Monthly Matters:

• Billing Changes at GreenField
• GreenField Health on Facebook
• Influenza Flu Update
• Running Is Good for Your Knees
• Adolescent Matters: The Facts on Oral Contraceptives

GreenField Health’s Health Matters

September 2009

Billing Changes at GreenField

*** Please read the following details about our billing process carefully as it impacts how we will bill you and includes important details about our billing process.***

1. e-Statements
As we’ve announced recently, we have instituted e-Statements – instead of sending our billing statements by paper, you’ll now be getting them via a secure email message. These e-Statements are bills from GreenField to you – not statements of your insurance benefits. When you get a GreenField e-Statement, this is the part of a visit fee that you owe after your insurance has paid their part of the bill. If our secure e-Statement goes unopened after 5 days, our system will send you another secure email notification. If that secure email is not subsequently opened in another 5 days, then our system will automatically print the statement on paper and mail it to you.

Our secure e-Statements will allow you to pay your bills online – quickly, easily, and securely, thanks to our partner Kryptiq Corporation. You can simply follow the link in your e-Statement to log on to our Bill Pay site. If this is your first time, you will need to register with them. Alternatively, you can simply print our e-Statement and pay by mail as well. Please email or call us with questions.

2. Late Fees
Billing and collecting can be a challenge particularly when repeated bills need to be sent before payments are made. This obviously consumes the time and energy of our billing staff. When you receive a bill from GreenField, this is the part of a visit fee that you owe after your insurance has paid their part of the bill. We’ve seen a marked increase in the number of multiple statements that need to be sent, so we are instituting a late payment fee, which will be $10 per month. This will apply only after you’ve received a statement and have had 30 days to pay it. Please let us know if you have any questions about this change.

GreenField Health on Facebook

Are you a regular Facebook® user? We would like to invite you to become a fan of our new GreenField Health page- simply click on the Facebook badge above and you will be directed to our new page. This way you can stay current with our latest updates just as you stay current with all of your friends and their various updates.

We will try to keep our posts informative with upcoming information about open houses and other events, physician and staff changes, and important clinical updates, such as updates on the H1N1 (swine) flu virus and expected vaccine this fall. You may even see a few posts about fun events and activities that our physicians and staff are engaging in locally.

Over the years, we have appreciated your referrals to us of your friends and family members in need of a new personal physician. What better way to help spread the word about GreenField Health than by suggesting our page to your friends and family?

Please feel free to comment on our wall and share with others your personal experience as a GreenField Health patient. We hope to see many positive comments about your personal experience with us. As always, should you have concerns we would like to know about them so that we can respond in a timely manner, please contact our clinic administrator, Samantha Charles at Samantha.Charles@GreenFieldHealth.com.

Influenza Flu Update

As everyone realizes, this year we are dealing with two different influenza viruses – the regular seasonal influenza and the H1N1 (swine) flu. Both will have their own vaccine. For issues related to influenza and the H1N1 virus, please see the US Centers for Disease Control and Prevention’s website: www.cdc.gov/h1n1flu/. Oregon specific information is available at www.flu.oregon.gov.

GreenField’s Seasonal Flu Shot Clinic
at our Barnes Road Clinic---
Saturday, October 24th – 10:00am- 2:00pm

Seasonal Influenza: The seasonal influenza vaccine is now available at our office. However, the manufacturer has only shipped us about 20% of our order due to a high demand, along with a slower production, as they are producing both vaccines simultaneously. In general, vaccination started much earlier this year than it typically does due to the pervasive focus on flu this year. Our current supply is running quite low, but we will receive additional vaccine in approximately 2 weeks. If you have not yet had your seasonal flu vaccine, please stop by our Seasonal Flu Shot Clinic on October 24th at our Barnes Road location.

We recommend that everyone get the seasonal flu shot this year, even though it is predicted that the H1N1 virus will likely be the primary circulating strain of influenza. It is not anticipated that the regular seasonal flu will be any more severe this year than the typical yearly influenza.

H1N1 (Swine) Flu: A limited supply of the H1N1 flu vaccine will be available during the second week of October. We’ve been informed that we are getting the nasal spray form of the vaccine as opposed to the injectable vaccine. GreenField will receive a supply, but we do not know the exact number of doses. Because supplies of the H1N1 vaccine will be limited at least initially, we will follow national and state recommendations to vaccinate those at highest risk – those between 6 months and 24 years of age, parents of infants, pregnant women, healthcare workers, and those with compromised immune systems such as cancer patients, those with HIV or diabetes and the frail elderly.

Those less than 9 years of age will need two doses of vaccine separated by 3 weeks. Those 9 years and older will receive one dose of the vaccine. Anyone giving the vaccine will be required to put the data on who received the vaccine into a national database, meaning that with each vaccine we give, we’ll be required to put the recipient onto a national database.

We hope that there will eventually be sufficient vaccine for anyone who would like it, but we do not yet know how much overall vaccine will be available. All in all, the H1N1 virus does not appear to be a highly lethal virus in healthy adults.

Influenza Treatment: What should you do if you develop influenza symptoms? A few key points of understanding:

 - Influenza most characteristically causes the rapid onset of fever, muscle aches, and respiratory symptoms such as cough. However, there is a substantial overlap between influenza symptoms and the cold and other viral upper respiratory tract infections that present more subtly and not so abruptly. If you have particularly severe symptoms, consistent with influenza, then we will consider treating you with one of the antiviral medications specific to influenza such as Tamiflu.

- It is not possible to distinguish seasonal influenza from H1N1 by clinical symptoms and unless you are sick enough to require hospitalization, we will not be testing individuals to see if they have H1N1 virus based on national recommendations. Simple screening tests to rapidly distinguish H1N1 from seasonal influenza, the cold or other viral upper respiratory tract infections are not available.

- We do not recommend that people keep a supply of the antiviral agent Tamiflu at home because most people would likely end up using it for viral upper respiratory infections that are not confirmed to be H1N1 influenza. This risks substantial overuse, adverse effects of the drug, and subsequent resistance of viruses to Tamiflu.

- If you have flu symptoms, you can use acetaminophen (Tylenol), ibuprofen (Advil or Motrin), or naproxen (Aleve) along with rest and plenty of fluids to help manage your symptoms. Yes, we believe in chicken soup as well. Recommendations suggest using antiviral medications in those at high risk of complications and those with severe infections that might require hospitalization.

Influenza Prevention: The most important aspects of prevention are good hygiene and being vaccinated. Good hand washing and covering one’s mouth when coughing or sneezing are the most effective means of reducing spread of influenza, the cold, and other viral upper respiratory illnesses. Avoid putting your hand to your nose or mouth as that may help seed the virus in your respiratory tract, and in particular, wash your hands before eating or putting anything else in your mouth.

Running Is Good for Your Knees

It has been a longstanding controversy about whether or not running is bad for your knees. Several studies have been recently published on this topic. In a recent study from Europe, researchers examined the knees of marathon runners using MRIs before and after a marathon. Ten years later, they scanned the same runners’ knees again and the results were quite striking. The study demonstrated that no significant new knee damage occurred in marathon runners after the 10-year interval.

The Data on Running
A 2008 study performed by Stanford University researchers followed middle-aged, longtime distance runners for nearly 20 years, beginning in 1984 when most were in their 50s or 60s. At that time, 6.7%of the runners had creaky, mildly arthritic knees, while none of an age-matched control group did. After 20 years, however, the runners’ knees were healthier with only 20% showing arthritic changes versus 32% of the control group’s knees. Barely 2% of the runners’ knees were severely arthritic while nearly 10% of the control group’s were.

While other sports have been associated with the development of early-onset arthritis, running has not. For example, soccer and football have been shown to significantly increase the risk of early knee arthritis, most likely because they involve a greater degree of twisting motion at the knees and more direct trauma than does running.

Instead, recent evidence suggests that running may actually shield somewhat against arthritis, in part because the knee develops a kind of motion groove.

Another group from Stanford published a study in the February 2009 issue of The Journal of Bone and Joint Surgery that showed that by moving and loading your knee joint, as you do with walking, running or hiking, you “condition” your cartilage to the load. It grows accustomed to those particular movements.

This allows people to run over the course of their lives without harming the knees. But if this exquisite balance is disturbed by an injury, the loading mechanisms shift and the knee may no longer be in alignment potentially leading to degenerative changes. The best way to ensure that your knees aren’t hurt by running is not to hurt them in the first place. However, this doesn’t mean that individuals with a prior knee injury should not run.

Running to Prevent Arthritis
Running may help to prevent degenerative arthritis, even in those with a prior injury although it is difficult to predict which individuals with prior knee injuries will benefit and which will be harmed. We tend to allow symptoms of knee pain to be the guide.

The prevention of knee injury is also enhanced by strength training focusing on the muscles that support the knee and leg. Strong, conditioned core muscles such as the back and abdominal muscles, and the hip stabilizers, quads, and hamstrings all help your knee to work well. Weakness and poor conditioning can allow injuries to happen when running.

Lastly, because aerobic exercise is so important to your health, if running is not possible for you due to knee pain, then we recommend other regular aerobic exercise such as an elliptical trainer which is potentially easier on the knees, cycling, or swimming.

Adolescent Matters: The Facts on Oral Contraceptives

Oral contraception (“OC” otherwise known as birth control pills or “the pill”) has many medical uses other than its contraceptive purpose for which it was originally created. Other common uses, or possible benefits of taking an oral contraceptive include treatment of acne, relief of menstrual cramps, regulating periods, treatment of unwanted facial hair, preventing ovarian cysts and decreasing the pelvic pain of endometriosis. They also may help menstrual cycles become more regular, blood flow during menstruation can be lighter, which generally means less iron is lost, noncancerous cysts or lumps in the breast may occur less frequently, and they may provide some protection against the development of two forms of cancer - cancer of the ovaries and cancer of the lining of the uterus.

Given the multiple uses, it is not uncommon to find it on a female adolescent’s or young adult’s medication list. GreenField’s Dr. Paula Koeller addresses some of the most frequently asked questions regarding oral contraceptives here:

Q: Will it cause weight gain?
A: No. The current data suggests this is not the case. Studies have shown that OC use does not result in an increase in body weight or body fat percent. However, if you feel that your recent weight gain may be related to your OC, please speak with your GreenField physician.

Q: Is it necessary to have a pelvic exam before starting OC?
A: A pelvic examination is not required by the Food and Drug Administration (FDA) for the start of oral contraceptives. Deferring the pelvic examination is often the case, especially when there are no genital complaints (e.g., abnormal vaginal discharge, vaginal itching, discomfort or sores) or the patient is not and/or has not been sexually active.

Q: Which OC is best?
A: Although several of the newer OC are heavily marketed touting their superiority, there is no “best” OC. When treating acne, an OC containing a newer progestin will be more effective in reducing acne. When preventing ovarian cysts or pelvic pain from endometriosis, an OC with a different formulation may be indicated. When there is a particular medical issue being addressed, these factors will be taken into consideration when making a recommendation.

Q: What about taking active pills for more than a month and skipping a menstrual period, is that OK?
A: The desire to avoid monthly periods may be related to participation in athletic events, overseas or other extended travel, summer camps or to the general discomfort and “hassle” of monthly periods. In recent years extended hormone regimens have gained popularity. The “classic” OC has 21 days of hormone pills and 7 days of placebo pills. However there are now extended-cycle oral contraceptive regimens, with 84 days of hormone pills and seven days of placebo pills (Seasonale, Jolessa). Contraceptive efficacy is the same with extended regimens, but breakthrough bleeding is a common problem, especially the first 3 months of the regimen. There is no known increased risk to physical health in taking the extended use OC and extended contraception has been FDA approved.

Q: Is oral contraception okay for everyone?
A: No. There are some medical conditions where it is not advisable to use OC. Discuss your medical history and family history with your provider before starting oral contraception. It is also important to understand the risks and benefits to oral contraception so you can decide if it’s right for you.

This can be a difficult subject for parents and their young daughters to discuss. The issue will likely come up at some point in a young woman’s life. It is important to remember that there is a lot of information out there, a lot of different choices in OC’s, and that they can be prescribed for reasons other than their intended use. Your GreenField physician is your best resource for tackling this often times sensitive subject matter.

As our beautiful fall leaves begin to change colors, and the children are all well beyond their first day back to school, please remember to stay healthy this cold and flu season. Practice good hygiene with hand-washing and get vaccinated. Encourage your family and friends to do so as well. Please watch for important updates and information from us during this flu season in upcoming issues of Health Matters.

Sincerely,

Your GreenField Team

GreenField Health at Barnes Road
9427 SW Barnes Road, Suite 590
Portland, OR 97225

GreenField Health at NE Broadway
2606 NE Broadway, Suite C
Portland, OR 97232

Phone: 503.292.9560
Fax: 503.292.9510
Web: http://www.GreenFieldHealth.com

questions, concerns, comments always appreciated:
questions@GreenFieldHealth.com

© 2003-2009 GreenField Health