The Coumadin Clinic – Located in Internal Medicine Group Suite 201

Coumadin is an anticoagulant, or blood thinner. Anticoagulants do not really thin out or dilute the blood. They reduce clotting of the blood, and thus reduce the risk of conditions caused by abnormal clot formation. The following conditions may warrant the use of Coumadin therapy:

• Clots in the extremities and/or lungs

• Artificial heart valves

• Heart arrhythmia (irregular heartbeat)

• Strokes

• Heart Attacks

• Blocked Arteries

Millions of patients safely take Coumadin, but it requires tightly regulated dosing, administration, and follow-up. That is why IMG is making the Coumadin Clinic available to you. We provide periodic evaluation and monitoring of the blood so that we can make immediate adjustments to your anticoagulation therapy.

If you are on Coumadin or think you may benefit from the services offered in the Clinic, please speak with your physician about this matter.

Coumadin Clinic hours are 8:30 a.m. – 5:00 p.m. on Tuesdays, Wednesdays and Thursdays.

Bone Densitometry Testing – Located in Internal Medicine Group Suite 201

A bone density test determines if you have osteoporosis — a disease that causes bones to become more fragile and more likely to break.  In the past osteoporosis could be detected only after you broke a bone. By that time, however, your bones could be quite weak. A bone density test makes it possible to know your risk of breaking bones before the fact.  A bone density test uses X-rays to measure how many grams of calcium and other bone minerals are packed into a segment of bone. The bones that are most commonly tested are located in the spine, hip and forearm.

Doctors use bone density testing to:

• Identify decreases in bone density before you break a bone

• Determine your risk of broken bones (fractures)

• Confirm a diagnosis of osteoporosis if you’ve experienced broken bones

• Monitor osteoporosis treatment

The higher your bone mineral content, the denser your bones are. And the denser your bones, the stronger they generally are and the less likely they are to break.  Bone density tests are not the same as bone scans. Bone scans require an injection beforehand and are usually used to detect fractures, cancer, infections and other abnormalities in the bone.  Although osteoporosis is more common in older women, men also can develop the condition.

Regardless of your sex or age, your doctor may recommend a bone density test if you’ve:

• Lost height. People who have lost at least 1.6 inches (4 centimeters) in height may have experienced compression fractures in their spines. Osteoporosis is one of the main causes of compression fractures.

• Fractured a bone. Fragility fractures occur when a bone becomes so fragile that it breaks much more easily than expected. Fragility fractures can sometimes be caused by a strong cough or sneeze.

• Taken certain drugs. Long-term use of steroid medications, such as prednisone, interferes with the bone-rebuilding process — which can lead to osteoporosis.

• Received a transplant. People who have received an organ or bone marrow transplant are at higher risk of osteoporosis, partly because anti-rejection drugs also interfere with the bone-rebuilding process.

• Experienced a drop in hormone levels. In addition to the natural drop in hormones that occurs after menopause, women may also experience a drop in estrogen during certain cancer treatments. Some treatments for prostate cancer reduce testosterone levels in men. Lowered hormone levels weaken bone.

Centralized Laboratory – Located in Internal Medicine Group Suite 201

JPMA operates a state of the art laboratory. The laboratory performs testing in the areas of hematology, coagulation, chemistry, special chemistry, therapeutic drug monitoring, and serology. Our laboratory is CLIA certified and is staffed with medical lab technicians. The JPMA laboratory is open from 6:30 a.m. to 5:30 p.m. Monday through Friday. Our phlebotomy services are located on the second floor in our main office for your convenience.

Pulmonary Function Testing

Pulmonary function tests are a group of tests that measure how well the lungs take in and release air and how well they move gases such as oxygen from the atmosphere into the body’s circulation.

Spirometry measures airflow. By measuring how much air you exhale, and how quickly, spirometry can evaluate a broad range of lung diseases. In a spirometry test, while you are sitting, you breathe into a mouthpiece that is connected to an instrument called a spirometer. The spirometer records the amount and the rate of air that you breathe in and out over a period of time.

For some of the test measurements, you can breathe normally and quietly. Other tests require forced inhalation or exhalation after a deep breath. Sometimes you will be asked to inhale the substance or a medicine to see how it changes your test results.

Do not eat a heavy meal before the test. Do not smoke for 4 – 6 hours before the test. You’ll get specific instructions if you need to stop using bronchodilators or inhaler medications. You may have to breathe in medication before or during the test.

Integrated Behavioral Health Services

A majority of patients treated in a primary care setting have a physical ailment that is affected by stress, difficulty maintaining a healthy lifestyle or a psychological disorder. Behavioral health problems (disorders) are also often under-diagnosed and need the support of a behavioral health clinician to achieve optimum treatment outcomes. Because of this, it can be both clinically and cost-effective, to integrate behavioral health clinicians into primary medical care.  With this in mind, JPMA has created an integrated Primary Care Behavioral Health Program, a collaborative health care model offering coordinated and effective services for patients with mental health needs by integrating a behavioral health practitioner into our office setting.

Our Behavioral Health Practitioner is Judith Ervin, LCSW. She holds a Master’s Degree in Social Work, and is independently licensed to practice clinical social work. She has over 12 years experience in working with most age groups and behavioral health diagnostic ranges. Ms. Ervin is providing outpatient behavioral health services within our organization, which consist of a comprehensive assessment to determine the needs of the patient, and individualized treatment planning with the patient. The therapy approaches are evidenced based practices and her services are billable under most insurance companies. We found that the ‘warm hand of’ from your physician and the close collaboration with your counselor is highly beneficial in your treatment, management, recovery and healing from mental health/substance use, co-occurring, physical health problems you may be dealing with.

Patients do not choose to be ill, anxious, depressed, or sad over losing someone close and may use alcohol or substances to deal with stress or grief in life. However, patients can choose to work with a team that will support them in dealing with and overcoming problems they are facing in healthy ways.

Diabetes Education

Diabetes is a chronic disease that affects more 20 million Americans and is characterized by serious, costly, and often fatal complications. As the number of patients with diabetes continues to rise in this country, we recognize that we have a responsibility to help our patients achieve better metabolic control, improve lipid levels, reduce blood pressure and develop self management skills. In an effort to improve these services at JPMA we have added a Diabetic Educator to our staff.

Diabetes educators collaborate with physicians to help empower patients to modify lifestyle and adopt healthy self-care behaviors. Diabetes education may include, but is not limited to:

• Presenting basic information about diabetes and its management.

• Training patients and caregivers to use diabetes devices, such as blood glucose meters, insulin pens, insulin pumps and continuous glucose monitors.

• Teaching patients problem solving strategies and skills to self-manage their diabetes.

• Motivating patients to set and achieve behavior-change goals.

• Providing nutrition education including diabetes meal planning, weight loss strategies and other disease-specific nutrition counseling.

• Managing medications, based on physician-directed protocols.

• Educating patients on techniques for risk reduction of acute and chronic complications.

• Helping patients develop emotional coping skills.