What to Know About STDs

A major concern I currently see in my practice is the increase rate of STDs I see on a daily basis. Although the average American feels this is a teenage disease the fact is that all ages are affected by this including children and aging adults. With the more education we have on the subject it is assumed that most people know about safe sex. I have found after educating my patients however, that a lot of patients really do not know exactly how common STDs are or the outcome an untreated STD can cause.

HPV is something we hear in the news a lot these days due to cervical cancer and the Gardasil injections. These injections are recommended between the ages of 10-26 for both boys and girls. In some instances there are parents who question the need as the vaccine is still new and they truly do not understand the virus.  What most parents do not know is that 80% of the population in America has some form of HPV.

Certain strains of HPV can cause cervical cancer, esophageal cancer, rectal cancer, or genital warts. All of these strains are transmitted via sexual contact. By receiving the vaccine it can help protect against the 4 most common forms of cervical cancer and genital warts. HPV is a very contagious virus and can be spread easily from person to person including from a parent to child by simple skin to skin contact. It is highly recommended that all children get the vaccine due to the easy transmission and the possible deadly outcome.

Another concern is Gonorrhea and Chlamydia. This is a very common STD that many take in stride since it can be treated with an antibiotic. In recent years however, there has been a recent outbreak of Gonorrhea strains that are resistant to certain forms of antibiotics. This STD can cause pelvic inflammatory disease (PID) in females if untreated. Since the majority of females do not have symptoms the disease spreads into the uterus and fallopian tubes which cause inflammation and infection. This can lead to infertility. Due to the fact this can cause serious reproduction issues for the female and has very little symptoms it is tested on routine pelvic exams for females under 25 who have changed their partner since their last pelvic exam.

Herpes is another virus that can be obtained via sexual contact. This virus can be located almost anywhere on the body and is easily transferred with touch. The virus causes painful eruption of blisters to the affected area. Some of the areas include the genitals, oral sores including inside the mouth, and hands. There is no cure for this type of STD but medication can be used to suppress the symptoms. Pregnant women who have a history of genital herpes will need to make the OB aware as the virus could spread to their child during the birthing process.

Other STDs include HIV, Hepatitis C, Hepatitis B, and syphilis. The best way to prevent most STDs is condom use. If anyone questions if they have a STD they should make an appointment with their provider.

Rachael Youngblood, MSN, CRNP

Cumberland Family Practice, a member of PinnacleHealth Medical Group

The Importance of Yearly Physicals

As a primary care provider one of the most frequent questions I get from patients is “Why do I need to come to the doctor's offce when I don’t feel bad?” My response is that one of the most important things you can do is to see the provider when you are healthy.

The goal of healthcare is not to treat illnesses but to prevent them. Prevention and early intervention is the best way to prevent patients from having diseases that can cause anything from heart disease to cancers.  Yearly tests and screenings help detect diseases that would normally go undiagnosed until the patient develops symptoms.

This is when patients feel they were “healthy” until they went to see the doctor. These are the patients that have not seen a provider for years that are then diagnosed with diabetes, hypertension, high cholesterol, etc.  Had they had physicals, some of these diseases could have been prevented with simple dietary changes.

Currently it is recommended that adults 18 and older get biannual physical exams. Along with the general physical exam at these visits most providers also order screening blood tests that look at cholesterol, thyroid level, and glucose level. Hypertension can also be detected at this time. At age 40 women are encouraged to have mammograms and at age 50 both men and women are encouraged to obtain colonoscopies. These simple screenings can detect certain cancers in early stages which can help prevent an advanced stage that could be life threatening. It is also recommend that women get a Pap test which aids in the detection of cervical cancer.

When health exams are missed and patients make a visit to their provider because they are feeling bad the disease process is already in place. It takes a lot of intervention and time to get the patient back on track. This typically costs the insurance company and patient a lot of money. With the economic times ahead of us, and the ever changing insurance coverage, it is more important now more than ever to see your primary care provider in order to maintain your health and to help prevent costly illnesses in the future.

Rachael Youngblood, MSN, CRNP

Cumberland Family Practice, a member of PinnacleHealth Medical Group

Organ Donation

April is not only the month that we hope finally brings spring weather, but it is also Organ Donor Awareness month! This is the perfect time to remind everyone just how great the need is for organ donation in the United States and how you can help to make a difference.

There are many reasons why people do not agree to be organ donors, including fear, lack of knowledge, or they "just don't think about it." But if someone came to you today, and asked if, just by signing a piece of paper, you were able to save someone's life and leave a lasting legacy yourself; would you feel differently?

By choosing to be an organ donor, you can save up to 8 lives, and enhance the quality of life of up to 75 people! There are more than 115,000 people in need of organ transplants in the United States. Of those, over 6,000 will die each year because a donor is not found. It is important to note that the need is especially high in minority groups. If you choose to be an organ donor, you may be able to donate your heart, kidney, liver, pancreas, intestines, or lungs. You can also donate tissues such as your corneas, heart valves, ligaments, veins, bone and much more. This is why so many people can be affected and helped by your decision to donate! It is also possible to become a living donor. A living individual can donate a kidney, part of the pancreas, part of a lung, part of the liver, or part of the intestine. Healthy persons of a certain age can also donate stem cells, and of course can donate blood and platelets.

There are a few myths that many people still believe that may prevent them from agreeing to organ donation. The first and probably most common, is that not all efforts will be made to save your life if you are a registered organ donor. This is simply not true. Organ donation is not even considered until you are deceased. Secondly, many feel that they will not be able to have an open casket funeral. This is also false. There will be no signs of organ or tissue donation when prepared for burial. People also believe there are extra costs incurred to your family to donate your organs. In reality, all costs for organ removal are handled by the transplant recipient. Lastly, some think that they are not in good enough of health to be an organ donor, or they are too old. However, there are no medical or age restrictions put on organ donors.

So how do you become an organ donor? It's very easy! Visit organdonor.gov, and click on the link "become a donor." It's that simple. You can also choose to have the Organ Donor designation put on your driver's license whenever you visit a Penndot Photo License Center to have your driver's license photo taken. It is also important to be clear in your wishes to your loved ones and family. Although becoming a registered organ donor is a legal document, and your family cannot change a choice that you have made, it is important for your family to know and be comfortable with your decision. This is especially important if you are under 18, as you need parental consent to declare yourself an organ donor. Children and teenagers are in need of organs too!

Eighteen people die every day waiting for an organ. These are people that could easily be your mother, brother, wife, friend or child. With the medical and scientific advancements of today, we would be able to save these people's lives, if the organs were available. Choose to leave a lasting legacy and give the gift of life today! Please visit organdonor.gov for more information. You can also learn more about PinnacleHealth's transplant program at pinnaclehealth.org/transplant.

Bethany Rhoads PA-C

Why Donate Blood

What is the most important thing that you did today? Maybe you took care of your family, tried your best at work (you know we always do at Pinnacle Health!), or helped a friend. Can any of you say that you helped save a life today? And that it took only about an hour of your time? Donating blood is one of the easiest ways to truly make a difference to those who are in need.

More than 44,000 people need blood donations every day! Although science and medical management are advancing, there is NO substitute for blood that is necessary for transfusions and more. The only way to obtain the blood vital to saving people's lives, is from donators just like you. Many people associate the need for blood and transfusions with trauma victims and people who are injured or in accidents. Although this definitely accounts for a percentage of those in need, people who have chronic conditions such as sickle cell anemia or other blood clotting diseases, or who are undergoing chemotherapy treatments for cancer, or who require surgery are in need as well as others.

So now that we've talked about the WHY, let's talk about the WHAT. What is involved in donating blood?
You must first meet a few basic health requirements in order to be eligible. You must be in good health (you are not fighting a cold or feeling poorly that day), are at least 16 years old, and weigh at least 110 lbs. When you arrive at your donation appointment or the blood drive you may participate in, you will be put through a brief medical history, followed by a brief health screening.

You will have your pulse, blood pressure, hemoglobin, and temperature checked. So you basically get a mini-physical for free! Some tips to ensure a smooth donation are to drink extra fluids to maintain adequate hydration, about 16 ounces before the donation, and eat a healthy meal that is not high in fats. You should always try to eat an iron rich diet that includes foods such as leafy vegetables, beans, fish, poultry and red meat. If you have low iron levels in your blood, you will not be able to donate.

After the donation, which only takes about 10 minutes, you will be given a light refreshment and relax for a few minutes. Some centers also give coupons or incentives after you have donated. Eight weeks later you are able to return and do it again!

One single blood donation is separated into four different parts, and is able to help up to 3 people. Think about how many lives you can help save, if you began to donate blood onc e or twice a month now, and continue as you are able. If you have more in depth questions about whether you are able to donate, visit redcrossblood.org, americanblood.org or ask your health care provider.

You can also call the Pinnacle Health blood bank at (717)-782-5723, for more information or to make an appointment. Our blood bank is located in the Alex Grass Medical Sciences Building, on the corner of Second and Chestnut Streets. Someone in the United States needs blood every 2 seconds! That's about 60 people just in the time it took you to read this.

You can make a difference today!

Chronic Kidney Disease

In primary care, we talk to patients about a wide variety of topics. From diabetes to knee pain, we cover it all. But, what we don’t seem to talk much about is chronic kidney disease, or CKD. I can say this because every time I meet a new patient and bring it up, I’m stared at and inevitably asked, “what are you talking about?” “No one has ever told me that,” they tell me. Here is a summary of the conversation that follows.

Chronic kidney disease is simply a condition that many people have in which the kidney doesn’t filter as well as it did or could. The kidney has many functions, but most importantly it filters the blood of toxins or excess electrolytes, like potassium and calcium. Some people develop chronic kidney disease sooner than others. High blood pressure and diabetes are two of the most common conditions that cause people to develop chronic kidney disease. Chronic kidney disease is measured in stages, I-V. The higher the number, the more severe the disease is. Most people never “feel” chronic kidney disease. In all likelihood, you wouldn’t even know you had it without blood work. But, it plays a role in many decisions I make in your health.

 Many medications are filtered out of the body through the  kidneys.  This means that when you have chronic kidney disease, some medications are dosed differently or even prohibited entirely. Over the counter medications such as ibuprofen(Advil or Motrin) or naproxen (Aleve) are harmful to people with chronic kidney disease, especially if used frequently. Unfortunately, many people who have chronic kidney disease also have arthritis or chronic pain. In those cases, medications like acetaminophen(Tylenol) or prescription pain medications may be more appropriate long-term choices. Some natural herb products or supplements, such as St. John’s wort, ginkgo or ones high in potassium or magnesium, need to be monitored or avoided in chronic kidney disease. Medications as basic as antibiotics can require kidney function  adjustment, so it’s very important to work with your doctor and know your kidney function.

Chronic kidney disease can also cause changes in the body, such as anemia or bone disease. The kidneys secrete a hormone that stimulates bone marrow to produce blood cells. If the hormone is not secreted adequately, anemia may develop. The kidneys also help the body use calcium and vitamin D properly. Without the full function of the kidneys, people may develop bone disease, such as osteoporosis.

Well, given all of this information, what can you do to prevent it? By far and away the most important things a person can do is regulate blood sugar and pressure. Blood pressure should be checked often and diet should be built around the DASH diet, a nationally recognized low blood pressure diet. Many resources for this diet are available online. Low sodium is key. Like I tell my patients: wherever salt goes, water follows.

The more salt, the higher the blood pressure. High sugar also damages the kidney. If you are overweight, or have  family history of diabetes, it’s important to have blood sugar checked. The DASH diet is also a good resource for sugar control. Simple sugars are to be avoided. Medications like I discussed are also to be used sparingly. Follow these guidelines, work with your doctor and you will be successful in preventing chronic kidney disease.


Andrew Eckert, D.O.
Dillsburg FamilyCare

Eating Healthy When You Eat Out

You are trying to eat healthy. You have it under control when you are at home or work, for the most part. You control the ingredients that go into your food. But what happens when you go out to eat? Do you know how many calories you are consuming? You want to enjoy an evening out without ruining the diet! Don't panic!

Here are some helpful tips to keep the diet in check while having someone else cook for you:

1. If possible, decide where you want to eat ahead of time so you can look up the menu. Sometimes, we are nearly salivating by the time the waiter says, "And what would you like tonight?" that we impulsively blurt out, "loaded nachos to start, cowboy burger with extra bacon and cheddar cheese...no please don't hold the fries..." or something like that. Impulsive ordering gets us in trouble. Have a plan; decide ahead of time if able.

2. Eat a nutritious snack or drink a large glass of water before going to the restaurant. Just as you tend to spend more if you go to the grocery store hungry, you tend to eat more if you go to a restaurant too hungry.

3. I make it a habit to always order water. Drinks can contain many empty calories, especially alcohol. If you really must order a drink besides water, don't forget to mentally note that there are calories in that drink!

4. Ask the waiter to hold the freebies...you know...those carb-loaded little numbers that stare us in the face while we wait for our food, until suddenly that overflowing bread basket is just a basket. If you particularly enjoy bread, or whatever other food item is being served, take a small portion and then ask the waiter to remove the basket.

5. Red sauces over white sauces. Baked/broiled/grilled over fried/breaded. Broth-based soups over cream-based soups. Oil dressings over sweet or creamy dressings. Often you can ask that grilled chicken (or fish) be used instead of the fried chicken they are offering on the menu in a certain dish.

6. Portion sizes are out of control at restaurants. The fancier restaurants with the teeny tiny portions are really on to something. At most places, it is simply too much food. You shouldn't be leaving the restaurant feeling like you need to unbutton your pants or suck in your gut. We really need to learn the feeling of being satisfied. This is different than "full." Either find someone to split the meal with you, or ask that half of the meal be put in a to-go container before it even comes out to you. You just got two meals out of one! Even if you can't possibly stop after a half portion, resist the urge to lick your plate clean. There is nothing wrong with stopping shy of complete and packing up a few bites to-go.

7. Carefully choose your sides. Vegetables are your lowest calorie choice. Sweet potato over white potato, without the brown sugar topping.

8. Ask for all dressings, sauces, butter, oil on the side if possible.

9. A salad is a good choice for a starter. An appetizer is usually as big as a meal should be, so forgo the appetizer, split it, or get it for your meal.

10. If you must splurge, choose an area you want to splurge in. Is the main dish most important to you? Or the appetizer? Or maybe you can't resist dessert? Or you really want that high-calorie drink? Choose one of these areas to splurge in and make sure the rest of your meal is healthy.

11. If you really need that sweet ending to your meal, split a dessert. Better yet, get one dessert for a group. Then you can each have your 1-2 bites and still get that delicious ending to your evening, without breaking the (calorie) bank.

12. If you aren't quite ready to leave the restaurant, don't get dessert simply to justify more time, order a coffee or tea and sip until you are ready to go.

Finally, if you really blow it at dinner, don't give up on your diet. Set tangible goals for the next time someone else is doing the cooking!

Jenna Henault, PA-C
FamilyCare Middletown

Seasonal Affective Disorder (SAD)

Many people experience feeling down when the weather is cold and overcast but some people experience more significant symptoms when the winter months arrive. This condition is a form of depression called Seasonal Affective Disorder or SAD. Most people with SAD have symptoms that begin in the fall and resolve in the spring. The exact months can vary with the individual.

Common symptoms of SAD include:
- Sleeping more than usual
- Eating more than usual especially craving starchy foods
- Irritability
- Difficulty with relationships, especially feeling like they are being rejected
- Feeling sluggish, as though their arms and legs are weighted down

While everyone may experience some of these symptoms occasionally, people with SAD will experience them most days of the week for many weeks in a row. If you feel you may be experiencing these symptoms most days of the week you should make an appointment with your primary care provider to discuss the problem.

The good news is that Seasonal Affective Disorder is very treatable. Many people will respond well to treatment with antidepressant medication. Often the medication is started in the fall and discontinued in the spring but some people will take medication year round. There are many types of antidepressants that work in different ways. If you try a medication and experience problems or it doesn’t work, there are others to try.  Your primary care provider will make recommendations based on your individual circumstances.

Another treatment option for SAD is light therapy. This is the use of exposure to bright light of a specific intensity for a prescribed period of time each day. Normal light fixtures are not able to produce the intensity of light needed for this treatment so a special light must be purchased. Often this type of light fixture is not covered by insurance so if your provider has recommended this type of treatment you should check with your insurance regarding coverage. Light therapy is attractive to many people because it doesn’t involve a drug; however it is important to realize this therapy will involve a commitment of time each day. Most people using light therapy require 30-60 minutes of treatment every day. You should talk with your primary care provider about whether this type of time commitment will be realistic for you.  Side effects of light therapy can include headache, irritability, insomnia, and fatigue. These can often be managed by changing the length of time or time of day of the light therapy.

A small number of people experience seasonal changes in mood that begin in the spring and go away in the fall and some people being treated for Major Depression will experience some seasonal variation in their symptoms. These are special circumstances that you should discuss with your primary care provider.

Beverley Uniacke, MD

Dillsburg FamilyCare, a member of PinnacleHealth Medical Group