Concussion is a common injury, especially in athletes, military and first responders, and other active patients. While most people make a complete symptomatic recovery from concussion within a few weeks, a minority of individuals will experience prolonged symptoms even after the concussion itself is over. This is called post-concussion syndrome. A very common area of confusion is understanding the difference between concussion and post-concussion syndrome and the two terms are frequently used incorrectly, often interchangeably, when describing symptoms that occur after a brain injury.

Concussion is an acute traumatic brain injury caused by an external force such as a blow to the head, face, neck, or body. This injury causes transient changes in the brain that impair neurological function and can lead to a variety of symptoms. An injury of this nature typically resolves in 1-2 weeks. Any individual with persistent symptoms beyond that time should be suspected to have post-concussion syndrome.

Post-concussion syndrome (PCS) is when symptoms persist after a concussion has resolved. Post-concussion syndrome is not a long concussion and does not signify that there has been a more severe injury to the brain. The ongoing symptoms of post-concussion syndrome can be present for a variety of reasons that tend to differ from individual to individual. Common potential contributing factors to developing post-concussion syndrome include:

  • Pre-existing neurological diagnoses (migraine, ADHD, etc.)
  • Sleep issues
  • Cervical injuries
  • Mood disorders (anxiety, depression, irritability)
  • Changes in activity level from baseline (the “unplugged syndrome”)

It is critical to determine whether concussion or post-concussion syndrome is present, as the approach to treatment is very different. Management of post-concussion syndrome requires a comprehensive evaluation to:

  1. CIarify the diagnosis and determine that the concussion has resolved
  2. Identify all contributing factors and how they interact with each other
  3. Develop a multifaceted approach to treatment

Post-concussion syndrome can be a life-altering diagnosis, affecting all aspects of a patient’s daily functioning, but it is a treatable condition in the right hands and with a comprehensive and individualized management plan.

For more information, please visit

Contributed by: The Sports Neurology Clinic at The CORE Institute, located in Brighton (8273 Grand River Ave, Suite 210) and Plymouth (44191 Plymouth Oaks Blvd, Suite 400).


This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.


According to the U.S. Department of Veterans Affairs, around 50 percent of Americans have experienced a traumatic experience and approximately 8 percent of the population will have Posttraumatic Stress Disorder (PTSD) at some point in their lives.

PTSD is a potentially debilitating condition that can occur in individuals who experienced or witnessed a serious accident, terrorist incident, combat/war, natural disaster, personal assault such as rape, or other life-threatening events.  PTSD is considered a mental health condition that can occur after someone goes through a traumatic event.

Many individuals experience stress reactions after a trauma. If the reactions disrupt a person’s life and does not go away over time, they might have PTSD. New research shows that PTSD among military personnel may be a physical brain injury, specifically damaged tissue, caused by blasts in combat.  For more information on this research, go to U.S. Department of Veterans Affairs webpage on PTSD.

PTSD is usually diagnosed when a person has experienced symptoms for at least one month to three months following a traumatic event. Symptoms may not appear for several months or years past the event.

Four main types of PTSD symptoms are:

  • Reliving the event (through nightmares, flashbacks etc.…)
  • Avoiding reminders of the event (avoidance of people, activities and certain places)
  • Negative changes in beliefs and feelings
  • Feeling jumpy (easily irritated)

A provider who is skilled in helping people with mental illnesses, such as a psychiatrist or psychologist, can diagnose PTSD. The National Center for PTSD has created a handout to help give healthcare providers resources for PTSD.  To raise awareness of this disorder, providers can download a printable PDF: Help Raise PTSD Awareness.

For individuals seeking information and who may already have a mental health provider, contact your provider to set up an appointment to discuss PTSD and treatment options.  If an individual does not have a mental health provider, here are some tips to find one: Where to Get Help for PTSD.

This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.

Sources:  National Institute of Mental Health, Anxiety and Depression Society of America, U.S. Department of Veterans Affairs National Center for PTSD

Thursday, 25 May 2017 17:57

Cancer Survivors Day, June 4, 2017

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Sunday, June 4 is Cancer Survivors Day and in Michigan alone there are approximately 526,100 cancer survivors according to Michigan Cancer Consortium Institute.  Nationwide that number grows to 15.5 million cancer survivors.

The American Cancer Society has developed free training opportunities for community health workers and clinicians (Online Cancer Trainings) in order to implement interventions to increase cancer screening rates.

  • Colorectal Cancer (Delivering life-saving messages)
  • Motivational Interviewing (help individuals to make healthy changes)
  • Options for Increasing Cancer Screening in Community Health Centers (CHC’s)

The Physician Alliance has created patient education posters related to breast cancer screening and colorectal cancer screening to help initiate dialogue between patients and healthcare providers (go to patient education materials webpage to order posters) regarding screenings.

Enhanced access to screenings and early detection of cancer allows for more effective intervention treatments for improved survival rates.  It is so important for cancer survivors to discuss with their healthcare providers follow up care and associated risk factors for cancer detection.

For individuals interested in getting physically active, there is a great opportunity to support cancer treatments by joining the St. John Cancer Center in participating in the annual Colors of Hope Cancer Survivor 5k run/walk at Stoney Creek Metro ParkClick here to download the flyer to register for this event that is taking place on Sunday, June 4, 2017.

Cancer resources are available through the National Cancer Survivorship Resource Center, which is a joint collaboration between Georgetown University Cancer Institute and the American Cancer Society.  One of the goals of this partnership is to improve the quality of life for cancer survivors.  This Survivorship Center provides tools for cancer survivors, caregivers and also for healthcare professionals including community advocacy and policies.

The American Cancer Society also has a toll-free number for the National Information Cancer Center for individuals to access information at 1-800-227-2345.


This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.

Source: Michigan Cancer Consortium, Centers for Disease Control, American Cancer Society

To read additional blog articles, please visit our Blog archives page.

Are you aware that loud noises may cause permanent hearing loss? And that close to 70% of individuals who are exposed to loud noise levels do not wear hearing protection? May is a great month to learn how to protect and prevent hearing loss.

Hearing loss is the 3rd leading chronic health condition in the United States.  In older adults, annual costs for 1st year hearing loss treatment is on the rise and expected to be near $51 million by 2030.

Help protect your hearing by:

  • Lowering the volume
  • Wearing ear protection
  • Avoiding loud, noisy places

If you have to shout to talk then the noise is too loud.  Take steps now if you feel that you are experiencing hearing loss to prevent further damage.  Additional resources regarding addressing and preventing hearing loss can be found at the Centers for Disease Control National Center for Environmental Health.  Check out their hearing loss website to download a fact sheet.

Macomb County Health department technicians will perform free hearing and vision screenings through the end of May for children aged 3-5 years old prior to entering kindergarten.  Click here for the hearing and vision screening flyer.   

Oakland County provides free hearing screenings to children 3 through 18 years old who live or attend school in Oakland County.  Screenings are by appointment only.  Click here for more information or call (248) 424-7070.

Wayne County Department of Public Health (WCDPH) also provides free hearing and vision screenings for children 3 through 18 years old. Call (734) 727-7136 to make an appointment. Free screening appointments are offered every 3rd Friday of the month.

Audiologists at the Holley Institute are providing free adult hearing screens during the month of May.  The Holley Institute, a non- profit organization is located at St. John Hospital & Medical Center Professional Building One (22151 Moross Rd, Ste 223, Detroit).  Call today to schedule a free hearing screening, (313) 343-4436.

This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.

Contributed by The Physician Alliance.

Source: Centers for Disease Control, St. John Providence Holly Institute, Wayne County Health department, Oakland County Health division and Macomb County Health department

To read additional blog articles, please visit our Blog archives page.

How to dispose of unused and expired medication, April 2017

The Drug Enforcement Administration (DEA) is joining efforts with police departments throughout the country on Saturday, April 29, 2017 for National Prescription Drug Take Back Day to safely destroy prescription drugs through convenient drop off locations. This past October, individuals turned in over 730,000 pounds of prescription drugs at nearly 5,200 sites carried out by the DEA and state and local law enforcement agencies.  

According to the Monroe MI Health department, close to four billion prescriptions are filled in the United States every year, and around one third of the prescribed and dispensed medication is unused. This relates to almost 200 million pounds of pharmaceuticals that have the potential to negatively affect the environment and risk for abuse if not properly disposed. 

Unused prescription medications should not be given to or shared with other individuals.  It is important to remember that medications should also not be flushed down the toilet or poured down drains. When disposing of medications, take off personal and identifying information on the prescription bottles.  To take advantage of communities that offer ongoing medication drop off sites, click below:

**For Wayne county residents, Wayne county will be participating in the National Take Back Initiative Day on April 29.  Anyone can check with their local police department or visit to locate collection sites in your area.  The national event takes place from 10am-2pm.

Call 1-800-882-9539 or click here to find out city collection sites taking place on April 29.  Download the National Take Back Day flyer here.  For proper needle disposals, please check out for more information.

This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.

Contributed by The Physician Alliance.

Source: Michigan Pharmacists Association, Oakland County Sheriff Department, Macomb County Health Department, The Drug Enforcement Administration Diversion Control Division

To read additional blog articles, please visit our Blog archives page.

The title of this blog is the 2017 Theme for National Healthcare Decisions Day (NHDD) that runs through the week of April 16 through April 22. Now is a good time to talk with your doctor about future medical treatment choices prior to a life limiting event.  Regardless of age, a medical emergency can limit a person’s ability to convey type of care wanted.  Did you know that according to an American Journal of Preventive Medicine study that lack of awareness continues to be a main reason as to why individuals do not have advanced care directives in place?

What matters most to you in case of a life limiting illness?  Advanced directives include desired preferences that can be set up when you are wanting and able to clearly describe your medical preferences and to appoint a trusted person to serve as a healthcare agent.

Previous end of life treatment survey results show:

  • Most adults surveyed stated a preference to die at home, but only one-third have an advance directive expressing their wishes for end of life care (Pew Research Center, 2006)
  • More than eight-to-one (84%-10%) of the public approve of laws to let terminally ill patients make decisions regarding whether or not to be kept alive through medical treatment (Pew Research Center, 2005)
  • 2013 survey by Pew found 35% of adults stated that they have wishes in writing or have a living will

For more information, download a free advanced care directive toolkit through St. John Providence website.  Another resource is the Michigan Department of Community Health overseeing the MIPeace of Mind Registry where you can register and also download patient advocate forms.

This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.

Source: National Healthcare Decision Day, Institute for Healthcare Improvement, American Academy of Family Physicians; American Journal of Preventive Medicine, American College of Physicians, National Institute on Aging, Pew Research Center

To read additional blog articles, please visit our Blog archives page.

Annual Wellness Visits (AWV) with primary care providers is a Medicare benefit to help patients prevent or manage health care concerns/issues.  Currently, this Medicare provided benefit has no co-pay to the patient. 

Wellness visits include a health risk assessment that can help identify high-risk behaviors, and make recommendations for preventive screenings and referrals.  A physical examination is different from a wellness visit in that it is a hands on annual exam.  Medicare does not cover routine physical exams.

Guidelines to check:

History - Conduct patient history and medication list by requesting this information in advance so that documentation is completed and can be discussed when a patient enters the wellness visit.

Screen patient for depression, their safety and functional ability.  Depression screening and functional ability assessment, along with the safety screening, may be able to be managed by trained support staff in advance of the patient visit.

Cognitive assessment of patient with input from caregivers or family members who may be present during the wellness visit. Gathering impressions from the staff who obtained the patient history or performed other elements of the encounter could also be beneficial. Documentation should include evidence of assessment, such as notations of the patient's general appearance, affect, speech, memory and motor skills.

Screen for hearing and vision loss.

The wellness visit also includes checking height, weight, body mass index and blood pressure.  It is a good time to check a patient’s physical activity level and last exam date, recommend preventive screenings and check for known medical conditions.  By identifying patient behavioral risks and problems through their medical history and screenings, the AWV can be an opportunity to discuss interventions and order further screenings.  Discussion can also include education on advance care directives.

For more information go to ACP tools for wellness visits.  Billing codes for initial AWV is G0438, subsequent AWV G0439, diagnosis code V70.0.


Contributed by: The Physician Alliance, one of Michigan’s largest physician organizations serving more than 2,200 physicians in southeast Michigan.

This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.

Sources:  American College of Physicians, American Academy of Family Physicians, The Centers for Medicare and Medicaid Services (CMS)

Thursday, 26 January 2017 20:36

Concerned about your toenails? January 2017

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Onychomycosis (fungal nails) affects at least 10% of the world’s adult population. It is difficult to treat and has a high rate of reinfection. Foot Healthcare Associates practice strives to cure fungal toenails and significantly reduce reinfection and is the first in Michigan to be able to offer Lunula Laser treatment for fungal toenails.

This new and exciting treatment is a proven noninvasive treatment for onychomycosis. The Lunula Laser has gone through extensive research which has been published in reputable medical journals. There is no discomfort, downtime or side effects associated with this laser treatment.  It uses low-level laser light to treat fungus and usually requires four 12-minute sessions to the affected area.  

Before Lunula Laser              After Lunula Laser                   

In an 18-month study of 323 patients, 99% of patients reported full clearance of their fungal infections after four treatments.  In another study that evaluated 168 toes which had fungal involvement of 81.15% of the nail, it was revealed that the disease was reduced to only 31.32% within the nail after one treatment.

At the end of the study, 63.58% of the nail plate had no fungus remaining in it. An additional study, which was FDA directed, evaluated 105 toes and reported an average clear nail of 73.79% and 79.75% at post-procedure months 3 and 6, respectively. Also, there was not a single adverse event.

Contributed by:  Dr. Barnett at FOOT HEALTHCARE ASSOCIATES with locations in Southfield, Novi, and Livonia, Michigan. New diagnostic and treatment technologies are offered for all foot and ankle conditions.


  2. Robert Sullivan1 and Deirdre O’Flynn.Erchonia Laser Therapy in the Treatment of Onychomycosis.  Podiatry Review. Vol. 71(2):6-9.
  3. Scher RK, Tavakkol A, Sigurgeirsson B, et al. Onychomycosis: diagnosis and definition of cure. Journal of American Academy of Dermatology. 2007;56:939-944.
Wednesday, 04 January 2017 17:28

Early Detection of Retinopathy, January 2017

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The value of early detection of retinopathy through dilated retinal exams has been well established in peer reviewed analysis toward reducing morbidities of vision loss and reducing cost of care. Yearly retinal exams in diabetic patients and biannual exams in patients with established retinal disease are established practice patterns by the American Academy of Ophthalmology and the American Medical Association. Similarly, screening of elderly patients for the presence of age related macular degeneration, glaucoma and medication toxicity is highly efficacious in preserving vision. When patients question the necessity of these exams, I usually respond that "it’s what you don't know that may hurt you most."

The use of single field fundus photography as a screening tool has proven highly effective in detecting retinal disorders and generating referrals for further ophthalmic management. Emerging technologies such as smart phone fundus imaging may make these types of screening even more convenient. The use of these technologies alone rather than as a pre-screening tool may however result in under diagnosis of other ocular disorders. Meta-analysis of digital fundus imaging as early detection of disease confirms that fundus photography alone is not as effective to early detection of disease as clinical ophthalmoscopy.

In the diabetic patient, co morbidities for glaucoma, cataract and macular degeneration may be overlooked at least at the early detection phase of the disease. Visual symptoms associated with hyperglycemia, cortical vision loss or ocular motility disorders might also be misinterpreted without clinical correlation. Hypertensive disorders or venous stasis from blood dyscrasias can be mistaken for diabetic retinopathy.

High cost neuro imaging studies and systemic work ups can sometimes be avoided or better tailored with the guidance of a simple clinical exam. A yearly dilated fundus exam by an ophthalmologist is still the gold standard for the early diagnosis and management of retinal disease.

Contributed by: Michael J. Clune, MD, with Eastside Eye Physicians with practices in St. Clair Shores and Shelby Township.  Dr. Clune has published work on the management of diabetic retinopathy, glaucoma surgery and photorefractive keratectomy. He has been the Section Chief of Ophthalmology at St. John Providence Medical Center since 2005.  Dr. Clune has been recognized as a “Top Doc” on multiple occasions by Hour Detroit Magazine. Specialty areas: cataract surgery, LASIK/refractive surgery

Dr. Clune is a member of The Physician Alliance, a physician organization representing more than 2,200 primary care and specialty physicians in southeast Michigan.

This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.

Thursday, 01 December 2016 18:37

Winters Are Tough on Arthritis, December 2016

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One reason why winters are so tough on arthritis is that people get less exercise. A lot less. A study of arthritis sufferers in Chicago, a place that knows something about winter, found that they were a third less active in November than they were in June. Essentially, they were spending three more hours a day just sitting around as the days grew shorter and temperatures dropped. And winter hadn't even officially begun.

Exercise eases arthritis pain. It increases strength and flexibility, reduces joint pain, and helps combat fatigue. And clearly the study subjects weren't getting much in November. Cold temperatures and rainfall (but not snowfall) all contributed to this decline. But the greatest factor was the lack of daylight hours later in the year.

The study tracked 241 Chicagoans with arthritis for three years by using accelerometer readings, which measure a person's energy expenditure.

Most of the participants were over 60. All had been diagnosed with knee osteoarthritis or rheumatoid arthritis. Over a three year period, they wore an accelerometer up to six days a week, at three to six-month intervals. Their energy expenditure readings were compared to Chicago's daily weather conditions and the amount of daily sunlight over the three-year period.

Many of the participants would get their exercise from a brisk walk, an idea that was much less appealing during the cold Chicago winter.

The researchers blame part of the decline on a lack of indoor exercise facilities for the urban elderly. Just as cities have food deserts, they also have exercise deserts and the lack of convenient places to exercise grows during the year's colder months. Looking at Chicago specifically, the researchers note that there's a great deal of money spent on outdoor activities for younger and healthier people in the summer but little spent on indoor activities for the elderly in the winter, an inequality they'd like to see addressed.

Does cold weather itself aggravate arthritis? Studies have given conflicting results. Some suggest that cold, damp weather aggravates arthritis while others have found no such link. The current consensus is that the cold makes some people's arthritis worse but not everybody's.

The tendency to get less active and hibernate during the winter isn't just an issue for arthritis sufferers, it seems to affect everyone. And the human body wasn't meant to sit around. Long periods of sitting produce many ill effects. Everybody needs to be aware of and cope with this.

One way is to keep more active indoors. Indoor malls can serve as a replacement site for outdoor walks when the weather gets chilly. And joining a swimming, yoga or dancing class will also keep you active. Exercise doesn't have to be boring. Anything that keeps you moving works.

There's also good reason to spend time outdoors. When going outside, dressing warmly is the key. Dressing in layers traps body heat and helps keep you warm. And since most heat is lost from the extremities, you need to pay special attention to your head, hands and feet. This means a hat, gloves or mittens, and warm shoes with good traction.

Marilyn Monroe beat the summer heat in The Seven Year Itch by keeping her undies in the icebox. You can take the chill off of winter by putting your clothes in the dryer for a few minutes before going outside. This warms them up and make sure you start out nice and toasty. In fact it might even make you want to go outside to cool off.

An article detailing the study appears in the September 2011 issue of the Journal of Physical Activity and Health.


  Contributed by: Dr. Jeff Carroll, DO is a board certified orthopedic surgeon and professor of orthopedic surgery. He practices at Movement Orthopedics, located at

 43475 Dalcoma Drive, Suite 160 Clinton Township, MI  48038.



This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.



Monday, 10 October 2016 13:04

TPA practices designated patient centered medical home

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Congratulations to The Physician Alliance (TPA) primary care practices that were designated as patient-centered medical homes by Blue Cross Blue Shield of Michigan. A patient-centered medical home (PCMH) is a type of care model that transforms the delivery of primary care to children, adolescents and adults.

Physician practices that are designated as a PCMH pursue innovative new care delivery methods, technologies, and relationships with patients and their families. Join us as we celebrate 132 physician practices, representing 355 primary care physicians that earned this prestigious designation!

Through PCMH, primary care physicians form integrated partnerships with other physicians, health care providers and patients to coordinate enhanced access to care. Within this medical home model, practices seek to improve the quality, effectiveness, and efficiency of the care they deliver to patients while addressing each patient’s preferences and needs.

Physician practices advocate for their patients by seeking out optimum patient-centered outcomes driven by care planning processes that include compassionate care along with facilitated partnerships among physicians, patients, and the patient’s family. Research shows that primary care matters in regards to access, cost, and quality. Patients who have an ongoing relationship with their primary care provider have better outcomes and lower costs.

When care is effectively managed by a primary care physician in an outpatient setting, patients who have chronic conditions incur less complications, leading to fewer avoidable hospitalizations. There is increasing data supporting the positive benefits of this medical home care model. Physician practices that become a patient centered medical home benefit patients across the care continuum through improved quality of care and patient experience.

**Check out The Physician Alliance website for the 2016 list of PCMH physician practices.

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