Why Your Doctor Is Asking You About Guns

Joseph Cincotta, MD

One of the routine questions I ask my patients during an office visit is whether they have guns in their home. Some of my patients find this intrusive and even offensive, and they are not alone. But my goal, and that of other doctors like myself, is not to judge or debate, but to make sure my patients stay safe and healthy.

Whether or not health professionals should be asking about guns in the home has sparked a national debate. Emotions may run high when there is any conversation that is perceived to challenge one’s right to own and keep a gun, and those emotions can block any further conversation about guns and gun safety.  Health care professionals are not challenging anyone’s Constitutional right to own a gun.  Many health professionals own guns themselves and use them for a variety of recreational activities.  Our focus when we discuss this issue is one of safety, not the right of ownership.  According to a report by NBC News, firearms injured 15,576 children in 2010. And because of frightening statistics like this, the American Academy of Pediatrics recommends that pediatricians and other health care professionals counsel patients about gun safety.

When I inquire about guns in the home, it is with the best intentions. I am not calling a parent’s judgment into question, nor am I attempting to interfere with anyone’s right to own guns. But, the fact is that unsecured guns pose a health risk to children. Just as I would counsel parents about car seat safety, I counsel parents about precautions they should take to keep firearms safe.

A few states have enacted laws prohibiting doctors from asking patients about guns in the home. The practice is not prohibited in Pennsylvania, but patients are also not required to disclose whether or not they have guns in the home to their doctor.

For parents or caregivers who have guns in their home, I recommend taking the following precautions:

• Make sure that guns are unloaded and stored in a locked location, preferably out of a child’s reach and sight.
• Store ammunition in a different locked location from the gun, preferably out of a child’s reach and sight.
• Keep keys and combinations hidden from children.
• Do not leave your gun unattended when it is not locked up.
• Use gun locks.
• Do not leave guns, loaded or unloaded, anywhere where a child can access them (nightstand, table, etc.)
• Talk to older children about gun safety. Let them know that they should tell an adult immediately if they find one.
• Talk to your child’s other caregivers about gun safety.

When it comes to gun accidents involving children, there are very few second chances. A high percentage of accidental shootings result in death. Remember, when your doctor asks about guns in the home, they have your family’s best interests in mind.

For more information about gun safety. 

Detergent Pods Pose Poisoning Risk

Dr. Joseph Cincotta

Although consumers love the convenience, laundry and dishwasher detergent pods can pose serious health risks if they fall into the hands of young children. According to a recent study by the American Academy of Pediatrics, more than 17,000 children younger than six years of age were exposed to detergent pods in 2012-2013.

Children often mistake the brightly colored pods for candy or toys. Because the sacs containing the detergent are water-soluble, they are especially dangerous if a child puts them in his or her mouth. The study showed that nearly 80 percent of detergent pod exposures involved ingestion, which can cause vomiting, respiratory distress, lethargy and, in one case, death. If a child’s skin or eyes are exposed to the detergent, serious irritation can occur.


“It is critical that parents are aware of the potentially harmful effects of household products and take preventative measures to protect their children,” said Dr. Joseph Cincotta, family physician and medical director for PinnacleHealth Medical Group. “One mistake could have serious consequences.”
If you use detergent pods in your home, your best bet is to keep them safely out of sight and out of reach in a locked cabinet. Here are some other tips to help you protect your children and prevent poisoning at home:

• Store household products and medicines in their original containers. Store household products in a different place than food and medicine.
• Keep the nationwide poison control center phone number (1-800-222-1222) near every phone in your home and save it in your cell phone. Poison Control can provide assistance 24 hours a day, seven days a week. If your child is unresponsive or is having a severe reaction, dial 911.
• Do not store household products under the sink or in unlocked cabinets. Never underestimate your child’s ability to defeat a safety lock or climb. 
• Put household products away immediately after use. Do not leave household products unattended during use.
• Do not rely on packaging. Containers are typically child-resistant, not child-proof.
• Don’t keep it if you don’t need it. Safely dispose of any medicines or household products that you no longer use.
• Talk to older children. Explain the importance of staying away from unfamiliar plants and household products. Tell children they should never take any medicine unless an adult says it’s okay.

“In the course of busy family life, it can be easy to forget to keep household safety a top priority,” said Dr. Cincotta. “Fortunately, there are a number of online resources that can provide a good refresher for busy parents.”

For additional tips on preventing poisoning and other common childhood accidents, visit the Centers for Disease Control and Prevention’s Safe Child website at: www.cdc.gov/safechild.

School bus safety

Blog contributed by Kathleen
Zimmerman, MD, Pediatrician

School is well on its way and your child is probably getting comfortable in their routine.  This is a good thing, but we don’t want them to forget to be safe.  You should review school bus safety rules with your child:

1. Wait for the bus to come to a complete stop before stepping off the curb
2. Stay in seat  and don’t move around on the bus
3. Listen to the bus driver – they are in charge
4. When getting off the bus, don’t cross until the bus is at a complete stop, with the red lights flashing. Children should cross at least 10 feet in front of the bus.
5. Always watch for oncoming cars before crossing.  Not everyone stops for those flashing lights like they are supposed to!

Your child may ask why they don’t need to wear their seatbelt on the bus.  Pennsylvania does not require this.  Why not?  National Highway Traffic Safety Administration has done research that showed that the “compartmentalization” of school bus seats protects children very well.  Their research also shows the lab belts provide little if any benefit and could even cause injury because of misuse.  Shoulder belts would likely give better safety statistics, but children are not reliable to put these on appropriately and could increase their risk.   So, as of now, your child will not need to wear their seatbelt on the bus.  But you should explain to them the importance of seatbelts in all other vehicles.

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.

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.

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

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

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.

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 20^th 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. 

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.

What is Juvenile Arthritis?

Blog contributed by Kathleen
Zimmerman, MD, Pediatrician

It is estimated that about 300,000 children in the U.S. have some form of juvenile arthritis.  Most people have heard of Juvenile Rheumatoid arthritis, or JRA.  But there are other forms of arthritis as well, including Juvenile Idiopathic Arthritis (JIA), which is the most common form in children.

Most forms of Juvenile Arthritis are autoimmune.  This means that the child’s immune system is attacking their healthy cells.  It is thought that this autoimmune attack may be triggered by a virus and in some cases children have a genetic risk if arthritis is in the family.

Arthritis in children can have different symptoms and these symptoms can come and go for long periods of time.  The most common symptom is constant joint swelling, joint pain, and stiffness.  This may be in one joint or in multiple joints.  Some children are limping or clumsy because of the joint pains.  The pain is often worse in the mornings.  Other symptoms may be high fevers or skin rashes that don’t have another cause.   Children may also have eye inflammation and growth problems.

There is not a single test for Juvenile Arthritis.  Your child’s doctor may suspect arthritis if they have the symptoms above and they do not have an explanation (no recent injury or recent illness) and also if the symptoms do not go away on their own.  If your child was suspected to have Juvenile arthritis they would need a thorough exam of the joints as well as bloodwork. Referral to a Rheumatologist (specialist in arthritis) is typically recommended to help with the diagnosis and treatment. 

Juvenile Arthritis is a chronic illness that comes and goes.  During a “flare”, children may need medication to help control their symptoms. Physical therapy is helpful as well.  If the pain is severe or difficult to treat, stronger medications that suppress the immune system are used to calm the symptoms down and allow the child to live a more normal life.  The goal is for the child to remain active and to have long periods of “remission”, where the symptoms are gone for months to years.   Children with juvenile arthritis may also have “silent” problems with the eyes or growth (without symptoms).  Therefore, it is also important to have regular eye exams and checkups even if they have no symptoms. 

Researchers are working on finding causes of Juvenile arthritis and also researching better medications with fewer side effects.  To learn more about Juvenile Arthritis and the most recent science on these diseases you can go the National Institute of Health site: www.niams.nih.gov and the Arthritis Foundation site: www.arthritis.org

May is national Osteoporosis (OP) month

Blog contributed by Renu Joshi, MD,  Endocrinology

Osteo means bones and porosis means holes. As the name suggests we have bone loss which can lead to Bone fractures.

It is a silent disease and does not cause any pain until Fracture occurs.

Did you know that 50-65% of women between 50-75 suffer from Osteopenia / osteoporosis and 50 % of white women will suffer from Fracture due to Osteoporosis.  25 % of patients with hip Fracture will die within the first year. Incidence of Hip fracture is higher than combined Breast cancer, Heart attack and stroke in Females.


Men can also suffer through OP but it starts at age 70 or higher.

While we all get screening for other things the screening for OP still remains very low. A 5-minute screening test for OP is the U/S of the heel, which almost picks up > 70 % cases of OP and it is free.

We as women are always taking care of others but we can be better care taker if we take care of ourselves
SO Be In charge of your health!!!

You can prevent OP by these simple things:

1. Take 1000 -1500 mg calcium  (diet and supplement combined) daily
2. Vitamin D at least 800 units daily
3. Exercise both aerobic and Muscle strengthening (by lifting weights) at least 3 times weekly 
4. Drink < 3 caffeine beverages (including Coffee and sodas)
5. Getting screened early after Menopause so treatment can be given appropriately 

  Let’s do it together so we can save Fractures!!!

How to Eat Healthy at Home and at Work

Patients typically tell me about one struggle or the other: “I have a hard time eating healthy at home” or “I have a hard time eating healthy at work”. With obesity on the rise, as a whole we have got to learn to do better at both! I believe the keys to healthy eating are knowledge, discipline and preparation.

Knowledge. Being educated. Being an aware consumer. Knowing how many calories are in food items. Knowing what are healthy choices and what are not.

Discipline. Being determined to eat healthy the majority of the time. Being able to say no to junk food the majority of the time. Choosing unsweetened drinks over sweetened ones.

Preparation. Planning ahead for meals and snacks. Having a list before you go to the grocery store. Not allowing yourself to become too hungry, resulting in binge eating. Having water on hand.

I feel like most people get the first two points, it’s more a matter of applying them. The third point, preparation, is what I want to focus on. Being prepared sets one up for success. Start with a list. What are healthy food items you would like to purchase on your next trip to the grocery store? This list must include variety, snacks, and meals. As far as meals go: The internet holds a plethora of recipes (do people use cook books anymore?! Ok…kidding, but seriously). Try to avoid recipes with white flour/pasta, the word “fried”, and cream sauces/a lot of cheese.  And when you find those tasty, healthy recipes…make extras! Then you have leftovers for work! I try to avoid casseroles and make soups (broth-based) or stir-fries instead.

When you get home from the grocery store, rinse and prepare whatever you can. Cut celery sticks. Wash lettuce and prepare veggies for easy salads. Cut up fruits that need it. Put snack items into baggies/containers. Hard-boil eggs. Get the junk food out of the house. If it’s not there, it can’t be consumed!

Get your lunch/snacks ready for work the night before. If you plan for your meals, you are less likely to grab unhealthy food on a whim. May I suggest salads in a jar: dressing on the bottom, other items such as low-fat cheese/egg/chicken/nuts/seeds/fruit/other veggies next, then lettuce on the top. When you are ready to eat, just turn it onto a plate and the dressing is on the top and nothing is soggy. Another idea is  fruit and yogurt parfaits with plain yogurt (check out how many grams of sugar are in flavored yogurt!). Use fruit as your sweetener and add some low-sugar granola, oats, or nuts. Be careful of cereal, flavored oatmeal and bars, as they often contain high amounts of sugar!

At home, I make a baked oatmeal, bran muffins or quiche weekly. That way there is always something in the fridge to grab for breakfast that is healthy. I use very little to no sugar in my recipes and add lots of extras: fruit, cinnamon, nuts, etc. I load up the quiche with veggies and omit the crust. These are also good options for lunch or a snack at work.  It is also helpful to have nuts, carrot sticks, or an apple in the car to keep you from making a stop for some less-nutritious choices.

And one last point: choose foods that will fill you and not leave you hungry soon after. Protein and healthy fats (like nuts and avocados) can really help with satisfaction. 

Why are we seeing Measles again?

Blog contributed by Kathleen Zimmerman, MD,  Pediatrician

In recent news there have been a multitude of stories on increasing outbreaks of measles.   Measles was almost eradicated by the year 2000, so why are we seeing measles again?

Measles is spread by a very contagious virus.  The virus is spread as easily as influenza virus.  Therefore once a case comes into a community, it quickly spreads to those who have not been vaccinated. Widespread vaccination against measles creates “ herd immunity”.   This is the best protection a community can have from measles outbreaks.  Herd immunity stops isolated cases of measles from spreading into an epidemic.

Vaccination rates have declined in certain areas of the United States and these are the areas that have “holes” in the herd immunity and these are the communities that are having increasing outbreaks of measles.   California’s cases went up from 4 last year to 58 as of this month (and will be higher by the time you see this blog).

Vaccination refusal and delays are most commonly due to misconceptions about vaccine safety.  Also many young parents have never seen measles before and they do not understand that just 50 years ago there were 500,000 Americans infected with measles per year with 48,000 hospitalizations and 500 deaths each year.   The near eradication of this deadly disease 14 years ago was achieved by vaccination.  The return of this disease in exponential numbers is occurring because of vaccine refusal.

It’s important for parents to realize that when they refuse or delay vaccines for their child, they are not only putting their own child at risk, but also their whole community.   This couldn't be exemplified more clearly than in what we are seeing unfold in our country with the current measles outbreaks.

Child Abuse Prevention

Blog contributed by Andrea Burks, DO, Heritage Pediatrics, PinnacleHealth Medical Group



April is child abuse prevention month.  In the United States of America there are approximately 3 million reports of child abuse and neglect each year involving 6 million children. 686,000 children were determined to be victims of abuse and neglect in 2012 and of those 1,640 resulted in death. That is greater than 4 child abuse related deaths per day. There are likely many more cases that are not reported. Child abuse and neglect happens at every socioeconomic level, across ethnic and cultural lines, within all regions and levels of education. Boys and girls are maltreated in equal numbers.  Children less than 4 years old are at greatest risk for severe injury and death from abuse. The most common abusers are parents, other family members, or an unmarried partner of a parent. Children who suffer maltreatment are at higher risk for cognitive delays, emotional difficulties, harm to development of nervous and immune systems, and health problems as adults. It is important to recognize, help prevent and report suspected child abuse and neglect because its lasting effects can impact us all. Small acts from everyone in a community can help save a child from harm.

The first step is to recognize child abuse. Child abuse can be physical, emotional, sexual, or involve neglect of a child by someone who has responsibility for the child. It is common for more than one type of abuse to occur at a time. It is important to note a single sign does not mean maltreatment has occurred but if signs appear repeatedly or in combination a closer look at the situation may be warranted.

• Physical abuse involves non accidental physical injury including but not limited to hitting, kicking, biting, burning, choking, shaking, and throwing. It often leaves bruising at different levels of healing, marks on body consistent with objects or hand prints, or unexplained bruises, black eyes, or broken bones. The physically abused child may wear clothing inappropriate for weather (e.g. long sleeves in hot weather to hide bruising). They may also be reluctant to go home or fearful of parents.
• Emotional abuse involves with holding love, support or guidance from a child. Emotional abuse is as strong a predictor of subsequent impairment in child development as physical abuse. Emotional abuse may include ignoring, rejecting, isolating, verbal assault, threatening, blame, belittling, or shaming the child in a persistent chronic pattern. The caregiver may appear unconcerned about the child. The child may show overly compliant or demanding behavior, be extremely passive or aggressive. They may speak of attempting suicide or they may report lack of attachment to parent.
• Sexual Abuse can involve engaging a child in sexual acts, exposing a child to sexual activities, indecent exposure, or exploitation of a child through pornographic material. Effects of sexual abuse extend beyond childhood. These children often have loss of trust and feelings of guilt. The child may show signs of regression such as bedwetting, rocking, head banging, stranger anxiety, withdrawal from family and friends, suddenly refuse to change clothes in gym, or refusal to participate in physical activities. The adults may appear extremely protective and limit contact of the child with other children.
• Neglect is failing to provide the basic needs for a child including food, clothing, shelter, proper hygiene, education, and medical attention. Neglect can also involve abandoning a child or putting a child in unsupervised or dangerous situations. The child may miss a lot of school, beg or steal from classmates or friends, or lack medical/dental care. They may have dirty clothes or clothing inappropriate for weather.

Prevention of child abuse and neglect is a community effort. Individuals in the community can play a role in helping families find the strength to raise safe, healthy, and productive children.  A majority of parents don't want to harm their children. Abusers are more likely to have been abused themselves and don't know other ways to parent. They may suffer from mental or chronic health problems, struggle with substance abuse, and commonly have high stress and lack of support. Parenting is one of the toughest and most important jobs. We all have a stake in ensuring parents have access to the support they need to be successful parents. You can start by getting to know your neighbors. Help a family under stress by offering to give them a break and babysit for a few hours, help run errands, help a parent with a small child get through checkout line at the grocery store, or reach out to children in the community. If a child discloses they are victims of abuse, first believe them, listen, and don't be critical or negative of child or parent. Assure the child they are not to blame and report the incident.

It is the right and responsibility of everyone in the community to report suspected child abuse or neglect. You can make a report by contacting your local child protective service agency or police department. You do not need to have evidence or actual knowledge of abuse to make a report. You should have reasonable cause, heightened concerns, or belief based on observation. Reporters can be anonymous but giving your name may help the investigation. Good Faith Laws protect the reporters from legal liability. Trust your instincts. Reporting your suspicions may protect the child and get help for a family who needs it.

If you are a parent under stress find ways to regain control. Try counting to 10, take deep breaths, call a friend, put your child in a safe place and take a few minutes to calm down and relax. Never be afraid to apologize to your child if you lose your temper and say something in anger that wasn't meant to be said. Reach out to community centers, church, schools, and physicians for guidance on positive parenting skills. It is often helpful to learn good communication skills, appropriate discipline, and how to respond to children's physical, developmental and emotional needs. Understanding appropriate developmental milestones may help you set reasonable expectations for a child. Creating social connections with family, friends and the community gives encouragement and can help improve parent child relationships. There is also concrete community support that assists with food, clothing, housing and access to healthcare.  You can contact you physician for information about these services.

In Pennsylvania report concerns for child abuse and neglect to ChildLine 1-800-932-0313

March is National Nutrition Month

Blog contributed by Tina Metropoulos, DO, Primary Care Physician

In primary care, we often counsel patients about healthy dietary habits. 
I’m frequently asked about what foods are healthy.  Another common question is whether a fad diet is safe, effective, or advisable – “How about Atkins?”, “Is South Beach okay?”, and should I go “Paleo?". Sometimes the goal is weight loss, and sometimes it is to improve lifestyle. Specifically, patients are often concerned about their heart health and providers often discuss diet as a means to reduce risk for heart disease.

Recently, the American Heart Association updated their healthy nutrition guidelines.  I read through them, after their release in 12/2013.  The overall focus is on a balanced, moderate, diet with limited processed food intake.  An important recommendation is to have a diet rich in fruits and vegetable – with an average of 9-10 servings a day for an adult.  There are other guidelines and diets which focus on fresh fruits and vegetables, such as the DASH diet and the Mediterranean diet.  This may seem as hard as climbing Mt. Everest, especially if you count an occasional side salad as your token veggie for the week.  However, I try to help patients realize how easy it can be to include healthful, and flavorful, fruits and vegetables in their daily meals.

First, it’s important to understand how much “a serving” is.  A serving of fresh fruit is equal to 1 medium fruit, ½ cup cooked, chopped, or canned fruit, ¼ cup dried, or ½ cup juice (easy to get when you add some dried cranberries to some mixed nuts!).  A serving of fresh or cooked vegetables is roughly ½ cup; vegetable juice is ½ cup, while 1 cup constitutes a serving of raw leafy greens.

So, if you chop up some tomatoes, peppers, cucumbers in your lunchtime green salad (or if you are feeling adventurous, some artichokes or asparagus), you’d have at least 3 servings to put toward your daily quota.  Add some sliced berries to your AM bowl of Wheaties and you have another serving.  Snack on hummus and carrot or celery sticks (much better for your afternoon slump than a double mocha) and you’ve added another serving or two – more than half-way there!  And, we haven’t even counted dinner yet.

Now that spring is in full swing we will soon have an abundance of fresh fruits and vegetables available!  By visiting your local farmer’s market or grocery store you can stock up on colorful, visually appealing, and delicious produce.  Eat up!

What is a serving size?

http://www.heart.org/HEARTORG/Caregiver/Replenish/WhatisaServing/What-is-a-Serving_UCM_301838_Article.jsp

Recipe Ideas:

https://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyCooking/Simple-Cooking-with-Heart-Vegetarian-Recipes_UCM_458020_Article.jsp

Does My Child Have an Eating Disorder?

Blog contributed by Kathleen Zimmerman, MD,  Pediatrician

If you are asking this question, then your child needs to be seen by his or her provider.  Over the past decade the United States and other parts of the world have seen steady increases in the incidence of anorexia (nervosa) and bulimia for both females and males.  There is also an increasing trend for younger children to develop eating disorders as well as teens.  Eating disorders present with many different signs and symptoms.  Sometimes these are difficult to detect if your child is hiding them.   Here are a few that should raise a flag and prompt you to bring your child to the office:

1. Constantly worried about their size or weight
2. Not eating as much food as they used to but insisting they ate when you weren't around
3. Binge eating large amounts of foods 
4. Menstrual period is becoming irregular or skipping months
5. Intense exercise more than 1-2  hours per day and they are very stressed if they miss a workout
6. Symptoms: cold intolerance, dizziness,  abdominal pain, constipation, diarrhea, muscle cramps, looks pale and weak
7. Either parent has a history of eating disorder

Your provider will measure height, weight, BMI and get a thorough diet and exercise history.  They may need to talk with your child alone.  Follow up appointments will be important to track the weight.

Early detection of eating disorders is important to prevent serious consequences.  So, even if your child denies there is a problem, it is important to have your provider evaluate any concerning eating behaviors or weight changes.

Strep throat vs. Viral pharyngitis

Blog contributed by Julie A. Lundblad, MSN, CRNP

How do I know if child has strep throat? Medical care providers cannot always tell by looking in the throat. Most offices can run a rapid strep test and the results are just minutes away. 80% of all sore throat office visits are viral, only 20% are from Strep.

Common symptoms of step throat:

• Sudden onset of sore throat
• Pain with swallowing
• Fever >101
• Red, swollen tonsils (sometimes white patches)
• Swollen lymph nodes

Strep can also cause headaches, nausea, vomiting, rash, body aches, or tiny spots on the back of the throat (petechiae)

What is viral pharyngitis? Basically inflammation of the tonsils and back of the throat, with or without a fever. These are caused by viruses and upper respiratory infections.

Common symptoms of viral sore throat:

• Sore throat, dry and scratchy
• Runny nose, sneezing
• Headache
• Cough
• Fatigue
• Low grade fever

Strep throat is contagious, so if there is a known exposure, testing is necessary.  I recommend calling your Primary Care Physician for an appointment to rule out Strep. It is usually easily treated with an antibiotic for 5-10 days. If the sore throat is viral, the treatment is supportive and symptomatic.

My Child’s Ear Hurts – Is it an ear infection?

Blog contributed by Kathleen Zimmerman, MD,  Pediatrician

All parents have experienced the middle of the night cry from their child, “my ear hurts!”  Ear pain is one of the most common reasons a parent calls their child’s doctor or provider.  But how do you know if it is an ear infection? When do you need to bring your child to the office?

There are many causes of ear pain.  Sometimes the pain has nothing to do with the ear itself.  Children can have “referred” ear pain that is actually coming from the tonsils or the teeth.  You may see ear pain or ear pulling in a baby that is teething, especially when the molars are coming in.  Children with swollen tonsils or strep throat will often come into the office complaining of ear pain.  This referred pain occurs because the tonsils and throat are actually quite close to the inner ear.  Another example of referred ear  pain is seen in an older child or teenager that has temporal mandibular joint pain (or TMJ syndrome) – the hinge of the jaw is right in front of the ear, so a child with teeth grinding or TMJ pain can also feel ear pain.

Of course many children with ear pain do have a problem with their ear.  This could be swelling of the ear canal as in “swimmer’s ear”, which is common in the summer.  But in most cases ear problems are behind the ear drum, which is sometimes referred to as the “inner ear”. The inner ear has a tube connecting it to the nose. This is called the Eustachian tube. If your child has a stuffy nose from a cold or from allergies, fluid can push back through this tube and cause ear pain. This kind of fluid and pressure will go away with time and also improves as the nose is decongested. Ask your provider if an over the counter medicine, such as a decongestant or an antihistamine, would be appropriate for your child.

In some cases, the fluid behind the ear drum develops bacteria in it.  The bacteria create pus and more fluid and pressure behind the ear drum.  This is an inner ear infection, or “otitis media”. A child with and ear infection and ear pain will usually need antibiotics.

When you call your medical provider about your child’s ear pain, they will ask questions to try to figure out the cause of the pain. In most cases, they will recommend your child be seen if the pain persists or is severe. Sometimes they may recommend over the counter medicines if it is safe and appropriate for your child. But the only way to know if it is an ear infection is for your provider to look in the ear. Antibiotics will not help your child if it is not an ear infection and antibiotics should only be used when needed.  This is why your doctor will usually not want to prescribe an antibiotic over the phone.

Blood Donations

 Blog contributed by Dr. Joseph Cincotta, primary care physician

January is often a time when there is a greater need for blood donations.  So, once again this year we are coming to you to make a gift only YOU can provide – the gift of a blood donation.  You can be the one to save someone’s life.  You can be the one to make a critical contribution to the care of someone in need.  You can make a difference.

Donating blood does take some of your time, and it does require a needle stick.  I will not kid you on these facts. Yet, those who do this work are skilled professionals who work to make the experience efficient and friendly.  The discomfort is minimal and is short-lived.  The benefits are enormous and last a lifetime. 


PinnacleHealth's Blood Bank is located at: 
Alex Grass Medical Sciences Building
100 South Second Street
Harrisburg, PA 17101
Phone: (717) 231-8900

Here are some facts about blood donations from the American Red Cross:


Facts about blood needs

• Every two seconds someone in the U.S. needs blood.

• More than 41,000 blood donations are needed every day.

• A total of 30 million blood components are transfused each year in the U.S.

• The average red blood cell transfusion is approximately 3 pints.

• The blood type most often requested by hospitals is Type O.

• The blood used in an emergency is already on the shelves before the event occurs.

• Sickle cell disease affects more than 70,000 people in the U.S. About 1,000 babies are born with the disease each year. Sickle cell patients can require frequent blood transfusions throughout their lives.

• More than 1.6 million people were diagnosed with cancer last year. Many of them will need blood, sometimes daily, during their chemotherapy treatment.

• A single car accident victim can require as many as 100 pints of blood

Facts about the blood supply

• The number of blood donations collected in the U.S. in a year: 15.7 million

• The number of blood donors in the U.S. in a year: 9.2 million

• Although an estimated 38% of the U.S. population is eligible to donate, less than 10% actually do each year.

• Blood cannot be manufactured – it can only come from generous donors.

Facts about the blood donation process

• Type O-negative blood (red cells) can be transfused to patients of all blood types. It is always in great demand and often in short supply.

• Type AB-positive plasma can be transfused to patients of all other blood types. AB plasma is also usually in short supply.

• Donating blood is a safe process. A sterile needle is used only once for each donor and then discarded.

• Blood donation is a simple four-step process: registration, medical history and mini-physical, donation and refreshments.

• Every blood donor is given a mini-physical, checking the donor's temperature, blood pressure, pulse and hemoglobin to ensure it is safe for the donor to give blood.

• The actual blood donation typically takes less than 10-12 minutes. The entire process, from the time you arrive to the time you leave, takes about an hour and 15 min.

• The average adult has about 10 pints of blood in his body. Roughly 1 pint is given during a donation.

• A healthy donor may donate red blood cells every 56 days, or double red cells every 112 days.

• A healthy donor may donate platelets as few as 7 days apart, but a maximum of 24 times a year.

• All donated blood is tested for HIV, hepatitis B and C, syphilis and other infectious diseases before it can be released to hospitals.

• Information you give to the American Red Cross during the donation process is confidential. It may not be released without your permission except as directed by law

Remember, this is a gift only you can give.  So, please consider donating blood this month - this year.  Your help is vital to save the lives of those in need.  Thanks.

New Year’s Resolutions

 Blog contributed by Dr. Joseph Cincotta, primary care physician

Each year many of us start the New Year with a list of things we are going to do better or differently from last year.  Many of the items on the list are health-related.  And, a number of us, me included, will fall short of our declared intentions.  So, how can things be different this year?  When December 2014 rolls around (and the years seem to pass more quickly for me each year, the older I get), how can we look back with a sense of accomplishment for those things we set as goals for 2014?  I hope these ideas are helpful to you.

1. Do not set too many goals.  Sometimes our list of things we are going to do differently takes up an entire page – it can be 20 or 30 items long.  Keep the list small – no more than 2-5 items that is plenty for one year.
2. Understand that change is work and that improvement does not follow a straight line upward.  Shifting habits and ingrained ways of doing things takes time, attention, effort, and practice.  Expect that you will have some setbacks, and that you can recover from those and move forward.  Accept your capacity for failure – and commit to learn from those setbacks.
3. Make incremental changes and build on small successes.  Sometimes we set our goals too high, and they need to be broken down into smaller pieces.  The ultimate goal remains the same, but having some intermediate goals along the way helps to identify and celebrate progress.
4. Enlist the help of others.  By our very nature we are social creatures.  Teaming up with those who care about us or who may share the same goals can help along the way.  This past year I had a goal of doing a longer bike ride but I knew I had failed in my efforts the year before.  So, I teamed up with a friend in my office to help keep me focused and to share the same goal.  Together we made the ride in August – and I was proud of the accomplishment.

I wish you the best in your efforts, particularly as they relate to better health.  Being healthy and staying healthy requires each of us to be active participants.  Many of the health issues we face today can be addressed through better choices and some changes to current habits.  It is not easy work – yet it is important work – for each of us, and for those we love and who love us.

Cold Weather Safety

 Blog contributed by Dr. Joseph Cincotta, primary care physician

As we enter this week we are anticipating another series of very cold days.  Here are some points on staying safe during this challenging time.

• If possible try to stay out of the cold weather.
  
• If you need to be outside try to avoid getting wet.  The combination of cold and wet increases the rate of loss of body heat.  If you do get wet, try to get inside quickly and change into dry clothes.
  
• Dress in multiple layers, as opposed to one.  The layers help to keep heat in.
  
• Wear mittens instead of gloves, if possible.  They will help to keep your hand and fingers warmer.
  
• Wear a hat (Yes, your mother was right – keep that winter hat on when you are outside).
  
• Cover as much of your skin as possible to keep the cold off your skin.  This helps to reduce the chance of frostbite.
  
• Breathe in through your nose when you are out in the cold.  That helps to warm the air you are breathing in.
  
• Check your smoke and carbon monoxide detectors.
  
• If you use an electric heater, use extreme caution.  Keep the heater away from curtains and flammable items, and be sure to turn it off and unplug it when you go to bed.
  
• Do not run your car in a garage attached to your house – even if the garage door is open.
  
• Make sure your car tailpipe is free of blockage by snow when you do run your car.
  
• For those with pets – do not keep your pets outside in cold weather.
  
• For those of you who are interested in more information we are providing access to a document from the CDC on how to prepare for and deal with extremely cold weather.