ZoomCare: Healthcare on Demand

Greetings!

"Can you be my PCP?"

We are delighted that more and more people ask us this question.

And the answer is an emphatic, "We want to be Your Doctor!" That's our reason for being.

But, oh how that acronym (PCP) is like nails on a chalkboard for us Zoomers. You see, the term "PCP" was a concoction of the HMOs in the 1980s and it stuck. The HMOs were promising to cut health care costs by assembling a bureaucracy to manage your access to health care services. The linchpin of this strategy was to turn family physicians, pediatricians and internists into gatekeepers dubbed PCPs - short for Primary Care Physicians - by the HMO marketing departments. Thankfully, the public rebelled against the notion of physician as gatekeeper and insurance company as manager of your access to care. But the term PCP survived. Insurers, physicians and the public continue to use this term. But not at ZoomCare.

So, is our disdain for the acronym PCP merely idiosyncratic and semantic?

We don't think so. Deep down, the PCP gatekeeper philosophy is predicated upon you being a PTP - a Passive Trapped Patient. The assumption was that you were Passive; you didn't care about or couldn't understand differences in performance and in price between different doctors and hospitals. You couldn't handle treatment options. The assumption was that you were Trapped; you didn't have choices. And that you were a Patient; in other words, you were perpetually ill.

ZoomCare is for EHCs. We believe you are a super-Empowered Health Consumer who thrives on making decisions about every aspect of your life and wants to be in control of your health, too. You want your Doctor to know you, to collaborate with you and to present options and recommendations-- not orders. We believe you want to know the risks, rewards and costs of your options. It's not an unreasonable request. Though you often call on us when you are ill, most of your life you are well and work hard to stay that way. You are a patient less than 1% of your life. The ZoomCare culture is based on assuming that you are an EHC. You can go anywhere for your care, so you'll only choose ZoomCare if we are far better.

This is why we are open 362 days a years. This is why we let you pick your visit time online and guarantee you're seen on time. This is why we search for the best physicians and associates. This is why we offer a wide range of preventive care, primary care, procedures, and urgent care. This is why we have a laboratory and fill your prescriptions onsite. This is why we make it easy to know your costs before you come in. This is why your ZoomCare chart is your chart, not ours. This is why we make it easy to pay with or without insurance. This is why we invented Zelp (ZoomCare's Online Help). And much more.

So, yes, yes, yes. We want to be Your Doctor! And really, it's fine to ask us to be your PCP. But if you notice our foreheads wrinkle a bit, now you know why.

By the way, we'll both be at ZoomCare on First Thursday in the Pearl District. Please stop by and introduce yourselves. We'd love to hear from you in person.

Best of health,

David Sanders, MD
dsanders@zoomcare.com
&
Albert DiPiero, MD, MPH
adipiero@zoomcare.com

Get a sneak peek at the new ZoomCare in the Pearl District:

From bare floors to bare walls...
Opening January 2008

For the latest updates and info about ZoomCare in the Pearl, visit us at www.zoomcare.com/pearl.

To check it out for yourself, stop by on First Thursday December 6th anytime between 6 and 8PM.

Like what we're doing? Want to get in with the future of healthcare? Join the ZoomCare team! Opportunies available at both Bridgeport and Pearl locations.

Ask Your ZCP:

Why do some vaccines contain mercury? Is it dangerous?

Thimerisol has been used for more than 70 years as a preservative in many medicines and vaccines. It prevents contamination from life threatening infection with germs. Vaccines are particularly susceptible to contamination as the health care worker repeatedly inserts needles into the vial of vaccine to draw out a dose. These are called "multi-dose" vials, and, while all precautions are made to prevent contamination (using new needles with each draw, cleaning the cap off with alcohol), it is impossible to prevent all contamination. The thimerisol destroys any contaminant thus preventing its spread to those who receive doses of the vaccine.

Thimerisol is a mercury containing compound. It is 50% mercury by weight and is degraded to ethylmercury and thiosalicyalate. Ethylmercury has not been well studied, but a related substance, methylmercury, is known to be dangerous in high amounts. In low doses, it doesn't seem to cause problems. Humans are exposed to methylmercury mostly from eating seafood and it can cause neurotoxity: brain damage. The recommended maximum "exposure levels" for methylmercury is 0.1 ug-0.47 ug (micorgram=0.001 mg=0.000001 gm) per kg of body weight per day. For the average adult, this would be 7-30 ug per day. A 6 oz can of tuna has 53 ug of methylmercury in it. An adult flu shot has 25 ug of ethylmercury in it.

But what about ethylmercury, the compound found in thimerisol? Well, as discussed above, ethylmercury has not been well studied. However, we do know that in very high doses (3 mg/kg to 100+mg/kg), patients will suffer from acute mercury poisoning. But there have been studies that show that ethylmercury is less neurotoxic than methylmercury--the compound upon which we base our maximum exposure level (above). Furthermore, when doctors took blood samples from infants who received routine vaccines containing thimerisol, blood levels did not exceed the recommended levels of mercury. Also, ethylmercury left the babies' systems faster than methylmercury does.

In the late 1990's the Food and Drug Administration (FDA), under the FDA Modernization Act, listed all regulated compounds containing mercury, including those containing thimerisol. When all of an infant's recommended vaccines were added up, the total amount of ethylmercury was within acceptable limits for methylmercury exposure guidelines. Still, there was concern that in the first 6 months of life, the mercury exposure might exceed the guidelines (depending on which vaccine formulations were used, the baby's weight, etc.). So, the US Public Health Service took the precautionary step of urging vaccine makers to reduce or remove thimerisol from their vaccines.

The vaccine makers complied and currently all vaccines for infants (except for flu shots--see below) contain no or only trace thimerisol. They did this by making vaccines as single dose vials, thus obviating the need for a preservative to prevent contamination.

Annual flu shots are recommended for children between 6 months and 59 months of age and adults at high risk. High risk is defined as:

• people age 50 or older
• people living in nursing homes
• people with chronic heart or lung diseases
• people with other chronic diseases such as diabetes, kidney disease, or immunosuppression
• children under the age of 19 who are on aspirin therapy
• women who will be pregnant during the flu season
• children age 6-59 months
• any person who lives or works with people in the above high risk groups

All other healthy people who want to decrease the chance of becoming ill with influenza may also benefit from getting the vaccine.

Currently, flu shots come in thimerisol free or thimerisol containing versions. One would prefer the thimerisol-free version, but it is harder to find. Still, given that this will be one of only a few thimerisol containing vaccines in a baby's life, that baby will stay far below the acceptable limit for methylmercury. And remember, thimerisol contains ethylmercury, which is felt to be safer than methylmercury. In short, the amount of thimerisol in the flu shot (12.5 ug for children < 3 years old) is less risky than contracting influenza, which kills 36,000 Americans every year.

Let us address the elephant in the room, so to speak. Does mercury cause autism? Or, more specifically, could the thimerisol (ethylmercury) in vaccines cause autism? In 2001, the Institute of Medicine convened a committee called the Immunization Safety Review Committee. The committee reviewed issues related to vaccines and neurodevelopmental disorders (including autism). After reviewing evidence from the US, Denmark, Sweden and the UK, the committee concluded that there was not a causal relationship between thimerisol containing vaccines and autism. This causal relationship was theoretical and unlikely. And, of course, the committee pointed out that rejecting vaccines due to concern of this relationship would lead to an increase in whooping cough, meningitis and measles to name a few.

What does this mean for adults? The adult dose of flu shot contains 25 ug of ethylmercury. This is half the amount of methylmercury found in a can of tuna fish. At the risk of sounding flip, it seems one should skip the tuna fish, but NOT the flu shot (Again, influenza kills 36,000 Americas each year).

In short, the US Public Health Service did the right thing when they recommended removing thimerisol from infant vaccines. Now even many of the adult vaccines no longer contain thimerisol. This precaution markedly reduces the amount of ethylmercury exposure for infants, children and adults. The few vaccines remaining that contain thimerisol/ethylmercury do not seem to pose any risk of mercury toxicity but rejecting those vaccines could lead to serious health risks. Get the flu shot, no matter what age you are, especially if you are high risk.

ZoomCare is offering flu shots to current patients, while supplies last.

Get poked today.

Albert DiPiero, MD, MPH
Lisa Reynolds, MD

In This Issue

ZoomTip of the month:
Improved scheduling

The truth behind the Thanksgiving "food coma"

ZoomGrant Winner:
Autism Service Dogs of America

Quick Facts about Zoom2

Video: Get a sneak peek at the new location in the Pearl

Ask Your ZCP:
Vaccines and Mercury: what you need to know

Quick Links

Schedule an Appointment
Improve Your ZoomCare
Ask a question (Zelp Me!)
Prices
Insurance
Opportunities
Doctors
Podcasts
Services

ZoomTip of the Month:

Scheduled an appointment online lately? Ever?

In case you didn't know, ZoomCare is the only medical clinic that offers same day scheduling in an easy online format.

And, we're constantly trying to make it better.

Recently, we've added a few new features to our scheduler including:
An option to confirm via phone call, and a section to write in any comments, concerns or questions you have about your visit.

So go on, give it a try. (It's almost fun...)
And don't forget to let us know what you think, or how we can keep improving.

What causes the Thankgiving nap?
Is it really the tryptophan?

(Click on the napping guy to hear a podcast about this topic.)

With Thanksgiving reduced to leftovers in the fridge, it's hard to remember just how full you were after the big meal. That may be of course, because you were asleep...

After this gluttonous meal, everyone is familiar with the inevitable "food coma" that follows. For years, I have been hearing that it's the "Tryptophan" in the turkey that is primarily responsible for legions of folks who can't keep their eyes open after the big meal. Whether it's that, or the big mounds of dishes (or, in my case- a desire to avoid the football games on tv)- one thing is certain- thanksgiving isn't thanksgiving without a nap.

But why do we get so sleepy?

I decided to get to the bottom of this tryptophan conspiracy, and here's what I found.

Yes, turkey does contain L-tryptophan, an essential amino acid our bodies need that we must get from outside sources.

The body uses tryptophan to help make niacin and serotonin. Serotonin is thought to produce healthy sleep and a stable mood.

In order for tryptophan in the diet to be changed into niacin, there needs to be enough vitamin B-6, riboflavin, and iron in the body.

Tryprophan is found in many foods such as:

• Turkey
• Chicken
• Milk
• Cheese
• Fish
• Eggs
• Tofu
• Soy
• Sesame seeds
• Pumpkin seeds
• Nuts
• Peanuts
• Peanut butter

If eating foods with tryptophan really does induce immediate sleep, then a peanut butter sandwich could be dangerous without a couch nearby. So, where does this sleep-tryptophan connection come from?

Turns out, if tryptophan is taken on an EMPTY stomach and without other amino acids, it can cause marked drowsiness. Now, I don't know about your family but all the thanksgiving dinners I've ever been to have consisted of more than just a turkey.

In fact, Thanksgiving is known for the dizzying array of side dishes and traditional foods...

Come to find out- these things are generally the culprits of the dreaded "food coma" In fact, it is the carbohydrate and fat rich foods which your body uses extra energy to digest- leaving you a sleepy pile on the couch.

Also, it's worth noting that alcohol is a central nervous sytem depressant, so if you indulged in a few beverages on the holiday, this probably increased your nap factor.

So, now you know the mystery of the post-thanksgiving nap (it's not really the turkey's fault after all!).

We hope you enjoyed your Thanksgiving and your nap!

- Amanda Thibodeau

As part of our commitment to growing deeper roots in the communities we serve, each month, ZoomCare gives a ZoomGrant of $250 to a local area non-profit.

Congratulations to November's winner:
Autism Service Dogs of America

If your organization would like to apply for a ZoomGrant, you can do so on our website. Or, click here.

Quick Facts about
ZoomCare in the Pearl

• Centrally located to be easy to reach by car, bus, light rail, bike, foot, horse, hoverboard, etc.
• Ample parking available right down the block at the secure Whole Foods parking lot
• In the historic Wieden and Kennedy building at NW 13th and Davis
• Staffed with experienced, compassionate, board certified family doctors
• Same day walk-in and scheduled appointments, seven days a week, 362 days a year
• Opening January 2008...in about 40 days!