Know when to go: ER vs. primary care

When you or a loved one needs medical attention, you want to make the right decision and fast. Do you need to go to the emergency room? Will an urgent care clinic be able to help? Or can you wait and make an appointment with your primary care provider? It’s important to understand all of your options before it’s an urgent situation, so you don’t waste time during a medical emergency.

20% of Americans visit the ER at least once a year. With those odds, you need a plan. Click To Tweet

I recently spoke with Dr. Miles Varn, Chief Medical Officer of PinnacleCare, the world’s leading private health advisory firm. Dr. Varn is also a board certified emergency physician who spent 15 years at Inova Fairfax Hospital, a level 1 trauma center in Northern Virginia to get his advice on how to decide which treatment path to take.

There can be cost and time implications to going to the emergency room, which has a higher out-of-pocket deductible than a doctor visit. But in a life-threatening emergency, an emergency room (either hospital-based or freestanding) is your best option. Emergency rooms are always open, and have access to specialized care not available elsewhere. So when is it really worth it to head to the ER?

Don’t Wait

If someone is choking, has stopped breathing or is severely burned, call 9-1-1 and take an ambulance to the ER. The same is true for someone suffering from a head, neck or spine injury, or electric shock.

You should also head to the emergency room for severe chest pain or pressure, which could indicate a heart attack. Stroke symptoms – sudden numbness or weakness, confusion, blurred vision, dizziness, loss of balance or coordination – necessitate an emergency room visit. Seizures, deep wounds, severe allergic reactions, or poisoning are also best treated in the ER. 


Schedule An Appointment

If you think you have a common illness like the flu or an ear infection, or a minor injury, there is no need to go to the ER. In addition to the higher out-of-pocket cost, you’re likely to spend a long time waiting. Emergency rooms prioritize patients based on the seriousness of their situation. Those patients described above will need immediate attention. You and your ear infection will be forced to wait.

If you have an established relationship with a primary care provider, you can always call your doctor if you’re unsure about what to do. Even after hours, you should be able to speak with a doctor on call.


While we can all hope to never need to make that call to 9-1-1, the truth is that roughly 20% of Americans have at least one emergency room visit in any given year. With those odds, it’s a good idea to think ahead and have a plan in place.

To find the nearest Emergency Room, click here. To schedule an appointment with a primary care physician, click here.

5 tips for returning to exercise after pregnancy

We all know how important exercise is to our health. I can attest to the endorphin rush from a good workout, and crave that post-run euphoria. Or at least I used to.

When I got pregnant two years ago my doctor advised me to keep my heart rate below 140, which meant a dramatic shift in my exercise regime. And since having my son I’ve hit the sidewalks sporadically, but not with any consistency. The net effect is that I can feel the difference in both my physical and mental well being, and it’s not a good difference.

The good news is that each day gives me a new opportunity to make the right choices. I’m registering to run a 10k at the end of February, and using the Couch to 5k app to track progress for the first eight weeks.

I recently spoke with Jace Duke, manager for Houston Methodist Orthopedics & Sports Medicine Athletic Training Services, about returning to exercise after pregnancy. He offered these five tips.

Talk to your doctor before starting any new exercise program. Tell him or her why you want to exercise, and what activities you had in mind. Do you want to improve cardiovascular health? Lose weight? Gain strength and flexibility? Your doctor will help make sure you are in good enough shape to start exercising, and then you can design a program to meet those goals.


Progress gradually. Make sure your exercise plan increases the strain on your body incrementally. Also, take note of your environment. You might not look forward to your second workout if your first run is at noon on July 4th.

Wear the right shoes. You don’t need to spend $150 on high-tech shoes, but you do need to have shoes that are appropriate for your exercise, and they need to be replaced whenever you can see wear.

Your body is a machine that depends on fuel, and that includes hydration. Just don’t make the fatal calculation that a 30 minute jog is license to eat anything you want for the rest of the weekend – espeically if weight loss is one of your exercise goals!

Listen to your body. You will probably be sore the day after a workout. You might be even more sore the second day. This does not necessarily mean you are injured or sidelined. Jace has a helpful way to identify injury from soreness. “God gave us two of most of our body parts. If you are experiencing symmetrical pain, you are probably just SORE. If you are experiencing asymmetrical pain (your right calf feels strained but your left calf feels just fine) you might be injured.”

Even if you are injured, though, you never have to stop exercising entirely. You might need to modify your activity. You might be sidelined from running, but you can walk, or bike, or swim. The key is to always stay active.

How to effectively treat postpartum depression

Pregnant women have a lot to think about when it comes to health. Every decision we make for ourselves directly impacts the health of our developing babies. One medical condition that every woman should be prepared for, regardless of her health history, is postpartum depression or PPD.

Mental illness is a medical condition, no different from any other, with serious symptoms. And like other medical conditions, mental illness can and should be treated.

Am I at risk?

If you are a woman who is pregnant, you are at risk for experiencing PPD. According to the CDC, 8 to 19% of women report having postpartum depression symptoms, and as many as 80% of women will experience the “baby blues.” By comparison, 5-8% of adults in the United States experience depression in a given year. There are a few factors that increase a woman’s risk for developing depression during pregnancy or postpartum. These include:

  • A history of depression or other mood disorders outside of pregnancy (if you have been depressed in the past you are three times more likely than the average woman to experience postpartum depression)
  • A history of postpartum depression specifically (this increases your risk by 70%).
As many as 80% of women will experience the “baby blues” Click To Tweet

What can I do about it?

As in many other areas of life, the best defense is a good offense. In this time of your life when all eyes are on your expanding belly and brand new bundle of joy, make sure you are keeping yourself and your own health a priority.

I know the last thing any pregnant woman wants to think about is yet another doctor’s appointment, but if you are at an elevated risk for PPD, you owe it to yourself to establish a relationship with a mental health professional before you have your baby.


If you’re not currently experiencing depression, you’ll likely only need to meet with a doctor two or three times during your pregnancy. These preventative appointments can help your doctor establish a baseline for your mental health.

Your doctor will also meet with you and your partner toward the end of your pregnancy, to ensure someone at home understands the warning signs of PPD, and the importance of prompt treatment. You’ll meet with your doctor again 4-6 weeks postpartum, to confirm you are still hanging in there.

There are psychiatrists who specialize in treating women during pregnancy and postpartum. Ask your OB for a referral if you need one.

What about treatment?

There are options that are safe for you and your baby, including psychotherapy, bright light therapy, and alternative medical treatments like acupuncture or supplements, as well as antidepressants.

Women are generally concerned about the safety of antidepressants during pregnancy, but it is important to remember that depression is a medical condition that sometimes requires medication. The risk of taking any medication must be weighed against the risk of not taking it, whether it’s for treating high blood pressure or depression.

The risk to a child from living with a depressed mother is just as real as the risk of taking an antidepressant. Do not ignore the warning signs and outward symptoms of depression because you are afraid of labeling and treatment.

The value of childbirth classes

Despite being intensely type A about everything in my life, I am “that person” that consciously avoids listening to anyone talk about giving birth. When women share war stories at baby showers (which they all love to do!) all I hear is “la la la la la …”

I intentionally stopped reading What to Expect When You’re Expecting when it got to “those” chapters, and I actually got physically ill reading about my “cervix ripening.” As a result, everything I knew about giving birth came from the movies and TV.

Spoiler alert: It’s nothing like the movies and TV, which focus almost exclusively on a few minutes of pushing and voila! A baby arrives! Mom and Dad lovingly embrace; end scene.

At 30-plus weeks pregnant, it was time to get registered for both breastfeeding and prepared childbirth classes and a parenting series at Houston Methodist Hospital. For the breastfeeding class, I came to the hospital for a two-hour session (surprisingly, I was one of the only women without a husband in attendance.)

I furiously took notes and tried to absorb as much information as I could. Luckily when my baby arrived he had a great latch, and the class came in handy. Even still, I worked with the lactation consultant in the hospital, and even had a lactation consultant come to my house.

It’s one thing to go through the motions with a doll. It’s another thing to try it in the hospital, with a team of nurses at your side. It’s a whole new ball game when you’re at home, by yourself, engorged and sleep-deprived. I never would have made it through the first few months of breastfeeding without the information and support I had in advance.

For the prepared childbirth classes, I did bring my husband. The class is typically offered over four weeks, but we opted for the two-day cram session. I was by far the farthest along in my class, but that just meant I didn’t have as much time to forget what we learned!


We spent the first day talking about the phases of labor, contractions and breathing techniques. We even practiced breathing through simulated pain (our husbands pinched our arms.) I always planned on getting an epidural, but during this class I foolishly told myself, “I have a fairly high threshold for pain. I have run two marathons. Maybe I’ll just hold off on getting my epidural until I really need it.”

As it turned out, I went into labor before the second class, and I really needed my epidural before we even got to the hospital. I am a big wimp. Once I did get it, there was no need for breathing through contractions – I barely felt them (or anything else)!

What I valued most about the class was the mental preparation. I finally knew what “effacement” and “dilation” meant – even though I still get queasy just looking at those words. I knew how long my contractions were going to last and how much time I’d have in between each one. I also knew what to expect in the event of an emergency C-section.

I pulled back the curtain behind the mystery of labor and delivery, and armed myself with the information I needed to get through the most important day of my life, my baby’s birthday.