Frequently Asked Questions

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Primary Care

 

Q: What’s different about the primary care Dr. Stracks provides? 
A: Most physicians are trained only to prescribe medications. Dr. Stracks’s Integrative Medicine training allows him to suggest herbs, vitamins, supplements, dietary changes, and other nonmedicinal, nonsurgical treatments when appropriate. 

Q: Does he prescribe any medications? 
A: Yes, but only as a last resort. Dr. Stracks oftentimes finds that other treatments work just as well--if not better--than using medication.

Q: Can he help me get off my medication?
A: Yes, absolutely, but only when a health condition is well controlled and it is safe to wean off medication. That means that other strategies need to be put in place first before deciding to wean medication. It’s very rare that Dr. Stracks would lower medication after the first visit, but as long as the relevant condition is well controlled, after several visits he will begin to consider slowly reduce the amount of medication you are using.

Q: Can I get antibiotics if I am sick? 
A: Yes, if antibiotics are what you need. Frequently, though, conditions such as bronchitis, sinusitis, laryngitis, and otitis are not bacterial in nature, meaning that antibiotics will not help. Dr. Stracks prescribes antibiotics when he believes it’s the appropriate course of action, but not if he thinks they will not be effective.

Q: Does Dr. Stracks have a hospital affiliation? 
A: Yes, he is affiliated with Northwestern Hospital.

Q: Does that mean he will admit me to the hospital when I need hospital care? 
A: No. Dr. Stracks only practices outpatient medicine. If you need inpatient care, you will be assigned one of the hospital physicians at that hospital who will admit you and make medical decisions about your care. Dr. Stracks will receive updates from the hospital physicians and will coordinate your care once you come home from the hospital.

Q: I see multiple specialists. Will Dr. Stracks help me coordinate my care among the specialists?
A: Dr. Stracks is absolutely available to help coordinate your care among a variety of specialists. That’s one of the main reasons patients choose him for primary care. Please be advised that coordination happens in the context of office visits, and so regular rates will apply for the coordination.

Q: Does Dr. Stracks take insurance? 
A: No, he does not. Please see the office policies for his rates.

Q: Why doesn’t Dr. Stracks take insurance? 
A: Insurance for primary care incentivizes quantity of visits and not quality of visits. Dr. Stracks is primarily interested in quality. Insurance reimbursements go down dramatically the longer your physician spends with a patient, which is why so many office visits last less than five minutes. Dr. Stracks likes spending time with his patients, getting to know them, and seeking out the best, most comprehensive treatments available. All that takes time, so Dr. Stracks has arranged his practice so that he is able to spend time with you on your health issues.

Q: Can I submit the bills to insurance companies on my own? 
A: Absolutely. Please note that Dr. Stracks is considered out-of-network for all insurances, so call your insurance company to find out about your out-of-network reimbursement rates and deductibles.

Q: Can I pay with my Health Savings Account? 
A: Absolutely. Dr. Stracks will give you a codified receipt for your visit that you can submit for reimbursement through your HSA tax-free account.

Q: Are labs and imaging studies covered by insurance? 
A: Almost all insurances will cover labs and imaging ordered by out-of-network providers as long as you use an in-network lab or imaging center. Speak with your insurance about in-network facilities, and double-check with them before you get your tests done to make sure that they will, in fact, cover the cost of the test.

Q: Are annual exams different because they’re integrative? 
A: Not necessarily. Annual exams are a time to take stock of your current health issues and make sure all your screening tests are up to date. Dr. Stracks is actually fairly conservative in his screening recommendations, so you’re not likely to end up with tests over and above what is normally recommended. Dr. Stracks will likely spend more time with you than average (60 minutes for a new patient, 45 minutes for an existing patient) and will talk more about diet, nutrition, supplements, stress, and lifestyle than most physicians will.

Q: What do I do if I have an emergency?
A: If the emergency seems life-threatening, call 911. If it is not life-threatening, then contact Dr. Stracks. He will make arrangements to set up an in-person, phone, or video visit as soon as possible to help you take care of the urgent health condition.

 

 

Integrative Medicine

 

Q: What is an Integrative Medicine consultation?
A: Dr. Stracks’s goal when practicing Integrative Medicine is to provide solutions for chronic health issues that lie outside the medical mainstream. This means that he focuses on nonmedicinal, nonsurgical treatments, such as the role of vitamins, herbs, diet, stress, the alternative use of hormonal medications, and referrals to other Integrative Medicine practitioners such as acupuncturists, chiropractors, massage therapists, naturopaths, and psychologists.

Q: What kind of conditions does Dr. Stracks treat?
A: Dr. Stracks treats all kinds of medical conditions. He commonly sees people with chronic pain, chronic fatigue, sinus issues, digestive issues, mental health conditions, migraine headaches, menopausal symptoms, and thyroid disease. No matter the condition, though, Dr. Stracks is happy to offer an opinion about whether nonmedicinal strategies might be helpful.

Q: Are there conditions Dr. Stracks does not treat?
A: Dr. Stracks does not treat Lyme. 

Q: What kinds of recommendations might Dr. Stracks make? 
A: All treatment plans are individualized, so the recommendations for you will be unlike those for any other patient that he sees. That said, he will frequently make recommendations to change diet (such as eliminating gluten, dairy, or sugar), use vitamins and supplements, try herbal combinations, have body-work done such as acupuncture or massage, and pay attention to the connection between stress or anxiety and chronic physical symptoms. He also frequently will order a battery of tests before making his recommendations.

 

Q: What kind of tests might he run? 
A: Frequently he will order nutritional tests such as iron levels, Vitamin B12, Vitamin D and magnesium. Sometimes he will order more comprehensive nutritional tests looking at a wide variety of vitamin and mineral levels. Food allergy testing is often ordered as are tests to try to measure levels or urinary neurochemicals, especially when anxiety or depression is the main issue. Comprehensive stool tests are run frequently. Hormonal tests are also ordered, looking at thyroid, adrenal, and ovarian or testicular function.

Q: Are those tests covered by insurance? 
A: Sometimes. In general, blood tests such as basic nutrients and hormonal tests are covered by insurance as long as your deductible has been met for the year. The tests run by alternative labs (such as Genova Diagnostics or Immuno Labs) are generally not covered or only partially covered by insurance. Dr. Stracks will do his best to let you know the exact cost of a test before it is run.

 Q: Does Dr. Stracks take insurance? 
A: No, he does not. Please see his office policies for his rates and a full discussion of why he does not accept insurance under the Primary Care FAQs.

Q: I’m coming in for thyroid or menopause consultations. What should I know about those services? 
A: Great. Please see the thyroid FAQs below and contact Dr. Stracks for FAQs about menopausal management and bioidentical hormones.

Q: Can Dr. Stracks serve as my primary physician? 
A: Yes, absolutely. Please see the FAQs about primary care.  

 

 

Thyroid Disease Management

 

Q: What should I expect if I'm seeing Dr. Stracks about thyroid issues?
A: Before seeing Dr. Stracks for the first time, please contact him about getting labs drawn so he can review the results with you at your first appointment. (Please note that several thyroid labs are sent to other states for analysis, so it can take up to two weeks to receive results.) During your appointment, he will also get a sense of your history, i.e., if you are taking medication, what kind you are taking; when you started; and how you are feeling. If you are not on medication, he will want to know how you are feeling, what makes you think thyroid is an issue, and what your previous experience is with medication, if any. He will also gather information about other medical conditions you have, what medications and supplements you take, whether thyroid disease runs in your family, and what kind of health habits you have in terms of eating, exercise, stress, and sleep.

Once he has all that information, he will make an initial assessment to determine whether he thinks you need additional labs, supplements, changes in eating, changes in medication, or different medication(s). His style is cooperative, so he takes your preferences into account as long as he believes the interventions are safe for you.

Please note that Dr. Stracks treats thyroid symptoms to alleviate the effects of thyroid disease. While weight management may occur as a result of treating thyroid properly, he does not use thyroid medication specifically to address weight issues. 

Q: Which labs does he look at?
A: Dr. Stracks finds that a TSH, free T4, free T3, total T4, total T3, reverse T3, TPO antibodies, and anti-thyroglobulin antibodies labs give him the information he needs. Each lab gives him a piece of information he's looking for. Between all these labs, he gets a 360-degree picture of what’s going on with your thyroid.

Q: Does he use the labs to make the diagnosis of hypothyroidism?
A: The conventional way to diagnose hypothyroidism is with a TSH greater than 4. Labs, however, do not tell the whole story. Dr. Stracks makes the diagnosis based on the entirety of the lab results along with a careful assessment of your symptoms. If you are feeling cold, tired, dry, constipated, depressed, and overweight, he doesn't need the labs to tell him that you are hypothyroid. Other symptoms such as joint aches, foot pain, thinning eyebrows, thinning hair, forgetfulness, hives, skin rashes, and difficulty swallowing can help him make the diagnosis as well.

Q: Do you look at ranges in labs or optimal levels?
A: Dr. Stracks normally looks at optimal levels and tries to get the T3 towards the top of the normal range, with the T4 and Reverse T3 in the middle to lower part of the normal range. He will tolerate a low TSH if you are feeling well (although over the age of 65 there is some risk with a low TSH), but he generally discourages T3 and T4 levels far outside the bounds of normal. Most of his patients can feel well with a T3 toward the top of the normal range or just slightly above as long as the reverse T3 is on the low side. 

Q: Does he use the labs to base his decision on therapy? A: The labs give Dr. Stracks some information, but not as much as you do. The labs help guide the therapy, especially when the clinical picture is unclear, but he gets more information from you than from the labs.

Q: Does Dr. Stracks look at other labs as well?
A: Depending on the situation, he oftentimes looks at nutrients such as iron/ferritin, B12, D, copper, and zinc. Also, if people are not feeling well and can’t tolerate enough thyroid medication to raise their numbers, he will evaluate adrenal function with serum or saliva testing.

Q: Does Dr. Stracks prescribe Armour Thyroid?
A: Dr. Stracks regularly prescribes Natural Desiccated Thyroid (NDT) but not always the Armour brand. His experience is that Armour has not been the same since coming off and then back on the market in 2010. He prescribes Nature Thyroid brand, WP Thyroid, or NP Thyroid; has Natural Desiccated Thyroid compounded by compounding pharmacies; and occasionally uses other brands, such as Westhroid and Erfa.

Q: What if I don't want to take medication?
A: Dr. Stracks rarely mandates a certain treatment. If your TSH is above 20, though, he will strongly recommend medication.

If your TSH level is below 20 and you'd prefer not to take medication, he will tell you about managing thyroid disease using diet, vitamins, supplements, and other holistic strategies. Some of his patients find that these strategies work well for them, and he's happy to work with you if you decide to manage your disease in this way.

Also note that some people feel fine with a TSH in the 5–15 range and seem not to need any treatment at all. If you are in this category, he will monitor you and provide input on whether you are safe to continue on without medication.

Q: How often do you check labs?
A: Remember, the labs give some information, but you give Dr. Stracks more information. Thus, at your first follow-up appointment, he will talk with you to find out how you are doing on the medication. Usually, he can get enough information from you to make a decision about the best next course of action. From there, he will adjust your medication and see how you do.

Note that Dr. Stracks normally orders labs in advance of the next appointment, so please allow enough time for the results. While looking for the best dose of thyroid medication for you, he may run labs every 3–6 months. Once you're on a stable dose of medication, he normally orders labs once per year.

Q: Can Dr. Stracks serve as my primary physician?
A: Yes, absolutely. Please see the FAQs about primary care.

 

Tension Myositis Syndrome

 

Q: What is Tension Myositis Syndrome (TMS)?

A: As you may know, TMS is a term coined by Dr. John Sarno, who was a physician in New York City, that describes the human tendency to express physically what doesn’t get expressed in other ways. Thus, what feels physical, such as back pain, neck pain, headaches, or even fibromyalgia, can ultimately be the physical expression of stress, past experiences, or strong emotions. The fact that we do this is not a necessarily a problem, but it does become one when we encounter a medical system that assumes all physical symptoms are physical in origin. When this happens, the only treatment options become medication, surgery or physical therapy many of which do not work, or do not work well. A diagnosis of TMS opens up other healing options that can be more effective.

Q: How is TMS diagnosed?
A; There is no test for TMS. Rather, any chronic symptom—pain or otherwise—can be a physical manifestation of TMS. People who develop symptoms in this way tend to be good people, want to be liked, don’t like to rock the boat, tend to take care of other before taking care of themselves, tend to keep their emotions inside, and tend to be people pleasers and somewhat perfectionistic. When people carry most or all of these personality traits and have chronic symptoms that have not responded to other forms of treatment, TMS should be strongly suspected. Other signs that point to TMS include physical symptoms that don’t have a clear physical explanation, symptoms that began at times of intense stress or life changes, symptoms that tend to move around the body into different locations, and symptoms that don’t get better no matter what type of treatment is attempted. 

Q: What happens in an initial TMS evaluation?

A: In an initial TMS consultation, Dr. Stracks and you will discuss your symptoms (how long they have been present, what helps them, what makes them worse, what they feel like, etc), discuss the various non-physical factors that may be contributing to your symptoms (such as stress, past experiences, and personality traits), perform a physical exam, and then discuss why or why not a diagnosis of TMS makes sense for you. If it does seem like TMS is the correct diagnosis for you, he will then put together the beginning of a treatment plan to get you started. Expect the initial consultation and treatment planning to take about 60 minutes.

Q: How is TMS treated?

A: Recovery from TMS is a two-part process. The first part involves simply recognizing that physical symptoms can have non-physical roots. Again, this is not bad and does not mean that the symptoms are imaginary, being made up, or somehow not real. It only means that the root of the symptoms is in the heart or the mind and not the body. Once this recognition takes place, it opens up a wealth of healing opportunities that don’t have to do with medications or surgery.