Influenza Cases On the Rise in Pennsylvania

 Blog contributed by Dr. Joseph Cincotta, primary care physician

Flu season has arrived!!  And, there is still time for you to get your annual Flu Vaccine.

Pennsylvania is experiencing a rising number of cases of acute influenza, most of which is due to the H1N1 virus strain – a strain that is in this year’s influenza vaccine. So, if you get vaccinated timely you should have increased protection from getting ‘The Flu’.

Why are we so concerned about this infection?  Acute Influenza is NOT the same as getting ‘a bad cold’.  Acute Influenza can be a deadly disease – even for otherwise healthy individuals.  Comments like ‘I usually don’t get sick’, or ‘This will never happen to me’, or ‘The risk of a flu shot is more than the risk of me getting sick from the flu’ are examples of comments I have had from patients who decline an annual flu shot.  And, each of these comments leaves those patients who decline the opportunity to get immunized vulnerable to a deadly infection.  So, first and foremost – GET VACCINATED – AND DO IT TODAY.

Other ways to reduce your risk of getting Influenza include:

• Avoid crowded areas
• Wash your hands regularly, or use an alcohol based hand cleanser, regularly
• Cover your mouth if you are coughing or sneezing – the Flu virus is spread by microscopic droplets when people cough or sneeze
• If you are sick, stay home – do not expose others to your illness

Influenza (or ‘The Flu’) is characterized by the rapid onset of a number of symptoms that may be severe. People who get ‘the flu’ often tell us they were fine in the morning but by the afternoon they felt terrible and had developed a number of the symptoms detailed blow.  Flu generally does not come on slowly over the course of a couple of days.  Symptoms include:

• Fever (which often can be quite high)
• Headache (which often can be severe)
• Muscle/body aching (which often is severe)
• Runny or congested nose
• Sore Throat
• Cough
• Vomiting and/or diarrhea (not as common as the other symptoms and less common in adults with the flu)

If you feel you have ‘The Flu’, please contact your primary care physician’s office for additional recommendations.  You may be asked to go to the office for an evaluation, particularly if you have other chronic illnesses, such as COPD, emphysema, asthma, heart disease, diabetes, or chronic kidney disease. Depending on your particular situation you may be eligible for an antiviral medication to help treat the flu. Other measures you can take to help treat some of your symptoms include:

• Rest
• Maintain a good fluid intake
• Acetaminophen for the fever and aching (as long as you may take this medication)

Here are some warning signs that the illness may be more severe and may require the assistance of your primary care provider for treatment (these are taken from the Centers for Disease Control and Prevention website):

What are the emergency warning signs?

In children

• Fast breathing or trouble breathing
• Bluish skin color
• Not drinking enough fluids
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough
• Fever with a rash

In addition to the signs above, get medical help right away for any infant who has any of these signs:
Being unable to eat

• Has trouble breathing
• Has no tears when crying
• Significantly fewer wet diapers than normal

In adults

• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms that improve but then return with fever and worse cough

Influenza season is here once again – and we all can take steps to reduce our risk of this serious illness.

Follow the steps outlined above – and, most of all please get your Flu Vaccine, if you have not already done so.  Thank you.

Oh, My Aching Back!

Blog contributed by Jamie Weeder, CRNP

Lower back pain is one of the most common problems seen by health care providers. Most individuals will experience back pain that interferes with their normal daily activities, such as work or recreation, during their lifetime. Luckily, most episodes of back pain resolve within a few days.

Back pain can be considered acute or chronic depending on the duration. Acute lower back pain can last from days to weeks while chronic pain persists beyond 3 months. Chronic back pain often worsens over time, is related to many factors, and can be difficult to treat. The focus of this blog will be to discuss acute lower back pain which is often caused by injury or trauma. The article will discuss conservative management and when to see a health care provider.

Acute lower back pain is often caused by sudden injury or trauma which results in irritation of the muscles, ligaments, or nerves within the back. Often actions as simple as lifting heavy objects or twisting to the side can cause lower back pain. Learning proper body mechanics, such as maintaining a correct posture and lifting objects correctly, would prevent back pain for most individuals.

Symptoms of lower back pain may range from muscle aches to a shooting or stabbing pain. Muscle spasms are often a common symptom. Individuals may also experience decreased back range of motion or flexibility. In some cases, individuals are unable to stand upright due to the pain. Some symptoms are considered “alarms” which if experienced individuals should promptly contact their health care provider. Symptoms that suggest a serious medical condition include back pain accompanied by leg weakness, leg numbness, fever, pain with coughing, or loss of bowel/bladder.  

Most, uncomplicated cases of acute lower back pain can be treated conservatively at home. With self-treatment at home, if there is not a reduction in symptoms within 72 hours individuals should contact their health care provider.

The application of cold compresses after an injury/trauma can aid in reducing pain and inflammation. Cold therapy can be used multiple times throughout the day with application of an ice pack or frozen towel for up to 20 minutes. After the first 48 hours after an injury, heat should be applied to relax the muscles and promote blood flow to the area. Hot packs, heating pads, or warm baths can be used, but individuals should be careful not to burn their skin.

While many individuals believe bed rest is needed to treat back pain, this is incorrect. Resting should be limited as immobility can lead to increased pain and decreased muscle strength and flexibility. Individuals should resume their normal daily activities as soon as possible. Routine exercise and stretching has also been found to speed recovery and prevent back injuries as exercising promotes muscle strengthening, good posture, and coordination/balance. 

There are many over-the-counter medications that can be used to treat acute lower back pain. Individuals should always check with their health care provider before taking any medications. Medications that are sold over-the-counter can cause various side effects and may interact with prescription medications. One class of over-the-counter medication that can be taken to reduce pain, stiffness, inflammation, and swelling is non-steroidal anti-inflammatories (NSAIDs). These medications include: aspirin, ibuprofen/Advil, and naproxen/Aleve. Topical sprays and creams (IcyHot or Bengay) are also available over-the-counter which can be applied to the back to dull pain and decrease inflammation.

Massage, acupuncture, and spine manipulation (chiropractor or physical therapist) have also been found to help treat acute lower back pain. Individuals should seek licensed professionals to perform these types of treatments to prevent complications.


Individuals that do not respond to conservative therapy or experience alarm symptoms should contact their health care provider. The health care provider will obtain a history by asking various questions and perform a physical assessment to determine the best treatment method. He/she may also order diagnostic tests to determine the cause of the symptoms. For individuals that are prone to episodes of acute lower back pain, a health care provider can educate patients on exercises and methods to prevent back injury and promote a healthy back.

Pertussis

Contributed by  Betsey Miller, CRNP, PinnacleHealth Medical Group

I was lying awake, listening to my son cough – again. How many nights had it been?  I was trying to count them up in my head and remember when his cough had first started.  Had it been two weeks or three? My thoughts were interrupted by another coughing fit.  I went in to check on him.   He was sitting up now, gasping for air in between fits of coughing.  Tomorrow, I promised myself.  Tomorrow I would call for an appointment. 

When it comes to my kids, I’m a mother first.  But I’m also a family nurse practitioner.  And as I settled us both back to bed that night the list of possible diagnoses were running through my head.  As I thought about his coughing fits and the length of time he’d been coughing, I couldn’t help but consider pertussis as a possibility.

Pertussis, also known as whooping cough, is a highly contagious illness, characterized by severe coughing fits that can last for weeks.  It can be hard to detect initially, because its early symptoms are not unlike those of a common cold – runny nose, mild cough, low grade fever.  But as the disease progresses the coughing fits become more pronounced.  And the cough can last for up to 10 weeks!

Pertussis has made a resurgence in the last few years.  There are a number of reasons behind this, but the driving force has been a decreased immunity in our overall population.  Our children get immunized against pertussis as part of their routine immunization series as babies, but it is a series of immunizations, and they are not considered to be fully protected until they have completed the series at age 5.  Even then, no immunization is considered 100% perfect. However, studies have shown that immunization lessens the spread of the illness significantly.  Additionally, persons who become infected who were previously immunized have shorter courses of illness and do not become as sick.  

Because adults are more likely to transmit the illness, and because infants are the most susceptible, it is recommended that all caregivers of infants be updated with a Tdap vaccine.  Pregnant women are often offered this vaccine in their third trimester, or in the hospital shortly after delivery.  But other caregivers including fathers and grandparents should consider getting immunized too.  Pertussis infection in an infant can truly be a life threatening situation. 

As an adult, if you’re due for a tetanus shot, you should check to see if you need a pertussis booster.  If so, instead of getting just a plain tetanus shot (Td), you should consider getting an injection with pertussis (Tdap).  Remember, this will not only help to protect you from getting whooping cough, but it will also protect those around you. 

As for my son, I did take him to his primary care provider the following day.  He had a culture for pertussis, but thankfully it came back negative.  A chest xray showed pneumonia, but after a short course of antibiotics, he’s no longer coughing and is back to his old self!

Benefits of Yoga

Blog contributed by Bethany Rhoads PA-C, Camp Hill Evening Care

It seems that if anything has been practiced and has lasted for more than 5,000 years, then there must be good reason for it.  Yoga is one such tradition. As a health care practitioner, I encourage yoga to my patients for many reasons, the first one being that almost anyone can do it!  There are many different types of yoga that make it suitable for almost anyone. The most general concept and purpose of yoga is to “bring mind and body together.”  Mental health is just as important as physical health, and I believe this frequently gets overlooked in our society.  We are so busy with our jobs, raising our families, and trying to squeeze in exercise that often stress management and our mental clarity gets pushed to the wayside. The three main components of yoga are breathing, meditation and exercise. As mentioned, there are multiple types of yoga, but the one most commonly practiced in the US is hatha yoga. 

There are many benefits of practicing yoga.  Medically, yoga has been proven to reduce the pain and improve the activities of daily living associated with chronic pain, decrease blood pressure and heart rate, and also improve symptoms of anxiety and depression. There are approximately 100 million American adults that suffer from chronic pain, 67 million with high blood pressure, and 54 million with anxiety/depression disorders.  This means that up to 200 million Americans , or about 60% of our population, could possibly benefit from incorporating the practice of yoga into their lives!

The best way to introduce yourself to yoga is to visit a studio in your area and attend a class.  You can also follow an introductory DVD or even catch it onDemand if you have cable.  As was mentioned, yoga is suitable for ALMOST anyone.  Pregnant women or people with other concerning health conditions should talk to their primary care provider before beginning such an exercise regimen.  However, keep in mind the breathing techniques and meditation that go along with the physical component of yoga can always be done by itself and still have health benefits!

I will leave you with the greeting that typically begins and ends  a yoga class- “Namaste.”  This translates to “I bow to you.”  So, Namaste, and I hope I have encouraged you to try yoga soon!

 Sources: National Center for Complementary and Alternative Medicine

American Yoga Association

Center for Disease Control and Prevention

Trusting Your Gut--Should You Be Taking Probiotics?

Blog contributed by Bethany Rhoads PA-C, Camp Hill Evening Care

Sometimes it may seem like there is always a new healthcare product or trend hitting the market and gaining awareness that you may begin to wonder if it is something you should be taking or using. One that seems to be getting some attention in the media and pharmacy aisle right now is probiotic supplements.  For example, I am sure we have all seen Jamie Lee Curtis advertising "Activia" on many TV commercials.  It can be very confusing to navigate around these products and verify health claims to figure out what is best for you and your particular health concern or situation.

The concept of probiotics has actually been around for quite some time, since the early 20th century.  The term "probiotics" actually means "for life" and describes live microorganisms (such as bacteria or yeast) that can work beneficially to your health when ingested. Most commonly you will see formulations containing Lactobacillus and Bifidobacterium. Research has shown that probiotics may work by restoring the delicate balance of the environment of our gastrointestinal (GI) tract, by reducing harmful organisms and stimulating your body's immune response.  To understand this, you must first realize that we all contain a certain makeup of healthy bacteria within our body and our GI system that is present since birth.  When this environment gets disrupted, such as with antibiotic over usage, GI and other health problems can occur.

So what are the recommendations regarding probiotic usage? Unfortunately, as with many things in medicine, the guidelines are not clear cut.  There is still research being done to confirm in which situations or diseases probiotic supplementation may be most beneficial, and at what dosage and which specific product or formulation.  Most commonly, probiotics are used in conjunction with treatments for antibiotic associated diarrhea (AAD), infectious diarrhea, irritable bowel syndrome, and some inflammatory bowel disorders such as Crohns disease or Ulcerative Colitis.  The possible benefits and side effects with the latter diseases are a little more complicated, and should be talked about with your healthcare provider if you have further questions.

However, research has shown with strong evidence that probiotics can be beneficial in the prevention/treatment of acute diarrhea and AAD. They have been shown to shorten the duration of symptoms in infectious diarrhea, and prevent the symptoms when administered for the same length of the antibiotic therapy.  There are many different products available over-the-counter, such as powders, capsules, fortified drinks or yogurts. You should realize that these supplements are not regulated by the FDA; and therefore, can differ quite a bit from one product to another. The usage of probiotics seems to be generally safe in the outpatient setting, but may not be with certain immune disorders or infections. The best way to decide if probiotic supplementation, and which product, is right for you is to talk to your health care provider! If you are prescribed an antibiotic or are suffering from acute diarrhea, ask your physician or mid-level provider if they think a probiotic would be beneficial. The best way to "trust your gut" is to trust the advice of your healthcare professional, so make sure you have found a PinnacleHealth primary care provider with whom you can have an open and confident relationship.  This is important for all aspects of your health!

Sources:NIH "Oral Probiotics: An Introduction"Therapeutic Advances in Gastroenterology "Use of probiotics: what to recommend?"

Is My Child Overweight?

Blog contributed by Kathleen Zimmerman, MD,  Pediatrician

It’s no secret that childhood obesity is an epidemic in the US.  About 1 in every 3 American children is overweight.  Ask your medical provider what your child’s body mass index (BMI) is and where it fits on the normal growth curve.  If your child’s BMI is >95%ile, then your child is overweight.  In this case, your child would be more likely to develop adult type diseases such as high cholesterol, high blood pressure and type II diabetes in their early teen or even pre-teen years.

What can you do to keep your child’s weight healthy?  Here are four simple tips:

1. Make sure your child has healthy food choices at home.  Do not keep junk food or soda in your house.  It is too tempting for everyone and introduces bad habits that are more difficult to break later on. 
2. Avoid all sugary drinks, EVEN JUICE.  Don’t be fooled.  Juices have as much or even more sugar than soda, even if the label says “all natural” or “no added sugar”.  Your child’s drinks should be mostly water and 3 cups of milk (for calcium and vitamin D).
3. Do not eat fast food more than one time per month.  I know this is difficult with busy schedules, but even making a quick sandwich at home is a much healthier option and just as fast.
4. Make sure your child exercises for at least an hour every day.  This can be an organized activity or playing outside, as long as their heart rate is up.  This is not only good for their body, but also good for their mind!

Preventing Shingles Through Vaccination

Blog contributed by Jamie Weeder, CRNP

Most of us have seen the commercials, the ones with the painful, blistering rash that burns like fire. Through personal experience, I can vouch that shingles is a horrible experience that is unlike any pain that I have ever experienced. I wanted to share my experience with individuals and use it to teach about shingles and the recommendations for vaccination.

What is shingles?
Shingles, also known as herpes zoster, is a painful rash that develops on one side of your face or body. Shingles is caused by the same virus that causes chicken pox, the varicella zoster virus. After a person has chickenpox, the virus becomes inactive (dormant) along a nerve route inside their body. The virus becomes reactivated many years later due to a decreased immune system caused by illness, medications, or stress.

Everyone that has had chickenpox is at risk for developing shingles. According to the Centers for Disease Control and Prevention (CDC), nearly 1 out of every 3 people in the United States will develop shingles. The risk for shingles increases with age and approximately 50% of shingles cases occur in people age 60 and older.

What are the signs and symptoms of shingles?

This past August on a Friday afternoon, I developed a painful aching along the right side of my jaw. I didn't think anything of the pain at the time, but the next day I realized something was wrong. The pain was getting worse and I had a red sore inside the right side of my mouth where the pain was coming from. I started to feel feverish and sick to my stomach. The pain was becoming more intense and felt like it was shooting from my jaw and into my right ear. I would like to believe that I have a good pain tolerance, but I must admit that the pain brought tears to my eyes and I would spend the next few days with an ice pack on my face to numb the pain.

Symptoms of shingles include a painful, itchy, blistering rash that presents as a band or stripe on one side of the face or body. The symptoms of pain and itching can occur between 1 and 5 days before the rash develops. In addition to the rash, people can develop fevers, chills, headaches, and nausea.

Due to my symptoms and developing more red spots inside my mouth that traveled along a line, I was started on antivirals and medication to help control the pain. A few days later the pain began to subside. Because of my age and the odd location of my rash (most rashes occur on the skin), blood work was done that confirmed that I had shingles. I remained on medication for approximately 3 weeks until the pain and rash completely resolved.

Shingles usually clears up within 2 to 4 weeks, but early treatment can help control the symptoms and resolve the disease faster. If you believe that you have shingles, contact your healthcare professional immediately as starting antivirals within 48 to 72 hours of developing the symptoms can shorten the length and severity of shingles. Early treatment can also help prevent chronic complications, such as postherpetic neuralgia which is severe pain along the rash that can last for months after the shingles rash resolves. The risk for postherpetic neuralgia increase in people over the age of 60 that are not treated for shingles.

Although rare, more serious complications of shingles include: pneumonia, hearing loss, vision loss, brain inflammation, or death depending on the severity and location where the virus activates.

How do you prevent shingles?

The only way to reduce the risk of getting shingles and postherpetic neuralgia is by getting vaccinated. Zostavax is the vaccine for shingles that the CDC recommends for individuals aged 60 and older regardless of whether they remember getting chickenpox.

Studies have shown that the risk of developing shingles after vaccination decreased by 50% and those who developed shingles had decreased severity and duration of symptoms. The U.S. Food and Drug Administration (FDA) has stated that the shingles vaccine was also effective in individuals between ages 50 and 59. If you are between the age of 50 and 59 and are interested in getting the shingles vaccine, you should speak with your healthcare professional. At this time, the shingles vaccine is not suggested for people younger than age 50 because more studies need to be completed.

Most individuals that have shingles will not develop the rash a second time, although it is possible to get shingles multiple times. Individuals that have had shingles can still get the shingles vaccine.

What are the side effects to the shingles vaccine?

The most common side effects of the Zostavax vaccine include headache and injection-site reactions. The vaccine in injected under the skin, usually on the upper arm. Possible injection-site reactions include redness, soreness, swelling, and itching. Some people may develop a chickenpox-like rash at the injection-site.

People that are allergic to neomycin should not receive the vaccine. The shingles vaccine is a live virus and should not be given to people with a weakened immune system such as those with HIV/AIDS, people taking medications to weaken their immune system such as steroids, and people receiving treatment for cancer. The shingles vaccine should not be given to women who are pregnant or may be pregnant.

It is safe to be around infants, pregnant women, and people with a weakened immune system after receiving the shingles vaccine.

How much does the shingles vaccine cost?

The cost of the shingles vaccine varies depending on your health insurance. While all Medicare Part D plans cover the vaccine, the amount that each individual pays varies. Medicare Part B does not cover the vaccine and Medicaid coverage varies. Most private health insurance plans cover the vaccine for individuals aged 60 years and older. Some private insurance plans provide coverage for individuals aged 50 to 59. For individuals that cannot afford the shingles vaccine, there are assistance programs available to make the vaccine more affordable.

Making Your Decision

As healthcare professionals, we want to provide you with education and your options for disease prevention and treatment. Deciding to get vaccinated is a personal decision that you should discuss with your healthcare provider. Due to my experience, I plan to get vaccinated when I reach the recommended age. If you have additional questions, speak with your healthcare provider or leave a comment below.

Does my child have allergies or a cold?

Blog contributed by Kathleen Zimmerman, MD,  Pediatrician

Does your child have a constant runny or stuffy nose?  Or have you ever thought, “my child seems to always have a cold”?  It is possible that your child may actually have allergic rhinitis.  Allergic rhinitis is also called “hay fever”, although that name is misleading because there is no fever involved.

Allergic rhinitis is very common.  It affects 1 out of every 5 people in the U.S.  Allergic rhinitis happens when your immune system overreacts to a substance in the environment, such as tree or grass pollen, animal dander, or indoor particles of dust.  This causes a release of histamines in the body.  Histamines produce the typical symptoms of allergic rhinitis, such as:  stuffy nose, runny nose, sneezing, and itching of the eyes, nose, ears, and/or mouth.  Don’t be confused – these symptoms are very similar to what is seen with a cold. However, colds are caused by a virus and should only last 10-14 days.  Allergies can last many weeks to months and tend to occur around certain triggers in the environment or during certain times of the year.

If you are concerned your child may have allergic rhinitis, discuss it with your child’s medical provider.  He or she may recommend a trial of an over the counter medication, such as an antihistamine, which can help block the symptoms discussed above.   Or they may recommend a blood or skin test to determine what, if anything, your child may be allergic to.  Often avoidance of the allergy trigger is the most important step in reducing allergic rhinitis symptoms.

For more information visit primary.pinnaclehealth.org

How Your Smartphone Can Help You Lose Weight

Contributed by  Betsey Miller, CRNP, PinnacleHealth Medical Group

Think about the things you do every day with your Smart phone…you might update your Facebook status, text a friend, check the score of the ballgame, play Words with Friends, check the latest headlines or check the weather forecast.   The truth is, the possibilities are endless.  But did y
ou know your Smartphone can help you lose weight?   It’s true – “there’s an app for that.”  In fact, your smartphone is the perfect tool to help you get the weight off and keep it off.  There are many great (and free!)  apps to get you started on your weight loss journey.

According to a study published by the Archives of Internal Medicine (December, 2012),  people who used a structured weight loss program via mobile technology (such as smart phone apps) to monitor their daily food intake, weight and physical activity lost an average of 9 pounds more  than people who didn’t use the technology.  And those who continued to use the technology maintained significant weight loss 12 months later. 

While there are probably many more great weight loss apps available, the three that I’m the most familiar with and that I recommend to my patients are MyFitnessPal, Sparkpeople and Lose It!   All three of these apps are completely free and do essentially the same thing.  They allow you to track your dietary intake, track your weight and log your exercise, and all of them make it super simple. 
  
Diets don’t work.  If you go “on” a diet, eventually you’ll go “off” the diet.  And when you do, you’ll go right back to the same old habits and gain back any weight that you lost.  There are so many “quick fix,” gimmick diets out there – the no carb diet, the cabbage soup diet, the grapefruit diet…the list goes on and on.  Let’s say, for example, that your favorite food is pizza, but you’re on a restrictive diet that doesn’t allow pizza.  What happens when you DO give in and eat pizza?  You might feel like a failure and quit.  Wouldn’t it make more sense to eat sensibly?  Couldn’t you still eat the things that you like if you eat less of them?  But how much is too much?

That’s why these apps are so great.  They function as a digitalized food log.  You enter what you eat and how much, and the app calculates the calories for you.  Many things are preprogramed, so there’s very little data entry.  Some apps even have the ability to scan a barcode on your food item to enter it that way.  Want to know how many carbs or how much fat you’ve eaten so far today?  The app will break that down for you too.  In essence, you can still eat the foods that you enjoy eating within the confines of a balanced, healthy diet. 

I often challenge my patients to pick an app, and stick with it for a minimum of four weeks.  I challenge them to enter every single food they put in their mouth for that amount of time.  What I love about this is that it gets people thinking about what they’re eating, it keeps them accountable, it gets them looking at food labels and thinking about serving sizes, and it helps them realize how much they should be eating.  After four weeks, new habits are established and it’s easy to keep going.

Local, Coupons, Tailored for YOU

These apps also allow you to enter your exercise activities and can account for any calories you burn.  You can enter your weight as often as you like and follow your trends as the weight comes off.  You can even link up with friends to keep each other motivated! 

And now, Pinnacle Health has added a new mobile app to help you make healthy decisions when you’re eating out.  Check out The Health Hub of Central PA -- an easy, convenient, and free smartphone app that helps you find healthy restaurants and fitness centers in the Central PA area. The app is designed to be completely personalized to your preferences. You can base your search on your specific diet and exercise preferences. You can view location hours, get directions, and receive a special coupon code for making your healthy choice!

Losing weight is still hard work.  There is no “quick fix.”  But now, smartphones allow us to have a personal coach in our pocket 24/7, and this does make losing weight a little easier and a lot more fun!

 

More Does Not Always Mean Better

Joseph A. Cincotta, MD

 Blog contributed by Dr. Joseph Cincotta, primary care physician

I grew up during a period when more or bigger seemed to mean better.  But, I have learned over time that this is not always true.  In fact, there are many examples of when more or bigger is harmful.  And, there are many examples in medicine when less is better and safer and healthier.  Unfortunately, this is a hard lesson to learn and it takes time to be embraced on a bigger scale in our community, our region, our state, and even our nation.

In the work I do it is not uncommon to be asked about the use of antibiotics or tests or procedures.  I need to work in partnership with my patients to find the best path when it comes to the use of medications, tests, and procedures.  Those decisions need to be based on a number of factors, one of which is what the accumulated evidence from carefully designed studies show about the effectiveness of medicines, tests, and procedures.  It is only through this type of critical and unbiased work that we will truly learn the benefits and risks of many different treatment interventions.  And, sometimes the evidence shows that NOT taking a medicine or doing a test or procedure is the BEST approach. 

An offshoot of this work is that we sometimes find we seek solutions in medicines or procedures instead of changing lifestyle habits and practices.  We are all inundated with commercials or information on the latest drug or test or procedure and encouraged to ‘talk with your provider’ to get this medicine or test or procedure.  And, many times the solution is not just in the medicine or procedure, but rather also in making some personal decisions for change.  This may mean a better diet, or some time to relax and meditate, or time to exercise, or a host of other healthy lifestyle changes that make a difference, do not cost anything, and have no bad side effects. 

So, the next time you start thinking that more is better, stop and understand that may not be the case.  Work with your primary care provider to find a path to better health based on evidence and a shared conversation about what is best for you.  You may find that it is less expensive, carries less risk for side effects, and helps you in ways beyond your immediate problem or concern.  We want to work with you as an active member of our health team to help you find the best path to health.  

For more information visit primary.pinnaclehealth.org

Heart Burn or Heart Attack?

Blog brought to you by  Make A Date Every 8 

“I feel my temperature rising
Help me, I'm flaming
I must be a hundred and nine
Burning, burning, burning
And nothing can cool me
I just might turn into smoke” - Elvis Presley, Burning Love

If you find yourself channeling Elvis Presley and you are feeling your temperature rising, and you are flaming, burning and nothing can cool you, and its not because of a significant other, you may be feeling heartburn.  Most people find heartburn to be a common annoyance, not a serious health issue. But increasingly heartburn can be an indicator of a serious health issue such as a heart attack or even cancer.  So how do you tell the difference between cardiac problems, cancer problems or just that bowl of chili you ate?

PinnacleHealth Medical Group physician Jessica Rubertone, MD explains what heartburn is.  “Gastroesophageal reflux disease, otherwise known as "GERD," is a very common problem in the Western world. Heartburn happens when stomach acid travels up the esophagus and causes irritation. Heartburn is a very common symptom of GERD, and can feel like a burning in the chest or throat. A sour or bitter taste, and sometimes a cough, may accompany the burning feeling. Sometimes it can even feel like chest pressure, or when it is severe, can feel like food or pills are getting stuck in the throat when swallowing.”

According to Dr. Rubertone, there are many things you can do to help avoid heartburn and GERD. Two of the most important things are to lose weight and quite smoking. She says, “ It is known that heartburn is more common in those that are overweight and also those that smoke. Avoidance of caffeine, spicy or greasy foods, and alcohol are also important, as these will contribute to heartburn.”  And, she adds, don’t stress as anxiety and stress can contribute to heartburn. Dr. Rubertone recommends treating yourself on a regular basis to yoga, prayer, exercise, or whatever you like to do to relax. If you have tried these ideas, and still suffer from heartburn, a sour taste, a feeling that food is getting caught in the throat, or a persistent cough, be sure to speak with your doctor as this could indicate a more serious condition like a heart problem or even cancer.

PinnacleHealth general surgeon Joseph Esposito, MD, explains the tie between cancer and heartburn(GERD). "Heartburn caused by acid reflux can over time change the cells in the lining of the esophagus. These changes, commonly referred to as Barrett's Esophagus, increase your risk for esophageal cancer which is especially lethal." For patients with frequent heartburn an upper endoscopy procedure can help identify the cause and determine if the patient has an increased risk for cancer. We can then determine in the individual patient the best alternatives. Minimally invasive or robotic anti-reflux surgery to cure reflux as well as radiofrequency ablation (RFA) to cure the existing Barrett's are options.  Surgery makes a new valve to prevent the cause and RFA heats the already present abnormal cells until they are gone. Fortunately, we now have multiple options.

Sometime heartburn is actually a symptom of a cardiac event, like a heart attack. “Unfortunately, women sometimes confuse the symptoms of a heart attack and heartburn,” says Mehreen Qureshi, MD, cardiologist with PinnacleHealth Cardiovascular Institute.

“Women are more likely than men to experience symptoms other than chest pain during a heart attack,” says Dr. Qureshi. Women’s symptoms often are more vague and are overlooked. Heart attack symptoms can include:

•    Pressure or burning feeling in the chest
•    Unexplained, extreme fatigue
•    Pain or discomfort that radiates to the arm, jaw, neck and/or back
•    Nausea, dizziness and/or vomiting
•    Breaking out into a cold sweat
•    Severe shortness of breath

Since time is muscle in a heart attack, call 911 and ask for PinnacleHealth’s Harrisburg Hospital if you think you may be having a heart attack.

If you have risk factors such as high blood pressure, diabetes, a smoking history, high cholesterol or a strong family history of heart disease and are concerned that you may be experiencing some of the above symptoms periodically, you should call to schedule an appointment to discuss your concerns with a cardiologist.

Sometimes though, that burning feeling is just a result of large bowl of chili, or similarly spicy food.  So how can you tell when there is a problem?  If you frequently experience heartburn you should consult your primary care physician who can evaluate your condition and risk factors and send you to an experience specialist if need be.  With the right team of providers working with you, you can look forward to getting warm and fuzzy feelings from loved ones, not heartburn.

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

Relieve Dry Skin

Dry, itchy skin is a common complaint during the winter months. Dry winter air and most types of indoor heating increase our chances of experiencing symptoms of dry skin. Symptoms of dry skin can include itching, mild soreness, flaking and cracks or fissures in the skin. Having cracks in the skin or scratching your skin open increases the risk of getting a skin infection.  So It’s best to actively treat dry skin as soon as you are aware of it.

Some people struggle with dry skin all their lives however it is more common for it to become a problem for people as they get older. The thinning of skin as we age causes our skin to become dry more easily.  The most common areas for people to have symptoms of dry skin are the hands and shins but any area of skin can suffer from dryness.  A few simple actions can help you get control of your dry skin.

First, minimize your skin’s exposure to water, especially hot water. Long hot showers or baths are not friendly for dry skin.  This means shorter, cooler showers or baths and consider showering only every other day. If you wash dishes or have a job that keeps your hands in water frequently wear  rubber gloves if possible.  When you dry your skin try to pat dry rather than rub. These things help to preserve your skin’s natural oils.

Next get a good moisturizer and use it often.  The most effective moisturizers are going to come in a jar or need to be squeezed out of a tube.  A lotion that is poured or comes out of a pump is usually not very effective for dry skin that is causing symptoms. Avoid heavily scented moisturizers as these frequently contain alcohols which are drying. Use your moisturizer at least twice a day. If you are a person who must wash their hands frequently during the day you may need to reapply your moisturizer much more often. Hand sanitizers are also drying so moisturize more often if you are using these products frequently.

If possible get some moisture back into the air in your home by using a humidifier, cool mist vaporizer  or even a pan of water on a radiator or wood stove.  It can be difficult and expensive to humidify an entire home so consider focusing on the room you spend the  greatest number of hours  in. For many people this room is their bedroom.

Lastly, get some moisture into yourself. Make sure you are staying well hydrated by drinking adequate amounts of water and non caffeinated beverages every day.

If you experience symptoms of dry skin that are not responding to your efforts to treat it or you have  significant soreness and/or redness especially if these symptoms are worsening you should see your primary care provider. They will be able to rule out other causes of your symptoms and if needed provide prescription creams which can help

Beverley Uniacke, MD

Dillsburg FamilyCare, a member of PinnacleHealth Medical Group

Aisle full of cold medicine choices, but which is the right one?

Achoo!  Gesundheit!  If you are coughing, sneezing and sniffling right about now, you’re not alone. The vast majority of people we’re seeing at the office at this time of year for same-day sick visits have an upper respiratory infection…aka, a cold. Now, colds come in different varieties; there’s the garden variety “Rhinovirus” which gives the old tried and true cold symptoms. There’s also the more powerful RSV (Respiratory Syncitial Virus) which packs a punch to all who get in it’s way but even more to our littlest babies (more to come on this, keep reading). The flu is also still out there too (yes, still time to call the office to get your flu shot). So if you’re in battle with any of these right now, you’re not alone. I was in a visit with a patient last week and we got into a lengthy discussion about cold medicines; I joked with him at the time that I should blog about this topic then thought about it some and thought it would be worth sharing…so now I am!

I’ve read estimates of Americans getting 4 billion colds every year. This is why the US spends in the neighborhood of 4.2 billion dollars (yes, that reads billion) every year in cold remedies. By the USA Today report I read, that is only the “traditional” medicines, not the alternative ones (think Vitamin C, Echinacea and Zinc…so that number could double!). So now you realize why the cold/cough/flu remedy aisle in your local pharmacy or grocery store is SOOOO long and full of options. Simply stated, we buy them. I hope to help clear up which options to consider in your quest to feel better.

The thing about any and all cold medicines is this: they don’t make you better. They help you feel better sometimes. I hear all the time that the cold medicines help, but as soon as they wear off, the love is gone and symptoms return. They mostly exist as 4 hour formulations, which is not really that great. By the time you find improvement in your symptoms, the medicine is just about to wear off. Taking it every 4 hours is so time consuming. I don’t think there is anything I can manage to do every 4 hours during a busy day as a mom and at work. So I can practically recommend the 12 hour extended release formulations of any drug you take. Take one in the mornings when you wake up to help you with those daytime symptoms and another sometime 12 hours later—this second dose will help you manage symptoms overnight while you’re sleeping. Getting rest can be the difference in getting better or lingering sick. It won’t magically make you better but when you’re rested, you’ll FEEL better…and isn’t that really what you’re looking to do?

Let me start with the one I wish didn’t really have such a big place on the shelves. Dextromethorphan. It is billed as a cough suppressant. This makes sense at first. Yes, stop the cough. But think about it a little more carefully and you’ll see that the cough is actually protecting you. Let’s consider two scenarios. One - the cough is from lung/heart/stomach disease; so suppressing it allows you to go undiagnosed and that could be life-threatening…so, suppressing that cough is not a great idea. Two - the cough is from your upper respiratory area; the mucous is coming from your nose and sinuses and is caused by the mucous as it drips and drains into the upper part of your throat. The body tries to avoid that mucous from getting into the lungs to cause a pneumonia/lung infection...so the cough is actually a good thing there. The other thing about dextromethorphan is that it actually could be DANGEROUS! Yes, dangerous. It can interact with many depression/anxiety medicines causing a serious interaction. Since you can buy dextromethorphan without a prescription or even a talk with your pharmacist, this frightens me. So look for this drug and think three times before you buy it. Look for any drug that has a DM after it (DextroMethorphan) and, in my opinion, avoid it.

The one I really DO like is pseudoephedrine. This drug is not for everyone. Some people don’t tolerate it. I’d say, in my experience, 1 in 10 people tell me they cannot take it because it makes them jittery or have a fast heart beat. The other consideration is people with high blood pressure. For most patients who have controlled, treated high blood pressure, it’s OK to take this drug FOR A FEW DAYS while you’re sick and not worry it will cause serious damage (if your blood pressure is uncontrolled or it’s used beyond a few days, your doctor or provider should be involved). If you’re one of those people, this drug is not for you. If you’re not, this may be something that helps open up your nasal passages and keep you moving air…which is a good thing! In addition to causing nasal passages to clear, this can dry up some mucous secretion (more of a side effect than anything) making you feel better too, reducing that pesky cough. Phenylephrine is an alternative to the pseudoephedrine;  it is less stimulating and doesn’t raise the blood pressure. To buy pseudoephedrine, you must show a photo ID to the pharmacy staff. Phenylephrine is available grab-and-go off the shelf. Be warned, it doesn’t have the same power pack the pseudoephedrine punches.

The next among the big-three of cold medications is guaifenesin. This functions to loosen the mucous and help make it slippery and ready to cough/blow/spit out. This keeps down the likelihood that the mucous will be a breeding ground for bacteria to come in and infect later. This is a particularly good one to consider if you’re prone to sinus and ear infections after a cold. All in all, it’s not a bad choice.

One word of advice: READ!  Read the label of the drug you are about to buy and put into your body. This is important. If you decide to get a multi-symptom drug it has multiple drugs in it. Often, one of those drugs is a fever reducer/pain medication. If you don’t have pain or a fever, that may be unnecessary. Also, you may not need a cough suppressant AND decongestant AND mucous thinner AND fever reducer. I’m a minimalist. If you are not experiencing a particular symptom, don’t take a drug to fix it. There are side effects and interactions for every drug so choose them carefully and only when necessary. Many of them interact with prescription drugs—fever reducers can interact with blood thinners and contain the same active ingredient as some pain medicines. If you’re taking a prescription drug and see the same ingredient on the cold medicine label, think again and consider asking the pharmacist or your healthcare provider if it’s OK. Also, it’s helpful to us if you know what you’re taking if you come to see us. It helps us know what to avoid giving you to avoid further interaction if a prescription drug is provided at your visit. So please, read labels.

I mentioned RSV and babies. This is yet ANOTHER reminder that there are NO SAFE COLD MEDICINES FOR BABIES and children under age 5. Never give a child with a fever aspirin. Also, remember that doses of medicines are weight based. If you don’t know what dose of acetaminophen or ibuprofen to give your child/baby, don’t guess…please ask your doctor or pharmacist for some help.

Now, I’m a mom of 3 little boys. So I understand that weakness you feel at 3 a.m. with a coughing child (or more) wanting to get them to feel better and get everyone back to sleep. The problem is, the cough and cold medicines not only don’t work for them, but they also cause HARM to them. Many thousands of children under age 5 were taken to emergency rooms yearly when the FDA allowed the sale of those medicines. They removed them from shelves after it was clear they were causing more harm than good.

So what can you do for those little ones? There are a few old-school remedies that can help. At any age, the menthol/eucalyptus/rosemary rubs can be wonderful. They make reduced strength formulations for the little babies. It’s been shown to reduce symptoms in trials but this mom can tell you that it works. There’s no placebo effect (improvement/positive change in symptoms caused by the person’s desire to improve rather than the medication) when you’re dealing with a baby. So rub away! The other thing that helps lots of kid viruses (RSV, Croup) is humidified air. The humidity is helpful in decreasing the irritation of the lining of the respiratory tract. Finally, in children OVER AGE ONE; taking two teaspoons of honey before bed can help reduce cough symptoms.

Many will say these methods lack serious scientific clinical trials. I agree but challenge…is a safety trial needed for honey in a 3 year old? Dr. Andrew Weil spoke at the American Academy of Family Physicians’ educational meeting in Philadelphia this past fall. I was in the audience and was struck by something he said - I’ll paraphrase:  the more harm that can be done, the more studies that should be done. The harm factor of honey in a child OVER THE AGE OF ONE is minimal and so should be the trials. In my house, we mix in a little lemon juice and we call it honey-syrup (my kids don’t like the sweetness of honey straight-up).

I didn’t get into the alternative options much for adults but can say the honey trick would be something worth trying. I also read adding Cinnamon to that mixture in adults helps decrease the sugar-shock factor in people with blood sugar problems—so be sure to track your home blood sugars with your monitor to be sure your sugars are not bouncing high with this treatment. Remember, a sudden spike in your blood sugars could be a sign a serious infection is lurking.

I hope you all feel better soon. I keep hoping for an early spring but fear we are destined to another 5-6 weeks of winter. Well, mostly because that’s when it ends….March 21st! So keep hoping and marking off your calendar and before you know it, we’ll be right back here talking about seasonal allergy treatments!

Sandra R. Costa, DO, FAAFP

Heritage Family Medicine

Member, PinnacleHealth Medical Group