For many people the idea of a medical practice that doesn't take insurance is unfamiliar and some think that it's not worth it to pay for office visits on top of paying for  insurance. So I want to explain my thinking and create some context for you. Here's why I think it's a good idea. In order to work with insurance a practice needs to see more people in the same amount of time, which generates more paperwork. The increased number of people and the increased paperwork requires a practice to hire someone for billing and someone for scheduling.  This is very difficult for newly graduated Physicians to do because they already have medical school loans to pay off at the same time they are starting a family. Consequently, most Physicians join practices that are owned by hospitals or other large organizations. Then, all of the other people in those organisations need to get a piece of the pie, so prices increase. Patients don't see these prices because insurance pays for them, but they experience the friction created by being cared for by a practice owned by a very large organization  in the form of long wait times, a very slow response rate to phone calls or emails, rushed office visits, and impersonalized service. After everything is factored in people end up spending more through the costs of wasted time, increased stress, and avoidable visits to urgent care or the ER due to slow office response times.  
    In our practice you will not wait more than 20 minutes without being compensated for your time, you have direct cell access to your provider and will receive a return call, text, or email within 48 hrs, visit times are never rushed, and we will know and actually care about you.  Since we are a small physician owned practice our overhead is low, so we can offer these services at affordable prices. The new patient visit is about the cost of a nice dinner for two people, $100 - $150. Follow-up visits are about the cost it takes to fill up a SUV with a full tank of gas, $50 - $75.   These charges are based upon the amount of time needed for the visit. insurance will still take care of any labs or Imaging we order, and we draw labs in office for your convenience. For your average person who only needs to come and see the doctor two to four times a year (price range for 2-4 vists $150-$375), the cost is quite low for what you get.

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As part of the move to our new space this Novemeber 4th we will begin providing primary care to patients.  This does not mean patients have to do their primary care with us if they want to recieve only Osteopathic manipulation and keep their current primary care provider.  The same is true if you want to come to the clinic for  Primary Care, you are not required to receive Osteopathic Manipulative Medicine.  Our goals in providing Primary Care are to create a healing environment where you feel at home.  One where the provider-patient relationship is taken care of.  In service to this goal we will not be working with insurance because of the constraints that are placed on that relationship if we do.  The main reason that working with insurance constrains the patient-doctor relationship is that it provides no incentive to take care of that relationship. It only incentivizes the physician to go as quickly as possible, to see the most patients in order to bill the most.  Then the physician is left with a mountain of paperwork that they frequently stay after work to complete. If the provider is not happy and ease, he or she will not be fully available to take care of their patients. If they're not fully available, they may miss something.  By taking Insurance out of the picture we can take our time and decrease the typical stresses associated with seeking Medical Care.This does not mean that our prices will be unattainable. in fact, we plan for a simple follow-up (15-30 minutes) visit cost somewhere from $50 - $100 And a new patient visit (about 45 min - 1 hr) to cost between $125 - $175.  We know that the relationship with the patient is a piece that has been undervalued in recent years. This is because it's not reimbursed by Insurance, so it tends to fall by the wayside. The trend has been for Physicians to spend less and less time with their patients, and this rush has decreased their job satisfaction, the quality of the relationship with the patient, and led them to focus too much on what medication can they prescribe. This approach makes it difficult to be holistic.   The top five causes of death in the United States are lifestyle-related, that means they're created by daily choices. Thus, preventative medicine is a crucial component for Physicians to focus on in our society today. The current Insurance system makes it difficult to do that well. We take the time to consider the context in which you live. Inquiring about diet, exercise, relationships, vices, and fulfillment with life in general. All of these aspects of your life influence health and well-being. of course we are also able to take care of all of those other typical Primary Care things such as prescriptions, Laboratories, Imaging, Etc.  In fact, we have a relationship with a laboratory so we will do in office collection for all of our labs, which means you won't have to run over to another place to get it done. Additionally, we have a relationship with a pharmacy that can deliver medicines directly to your home. Our goal is to minimize the stress of Medical Care as completely as possible, and hopefully make an enjoyable experience were you know that you are important and you feel taken care of.  This is our commitment to you.

Most people have some sort of addiction.  No matter the substance that the addiction is associated with the pattern is basically the same.  We have a feeling in our body, me subconsiously conclude that that feeling is bad and we need to change it, we erroneously conclude that the way to fix this bad feeling is to take the substance.  Let's look at sugar to start as an example.  For people who are addicted to sugar they use it as an escape, a way to alter their mood temporarily and avoid confronting a feeling.  Of course there is a way to have a healthy relationship with sugar, but when the relationship is being abused it can be an addiction like anything else.  When it is overused over time we feel worse and worse.  Maybe because sugar causes us to put on more fat and we don't look the way we want to, or because of the physiologic changes from diabetes.  Either way this bad feeling becomes a reason to use more sugar to try and alter our state.  In addition, the bad feeling itself can simply be withdrawl from the substance.  If we eat too much sugar, too regularly over a long period of time we will become tolerant to it (meaning we need more to get the same mood altering effect) and if we take it away we will experience withdrawl.  I know of people who went through headaches, nausea, irritability, difficultly sleeping all from sugar withdrawl.  Now, we can replace sugar with any other addictive substance and the process will be the same.  Bad feeling, subconsious mental conclusion that leads us to use substance, altered mood, experience negative effects of altered mood, experience withdrawl from substance, repeat cycle.  So, addiction is a common human strategy to deal with suffering.  The problem is that it creates more suffering.  It is better to notice the feeling that starts the whole process, look it right in the face, accept, and feel it.  Typically we need counseling to help us be successful in this approach.  
    For someone who is already addicted to something, it can be quite difficult to break the cycle.  Today we see more people dying from Opiod overdoses than any other form of accidental death.  Cigarette smoking has been a leading cause of cancer for years.  There are ways though to untangle even these very strong addictions.  I, Dr. Starsiak, recently completed additional training to be able to prescribe buprenorphine.  This is a medication that helps with stabalizing opiod/opiate addictions.  Most people who try to quit opiods/opiates on their own return to usage within a year, >90% of people in fact.  Buprenorphine is a medication that will stabalize the addiction.  It does not create a high like the opioids that people typically abuse recreationally.   Instead, it will prevent withdrawal symptoms and eliminate cravings for other opioids. This allows a person to get their life in order, to develop a support system, to go through counseling, basically to experience stability, so when they're ready they can be more successful at completely quitting opioids. In fact, buprenorphine itself is an opioid but the way it interacts with the opiate receptors is different than commonly abused opioids and opiates. It does not fully activate the receptors, so it doesn't create the same high. It does however prevent withdrawal and cravings so a person can go on living their life.  Typically a patient needs to be sustained on buprenorphine for at least a year before attempting to  taper it down. Studies show better success rates  with long term abstinence with sustaned mantainence on buprenorphine compared to using buprenorphine to detox quickly from another opiate and then stopping the buprenorphine. Success rates of long-term abstinence go up the longer a patient is on this medication. A patient takes this medication at home and only needs to come into the office once a month to be reassessed, so it is quite convenient and will not interfere with daily life. The phase where we switch over from whatever the abused opiate or opioid are to buprenorphine is called induction. Induction can be done at home or in my office depending on a few medical variables along with the patient's preference. the risk of death from opiate / opioid overdose is quartered when someone is on buprenorphine. So, it really is a matter of life and death for many.  If you are struggling with opioid or opiate addiction please give me a call. I will help.   

I first opened the Starsiak Osteopathic Clinic in the summer of 2013. It has been my dream since I was a high schooler who had his back pain resolved with Osteopathy become an Osteopath.  Over these six years my practice has grown to the point where it is time for a new, bigger space and to begin offering additional services. I will of course continue to offer Osteopathic Manipulative Medicine  because there are so many people who benefit from it and it resolves problems that are resistant to other forms of treatment. In addition to Osteopathy, you are now able to come to the Starsiak Osteopathic Clinic for deep medical massage, Primary Care, one on one yoga classes, and buprenorphine assisted treatment for opioid dependency (I can only accept 30 patients my first year so if you are interested in this please contact me as soon as possible because it is likely to fill up quickly). This evolution is a move closer to my vision of a complete medical home for my patients.  I'm happy to be able to connect patients with providers who I know are excellent at what they do in a convenient setting. I will be working closely with the Family Nurse Practitioner, Lisa Martin, and the massage therapist / yoga instructor, Tatiana Barton, to coordinate optimal care for patients of the clinic. We are not requiring an expensive concierge membership to see us, but we are delivering individually tailored medicine in a patient-centered environment. We currently have not signed on with any insurance companies so we are not bound by there limitations, so patience pay us at the time of visit.  I think taking care of ourselves can be enjoyable and stress-free. That is the experience we are committed to delivering at the Starsiak Osteopathic Clinic. ​

    Trauma, whether physical, mental, or emotional, leaves behind a residue.  This residue tends to show up as a lack of flow, freedom, and/or ease in some part of our life.  After the acute sequelae of the trauma subsides what is left can make one feel , stuck, depressed, frustrated,  pain, or like they can't take a full breath,  It is like some aspect of a persons being has frozed in response to the trauma.  Since the tramua residue is limiting, it is best to get it out.  How is this done?
      There are two ends to the spectrum how one can begin to release trauma residue, direct and indirect.  A direct approach involves introducing the opposite of whatever the trauma is.  An indirect approach involved connecting with the trauma residue and working with it, letting it do what it wants to do until it completes itself and lets go.  Let's take the example of someone who has recently been dumped by their partner when they were still very invested in the relationship.  The role of this persons friends will be to help their friend get over the breakup so it doesnt get in the way of their possible relationships in the future.  If this person's friends used a direct method they may try to distract this person by taking them out to for a night of drinking and fun, or they may simply be unwilling to listen to them about the relationship and simply tell this person that they should get over it.  The indirect method would involve sitting down and listening to this person, letting them share their thoughts and feeling while  

    Much of what I work with in my office is the result of shock trauma.  What is shock trauma?  Think of the moment before a car accident; the breath is held in on inspiration, the shoulders tense upwards, and the eyes are opened wide.  Then the force of the accident is delivered.  Most physical traumas are shocking and elicit that same response described above.  After the event is over, our body's structure is not the same.  The force has traveled through like a lightning strike and created either increased or decreased resting tone in the fascia and ligaments of the body and locking in the tension created by the shock response decribed above.  The change may only present itself to our awareness briefly, for a day or two, or it could become a chronic companion.  If our body is able to accomate that change well enough we will not have any problem other than an unoticed loss of fluidity, but if it can't then some sort of undesireable symptom will develop (frequently pain, but can be many different disease processes).  Either way, the balance of tension is changed in the body.  What do I mean by balance of tension?  One way to understand it is to imagine the body totally relaxed and floating in space.  What position would it take?  Would it twist to the right?  Bend off to the left?  Flex forward?  etc.  The ideal balance of tension is for all structures to be symmetric around the mid line without perfering motion in any direction over another.  In this ideal balance, there is a minumum amount of tension in the body and all of the channels (lymphatic, blood vessels, nerves) are free to do their jobs without resistance.  
    Now imagine how a side impact car accident could effect the balance of tension in the body.  For this thougt experiment let's imagine that the driver of a car is hit hard on the left side of their car.  Their spine abruptly bends to the left, perhaps throwing their head into the driver side window (or airbag if it deploys).  Then it will whip back the other way.  Typically the first motion will set the tone for the change in the bodies balance of tension because it is the point of greatest force delivery, by the time the body whips back much force has already dissipated.  This sort of force trauma would likely result in the person's spine overall preferring to go into left sidebending over right sidebending.  So their new balance of tension would be found with them in slight left sidebending.  This balance of tension would require the muscles along the right side of the spine to be kept at a greater length, which will result in them trying to pull back to their normal length.  This new increased resting muscle tone sets the muscle up to become painful.  This can be confusing to body work practitioners because they think they should work on the painful muscle, but if we consider the underlying change in the balance of tension in the fascial ligamentous system that gives us a totally different window in on how to resolve the problem.  Now, this is a very simple, 2 dimensional  explantion.  We can imagine of more complex changes could be made through force that produces a combination of motions (flexion/extension, rotation, sidebending, compression, traction) with more complex problems resulting from it (impingement of nerves, arteries, veins, lymphatics, etc)  
    My job it is find my patient's balance of tension and gently coax their structure to let go of the traumatic holding so that treatment by treatment they move closer and closer to their ideal balance.  The great thing about this approach is that as they let go of their shock trauma they do not need to come in an see me as oftens and they do not need to do as much homework (exercise prescription) to stay out of pain.  

For my next entry I will discuss the means by an Osteopath can help patient  release their shock trauma.

    One of the principles of Osteopathy is that the body has the ability to heal itself.  It is, in fact, constantly tending towards health.  Why then do we get sick?  We get sick because, for the most part,  we are choosing to do things that suppress our bodies natural ability to heal.  Let's look at this in greater detail through the lens of the digestive system to understand this claim better...
      It is helpful to look at our overall health as starting with our digestive system because we can usually make the biggest positive impact by making improvements here.  Also, this is where all of the nutrition we use to maintain and heal our bodies enters our system.  We can think of our digestive ability like a fire.  If the fire is strong, we can throw almost anything on it and it will burn it up.  If the fire is weak, then it will struggle to consume heavier, wetter fuels and leave more incompletely burned material.  The same is true of our digestion. thus it is crucial to learn how to cultivate a healthy digestive fire.  There are 2 downsides to incompletely digesting food.  First, we don't get the nutrients we are trying to give our cells.   Second, we accumulate incompletely digested food products that are toxic (such as of arterial cholesterol plaques) in the channels of our bodies (intestines, lymphatics, blood vesels, end organs).  This then sets the stage for diease to set in.
    
    Here are some simple rules to keep your fire strong; eat seasonally (no salad in the winter, little or no wheat in spring and summer, buy from local farmers markets), avoid ice water (especially with meals because it dilutes stomach acid and lowers the temperature which decreases the efficiency of digestive enzymes), have the biggest meal in the middle of the day and smallest at dinner, keep regular sleeping hours, do not eat heavy foods if you are not hungry, avoid red meat, fried foods, ice cream, and refined sugars, do not combine fish and milk, fish and fruit, milk and carbohydrates, milk and fruit, meat and dairy, do not eat/snack in between meals, avoid very spicy food, cook with mild spices like turmeric, coriander, cumin, fenugreek, ajawan, black pepper, cardamom, parsely, cilantro, and ginger, avoid heavily processed foods (cook at home as much as possible), cook with high quality oils (organic grass fed ghee, organic raw coconut oil, organic raw sesame oil, organic raw olive oil, take beneficial medicinal herbs.
    
Stay tuned for the next week when I will discuss how shock trauma compromises our natural healthy state.