Monday, December 30, 2013

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.

Friday, December 27, 2013

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.


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!

Monday, December 2, 2013

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