll, they simply use their smartphones to download a mobile app such as “Amwell” by American Well.

What does the research show on its effectiveness?

Studies on hypertensive and diabetic patients that were telemonitored at home reported a significant decrease in blood pressure and glucose level, respectively. Also, cardiac patients on such monitors showed significant improvement in their quality of life. Data transmitted is reliable and well received by patients. Research on home-based telemonitoring of chronically ill patients is promising; it’s data is reliable and accurate, it empowers and influences their behaviors, and this technology might improve their medical status.

What are the laws on telehealth?

Reimbursement for telehealth services is crucial in its expansion. Medicaid reimbursement for telehealth services is required on some level in a total of 43 states and the District of Columbia. Telehealth is covered by private insurance plans that are based in 19 states and the District of Columbia, and soon in Arizona. Fortunately, Michigan has passed laws to allow for both state and private insurance reimbursement for telehealth services in the state.

Why do we need Care Coordination?

Posted on September 17, 2014April 26, 2020 by Daria Massimilla

What is Care Coordination?

Care coordination is the effort by multidisciplinary teams of two or more providers working with the patient to facilitate appropriate delivery of healthcare services to improve quality of care and reduce hospital admissions. (Technical Reviews, No. 9.7. McDonald KM, Sundaram V, Bravata DM, et al. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007 Jun)

The Problem: Fragmentation

The cost of caring for people with complex medical needs is spiraling out of control. We spend 17.6% (and rising) of our GDP on healthcare. The WHO ranks the US #1 in healthcare expenditures, yet our healthcare system is in 37th place behind Canada and Costa Rica. Most of these healthcare dollars (84%) were spent on chronic illnesses…increasingly being treated in the outpatient or home setting. Such treatments are inadequate and a fraught with insufficient care coordination, resulting in poor care quality.

The typical Medicare beneficiary sees 2 primary care physicians and 5 specialists across 4 different practices; 50% of these folks are being treated for 5 or more conditions. Over 19% of beneficiaries are readmitted to hospitals within 30 days of discharge. These are the “complex need” patients that face high risk for fragmented and inadequate care, resulting in poor outcomes. Many readmissions to hospitals can and should be avoided to save our tax dollars to the tune of $25 Billion each year.

What conditions and factors contribute to these high readmission rates?

The top conditions are: heart failure, COPD (lung disease), psychoses, intestinal problems, and post-surgical patients (cardiac, joint replacement, or bariatric procedures).

The top factors are: access to care post-discharge, inadequate discharge instructions, medication reconciliation, poor communication with and record transmission to care providers, medical errors in hospital. Elders report problems with their medical care including medical errors 23%, poor communication 20%, readmission 15% and lack of follow-up 6% (AARP, 2009).

The Solution: Care Coordination

Beyond upgrading discharge processes, which many hospitals are in process of doing, patients need timely access to care in the community through Care Coordination and using telehealth technologies to transmit clinical data to providers and to exchange information to facilitate their self-management (National Priorities Partnership).

Care coordination keeps patients on their care plan for follow-up visits and tests, medication, diet, and exercise. Old habits die hard and a care coordinator can help keep patients on plan to avoid setbacks, hospital readmissions, and ultimately higher health care costs. Through care coordination, the providers will engage the patient by viewing the patient as a whole, and giving the patient-client the opportunity to drive the course of their care plan and coaching them along towards better health. If done well, the patient will experience continuity of care and communication as they move from a healthcare facility to home.

This is not new. The idea of coordinating care in the form of case management has been around for more than a century. Primarily practiced by nurses and social workers, its goal has always been to coordinate complex, fragmented healthcare services to meet client the needs while controlling their costs (Nurs Outlook. 1996 Jul-Aug;44(4):169-72. Kersbergen AL).

This goes beyond redux….as care coordination is supported by Obamacare! Provisions in the Affordable Care Act 2010 give financial incentives to primary care providers for their care coordination services that are value-based; and penalize hospitals for high readmission rates. As research grows on how this can be done in a cost-effective manner, it is the hope this practice will spread to providers and hospitals. Medicare could save $188 billion in spending through 2019 by preventing avoidable readmissions, based on early research from the Congressional Budget Office.

HAS Case Study:

Our 48 year old male, diagnosed with Type 2 Diabetes on insulin, heart disease, and depression, recently lost his job and health insurance. With limited resources to care for his family, he could no longer afford the $800 plus monthly cost of medications and stopped taking his them. His blood sugars soared to 400-600 range, risking serious complications and hospital admission. When they came to us, the wife was distraught and overwhelmed. We obtained a stop-gap supply of insulin, test strips and syringes from a local charity and a few days later his sugars were lowered to low 200’s. We also guided him on his unemployment application. Now on Medicaid, the couple feels more encouraged about taking further steps with nutrition education and our health coaching.