Blood pressure is measured in 2 numbers:  systolic and diastolic.  For example, if your blood pressure is “120 over 80”, the first number, 120, is your systolic blood pressure and measures the pressure when your heart beats.  The second number, 80, is your diastolic blood pressure and measures the pressure when your heart is at rest in between beats.  Both measures are important however the systolic pressure is typically given more attention because it’s a major risk factor for cardiovascular disease.  Doctors typically want your systolic blood pressure to be less than 120 and your diastolic blood pressure to be less than 80.  If your systolic blood pressure is greater than 130 OR your diastolic is greater than 90, then you’d be formally diagnosed as having “Hypertension”.

Measuring blood pressure can be tricky.  Readings from an automated blood pressure cuff may not be consistent with readings done manually.  Blood pressure can vary throughout the day and can be influenced by activities and stress.  Some patients experience anxiety having their blood pressure measured in a doctor’s office and such anxiety can temporarily raise your blood pressure.  Thus, your doctor may ask you to record your blood pressure several times per day for several weeks at home.  There are many automated blood pressure monitors available for home use and your doctor will help guide you to obtain good, consistent readings.

Hypertension is a long-term condition that typically manifests as we age.  Most patients don’t have a specific cause and the accumulation of risk factors can take years to develop hypertension.  Risk factors include poor diet, inactivity, tobacco use, alcohol abuse, obesity, race, and family history.  Most patients don’t have obvious signs or symptoms of hypertension so it’s important to have your blood pressure measured at least once per year.

If you’ve been diagnosed with early-stage hypertension, your doctor will discuss lifestyle changes to lower your blood pressure, such as reducing salt in your diet, more exercise, quitting smoking, or losing weight.  If lifestyle modifications don’t reduce your blood pressure enough, then your doctor may prescribe medications.  There are many medications from which to choose and it’s common for patients to be prescribed more than one.  The good news is hypertension is usually very treatable if you regularly see your doctor and follow your treatment plan.

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Cholesterol is a form of fat used by your body to make cell membranes. If you have too much in your blood, it can stick to the walls of your blood vessels and result in narrow arteries. This means your heart has to work harder to pump your blood and increases the risk of blood clots, which can cause strokes and heart attacks. Thus doctors often order “Lipid Panel” tests to measure your cholesterol and measure your risk of heart disease.

A lipid panel breaks out your cholesterol into 4 measures:

1. Total Cholesterol
2. LDL (low-density lipoprotein), also known as “bad cholesterol”
3. HDL (high-density lipoprotein), also known as “good cholesterol”
4. Triglycerides

In order to get an accurate measurement, you must fast for at least 8 hours (no food or liquid, except water) prior to your blood draw. If you forget to fast, your results may be distorted and your physician may need to repeat the test. Interpreting cholesterol results is complicated because your risk for heart disease varies based on age and the presence or absence of other related diseases such as Diabetes. In general, your doctor will look at the following:

1. Total Cholesterol. Less than 200 is normal. More than 240 is high.
2. LDL. This is the most important component. Less than 100 is normal. More than 130 is high. However if you have certain diseases like Diabetes that increase your risk of heart disease or if you’ve already been diagnosed with heart disease, your LDL should be under 70. If you are over age 75, your risk of heart disease is already higher due to age and it is thus more difficult to evaluate your risk based on LDL. You would need to speak with your physician about how your LDL interacts with other risk factors.
3. HDL. Unlike LDL, you want your HDL to be high. Greater than 60 is good, between 40 and 60 is OK, and less than 40 increases your risk of heart disease.
4. Triglycerides. Less than 150 is normal. Greater than 200 is high.

The American College of Cardiology has developed an online tool used to evaluate your cardiovascular risk, http://www.cvriskcalculator.com/. The tool can give you a quick snapshot of your risk and whether to consider cholesterol-lowering medications such as statins.

Treating high cholesterol starts with Diet and Exercise. Exercise in particular will both lower your LDL and increase your HDL and will also help address other cardiovascular conditions such as Hypertension. Any activity that can move you away from a sedentary lifestyle will help, such as gardening, taking the stairs, or walking. When it comes to Diet, you want to avoid foods that contain saturated and trans fats typically found in red meat and processed foods such as cookies. Instead eat more fresh leafy vegetables. Finally, smoking is one of the highest risk factors for heart disease and quitting, even in old age, can dramatically reduce your risk.

If lifestyle improvements don’t reduce your cholesterol enough or if your risk is very high, then your doctor will probably prescribe cholesterol-lowering medications. There are many choices that offer different combinations of effectiveness, cost, and side-effects and your physician may try different medications before settling on one that works best for you. Most patients who start on cholesterol medication take it for the rest of their lives and will require regular blood testing to monitor effectiveness.

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The symptoms are very similar and it can be difficult to determine based only on your history and physical examination. The gold standard test is a “throat culture”, which consists of a swab of mucus from your throat incubated for several days to see whether certain bacteria are present. Because this test takes at least 2 days to perform, waiting for the results to come back before initiating treatment will cause the patient to endure more symptoms in the interim if it was positive. On the other hand, most sore throats are not bacterial and the doctor will run a high risk of prescribing unnecessary antibiotics if he prescribed without waiting for a positive test result.

Thus, most physician offices use “Rapid Strep Tests” in their office. As with throat cultures, the Rapid Strep test uses a swab of mucus collected during your office visit. However the test looks for antibodies related to the bacteria, rather than directly measuring the bacteria. The test is not as accurate as the throat culture, so many physicians will decide whether to initiate treatment based off of the Rapid Strep test but simultaneously order a throat culture in addition. If the throat culture results differ from the Rapid Strep results, then the physician can alter treatment via a simple phone call rather than an additional office visit. Both tests are relatively inexpensive and this can be a cost-effective way of diagnosing and treating sore throats.

Some CRMA offices offer a new “Immunoassay” version of the Rapid Strep test that is almost as reliable as a throat culture, but can be done within an office visit similar to the old Rapid Strep test. The immunoassay test requires a special piece of lab equipment and is considerably more expensive to perform. The advantage is it’s so reliable that you will not need a throat culture in addition. If you have an insurance plan with a deductible, the cost of this test will likely track to your deductible and you will pay out of pocket. Since this test is more expensive (typically $70) than traditional Rapid Strep tests, you should inform your provider if this cost will be a concern for you.

If your sore throat is caused by a viral infection, it will typically resolve on its own within five to seven days and does not require any formal medical treatment. You can use simple over-the-counter medications to treat the symptoms. If your sore throat is caused by a bacteria infection and you are prescribed antibiotics, be sure take the full course of medication prescribed. Even if you feel better, you should continue to take the medication as prescribed.

The post Treating a Sore Throat: Rapid Strep Tests appeared first on Charles River Medical Associates.

CRMA’s most difficult billing-related complaints are often the result of large bills patients receive due to an insurance deductible. In the last 10 years, health plans and employers have been shifting more and more medical costs to patients in the form of copays, deductibles, and coinsurance. Theoretically this is supposed to foster “patient engagement”. If a patient is going to share in the cost of a given medical decision, then that may motivate them to work with providers to make better decisions and minimize costs. In reality, most patients and providers don’t understand the details of their insurance well enough to be truly engaged and the result is often a surprise bill months after the time of service. This article will explain some of those details.

Almost all insurance claims start with a list of “procedure codes” submitted by your doctor to the health plan listing each service that was performed. Each procedure code is accompanied by a “diagnosis code” that explains why the procedure was done and many payers apply “medical necessity” checks to confirm the procedure (say, an office visit) was justified. Each procedure code has an “allowed amount” that determines how much the payer will pay for that procedure. This is determined by your physician’s contract with the insurance company. The amount charged by your physician plays no role in the billing process for the vast majority of insurance claims.

Copays Explained

Let’s say the health plan determines that the office visit’s allowed amount was $100. If the patient’s plan has a copay of $25, it will deduct $25 from the payment to the physician and pay $75. The insurance company expects the physician to collect the $25 copay directly from the patient. Physicians dislike copays because they directly subtract from payments that otherwise were supposed to come from the insurance companies. If the patient didn’t pay the copay at the time of the visit, then the physician will have to bill the patient for it.

Deductibles Explained

For deductibles, using the same case above the insurance company would typically allocate the entire $100 allowed amount to the deductible and expect the physician to collect from the patient directly. The amount charged to a patient deductible is governed by how much the insurance company would have paid the physician, not what the physician charges. Claims will continue to track to the deductible until the cumulative sum exceeds the deductible. When you start a calendar year, your first few claims will track to your deductible, the insurance company will pay your physician $0 for those claims, and your physician will have to collect the deductible amount from you directly. Once the deductible has been met, then the insurance company will pay all subsequent claims at the normal contracted rate.

Doctor’s Offices Rarely Know Copay and Deductible Details

Many patients assume the physician’s office staff will know their copay and deductible details. This is rarely the case. Physician offices deal with dozens of different insurance companies and each one can have dozens of health plans. There’s no consistency to how plans are designed, even within the same insurance company, and there’s no easy way for office staff to find out. Patients see multiple providers and the physician you’re seeing today doesn’t know what expenses may have already been charged to your deductible by other providers from previous visits. Even if staff knew your remaining deductible balance, it would be difficult to calculate how much would be charged to your deductible. The office staff would know their own physician’s charges, but charges play no role in insurance billing and most office staff don’t have access to what the insurance companies would pay their physicians. And even if they called the insurance company to find out, they wouldn’t necessarily know the exact procedure and diagnoses codes ahead of time so the best they could achieve would be an estimate.

Deductibles Rules are Complex

Most plans have complex rules governing how claims are charged to deductibles. For example, most plans offer “free annual physicals’; but the lab tests, blood draw, pap smear, EKG, vaccine injection, etc that are often done in conjunction with an annual physical are not necessarily “free”. Many plans track these to a patient’s deductible and they can often cost hundreds of dollars. Or sometimes a plan will make a distinction between tests ordered for screening purposes (i.e. patient doesn’t have any symptoms) versus tests ordered for diagnostic purposes (i.e. patient has symptoms). So the same lab or radiology test billed with a screening diagnosis code may incur no out-of-pocket cost whereas if it’s billed due to symptoms, it will track to the patient’s deductible. Unfortunately, some payers will pay for screening tests and some won’t so it’s not possible to minimize out-of-pocket costs by coding all tests as “screening”. If you call the insurance company and ask “Will xyz test be covered?” the customer service rep may confirm “yes” however they won’t necessarily tell you whether or not it tracks to your deductible unless you specifically ask.

Tips to Minimize Out of Pocket Costs

• Inform your physician’s office if your insurance plan changes, even if it’s within the same insurance company.
• If you have a deductible and are concerned about out-of-pocket cost, inform your physician at the time of service. Most physicians make treatment decisions without regard to your insurance but if you express concern for out-of-pocket cost, the physician can at least make some effort to minimize it.
• Confirm whether your health plan requires testing to be done at specific facilities. Hospital employees, for example, will often incur bigger out-of-pocket expense if they receive treatment or testing outside of their employer’s hospital. Some plans specify that lab testing go to certain labs, which can be a problem since all CRMA providers utilize the CRMA lab unless otherwise told.
• Be aware that some plans have frequency limits on certain wellness services, such as annual physicals and screening tests. Find out if your plan has any such restrictions. When scheduling, ensure your next wellness appointment is at least 366 days from your last one.
• If you call your insurance company to find out about coverage issues, be sure to ask the right questions. Don’t ask “Is this a covered service?” Instead, ask “Will I incur any out-of-pocket cost if this test is done by ____ provider for ___ reason on ____ date?”
• If you receive a bill from CRMA that looks “wrong”, call the CRMA billing office right away. Payers have filing deadlines and if you delay calling you may miss your opportunity to re-bill or appeal a claim.

The post Strategies to Minimize Medical Insurance Co-Pays and Deductibles appeared first on Charles River Medical Associates.

During the stress test, you will likely exert varying levels of physical stress as you walk on a treadmill until your heart rate reaches a targeted number of beats per minute (bpm). At that point, each minute is monitored to see how quickly your heart recovers from the exercise.

What is a normal heart rate under a stress test?

Your target heart rate during a stress test depends on your age. For adults, the maximum predicted heart rate is 220 minus your age. So, if you’re 40 years old, the maximum predicted heart rate is 220 – 40 = 180.

For diagnostic treadmill testing, some doctors try to achieve about 85 percent of the predicted maximum heart rate. This provides enough stress to adequately test the heart without maximizing the stress and potentially producing false positive results.

Hassle-free healthcare and heart care in Framingham

Getting the care you need to stay healthy should be easy. No one works harder to make your healthcare more accessible and convenient than the team at Charles River Medical Associates. You can choose from 50 physicians, some of whom provide all-encompassing care for your whole health, while others specialize in areas such as cardiology, oncology, pediatrics and more. And you can count on 15 Metrowest locations, on-time appointments and timely test results. Whether you need general checkups, specialized testing and screening or urgent care, Charles River Medical Associates is here for you.

To learn more or schedule an appointment at a Metro West location near you, call 508-848-2190 or click here to use our online form.

The post What is A Normal Heart Rate Under a Stress Test for Adults? appeared first on Charles River Medical Associates.

How long does a cardiac stress test take?

The test takes about one hour, including prep time and actual test time. The cardiac stress test itself only lasts around 15 minutes. During your test, you may walk on a treadmill or pedal a stationary bicycle. If you cannot exercise, you’ll receive a drug through an IV that mimics exercise by increasing blood flow to your heart.

Why a stress test is done

Your doctor may order a stress test to:

• Diagnose coronary artery disease– This disease develops when the coronary arteries (the major blood vessels that supply your heart with blood, oxygen and nutrients) become damaged or diseased; usually due to a buildup of plaque or cholesterol deposits.
• Detect heart rhythm problems (arrhythmias) – Arrhythmias occur when the electrical impulses that coordinate your heart rhythm malfunction. This causes your heart to beat too fast, too slowly or irregularly.
• Inform treatment of heart disorders – If you’ve been diagnosed with a heart condition, a cardiac stress test can show your doctor how well treatment is working. He or she may also use test results to develop your treatment plan by gauging how much exercise your heart can handle.
• Determine the timing and type of cardiac surgery – For procedures such as valve replacement and for some people with heart failure, stress test results may help the doctor determine whether a heart transplant is needed or if other advanced therapies will be more effective. 

Hassle-free cardiac stress tests and you-first healthcare are close to home

Whether you need a cardiac stress test in Framingham or other advanced diagnostics, Charles River Medical Associates is ready to help, when and where you need us. In 15 locations across nine Metrowest communities, we continually strive to practice exceptional healthcare for your entire family. And we do so with a dedication to respecting your time and earning your trust each time we see you. From general care to specialized medicine, come experience a refreshing take on healthcare.

To learn more or schedule an appointment, give us a call at 508-848-2190 or click here to use our online form.

The post How Long Does a Cardiac Stress Test Take? appeared first on Charles River Medical Associates.

If you’ve been cutting calories and working out more, but still can’t lose weight, there is likely more than one reason for it. In fact, for most people, there are several factors that can interfere with successful weight loss.

Eating too much of a good thing won’t help you lose weight

“Good things,” such as avocados, dark chocolate, nuts and nut butters are highly nutritious, but can make you gain weight if you eat them in excess. Yes, these foods can be good for you, but they’re also high in fat. If you don’t burn that off with activity, your system gets flooded with more macronutrients than it needs at one time, so anything in excess will be stored as fat. Add these types of high-fat foods to your diet with a close eye on serving sizes and nutritional values.

Not eating enough can stunt weight loss

Think eating as few calories as possible is the key to losing weight? Just the opposite: “Under fueling” can lead to nutritional deficiencies and derail your weight loss efforts. When you severely reduce calorie intake, the body holds onto fat and turns to muscle stores for energy, which can slow your metabolism.

Not drinking enough water? You won’t reach your weight loss goal

That number you’re cringing at on the scale doesn’t just reflect the weight of fat. It can also include water weight. If you eat a high-sodium diet, your body retains water more readily, which can keep your weight up. Even if you feel bloated, and drinking more water is the last thing you want to do, hydrate! It helps your body flush out extra water weight so you can “de-puff.”

“You-first,” hassle-free healthcare and weight loss in Framingham

From leading-edge clinical care, to onsite testing and screening, to nutritional counseling, your optimal health is our priority at Charles River Medical Associates. If you’re struggling to lose weight, our registered dieticians are here for you; ready to customize a plan to help you lose weight in Framingham. And they can create that plan around any health challenges you’re facing, such as diabetes, gastrointestinal problems, cancer or food allergies.

To learn more or schedule an appointment at a Metro West location near you, call 508-848-2190 or click here to use our online form.

The post The Reason Why You Might Not Be Able to Lose Weight appeared first on Charles River Medical Associates.

Thankfully, you can reset your digestive system and help clear the backup in the colon. Cleansing the colon can improve the overall health of your body and even reduce your risk of colon cancer. And you can do much of this by eating the right foods.

Why cleanse your colon?

The benefits are many! Here are just a few reasons to eat foods that can help cleanse your colon:

• Improve the digestive process
• Spark weight loss
• Sharpen concentration
• Increase energy levels
• Lower the risk of colon cancer

Eat these foods to improve colon and overall health

Cruciferous vegetables – Kale, Brussels sprouts, broccoli, cabbage, turnips and cauliflower (just to name a few) are among the leading sources of fiber and antioxidants. More than 600 studies show that cruciferous veggies are some of the most powerful cancer-fighting foods.

Garlic – In addition to supporting your heart and circulation, garlic has antibacterial, ant-parasitic and antiviral compounds that help remove toxins, parasites and pathogens from the colon. And as an inflammation reducer, garlic can boost the absorption of food nutrients, promote digestion and fuel the elimination of waste and toxins.

Water and sea salt – Constant dehydration can lead to constipation; causing a buildup of toxins in the colon. Try to drink at least half your body weight in ounces of water each day. Add a pinch of sea salt to your water to amplify detoxification.

Avocados – Not only do they taste great, avocados are rich in both soluble and insoluble fibers, which promote regular, healthy bowel movements to enhance colon health.

Fermented foods – Greek yogurt, kombucha, pickles, sauerkraut, tempeh and kimchi are all rich in probiotics. These will help keep your entire digestive system, including your colon, in a healthy balance.

Want more colon- and health-friendly foods? Check out aloe vera (in juice form or concentrate), chia and flax seeds, beans and lentils, apples and apple cider vinegar, green tea and lemons.

Expertise and dedication to your total health is close to home

At Charles River Medical Associates (CRMA), we’re totally committed to your health. With our Endoscopy Center in Framingham, we help make vital colonoscopy and endoscopy testing convenient and efficient. And with multiple locations across Metro West, high-quality healthcare for your entire family is never far away.

To learn more or schedule an appointment, call 508-848-2190 or click here to use our online form.

The post The Foods to Eat to Improve Colon and Overall Health appeared first on Charles River Medical Associates.

Advancements in imaging technology have been the sparks behind a healthcare revolution. Over the past three decades, medical diagnosis imaging has allowed doctors to find diseases and conditions — from cancer to heart disease to neurological disorders — in their earliest, most treatable stages. This has saved countless lives and helped more people live normal, healthy lives with conditions that were once thought to be unmanageable.

Medical diagnosis imaging: The different types

The type of medical diagnosis imaging used depends on your symptoms and the part of your body being examined. Here are just a few examples of different imaging modalities:

• Computed Tomography (CT) – Also known as a CAT scan, this imaging technique combines X-ray projections taken from different angles to generate detailed, cross-sectional images of soft tissue, bone and organs.
• Magnetic Resonance Imaging (MRI) – Uses radio waves and a magnetic field to create detailed images of organs and tissues.
• Ultrasound – Also known as medical sonography or ultrasonography, ultrasound applies high frequency sound waves to create images of the inside of the body. It can also produce sounds of blood flow, so doctors can see and hear as they assess conditions from pregnancy to heart and blood vessel abnormalities to symptoms of pain, swelling and infection.
• Positron Emission Tomography (PET) – This nuclear imaging technique provides information about how tissues and organs are functioning. PET is often used to evaluate cancer, and neurological diseases like Alzheimer’s and multiple sclerosis.

Trusted medical diagnosis imaging services on your doorstep

At Charles River Medical Associates, we prioritize your good health above all else. Part of that dedication involves providing precision medical diagnosis imaging on-site. Not only does this allow us to efficiently diagnose your health issue and give your doctor an accurate, timely report, it minimizes your time in a doctor’s office. But when you need to see a Charles River Medical Associates provider, you can bet there’s a caring, experienced physician close by. With multiple locations across Metro West, we strive put high quality, low hassle healthcare where you are, when you need it.

To learn more or schedule an appointment, call 708-928-5040 or click here to use our online form.

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Sugar vs. glucose

There are different kinds of sugars, but the type the body uses most is glucose. Other sugars, like fructose from fruit or lactose from milk, are converted into glucose and used for energy. Our bodies also break down starches, which are sugars that bond to form glucose.

But when medical professionals use the terms, “blood sugar” and “blood glucose” in relation to assessing levels, they are simply using different phrases to describe the same thing.

What are normal blood sugar levels?

For people with diabetes, the American Diabetes Association suggests keeping blood sugar levels before meals from 80–130 mg/dl. One to two hours after meals, levels should be under 180.

In people without diabetes, healthy insulin function keeps sugars in a normal range. But in diabetics, insulin function is damaged, so it’s essential to support the body by eating right, exercising, taking medications or herbs and reducing stress.

Achieving normal blood sugar/blood glucose levels

For most people with diabetes, keeping blood sugar levels in check is all about being mindful of what and how much they eat and drink. Making healthy choices and watching portion sizes can help you control your weight and your blood sugar levels.

But don’t worry, you don’t have to navigate this road alone. When you have nutritionists who specialize in managing diabetes by your side, you can learn to choose the right foods, such as:

• Smart carbohydrates – Instead of white or flour-based bread, rice or pasta, choose whole grains, barley, brown rice, non-starchy vegetables and fresh fruit. These foods can be efficiently converted to energy.
• Lean proteins – Limit or avoid red meats and go for chicken, turkey, low-fat dairy, fish and shellfish.
• Healthy fats – Skip the cream sauces, butter, lard and processed foods, and start cooking with canola or olive oil. Like to snack? Munch on nuts like almonds, cashews, pecans and peanuts.

Nutritional expertise and individual care to help you manage diabetes

At Charles River Medical Associates, we take pride in supporting you and your family’s health from head to toe. When it comes to managing diabetes, whether for you or your children, know that you have comprehensive and caring diabetes nutrition in Framingham, Marlborough, and Natick, Massachusetts. Our specialists are here to help you learn proven ways to eat well and to give you the tools to keep you on track.

To learn more or schedule an appointment, call 508-848-2190 or click here to use our online form.

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