Friday, October 17, 2014

Feeling Overwhelmed with Health Related News?

Blog contributed by Melissa M. Brown, Psy.D, PinnacleHealth Psychological Associates

As with any serious event that carries uncertainty it can create stress and lead to worry.  Recently, we have been hearing a lot about the Ebola virus and may have developed a heightened awareness because it has affected several U.S. citizens.  While the United States is not currently experiencing an outbreak, it is important to keep yourself informed; however, at a healthy level.  One of the negative consequences of doing so can lead to feeling overwhelmed by information, excessive worry, or displaying symptoms of stress.  Therefore, it is important to be aware of when too much information is not helping but hurting you.  Some symptoms which may indicate that you are reaching a critical point include: not sleeping, sleeping too much, over or under eating, disengaging from previously enjoyed activities, constant worry or fear that you will contract the illness, excessive thoughts about the virus, unnecessary precautions with you or other family members, dizziness, difficulty focusing or concentrating, or anything else that is a deviation from your normal life functions.

There are numerous things to do to protect your mental health while taking the appropriate measures to inform yourself.  First, limit the amount of media information you are viewing about the virus.  If necessary turn off the television or change the channel. Second, educate yourself about the virus through reputable sources of information such as the: CDC, The WHO and your local hospital. These resources use scientific information which has been demonstrated to be the most accurate at the time and will alleviate any concern about things you have heard that may or may not be true.  Third, take the necessary steps to ensure good mental and physical health.  There are a few things you can do that will reduce your stress and anxiety: exercise regularly, eat a well balanced healthy diet, disengage from the media information, and reach out to family members and trusted support systems.  If you find that your symptoms are becoming increasingly bothersome or interfering with your life on any level, it may be time to seek out professional intervention.  A psychologist or other mental health professional can work with you to alleviate your fears and reduce your symptoms of stress.

Finally, it is important to remember that various professionals are available to provide support and, if necessary, intervention.  They have the training and expertise on what to do if you are experiencing any forms of distress.  Allow these individuals and professional organizations to provide you with accurate information.

Monday, October 13, 2014

Information About Ebola

PinnacleHealth
Infectious Disease Specialist,
John Goldman, MD.
While the Ebola virus continues to cause concern, we should be reassured that the risk for the spread of the infection in the U.S. remains low.

Ebola is transmitted through direct contact with an infected person's blood or body fluids. Ebola is not transmitted through the air or in water. Patients with Ebola are not infectious until they are symptomatic.

Healthcare providers locally and around the country are taking steps to protect our communities. At PinnacleHealth, we are asking patients to inform us of recent travel. We want to know if you have you lived in, visited, or cared for someone who is ill that traveled to one of the following countries within the last three weeks.
  • Democratic Republic of Congo
  • Guinea
  • Liberia
  • Nigeria
  • Senegal
  • Sierra Leone
By knowing this information, we can properly screen those who may have been exposed and begin treatment if needed. A patient with signs and symptoms of Ebola and recent travel to an area where Ebola transmission has been active will be immediately isolated in Standard, Contact and Droplet Precautions.

Early symptoms of Ebola include sudden onset of fever, weakness, muscle pain, headaches and a sore throat, each of which can be easily mistaken early on for other ailments like malaria, typhoid fever and meningitis. It generally takes about 5 to 7 days to develop symptoms. However, symptoms might not appear until two to 21 days after one is infected.  Ebola can cause viral hemorrhagic fever, which can affect multiple organ systems in the body and is often accompanied by bleeding.

While the medical community is working to develop a vaccine, there aren’t specific medications to treat the infection. We are able to offer supportive measures while the body works to heal on its own.  The following basic interventions, when used early, can significantly improve the chances of survival:
  • Providing intravenous fluids (IV)and balancing electrolytes (body salts)
  • Maintaining oxygen status and blood pressure
  • Treating other infections if they occur
It is our strong recommendation that all non-essential travel to West Africa should be avoided. If you are traveling, use common sense infection prevention. Do your best to avoid sick individuals and use good hygiene practices, such as regular hand-washing and hand sanitizer. The CDC offers the following information about travel and Ebola.

Friday, October 10, 2014

Flu Vaccine

Good Hope Family Physicians
Flu Vaccine—our view

Think about this: the people who at highest risk to die from the flu are the very old, the very young, and people with health problems. The reason they have a harder time with flu is because their immune systems don’t work as well as they should. For that same reason, when we vaccinate them for flu, their immune systems don’t make antibodies well either, so the flu vaccine doesn’t work as well for them as it does for healthy people. In the previous year’s flu season, the flu vaccine only had 10% effectiveness in the over-65 population. 10%!! If we could only choose to vaccinate healthy people or high-risk people, we might actually choose the healthy people, because if they don’t get sick, they don’t pass it to the high risk people. Fortunately, we don’t have to make that choice. So if you are low risk, please think about getting flu vaccine to protect your loved ones or others who are at higher risk.

For this reason, this year’s flu vaccine for those over 65 is a stronger vaccine.

“But you can get the flu from the flu vaccine” is a common response.  No, what is actually happening is that when the immune system is asked to really crank up production of antibodies, you can feel “flu-like symptoms” of body aches, fever, fatigue, etc. When these symptoms occur with flu disease or any other infection, it is your body’s immune response to the infection causing these symptoms, not the germ itself. Who knows, maybe having these symptoms is a good thing as your immune system is clearly responding to the vaccine. And having a few days of some aching is much better than being knocked down for a week with flu disease, or worse yet, dying from flu.

It is important that you know what influenza is. It is NOT vomiting and diarrhea, which is referred to as “stomach flu” but is not influenza at all. Influenza is fever, cough, body aches, fatigue (“like you were hit by a truck”), congestion, etc.

“But I’ve never gotten the flu before” is also a common response. The average healthy person gets flu once every 7 years, and it might be a mild case but doesn’t mean you won’t ever get a bad case. Don’t you wear your seatbelt to protect yourself from something bad which hasn’t happened? And if you feel this way, re-read paragraph #1.

There are so many myths about influenza and vaccines in general, which is really sad, because vaccines today are very safe and save lives. But they are a victim of their success; since we use them widely, we don’t see those illnesses very much and we underestimate how useful and important they still are.

Please ask questions if you have further concerns.

The Providers at Good Hope Family Physicians, PinnacleHealth Medical Group


Wednesday, October 8, 2014

Baby Safety Month Topic - “Bare is Best”

Blog contributed by Kathleen
Zimmerman, MD
Pediatrician



When you’re getting ready for new baby to come, it is fun to get the room decorated and looking cozy.  But as cute as those matching bumper pads, baby blankets and stuffed animals look, cozy is not always safe.  In fact, new parents should stick to the motto, “Bare is Best”.

The recommendations for safe sleep has changed a lot over the past few decades.  The Back to Sleep program and recommendations have dramatically reduced Sudden Infant Death Syndrome.  Unfortunately there have been increasing tragic deaths seen from babies being trapped or suffocated by extra items in the crib.  So in addition to sleeping you baby on his back, also be sure to follow these recommendations:

1. Use a firm sleep surface
2. Use only the mattress that came with the crib or playpen, don’t replace it with something else and don’t place something on top (like a pillow or wedge positioner). You should not be able to fit more than 2 fingers between the mattress and the side
3. IF the mattress needs to have a slight angle at the head (30 degrees or less) for congestion or reflux symptoms, then do it from underneath the mattress, not on top
4. It is safest for the baby to sleep in the same room as the parents for the first 4 months.
5. But DON’t put the baby in your bed to sleep.  Parents’ mattresses are often softer and there are bodies and pillows in the bed that can suffocate the baby.
6. No pillow, blankets or bumper pads in the crib.
7. Use a sleep sack to keep your baby warm, not blankets.  Or a swaddle sack or thin blanket swaddled tightly is safe for babies until they start to roll (typically 4 months of age)
8. Keep cords, blind pulls, or other hanging objects away from the crib or playpen in order to avoid possible strangulation

Wednesday, September 17, 2014

What is Enterovirus (EV-D68)?


John Goldman, MD
EV-D68 – What is this and why should we be concerned?
There has been quite a bit of alarming information about Enterovirus (EV-D68) making the news. Several states – including Colorado, Missouri, Kansas, Illinois, Kentucky, Ohio, Oklahoma, Utah and Georgia – have contacted the Centers for Disease Control and Prevention for help investigating clusters of the virus that’s being blamed for the illness.

Here is the 411 from PinnacleHealth Infectious Disease Specialist, John Goldman, MD.

What are Enteroviruses?
Enteroviruses, which bring on symptoms like a very intense cold, aren’t unusual. They’re actually very common. When you have a bad summer cold, often what you have is an enterovirus. There are more than 100 types of enteroviruses causing about 10 to 15 million infections in the United States each year, according to the CDC. They are carried in the intestinal tract and often spread to other parts of the body. The “cold” season often hits its peak in September, as summer ends and fall begins. The good news is that enteroviruses usually aren’t deadly. While children have been hospitalized, no one has died.

How is EV-D68 different?
This virus is causing more respiratory problems than usual in children. Symptoms are starting like the common cold, but then escalating to wheezing and shortness of breath. Children, who already have respiratory issues such as asthma, are at increased risk of becoming sicker with this virus.

What can parents do?
Enteroviruses spread easily so it could be likely that it will make its way here.

  • The best prevention is good hygiene. Properly wash your hands throughout the day. Consider sending your children to school with hand sanitizer.
  • Clean and disinfect surfaces that are regularly touched by different people, such as toys and doorknobs.
  • Avoid shaking hands, kissing, hugging and sharing cups or eating utensils with people who are sick. And stay home if you feel unwell.
  • If you have children with respiratory issues, make sure to have medications, such as inhalers or nebulizers, on hand should they become sick, even if the child has very mild disease and only requires their medications infrequently.

If your child has a cold and begins to wheeze or have shortness of breath, seek medical attention. Use your best parental judgment. If your children are experiencing symptoms, please contact your primary care physician. 

Why aren’t adults getting it?
No one is absolutely sure, but most likely adults have been previously exposed to the virus and have built an immunity to it.

What is the treatment?
There is no antiviral to treat EV-D68. Doctors can offer supportive treatments while the body works to heal itself. Its course is similar to the flu with being very sick for a few days and then fully recovering in a few weeks.

Wednesday, August 13, 2014

Nature Bites!

Having recently moved to a new house near the State Game Lands I was excited to take my nephews and niece out to explore. Being that it was somewhat chilly I had a long sleeves and long pants. I felt I was pretty protected as we were not going deep into the woods, but instead were staying on a trail that we only followed for a couple hundred yards.  When we got back, I sat down saw a tick run across my leg. Yes, I screamed.  I quickly grabbed a paper towel and scooped it up off my pants leg and promptly disposed of it.  At that point I made sure that everybody that went for the walk (including myself) was thoroughly checked for ticks. Luckily we did not find any more ticks, at least not then.

The next afternoon I happened to look down at my leg and noticed an unusual mark. Upon closer inspection I saw that there were little legs sticking out of it and yes they were squirming. I had a tick attached to me- ewwww!!  I used to be a lab tech so not much throws me but this little bloodsucker actively burrowed in my leg did and I needed to get it out ASAP as I couldn't tolerate the thought of it being attached a minute longer! I quickly got tweezers and extracted the entire tick, head and all, from my leg.  Just in case it was needed, I saved the tick in a container.  I then went and washed to bite wound and my hands thoroughly, just as the instructions I found on the internet said.

Having two friends with Lyme disease really made me concerned about my risk. I knew to look for a bull’s eye rash but didn't really know much else. My first thought was that first thing Monday morning I needed to call my primary care physician to see what they would recommend.  From the primary care standpoint I was grateful that I have a relationship with a primary care office and knew that if I called they would be able to help me, which they did.

On Monday morning I called my primary care office, PinnacleHealth Medical Group, Heritage Family Medicine, not really sure what to expect. After explaining the situation the office wanted me to come in evaluate the tick bite and see if there was any follow-up necessary. I was so fortunate in that they were literally able to get me in within a half an hour.

Dr. Metropoulos at Heritage Medical Group in Lemoyne was wonderful and explained the risks of Lyme Disease based on my case and our options for treatment. We both agreed that a prophylactic course of antibiotics would be the best route for me.

I typically spend a lot of time outdoors and thought I was pretty knowledgeable about healthcare. But this tick bite was definitely a learning experience for me.

I had some pretty big questions throughout this experience. Luckily, within PinnacleHealth we have a number of experts including those in the primary care field and infectious diseases. And consulting with Dr. John Goldman with infectious disease he was able to provide me with some great information answers to my questions.

Dr. Goldman recommends the following safety tips for tick bite prevention.
  • Wear long sleeves and long pants
  • Use insect repellent with DEET
  • Change clothes immediately after coming inside your house
  • Wash clothes promptly

Since all the boxes are unpacked and I am certainly not moving anytime soon, I'm going to have to learn how to live in an area where ticks are prevalent.  I've since stocked up on insect repellent, have made a habit of checking myself frequently for ticks and am looking forward to spending time going for more long walks this summer.


Want your questions regarding tick bites and Lyme Disease answered? Join Dr. Goldman on August 20th at the Camp Hill Giant for a free seminar titled Lyme Disease: What You Should Know. There is no cost to attend but registration is required.  Please call 231-8900 to register. 

Monday, August 4, 2014

Ebola Virus – What You Need to Know


 Blog contributed by
Dr. Joseph Cincotta,
primary care physician
The African Ebola Virus outbreak has been one story that has been a prominent part of recent health-related news.  Although not a new problem for the African continent the most recent outbreak has gotten much more attention as concern has grown about the spread of this virus from rural and more isolated communities to more urban settings, and the concern of its spread to even further places across the globe.

The Ebola virus was first recognized in 1976 in Zaire and since that time there have been a number of outbreaks across different African regions.  The infection currently has a very high mortality rate – 57 to 88%, and there is no vaccination to prevent the infection.  In addition, there is currently no specific anti-viral medication treatment program available to combat the infection once it occurs.  Treatment today is focused on what we call ‘supportive measures’ in an effort to give the patient’s own immune system time to overcome the infection.  Unfortunately, these ‘supportive measures’ are not always successful and patients still succumb to the infection.

The virus is spread by direct person-to-person contact.  This may involve direct contact with an infected patient or direct contact with infected body fluids from that patient.  If exposed, it generally takes about 5 to 7 days to develop symptoms but there are cases where it has taken longer than 2 weeks for symptoms to develop.  This raises the concern of the spread of this virus from one geographic area to another, as patients who are infected but who have no symptoms may travel out of a known area of infection and spread the virus.  As populations become more mobile and less isolated the possibility of spread of the infection is higher and requires more attention to efforts to contain the spread of the virus.

Symptoms of the disease usually start with a rather abrupt onset of fever, chills and tiredness.  These are followed by headache and muscle ache, nausea, vomiting, diarrhea, and abdominal pain.  As you will notice, these are very common symptoms for many other infections, and there is nothing specific to indicate an Ebola infection during the early phase.  Thus, the medical team needs to have a high degree of suspicion particularly when working in areas known to be at risk for this infection.  And, for health care workers not in those regions, getting a travel history from patients as part of the routine history when a patient has these symptoms is very important.

Over a period of several days the symptoms often worsen and may involve bleeding from different sites, problems with bruising, and very low blood pressure.

Work is going on to develop a vaccine as well as find medications to treat the infection.  However, efforts to date have been unsuccessful.  For now we need to rely on supportive measures such as IV fluids and nutrition and treating the complications of the disease when they occur.  These measures allow the body time to develop its own antibodies to fight off the infection.

Efforts at prevention involve avoiding travel to areas of known infection , doing your best to avoid sick individuals, and paying attention to good hygiene practices of regular hand-washing.