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.  

Influenza Cases On the Rise in Pennsylvania

 Blog contributed by Dr. Joseph Cincotta, primary care physician

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

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

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

Other ways to reduce your risk of getting Influenza include:

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

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

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

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

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

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

What are the emergency warning signs?

In children

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

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

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

In adults

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

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

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