ZoomCare: Healthcare on Demand

Greetings,

The other day I was driving home listening to Terry Gross interview Steven Soderbergh, the filmmaker. Gross asked him, "Who do you make films for?"

"Me", he said.

Isn't that brilliant? No need for market research. No agonizing over getting into the mind of your customer. Just delight yourself. Now this is not what they teach you in business school. No one in their right mind would make a movie or a product or a service for a market of ONE......

Here at ZoomCare we are building from the ground up a culture focused on you. We hope you've experienced that. Nevertheless, here and now we admit that we began ZoomCare by asking ourselves: "What would make us say, "Wow! Now, that's cool. I've never heard of a doctor's office doing that before!"

Here's what we jotted down on our Wow List when we were thinking up ZoomCare:

• I want to control my schedule (to pick my appointment time with easy online scheduling).
• I want to know what to expect up front.
• I want to know the price beforehand.
• I want my results in plain English with groovy charts (of course, all via easy online access.)
• I want treatment options and recommendations - not orders.
• I want you (the doctor) to know that my chart is my chart and not your property.
• I want follow-through.
• I want to deal with smart, passionate people from end to end. Not just the doctor, but reception, billing, everyone.
• I want a clean, healthy, professional, yet very personal environment. I don't like medical complexes, integrated delivery systems, hospitals and emergency rooms, unless I'm carried in on a stretcher.

What would be on your Wow List? Please send us your Wow List. We'll read it, discuss it and try to wow you.

We built ZoomCare at Bridgeport Village to begin to see if we could delight ourselves, and hopefully delight you, too. ZoomCare has been our prototype to test out our ideas. Yet, we always understood that if we were going to offer you a real alternative to the old guard health systems, we would need to be where people live and work throughout our community.

While we still have a ways to go to work through our Wow List, we now are preparing to expand the availability of ZoomCare. We'll soon announce the opening of Zoom2. Usually we email you just once a month. But we'll be sending out a special edition shortly about Zoom2, and we'll be inviting you to an open house and other stuff.

We want to be your doctor.
Try health care on demand.

Best of health,

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

And now, for your moment of Zoom:

"This is what happens when the world's greatest doctor meets the world's greatest patient."

For more information about who should get flu shots, and about the vaccine itself, visit the official CDC site.

Ask Your ZCP:

Oh the itching! Why me? Why now?

Oh the itching!
It's intense!
How can I make it stop?

At this time of the year so many people develop itchy skin. The symptoms often start on the lower legs, upper thighs, upper arms and even sides of the body. The skin can turn a little red, becoming scaly and cracked. What is going on here? Why do so many people come in with intensely itchy skin at this time of the year?

Many conditions may cause itching skin, including atopic dermatitis, contact dermatitis, and scabies (infection with the skin mite Sarcoptes scabiei). Itchy skin can even be a sign of a more serious internal condition such as liver or kidney disease.

However, most of the people we see at ZoomCare with intense itching of the skin have what is called "xerosis." It sounds scary, but it is not a deadly condition. Xerosis means dry skin. (If that is not bad enough, the medical term for itchy skin is "pruritis." So your pruritis may be due to xeriosis. Say that ten times fast).

In northern climates like Oregon, as it gets colder and wetter, heaters make their comeback. Heaters produce very dry, very low humidity heat. When the air surrounding the skin is very dry, then natural moisture of the skin evaporates, drying out the skin and causing it to become itchy. A vicious cycle can develop: as your skin dries, you become colder, and as you turn up the heat more - this further dries out your skin. Even worse, during the winter people tend to take long, hot baths or showers. Hot water further dries out the skin, again intensifying the cycle. Is there no end to this madness?

Furthermore, deodorant-type soaps are harsh and dry out the skin as well. Finally, we often don't drink as many fluids during the winter, leading to further dehydration of the skin. Everyone is at risk for xerosis during these periods. However, older individuals who have more fragile skin are more sensitive to the drying effects of heat and water.

So you itch. What's the big deal? Well, besides being incredibly uncomfortable, itchy skin poses several problems.

As we mentioned earlier, not all itchy skin is xerosis. The symptoms could be due to allergic reactions, infestations such as scabies and very serious medical conditions. That is why people usually come in to see a medical provider: to make sure the itching is not due to a serious condition.

The other reason xerosis can be more than just a nuisance is that it can lead to complications. Most importantly, persistent dry skin can lead to cracks or breaks in the skin, which can then become highways for infection of the skin.

So it's winter, it's cold, you have the heater on. You've got to stay warm, right? Then, how can you prevent xerosis?

* Don't overheat your environment.

* This might sound crazy but - don't over bathe! Yep, bathing less often during the winter minimizes moisture loss from your skin from steam evaporation. Once a day is okay. However, if you are really suffering from xerosis, back off to bathing every other day.

* Swap in that bath for a shower. And certainly limit your water time to less than 15 minutes, and use warm water, not hot water.

* Use mild, moisturizing soaps (such as Dove or Keri).

As you institute these changes, make sure that you keep your skin well conditioned. Right after bathing, while your skin is still moist, apply an emollient (a "moisturizer") for dry skin. Look at the ingredients of moisturizers and make sure they do not contain any alcohol (which is a potent drying agent). Common, useful emollients include but are not limited to:

* Eucerin
* Neutrogena
* Lubriderm
* Aquaphor
* Lac-Hydrin is available by prescription

Sometimes xerosis can become so severe that it can lead to atopic dermatitis (also known as eczema). Atopic dermatitis is a chronic inflammation of the skin that has many causes. When xerosis leads to atopic dermatitis, it is definitely time to visit the doctor. The best therapy includes the changes in bathing and skin care mentioned above, plus the addition of a low dose steroid cream to help reduce the inflammation.

Well, now you are armed with ways to ease the itch this heater season. And of course, if it gets unbearabe- well, you know where to go.

Albert DiPiero, MD, MPH

In This Issue

When is a cough more than just a cough?

ZoomGrant Winner:
North by Northeast Community Health Center

ZoomTip of the month:
Do you speak EOB?

Your moment of Zen:
Flu shots for current Zoomers

Ask Your ZCP:
Why am I itching?

Quick Links

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When is a cough more than just a cough?

(Click on the Chest XRay to hear a podcast about coughing)

You hear it everywhere, especially as the season grows colder. Everybody does it (some more often than others) but what is it and why do our bodies do it?

Coughing is a protective, primitive reflex that our bodies use to expel air, mucous, or food from the airway. Frequent or chronic coughing usually indicates the presence of disease.

Some causes of chronic cough are asthma, heartburn, or post-nasal drip. If the person is a smoker- chronic cough tends to go with the territory of that habit.

The real question when you're coughing like crazy is -

When should I go to the doctor?

Well, it's a good thing you (I mean I) asked...
Here's the report I got from our own Doctor Jeffrey Katz:

If you have developed a cough, or you do at a certain time each year- you may have what is called bronchitis.

Bronchitis can be either viral, bacterial, or both. Comforting, isn't it?

However, you do not generally need antibiotics if you have bronchitis, unless you have walking pneumonia- which is a different topic entirely.

Back to the bronchitis - in most people it will worsen up until you've had it for 7 to 10 days, then it should start to get better.

If it's not getting better after the 10 day point, or you have been experiencing fever of above 100.5 degrees these are good indicators that you should see the doctor. Also (as I'm sure you might imagine) coughing up blood, chest pain, and shortness of breath even when inactive are all signs that you need a trip to the doc...and probably a date with a chest Xray (just to be sure).

So, now you know what to look for to make sure your cough hasn't taken a turn into the danger zone. And if it has, or you're worried it's getting there- come see us. We're here everyday just for you!

For more in depth information about this topic check out:

Chronic Cough: Causes and Cures

Bronchitis Resource Center

For prevention tips to keep you healthy during this cough and cold season, listen to this.

- 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 October's winner:
North by Northeast Community Health Center!

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

ZoomTip of the Month:

Have you ever gotten an EOB* from your insurer?
(*Explanation Of Benefits or Everyone Obviously Befuddled...)

About as easy to understand as a voting pamphlet isn't it

Good news! We at ZoomCare are expert EOB interpreters, and would be happy to explain the finer points of your benefits.

Just scan in your EOB and send it to:
ZoomCare EOB genius**

**Most confusing EOB received will win a prize...