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

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. 

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. 

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.

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.  

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

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

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

Trouble Shooting Your Glucose Meter

When people with diabetes can control their blood sugar (glucose), they are more likely to stay healthy. People with diabetes can use a number of tools to help them better manage their diabetes.  One of these tools is a home glucose meter.

Glucose meters help people with diabetes check their blood sugar at home, school, work, and play. Other blood and urine tests reveal trends in diabetes management and help identify diabetes complications.  We are going to discuss the glucose meter (glucometer) and how it can help you control your diabetes.

Self-Monitoring of Blood Glucose
The process of monitoring one's own blood glucose with a glucose meter is often referred to as self-monitoring of blood glucose or "SMBG."

To test for glucose with a typical glucose meter, place a small sample of blood on a disposable "test strip" and place the strip in the meter. The test strips are coated with chemicals that combine with glucose in blood.
The meter measures how much glucose is present. Meters do this in different ways. Some measure the amount of electricity that can pass through the sample. Others measure how much light reflects from it. The meter displays the glucose level as a number. Several new models can record and store a number of test results. Some models can connect to personal computers to store test results or print them out.

Choosing a Glucose Meter
At least 25 different meters are commercially available.  

They differ in several ways including:

• Amount of blood needed for each test 
• Alternate testing sites (for example, using the forearm instead of a finger)
• Testing speed 
• Overall meter size 
• Ability to store test results in memory 
• Cost of the meter 
• Cost of the test strips used  (Insurance companies will often cover the cost of testing strips for certain meters….contact your insurance for the best coverage.) 

Newer meters often have features that make them easier to use than older models. Some meters allow you to get blood from places other than your fingertip (Alternative Site Testing). Some new models have automatic timing, error codes and signals, or barcode readers to help with calibration. Some meters have a large display screen or spoken instructions for people with visual impairments.

Using Your Glucose Meter
Diabetes care should be designed for each individual patient. Some patients may need to test (monitor) more often than others do. How often you use your glucose meter should be based on the recommendation of your health care provider. Self-monitoring of blood glucose (SMBG) is recommended for many people with diabetes, but especially for those who take insulin. The role of SMBG has not been defined for people with stable type 2 diabetes treated only with diet.

Often, self-monitoring plans direct you to test your blood sugar before meals, 2 hours after meals, at bedtime, and anytime you experience signs or symptoms. You should test more often when you change medications, when you have unusual stress or illness, or in other unusual circumstance.

Please discuss the your testing frequency with your personal provider or access the American Diabetes Association website at www.diabetes.org.

Learning to Use Your Glucose Meter
Not all glucose meters work the same way. Since you need to know how to use your glucose meter and interpret its results, you should get training from a diabetes educator. The educator should watch you test your glucose to make sure you can use your meter correctly. This training is better if it is part of an overall diabetes education program.

Instructions for Using Glucose Meters
The following are the general instructions for using a glucose meter:
1. Wash hands with soap and warm water and dry completely or clean the area with   alcohol and dry completely.
2. Prick the fingertip (or alternative site if your meter that allows that) with a lancet.
3. Hold the hand down and hold the finger until a small drop of blood appears; catch the blood with the test strip.
4. Follow the instructions for inserting the test strip and using the SMBG meter.
5. Record the test result.

You should carefully read the instructions for both the meter and its test strips. Meter instructions are found in the user manual. Keep this manual to help you solve any problems that may arise. Many meters use "error codes" when there is a problem with the meter, the test strip, or the blood sample on the strip. You will need the manual to interpret these error codes and fix the problem.

You can get information about your meter and test strips from several different sources.

Your user manual should include a toll free number in case you have questions or problems. If you have a problem and can't get a response from this number, contact your healthcare provider or a local emergency room for advice. Also, the manufacturer of your meter should have a website. Check this website regularly to see if it lists any issues with the function of your meter.

Measurement Range
Most glucose meters are able to read glucose levels over a broad range of values from as low as 0 to as high as 600 mg/dL. Since the range is different among meters, interpret very high or low values carefully.  Refer to the package insert of your glucose meter for the blood sugar range your meter will record.

Factors That Affect Glucose Meter Performance
The accuracy of your test results depends partly on the quality of your meter and test strips and your training. Other factors can also make a difference in the accuracy of your results. Some factors that can impact accuracy include the following:

• Blood counts (hematocrit)
• Vitamins and mineral supplements
• Altitude, temperature and humidity
• Generic or third party test strips

Refer to the package insert of your meter for specific instructions regarding these factors.

Making Sure Your Meter Works Properly
You should perform quality-control checks to make sure that your home glucose testing is accurate and reliable. Several things can reduce the accuracy of your meter reading even if it appears to still work. For instance, the meter may have been dropped or its electrical components may have worn out. Humidity or heat may damage test strips. It is even possible that your testing technique may have changed slightly. Quality control checks should be done on a regular basis according to the meter manufacturer's instructions. There are two kinds of quality control checks:

Check Using "Test Quality Control Solutions" or "Electronic Controls"
Test quality control solutions and electronic controls are both used to check the operation of your meter. Test quality control solutions check the accuracy of the meter and test strip. They may also give an indication of how well you use your system. Electronic controls only check that the meter is working properly.

Take Your Meter with You to The Health Care Provider's Office.
This way you can test your glucose while your health care provider watches your technique to make sure you are using the meter correctly. Your healthcare provider will also take a sample of blood and evaluate it using a routine laboratory method. If values obtained on the glucose meter match the laboratory method, you and your healthcare provider will see that your meter is working well and that you are using good technique. If results do not match the laboratory method results, then results you get from your meter may be inaccurate and you should discuss the issue with your healthcare provider and contact the manufacturer if necessary.

New Technologies: Alternative Site Testing
Some glucose meters allow testing blood from alternative sites, such as the upper arm, forearm, base of the thumb, and thigh.  Sampling blood from alternative sites may be desirable, but it may have some limitations. Blood in the fingertips show changes in glucose levels more quickly than blood in other parts of the body. This means that alternative site test results may be different from fingertip test results not because of the meter's ability to test accurately, but because the actual glucose concentration can be different. Glucose levels at the alternative site appear to change more slowly than in the fingertips.  Alternative site results may be different than the fingertip when glucose levels are changing rapidly (e.g. after a meal, taking insulin or during or after exercise).

Do not test at an alternative site, but use samples taken from the fingertip, if …

• you think your blood sugar is low, 
• you are not aware of symptoms when you become hypoglycemic, or 
• the site results do not agree with the way you feel. 

Below are a few contact numbers for a few meters if you are having trouble with your meter, please use the toll free number in your handbook or one of the ones below if you have one of these meters.

FREEDOM METERS	(888) 522-5226
BAYER METERS	(800) 348-8100
PRODIGY METERS	(800) 243-2636
PRESTIQUE/TRU TRACK METERS	(800) 342-7226
WAVESENSE	(866) 906-4197
ONE TOUCH METERS	(800) 227-8862
ACCU-CHECK	(800) 858-8072

Grace C. Eaton, LPN

Nurse Panel Manager

PHMG Patient Centered Nursing Team

Diabetes Self-Management Support

Certified Smoking Cessation Instructor

PinnacleHealth FamilyCare of Lower Paxton