What kind of medicine is that?

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One of the hottest topics in medicine that has gained much steam over the past few years is that of Integrated or Alternative Medicine. According to WebMD, the percentage of hospitals that offered non-traditional (or non-allopathic) therapies has increased dramatically in the past 20 years, with a large percentage of organizations with a plan to breach the market that is complementary therapy. With all of the fuss then, what exactly is integrated/alternative/complimentary or holistic medicine? 


Integrated medicine refers to the seemingly limitless variety of potential medical therapies that does not fall under the traditional standard of Allopathic (Western) medicine. The word Allopathic comes from two Greek terms meaning “different disease.”  This term (sometimes used in the negative) indicates a foundation of germ theory, or that foreign bacteria, viruses and pathogens cause disease in humans. These foreign pathogens become the target for medicines and treatments. Other words for this type of medicine include "scientific medicine" or "evidence-based medicine." 


If Western medicine deals with external causes of disease, alternative medicine takes the opposite view – that the causes of disease are primarily internal, and can be cured or remedied by restoring proper function of the body. The umbrella of alternative medicine literally covers anything that one might attempt for restoration, from chiropractic, massage, acupuncture and vitamins to homeopathy, tai chi, cupping, urine tonic and colloidal silver therapy.


What type of medicine should be trusted? A few things to note: there is great variation between alternative therapies as to their scientific basis – for example, chiropractic therapy versus cupping are worlds apart. To make things even more difficult, there is also great variation within alternative therapies that color the scientific validity of the approach – for example, while chiropractic therapy is widely used and has been shown to help with back pain, the fundamental reasoning behind chiropractic is dubious at best. This idea leads to the primary problem with non-western medicine – lack of evidence. Integrative therapies may work or they may not, but there is an overwhelming void when it comes to research and evidence for their use. Unfortunately for the most part, non-traditional medicines have come about largely due to a perhaps legitimate dissatisfaction with western medicine; the holistic movement is reactionary in large measure. 

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So we’re again left with the question of what to trust? Here are a few facts that one should take into consideration when thinking about medicine in general:
1. There are only two types of medicine – medicine that works and medicine that doesn’t. The dichotomy between western/allopathic, naturopathic, alternative, integrative etc. etc. is a bad way of thinking about these things. The questions should be:
“Does this work? How does it work? How do I know?”
2. The foundation is important. If someone is selling you a therapy that’s based upon personal subliminal messages received from outer space, you can pretty much discredit that one because it's not subject to inquiry – it can’t be tested, ergo it can’t be validated or disproven. Does it work? It might, but you’ll have nothing but personal experimentation to back it up. 
3. Just because the foundation of a medicine is false, doesn’t mean the therapy is. This makes it doubly difficult and here is where a whole new discussion of “mind/body medicine” could take place. But you have to refer back to the questions about how to get your bearings: “How will I know that this works?”

One point of great interest regarding the foundations of the holistic movement is that the idea of prevention and limited use of medication has long been a staple of Western Medicine. In fact, it's in a form that many of us have seen and probably trusted for years – the D.O. A doctor of Osteopathic Medicine (D.O.) undergoes the same level and rigor of training as the standard M.D., and is licensed in the same way. In addition, some well-respected, traditional U.S. universities are well known for their practice of alternative medicine.


A great resource for those who want an in-depth and entertaining look into complementary therapies of many shades is a book called “Trick or Treatment: Alternative Medicine on Trial” by Simon Singh and Edzard Ernst. This will give you a good starting point on how to evaluate medical therapy of all kinds.


Good luck and good health to you!

By Ns1ghter Provider: Joseph Accursio MD

Utilizing healthcare

Let’s face it – the healthcare system as we know it is a mess. It can be confusing and exceedingly difficult to navigate for both patients and providers. It is hard to know where to go and when because so many services seem to overlap. Believe it or not, each segment of the medical industry does have a particular thing it does best. One goal here at Ns1ghter is to provide a forum to have self-help questions, remedies and guidelines available for your use, and to fill gaps where we can. 


Let’s discuss one of those important “know-where-to-go” questions – Urgent Care versus the Emergency Room. You have probably seen public service advertisements in your area about “urgent or emergent” care. Though most people believe that the two are similar, they are in fact very different, and in a medical emergency, time is of the essence. 
So what are the differences? 


Urgent care (or immediate care) facilities are designed to take care of small medical problems and take some of the overflows away from primary care. Things such as lacerations (cuts that may need sutures), colds, flu, bronchitis, strep throat, nausea/vomiting/diarrhea, rashes, strains and sprains, skin infections…things that can be treated successfully with a single visit. Urgent cares can also be used for temporary medication refills in a pinch, though this is generally frowned upon and should go through your primary provider for better continuity of care. An urgent care should NOT be used for routine vaccinations, regular medication refills, annual physicals or referrals for further testing or to specialty clinics. 


For things that are long standing and require further looking into, your regular provider is the place to go. That’s ideally the role of the mysterious “Primary Care” – the first touch point in the system that will help you make connections with any other place you might need to go. But even more importantly, primary care is about prevention. Most people (including providers) would agree that staying out of the doctor’s office, to begin with, is the best route. That’s the role of primary care. 


The ER or ED (emergency room or department) is exactly as the name implies – for emergencies. Life threats, things that can’t wait, serious problems that need treatment now. The buck stops in the ER – whatever needs to be looked at, scanned or treated can be, and if it can’t, the ER can send to where you need to go to have these things done. 


Unfortunately, the confusion between the ER and Urgent Care leads to countless healthcare dollars being wasted. Because it’s so well equipped, the cost of an ER visit is many many times that of the Urgent Care, even if you receive the same exact services. On top of that, inappropriate use of the ER takes up space and resources that might be needed for life threatening emergencies. Another problem with going to the ER is the possibility of being subject to more extensive testing than is necessary for your condition, just because of the setting you’re in. 


So in the world of healthcare, knowing where to go and when is of the utmost importance. 

A simple rule for someone without a lot of medical knowledge might be the following:

  • If I think something is seriously wrong, or might be seriously wrong, I should go to an emergency room or call 911.
  • If I think something can be fixed or figured out without in-depth studies, I should go to the urgent care.
  • If I think something is routine or is not significantly affecting my daily life, I should call my primary care.
  • If I have a general need and questions, or aren’t sure what to do, log onto Ns1ghter! 

 

By Ns1ghter Provider: Joseph Accursio MD

GERD (Heartburn)

By Ns1ghter Provider: Traci L French MD

Heartburn is a common and annoying problem which affects most of us at some point in time. Overindulging in fatty, spicy foods combined with alcohol can be a recipe for the burning pain, bloating and nausea that often accompanies this condition. Acid reflux or heartburn occurs when the lower esophageal sphincter(a tight ring of muscle at the top of your stomach) relaxes and allows stomach contents to flow backwards into your esophagus. Sometimes the acidic contents of your stomach can flow backwards into your lungs causing coughing, wheezing or choking. Almost a third of us suffer from this condition on a daily basis. Common causes of acid reflux disease include obesity, smoking, alcohol use, pregnancy and other hormonal changes and eating too-large portions. 

Diagnosis and Treatment


Left untreated, GERD can develop into severe health problems. Some conditions associated with severe long-term acid reflux disease include asthma type symptoms as described above, insomnia, and pre-cancerous changes to the esophagus as well as cancer of the esophagus in very rare cases. There are several home remedies you can try to treat occasional heartburn. Effective remedies include weight loss and avoidance of trigger foods such as fast food, carbonated drinks, chocolate, caffeine and citrus foods. Along with preventing many other problems such as heart disease, cancer and lung disease, many people find that reflux symptoms improve as consumption of alcohol and tobacco products decrease. If your symptoms flare at bedtime, elevating the head of your bed slightly can decrease acid reflux. If your symptoms persist for more than a few days or are accompanied by weight loss, recurrent vomiting or blood in the stool an urgent visit to your provider is warranted. Simply discussing your symptoms with your provider can help you and your physician develop a plan to manage your symptoms but sometimes further testing is warranted to rule out more serious conditions. 

Treatment


As with many conditions, the primary therapy for GERD includes lifestyle modification. A 10 lb. weight loss is often enough to noticeably improve acid reflux symptoms. Switch to smaller meals every 3-4 hours and follow a low fat diet high in fruits, vegetables and lean protein. Herbal remedies for GERD include the use of cardamom or licorice to improve digestion and decrease bloating. Ginger is a well-known remedy for nausea and may decrease reflux by acting as an antispasmodic as well as by tightening the esophageal sphincter. Avoid trigger foods and add spices such as mint, ginger, cardamom and fennel to your diet if these remedies improve your symptoms. Decrease alcohol consumption, especially close to bedtime, and stop smoking. Tight clothing can worsen symptoms as well. There are many pharmaceutical treatments for heartburn that are safe for short-term use but have long term side effects including B12 deficiency, osteoporosis with hip fracture, gastric polyps and C. diff coliti s. It is typically recommended that prescription heartburn medications be used for no longer than 6-8 weeks without a physician’s recommendation. There’s no need to suffer in silence. Acid reflux disease is an unpleasant and often painful condition that can be improved with a few lifestyle changes. Speak with your provider today to develop a treatment plan. 

Citation: David C. Metz, MD. Gastrol Hepatol (NY). 2008 May; 4(5): 322-325. Long-term Use of Proton-Pump Inhibitor Therapy. 

 

 

Diabetes Self Care

By Ns1ghter Provider: Traci French MD

Diabetes is a disease noted by elevated blood sugar which affects almost 10% of the US population according to the CDC (2014 National Diabetes Statistics Report). There are two major types of diabetes. About 5% of patients have type I diabetes, which occurs when your body completely stops making insulin, a hormone which regulates blood sugar levels. The majority of diabetics have type II diabetes, which is caused by insufficient insulin production. Risk factors for diabetes include age, obesity, and belonging to certain ethnic groups.

Consequences of uncontrolled diabetes include blindness, infertility and birth defects, poorly healing wounds, heart disease, stroke and depression as well as many other conditions. Many of these outcomes can be avoided by following your doctor’s treatment regimen and performing routine self-care. 


Diabetic diet: dietary change is a cornerstone in the prevention and management of diabetes. Current guidelines recommend 150 minutes of exercise weekly along with behavioral modification. Your doctor will be happy to refer you to exercise and nutritional specialists who can tailor an individualized plan that meets your needs and preferences. A weight loss goal of 7-10% of your current body weight can delay the onset of diabetes in high-risk individuals and decrease the risk of consequences in patients diagnosed with diabetes.


Vision care: Yearly eye exams are recommended to monitor and limit the damage caused by elevated blood glucose on your eyes with more frequent visits recommended for patients with more severe disease.


Dental care: More frequent dental visits are recommended for diabetics in order to prevent tooth loss and gum disease.


Immunizations: Diabetes can weaken the immune system and increase your chances of catching diseases such as influenza and pneumonia. It is important to get a yearly flu shot and stay up to date on your pneumonia vaccine. Discuss getting a shingles shot with your doctor in order to prevent the debilitating skin rash and chronic nerve pain caused by the shingles virus.


Foot care: Your feet are your primary form of transportation and require some TLC. Avoid walking barefoot and check your feet daily for cuts, scrapes, calluses or other signs of wear and tear. This is a great excuse for a foot massage with healing lotion and be sure to contact your medical provider for further evaluation if you develop a wound or abnormal sensation in your feet.


Last but not least, follow up with your doctor on a regular basis to monitor your weight, blood sugar and blood pressure. Lifestyle changes are the primary treatment for diabetes along with the proper medical regimen. You have the power to lead a happy, healthy and full life when you and your care team develop a safe and effective disease management regimen.

When is it more than "just a cold"

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By Ns1ghter Provider: William Jantsch MD

Every human being on the planet is susceptible to catching a cold. The experience is annoying and frustrating, because when the illness starts, you generally know that you are going to feel miserable for several days and you hope that there is something you can do to make it better. 
A “cold” is what a doctor would call a “viral upper respiratory infection”, which is actually a whole range of conditions, caused by a fairly large number of different viruses. Depending on your age and general health status, the same virus that causes a runny nose and cough in one person may cause you to have a sore throat and a hoarse voice. 


In general, however, a cold will generally start with a feeling of body aches and fever, followed by some combination of: stuffy nose, facial pain, ears feeling plugged, sore throat, pain in the eyes with upward gaze, headache, cough, hoarse voice. 


Very commonly, the nasal stuffiness or sore throat will resolve in a day or two, then followed by a cough that will persist for up to several weeks. The alternative is also possible: an initial cough may give way to facial pressure and nasal congestion that goes on for weeks.
The general approach to treating a cold is entirely based on symptom relief. There is no scientific evidence to show that any treatment is effective in shortening or lessening the course of any viral upper respiratory infection. On the other hand, there are hundreds, if not thousands of treatments available that claim to relieve symptoms of a cold. Unfortunately, none of these works very well. 


So, what does a doctor do when a patient comes in to his office and requests help with a cold? The doctor knows that the patient is suffering from a benign, self-limiting disorder for which there is no good treatment. The patient is a wits’ end due to days of suffering with feeling unwell, and is hoping for a cure.


The prudent practitioner will attempt to accomplish two goals:
a. Reassure you that there is nothing serious needing any special attention
b. Identify and treat any other condition that may present with “cold symptoms”
The issue of antibiotics


Ever since the discovery of penicillin in the 1920’s there has been the hope of “getting something to knock this infection out”. However, now almost 100 years later, we have come to realize that antibiotics have been overused for so long that many bacteria are no longer susceptible to them. We need to stop using anti-bacterial antibiotics to treat viral infections, because there is no benefit from those antibiotics, and ultimately their overuse harms us all as a society.


An antibiotic should not be used for “just a cold”. But there are conditions that may benefit from antibiotic use that may be associated with cold symptoms, including:
a. Sinusitis
b. Pneumonia
c. Otitis media (middle ear infection)
d. Influenza
e. Streptococcal (“strep”) sore throat
Sinusitis is manifested by facial pressure, fever, and thick nasal discharge that has lasted for over a week. Most cases are still caused by viruses, but your doctor should be able to help determine if an antibiotic would be helpful.


Pneumonia usually is a complication of a viral upper respiratory infection, and the symptoms of this would include shortness of breath, high fever, chest pain, and unremitting cough. The diagnosis can be established with physical exam or with a chest x-ray.
Otitis media presents with pain and loss of hearing in an ear. There is often fever as well. Ear drainage may be present if there is a rupture of the ear drum.


Influenza (“flu”) is characterized by sudden onset of fever, muscle aches, headache, cough, and profound weakness. (It usually does not cause vomiting and diarrhea, as many people believe.) There are antiviral antibiotics that may be of some benefit if started early during the illness.
Strep throat causes sore throat, fever, and swollen glands. It does not cause cough or nasal congestion. Most sore throats are caused by viruses, and a doctor will not be able to tell for certain that you have a strep throat just by looking at you. On the other hand, a doctor may be able to tell you that strep is unlikely due to your symptoms and findings. There are rapid tests and cultures that can settle the issue. 


So, when should you see a doctor regarding your “cold”?
If you are otherwise healthy, and have no chronic medical conditions such as heart failure, diabetes, chronic lung disease, or cancer, and if you develop a cough, nasal stuffiness, sore throat, and mild muscle aches and fever, I would recommend:
a. Wait a few days and treat yourself with plenty of oral fluids, rest, and acetaminophen or ibuprofen as needed for fever or discomfort
b. If you feel better after a day or two, it is likely “just a cold”; note however, that full resolution of the nasal stuffiness, sore throat or cough may take up to 2 weeks
c. Seek medical attention if:
a. Fever is high (over 102 degrees Fareinheit) and associated with headache and weakness
b. Cough gets progressively worse over several days, and becomes associated with fever, chest pain and trouble breathing
c. Facial pain and nasal stuffiness persist for more than 10 days
d. Severe ear or throat pain

 

Hypertension: Silent but Deadly

By Ns1ghter Provider: Traci French MD

Hypertension or high blood pressure is a serious and common problem in the Western world. According to the CDC, 1 in 3 Americans have a diagnosis of hypertension currently being treated by a doctor. Nearly half of us have abnormally elevated blood pressure and are unaware of the issue. Untreated high blood pressure leads to heart damage and stroke as well as several other health issues including memory loss, eye damage and kidney failure. 


Causes of Hypertension
Hypertension occurs when your blood pressure remains above 140/90 on multiple occasions. High blood pressure often is inherited, but preventable causes of hypertension include smoking, excessive alcohol intake, obesity, diabetes and lack of exercise. 


Diagnosis and Prevention
You can decrease your chances of getting high blood pressure by exercising 20 minutes 3-5 times per week, maintaining a healthy weight, and quitting smoking. Switching to a diet based primarily on plants and lean meats with minimal processed foods and restaurant meals will lower your blood pressure and help to obtain and maintain a healthy weight. Regular checkups with your medical provider will help you set healthy lifestyle goals as well as screen for health warning flags such as abnormal sugar levels. Yearly visits with your eye doctor can help prevent dangerous consequences of high blood pressure such as glaucoma or retinal disease.


Hypertension Treatment
Your doctor will likely begin treatment of elevated blood pressure by prescribing a low fat, low sodium diet along with an exercise regimen such as walking. Just losing 10 pounds can lower blood pressure significantly, especially when added with lifestyle changes such as stress reduction, smoking cessation and decreased alcohol intake. If lifestyle modification isn't sufficient, your doctor may recommend one or more medications or additional testing based on your personal history. It is important to take the medications as prescribed on a daily basis and follow up with your doctor periodically to ensure that your treatment regimen is effective. High blood pressure is a common and important illness that has dangerous consequences if left untreated, but it can be safely controlled when you and your doctor work together to develop a treatment plan.

Ear pain when flying

By Ns1ghter Provider: William Jantsch MD

What to do when your ears feel plugged and you have to fly…

A common question I am asked when seeing patients in our Urgent Care Center is “how can I fly in an airplane with this ear and sinus congestion?”

The space behind the ear drum is called the “middle ear”, and this space is vented through a small channel called the eustachian tube into the nasopharynx. You can feel the eustachian tube opening up when you swallow or yawn; this opening is the source of your feeling your ears “pop”. When you experience a change in air pressure, such as a commercial air flight, you need to keep balancing the pressure behind your eardrums with the outside pressure. Hence the need to yawn or chew gum while taking off and landing in an airplane.

However, the eustachian tubes can fail to function properly if inflamed or full of secretions, as happens with a cold, sinus infection, or upper airway allergies. If you try to fly under this circumstance, the air pressure in your middle ear will not balance with the outside pressure, and there will then be tension on the ear drum. This can be very painful, and lead to hearing loss, ringing in the ear, and even rupture of the eardrum. Damage due to air pressure differences is called barotrauma.

Multiple interventions have been proposed to avoid ear barotrauma, and to treat it once it has occurred.

Prevention:

- Don’t fly if you have nasal congestion due to upper respiratory infection or allergy, and you feel like you can’t “pop” your ears

- Oral Sudafed, taken 1 hour prior to flight

- Topical decongestant (e.g. Afrin, used just before boarding the plane)

- Ibuprofen (in anticipation of pain)

- OTC antihistamine (if your symptoms are allergy related)

- Earplugs

The benefit here is if you place an air-tight plug in your ear at ground level, there will be no need to equalize the pressure in your middle ear at altitude. This can work well, but the plug must be air tight- use a “sticky” moldable silicone plug (e.g. Mack’s or Ear Plane) available at the drug store

Treatment:

- Valsalva maneuver (Traditional, Frenzel, Toynbee)

Tradition says to take in a breath, then hold your nose closed by pinching with your thumb and forefinger; imagine then trying to force air out through your nose (even though it is blocked), and gradually increase the amount of force against your nose until one or both of your ears “pops”. Be careful not to try to hard, because you can damage your eardrums with this maneuver

Dr. Frenzel suggests holding your nose and repeated make the sound “kah” or “gah”

Dr. Toynbee seems to have gotten good results with holding his nose shut and trying to swallow repeatedly

- Steam from hot-water soaked paper napkins

Ask the flight attendant for a cup of hot water, and an extra empty cup, along with several napkins. Crumple a napkin in the bottom of the empty cup, and soak the napkin with some hot water. Hold the steaming soaked napkin up against the painful ear; I have not tried this, but people have reported substantial pain relief with this method

- Sucking on hard candy vs chewing gum

Hard candy is believed to work better, because it causes you to swallow more than with standard chewing gum

- Allowing a child to feed

Having a baby with an ear infection on the flight is no fun for the child or anybody else. The act of swallowing is the best way to vent the eustachian tube, so make sure you have plenty of fluids for the baby to drink

Seek Medical Care if:

- Severe pain

- Unable to hear after a flight, or persistent unusual ringing sound

- Bleeding or discharge from an ear

- Dizziness or “spinning” sensation

- Fever, headache, confusion

Have a good flight!

Stress isn't a "thing"

By Ns1ghter Provider: Allison Godchaux MD

As I tell my patients, stress isn’t a ‘thing’. It isn’t like having the ‘flu’ or having a headache, or having your back hurt. Stress isn’t ‘a thing’ it is a reaction to things that happen to us in our everyday world. It is how our body reacts to what it senses is a threat to our well-being.

 For example, think back to the caveman days. A bear is chasing you, and your body goes into the normal “stress” (fight or flight—in this case, flight) reaction. And you run. If you run fast enough, you escape from the bear, and your stress goes away. If you don’t run fast enough, stress is not your biggest problem! Not being the bear’s next meal, is!

To help your body run away from this ‘threat’, it does a number of things. Your body increases the amount of ‘stress’ hormones (adrenalin, noradrenaline and cortisol), to help you run away from the bear. An increase in these hormones causes the following things to occur in your body:

- Heart rate, and therefore, output of blood from the heart increases

 (in medical terms, cardiac output)

- Respiration (the amount you breathe) increases.

- Blood vessels dilate that go to your arms and legs, carrying more oxygenated blood to your muscles (very necessary, of course, for running as fast as you possibly can!)

- Sugar is released into the bloodstream by the liver (glycogen—you may have read about it) to give you the energy you need.

- The stomach produces more acid to digest whatever is in it, and empty itself. (ever try to run fast with a full stomach?)

- Muscles tense up, allowing them to function optimally.

As you successfully run away from the bear, your body reabsorbs the chemicals it had been putting out, and you, thankfully, having escaped, and return to a more normal physiological state.

But what if it isn’t the bear that is the problem, what if it is too many deadlines, or responsibilities, too many bills to pay, the daily drive in traffic, a sick child or parent, in a day that is already filled with other responsibilities….

The problem isn’t that there is a bear chasing us—either you outrun the bear—or you don’t, but, in either case, the stress is over pretty quickly, either way. The problem is when “the bear never stops chasing us,” that the “chronic” stress response becomes a greater problem than escaping the bear! That wasn’t how it was meant to be.

With long-term stress what we begin to see is: our blood pressure goes up and we have high blood pressure; our blood sugars go up, and we become diabetic; we have tension or migraine headaches from the constant muscle tension;  and stomach ulcers from all that acid we’re producing.  

The immune system can be affected as well (adrenalin suppresses the immune system), and you get sick more often. Stress affects our sleep, and if we aren’t getting enough sleep, it makes everything that we have to deal with in life, that much worse.

So, you are stressed, or have stress? The question is, what can we do about it? Do the following:

1. Exercise – regular exercise; intentional exercise. Walking at work is great, but that is your body’s new normal, though every little bit helps. Up the ante! Burn off those chemicals that your body accumulates while stressed. And, with exercise, your body puts out endorphins. Endorphins are those “feel good” chemicals that are released into your blood stream by your brain, and that you want to have!! They make you; well, feel better—and can help decrease stress!

2. Yoga – it can help relax you, and you will learn deep breathing exercises, which can be used daily. It also puts out another feel-good chemical, serotonin, which helps lower cortisol, one of those chemicals that increase when stressed.

3. Eat a well balanced diet, if you need help with this, let us know. You have to give the body the fuel it needs to manage the stresses in your life!

4. Herbal supplements and teas are always a good ‘go to’. Both Chamomile and Lemon Grass tea have demonstrated benefit, but can cause drowsiness. Try making a cup of tea your daily activity. No multi-tasking but drinking a relaxing cup of tea. Enjoy the stress relief from the affects of the tea, and for taking a moment of time for yourself.

5. Make time for sleep. It is important!

6. Consider seeing a therapist. If you feel you need a medicine to help manage your stress and anxiety, you may be right! But, don’t forget the counseling to go along with it. I much prefer that my patients learn how to deal with the stress and anxiety in life, than to have to take medications, with their potential side effects.  

7. Take medications, if you have to. Think about what your future holds, in the area of stress. The problems in our lives will never go away. We will always have them. Do you want to commit yourself to a lifetime of dependency on medication to deal with these stressors? Or would you prefer to learn how to manage those stressors? If you feel the need to take prescription medicine in the short term, don’t forget that therapy can help you learn how to manage the stress for the long term!

Mindfulness and your health

By Ns1ghter Provider: Joseph Accursio MD

Let’s talk philosophically for a few minutes. Believe it or not, your ideas about healthcare profoundly impact the way you go about your daily life. Your health plays an undeniable and immediate role in your function at work, at home, during exercise…in everything that you do. And that’s why it is so important for us to change the way we think about health and healthcare. 


If you follow health news in any form or fashion, you’ve likely seen the latest buzzword, which gains increasing popularity everyday – the word is “mindfulness.” There are many definitions and attachments to this word because it’s the latest thing. But what exactly is mindfulness? And how can you use it to improve your health and performance? 
Boiled down to the simplest definition, mindfulness can be explained in two words – PAY ATTENTION! This sounds rather silly, but in hindsight, evidence of people not paying attention to what their body is telling them and how they’re feeling is quite common. Let me give you some examples: 


• The holidays roll around. You hear constantly around the office that people have “put on a few pounds” over the holidays and they just have get back in the gym to take that weight off. But every year, it’s a few more pounds MORE than it was last year.
• Life gets busy. Responsibilities temporarily increase and the time to prepare and eat meals takes a back seat to convenience. You swear that you’ll get back to “eating right” sooner or later, but before you know it, a LONG amount of time has passed and you’re still eating from a drive thru window. You’ve been more tired “lately” and just can’t seem to catch up.
• How often have you heard or made the statement about “getting back in shape”? Whether due to things noted above or another life circumstance, it’s pretty common to hear people discuss returning to a prior state of health. In most cases, people have been so “out of shape” for so long, that returning to the mythical “in-shape” is unlikely. 


These examples are not meant to be all inclusive, but to bring awareness to the fact that we generally only pay attention to our health when something has gone wrong and has been affecting us in significant ways.


Here is the core idea behind mindfulness, which is again, paying regular attention to your health. If we gave as much thought to our health as we did to so many electronic devices, we would have a lot less problems and be much better off for it. Ironically, this is the best use of fit-bit type devices. Though research has been less that stellar regarding fit-bit use, they do provide a conscious reminder of how much we move and other indications of health and wellness. 


Admittedly, paying attention to something that’s so obvious and easy to forget is an exercise in discipline. The discipline of reorganizing priorities. The first step to change and the initial period required to ingrain a positive habit is the most difficult. Here are some suggestions to help you achieve a better health awareness or mindfulness:
1. To start with, you’ll have to write this down! Make sticky notes, program your phone with alarms, keep a journal…whatever it is that helps you to remember. DO IT! BE DILIGENT! There is little in your day that is more valuable than your overall health.
2. You will need a support system. As human beings, change is extraordinarily difficult without external support. We simply don’t have it in us to make big changes without help. Recruit some help! People who are invested in you – close family or friends. Even better, people in whom you are invested, and will undertake a journey of health consciousness alongside you. Support is CRUCIAL to success!
3. Don’t be afraid to fail. You will fail. Often. That’s the way of it. But don’t see failures as the end. See them as a small challenge that is overcome by the next success. Keep at it! As the maxim goes, success is 90% perspiration and 10% inspiration. THERE’S NO SUBSTITUTE FOR WORKING AT IT! 

 

 

Sore Throat

By Ns1ghter Provider: Traci French MD

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Sore throat or pharyngitis is a common problem that can make you miserable. Bacterial infections such as strep throat or viral infections such as mononucleosis can cause throat pain. Other causes of throat pain include overusing your vocal cords, exposure to cigarette smoke or other pollutants, allergies and dry air found indoors in winter. Here are a few ways to soothe a sore throat:

Gargle with a mixture of 1 teaspoon salt added to 1 cup of warm water and repeat every hour until improved. DO NOT SWALLOW. Adding a little lemon juice may help with your symptoms and improve the taste of the gargle.
Swallow a teaspoon of honey or drink warm chamomile tea. Kids usually tolerate this remedy better than a salt water gargle but honey should not be given to children under the age of 1.
Try over the counter throat lozenges or throat sprays but follow label directions and use with caution in children under age 18. A homemade herbal recipe for throat drops consists of 5 tablespoons coconut oil, 1 ½ teaspoons honey, ½ teaspoon ground ginger and 1 teaspoon slippery elm powder. Mix together, place in a candy mold or ice cube tray and pop into the freezer until set then store in the refrigerator. Adding Vitamin C powder or cinnamon may make your throat drops more effective. (Recipe courtesy of Mommypotamus).
Try to get extra sleep and increase your fluid intake. Over the counter pain relievers such as ibuprofen or acetaminophen may help but follow recommended dosing instructions.
Steamy showers or using a humidifier can improve your symptoms as well. Try adding eucalyptus or peppermint oil to decrease congestion and ease throat pain but be careful to avoid slipping in the tub.

When Should I See a Doctor?
 

See a doctor if your symptoms last longer than three days, if you notice a rash or if you develop a fever greater than 102 degrees.
Seek a medical provider immediately if you have a sore throat and shortness of breath or difficulty swallowing.
Other worrisome signs include hoarseness in your voice for longer than two weeks, large swollen lumps in your neck, and weight loss.

What Happens When I See the Doctor?

Your medical provider will examine you and may order further testing based on your symptoms and personal medical history. He or she may recommend rest and symptom relief for your pharyngitis but take your entire dose of medication if antibiotics are prescribed. Follow up with your doctor if you still have symptoms after your treatment is completed or if you feel worse instead of better within two days of your appointment. 

Prevention is the Best Cure

One of the best things you can do for your health is to stop smoking. Smoking is a common cause of throat pain and can lead to cancer of the throat as well as increasing your likelihood of catching colds and the flu. Washing your hands frequently also decreases your chances of getting sick. A yearly flu shot will improve your chances of not catching the bugs that cause pharyngitis. If you have symptoms such as cough, runny nose, sneezing and itchy eyes along with your sore throat, ask your doctor if you have allergic rhinitis and your provider can recommend a treatment plan.

Tips for Better Eating Habits

By Ns1ghter Provider: Mike Polich, FNP-BC, MBA, Family Nurse Practitioner

Considering the bulging waist lines of 36.5% of the population in the United States (CDC statistic on obesity), it is obvious that sticking to a healthy eating plan is a challenge for many people. If you are having problems sticking with that resolution that you set in January, here are some simple tips to help you start to create new and healthy eating patterns.


• Calories count. It's not low fat vs. low carb. You can eat fewer calories by eating less food (which is why you can lose weight on any diet that restricts entire categories of foods or limits portion sizes), but you may get hungry and gain it back. Fat has 9 calories per gram, but protein and carbohydrates have only 4 calories per gram. This means that when you eat less fat, you consume fewer calories without having to eat less food. Eat less fat and fewer simple carbs. To achieve a one pound weight loss per week, 3500 calories should be subtracted from your normal weekly caloric intake. To do this, reduce your normal daily caloric consumption by 200 to 300 calories per day and increase your physical activity with a goal of burning an additional 200 to 300 calories per day.


• Be accountable for what and how much you eat, keep a food journal for a month or at the very least a few weeks to be aware of what, when and why you are eating. Paying attention to physical cues and signals can help you determine when your body is cuing you to eat due to hunger as opposed mental or external cues. Ask yourself, "Am I really hungry or am I eating because it is there, it smells good". 


• Do not restrict foods! There are bad foods but there are also inappropriate portion sizes! If you neglect certain food groups, you'll end up craving those foods and binge eating. You also miss out on vital nutrients. 


• Weigh and measure foods for at least a month but at the very least 2 weeks to be aware of serving sizes and portions. Serving sizes and portions have gotten so distorted over the years in restaurants and the like, that most people are completely unaware of what a single serving actually looks like! Most restaurant servings are 2-3 times single serving sizes. 


• Don't skip meals. Eating 5-6 times a day not only stimulates your metabolism but will keep your blood sugar level. By consuming five or six daily meals, your body will also convert less off the food you eat into fat and maintain a constant blood-sugar level, making you less likely to experience periods of low energy. Be careful not to simply eat the same sized meals you eat now, but more often - or you might actually gain weight and raise your cholesterol.


• Be positive. Recognize irrational thoughts. Focus on the things that you have done right and the positive changes that you have made. 


• Lose weight in a way that enhances your health not in a way that detracts from it. 


• Avoid trans-fatty acids and partly hydrogenated fats ("bad fats"). They may increase the shelf life of certain food products, but they decrease the shelf life of people who eat them. 


• Eat fewer "bad carbs" like sugar and white flour. They are low in fiber, so they are a double punch if you are trying to create healthy eating habits: a lot of calories that don't fill you up, 


• Eat more "good carbs" like fruits, vegetables, legumes and unrefined grains (such as whole-wheat flour and brown rice). They are rich in fiber, which slows absorption and fills you up before you take in too many calories.


• What you include in your diet is as important as what you exclude. With few exceptions, those protective antioxidant and health benefiting substances are found in good carbs, such as fruits, vegetables, whole grains and legumes. 


• Eat less red meat. It’s loaded with artery-clogging saturated fat and has been linked to an increased risk of cancer. 


• Begin by making moderate changes in your diet. If you want to lower your cholesterol level or weight even more (or if you have heart disease and want to reverse it), you may need to make bigger changes. 


• Choose quality over quantity. Smaller portions of good foods are more satisfying than larger portions of junk foods, especially if you pay attention to what you're eating

Allergic Rhinitis (Seasonal Allergies)

By Ns1ghter Provider: Traci French MD
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Coughing, sneezing and runny nose are often signs that spring is upon us. Allergic rhinitis is a condition affecting between 10% and 30% of the population according to the American Academy of Allergy, Asthma and Immunology. Symptoms of allergic rhinitis include itchy, swollen red eyes, itchy skin rashes, nasal congestion as well as dry cough, sneezing, clear runny nose and wheezing or snoring at times. Another name for allergic rhinitis is hay fever, which explains the fatigue and low grade temperature elevation which sometimes accompanies this problem. These symptoms occur when your body mounts an inflammatory response to these exposures by releasing a chemical called histamine. Both kids and adults are affected by allergy symptoms, but kids often have more noticeable symptoms and have more difficulty tolerating prescription allergy medications. Common triggers for allergic rhinitis include dust, mold, pollen and pet dander. 

Self-Care

If you have mild symptoms, try some of the following remedies:
  1. Many allergy sufferers swear by a daily dose of local honey or bee pollen to relieve symptoms, but avoid bee pollen if you have asthma or severe symptoms until you see your doctor.
  2. Nasal saline spray can relieve congestion and nasal drainage with minimal side effects. You can make your own by mixing 1 teaspoon salt in 1 cup distilled or sterile water with a pinch of baking soda added. Mix a fresh batch each time you use the saline wash in order to decrease the risk of bacterial infections. Neti pot use is now controversial due to severe infections associated with improper use but is safe and effective when used according to label directions.
  3. Peppermint, eucalyptus and basil oil have been noted to decrease inflammation associated with allergic rhinitis. Try adding one or a mix of these oils in your shower or use in a diffuser. Do not apply these oils to your skin or take internally without consulting your physician.
  4. Peppermint and nettle tea are noted to decrease histamine production and are safe for both children and adults but consult your pediatrician before using in small children. Avoid use of these remedies in the first trimester of pregnancy due to possible stimulating effects on the uterus without first discussing the issue with your provider.

Diagnosis and Treatment

See your medical provider if you notice symptoms lasting more than a few days, headache, fever, ear pain, dizziness, nausea, cough producing green or yellow phlegm, or green or yellow nasal drainage. Serious symptoms warranting immediate attention include shortness of breath, swelling in your face or neck, full-body rash, wheezing or blurred vision. Your provider will evaluate your symptoms and prescribe a treatment regimen based on your personal history. Sometimes you can use your medications on an as needed basis but daily treatment may be needed for severe allergy sufferers. Follow your provider’s instructions in order to ensure the best outcome.

Prevention

There are many suggestions regarding allergy prevention. Dietary changes backed by scientific evidence include increasing probiotic intake and adding omega 3 fatty acids to your diet. This is accomplished by eating more fermented foods such as yogurt and sauerkraut as well as increasing your intake of fatty fish such as salmon or taking supplements. Decreasing your exposure to irritants such as cigarette smoke and wearing a dust mask while mowing the lawn or working in dusty environments will make a big difference in your symptoms. Wipe down your pets after they have been outside. Switching to HEPA filters in your AC system and vacuuming frequently are simple and effective methods for reducing allergen exposure. Allergies are frustrating but with a few changes in your routine, you will be able to get out and enjoy the outdoors again.


Citation: Allergy Statistics-http://www.aaaai.org/about-aaaai/newsroom/allergy-statistics

Gui Yang, Zhi-Qiang Liu and Ping-Chang Ying. N Am J Med Sci 2013 Aug; 5(8): 465-468. Treatment of Allergic Rhinitis with Probiotics: An Alternative Approach. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3784923/

What to do When a Tick Breaks off in Your Skin

By Ns1ghter Provider: Randy Anselmo, Physician

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When removing ticks, it’s not uncommon for them to get broken off in your skin, leaving some of their mouthparts behind. Proper technique helps prevent this – and I’ll get to that later – but that only helps the next time. You’ve got a piece of a tick in your skin now…so what to do?

First, don’t freak out! The mouthparts of the tick usually do not contain any of the bacteria that cause tick born illnesses, like Lyme disease, Ehrlichia, anaplasma, babesia or Miyamotoi. Those are generally in the tick’s gut, and once you’ve pulled the body off, the risk of getting one of these infections is minimal, especially if you’ve removed it within 36 hours of the tick attaching to you.

Next, clean the area by putting an alcohol-soaked cotton ball or tissue on it for a few minutes. You should avoid putting anything like alcohol on a whole, live tick because it might agitate the tick and cause it to regurgitate the bacteria from its gut into your skin. But when part of the tick is gone already, it’s fine to do.

Grasp the tick parts as close to the skin as possible using the kind of tweezers that people pluck their eyebrows with. You know, the ones with wide, flat tips that come nicely together. Give a steady pull straight up, and don’t twist.

Don’t worry if you don’t get everything out. And don’t spend too much time digging around trying, as you are liable to make things worse by causing a skin infection. You can just leave the tick parts in your skin, and your body will eventually break them all down and dispose of them. Sometimes, the bite area will get itchy, which is a natural indication of the healing process. Try to avoid scratching it, and feel free to dab it with some 1% hydrocortisone cream (over-the-counter) if needed.

If it’s really making you uncomfortable, either because of the itch, or just the idea of having tick parts in your skin creeps you out, your doctor can remove the piece of skin containing the parts. It won’t likely alter your risk of getting a tick born disease, but it can relieve the itching or anxiety. It’s done by injecting the area with a local anesthetic, then using a biopsy punch (sort of like a tiny cookie cutter) to cut out a little core of skin, then putting in a stitch or wound closure strip.  While it’s a simple process, it’s not without risk. Even in the best of hands, it can get infected, or you could have an allergic reaction to the anesthetic. Depending on where the bite is, a biopsy could cause bleeding or damage to a nerve.

As with any tick bite, whether or not the tick is completely removed, you should be on the lookout for any signs of tick born disease over the next month. These include symptoms like unexplained fever, head or body aches, bull’s-eye rash, significant fatigue, etc. You should visit your doctor promptly if any of these occur. If you go a month without symptoms, there’s almost no likelihood of developing them later.

Removing a tick properly helps reduce the chance of it breaking off in your skin. There are some great little tools out there like tick spoons that work really well, but if you don’t have one on hand when you need it, a tweezer works well. Using either tool, grasp the tick as close to the skin as possible. Once again, hold tight, and slowly, steadily pull upward until the tick releases. Don’t twist. That’s all there is to it.

Of course, no conversation about tick bites would be complete without mentioning that avoiding them in the first place is the best plan. When ticks are in season in your area, curtail activities in the brush. When you do get out there, though, wear light colored clothes so you can see the little buggers, and tuck your pants into your socks, and your shirt into your pants. Ticks crawl upward, and this keeps them from finding a path to your skin. Use an insect repellent containing 30% DEET. And as soon as you get home, put those clothes in the wash (or leave outside until it’s time to do the wash). While you’re standing there naked, get in front of a mirror or a trusted friend or family member, and do a thorough visual check of your body. Where my family lives, there are lots of ticks, and we love the outdoors, so in tick season, this is a daily ritual, just like brushing our teeth.

Tick bites aren’t that big of a deal if you can remove the tick early. Take your time, and do your best to use good technique, but don’t worry if you don’t get everything out. Usually, the best thing to do is leave it alone and let your body handle it.

Health screening for Women ages 40 to 64

By Ns1ghter Provider: Komal Hanif; MD; Family Medicine

How many of these have you had? Call your healthcare provider today!

  • Blood Pressure
  • Cholesterol
  • Diabetes
  • Colon cancer: if you’re between 50 and 75. If you have a family history of colon cancer, or risk factors such as polyps or inflammatory bowel disease, you will need to be screened sooner. 
  • Dental exam
  • Eye Exam
  • Immunizations: Flu shot annually, Tetanus-diphtheria and acellular pertussis (Tdap) vaccine booster every 10 years, Shingles vaccine once after 60
  • Physical exam
  • Depression
  • Mammogram
  • PAP smear and HPV
  • Osteoporosis, if you have risk factors
  • Lung cancer annual screening for with low-dose computed tomography (LDCT) in adults aged 55 to 80 years who have a 30 pack-year smoking history AND currently smoke or have quit within the past 15 years

 

Dealing with Motion Sickness

By Ns1ghter Provider: William Jantsch MD

Well, it’s finally the day to begin the trip you have been planning for almost a year. You will be flying to Europe to begin a 2-week cruise on a luxury yacht sailing in the Mediterranean. However, you remember that the last time you were in a boat you got very sick from the water motion, and the last thing you want is a repeat of this. What can you do?


Motion sickness is a disorder caused by many factors, but is primarily due to a difference in the movement you feel, and the movement you see. When the brain receives conflicting signals, the result is clammy, cool skin, dizziness, nausea, and vomiting. 


People can get motion sickness on airplanes, automobiles, boats, or carnival rides. Some people can get waves of “sea-sickness” just by watching boats bob up and down at a dock. Some lucky people seem immune to this form of disorientation, but others are highly susceptible. 


If you know that you have the capacity to get motion sickness, there are several measures that you can employ to try to avoid experiencing symptoms that would otherwise spoil a nice vacation. 


Step 1- Planning
Start your journey well-rested and comfortable. Wear loose-fitting clothes, and do not eat or drink a large amount just before travel. Avoid caffeine, spicy foods, or alcohol just before the trip. If possible, try going for a short jaunt in the plane or boat you are going to spend time in, to get used to the surroundings. 


Step 2- Positioning
If in a car, try to sit in the front seat, and keep the back of your head rested against the seat with your eyes gently closed. You may find that you will not get motion sick if you are the driver of the car (but do not drive if you feel the least bit sick!). In an airplane or boat, try to be situated in the middle of the craft so that you do not feel the maximum motions. Again, by keeping you head rested against a solid surface and keeping your eyes closed, you will limit the amount of “confusion” that your brain feels during the journey.
Try to keep your head tilted back about 30 degrees, with your eyes focused on the horizon straight ahead. Lying flat may also be of benefit. Try to avoid enclosed spaces without a reference to the horizon, and avoid close work such as reading, knitting, or typing.
 

Step 3- Specific Treatments
There are many medical and non-medical treatments for motion sickness, that can be employed if you get sick in spite of optimal positioning. Non-medical treatments are generally based on the theory of counter stimulation of an acupuncture site in the wrist. You can find “Sea-sickness Bands” that put some mild pressure on a nerve in the wrist, and some people find these to be helpful. There are also bands that will stimulate the wrist area with electrical current or with pepper cream (capsaicin). Please be warned that medical researchers have tried to determine how effective these devices might be, and so far, such studies have not been able to show any measurable benefit from wrist bands of any sort in the treatment of motion sickness


There are many medications, however, that are very effective in treating motion sickness. There are both prescription and non-prescription medications for this indication, and these are in the same general class of medicines (anticholinergic antihistamines).


A commonly used medication is meclizine (e.g. Bonine), but diphenhydramine (Benadryl) may also be used. Perhaps a bit more potent is promethazine (Phenergan) or scopolamine (available in a patch worn behind the ear called Trans-derm Scop). The use of any of these medications is generally safe in otherwise healthy young people. These medications are all mildly sedating, and sometimes are used to help induce sleep. Do not drink alcohol while using motion sickness medications. These medications should be used in limited amounts if at all in people with chronic medical conditions such as heart disease, strokes, circulation problems, or people in advanced age. 


If you have any question as to whether a medication is safe for you, please ask your doctor, or consider a Telehealth chat with a service such as Ns1ghter. Most of the medications for motion sickness are available without a prescription in the United States. 
Here’s to hoping that your vacation trip is pleasant and healthy!

8 Tips For Dealing with “Pink Eye”

By Ns1ghter Provider: Komal Hanif; MD; Family Medicine

Pink eye, or conjunctivitis, is inflammation of the conjunctiva; a very thin membrane that lines the inner surface of the eyelids and white portion of the eye. The conjunctiva gets inflamed and causes the lining to become red and swollen. There are three main types: allergic, viral and bacterial. Although management is similar for all three, this article will focus on dealing with the bacterial.

Bacterial conjunctivitis is extremely contagious and can quickly spread through a household, workplace or classroom. Bacterial conjunctivitis typically causes eye redness, irritation, pain and/or thick discolored discharge initially in one eye. It’s common for a person’s eyelids to be “stuck” shut upon awakening due to the discharge.

In addition to medical treatment, here are 8 tips for managing bacterial pink eye: 

  1. Wash your hands frequently for at least 15-20 seconds with warm soapy water.
  2. Use alcohol sanitizer when water and soap are not available to wash your hands.
  3. Avoid eye makeup during an infection and discard any open eye makeup as it is likely contaminated.
  4. Remove contact lenses and wear glasses until the infection is cleared. 
  5. Thoroughly clean your contact lens case and discard disposable contacts.
  6. Avoid touching your eyes with your fingers. Conjunctivitis is commonly transmitted from one eye to the other this way.
  7. Avoid school and/or work until you have had at least 24 hours of antibiotic treatment.
  8. Apply Cold or warm compresses – whichever feels better!

Women's Health: 10 Ways to Avoid a Urinary Tract Infection

By Ns1ghter Provider: Komal Hanif; MD; Family Medicine

Ladies, you can take these steps to reduce your risk of urinary tract infections:

1. Drink plenty of water. Drinking water helps dilute your urine and ensures that you'll urinate more frequently. This allows the bacteria to be expelled from your urinary tract before an infection can begin.

2. Wipe from front to back. Doing this will help prevent bacteria in the anal region from spreading to the vagina and urethra.

3. Empty your bladder soon after intercourse, even if you don’t have to go. Urinating after sex flushes out any bacteria that could have migrated to the bladder during intercourse.

4. Avoid potentially irritating feminine products. Deodorant sprays, douches and/or powders can irritate the urethra. Also, douching washes away the good bacteria, disrupting the natural balance in your vagina and allowing more bad bacteria to grow along the neighboring urethra.

5. Consider your choice of birth control. Diaphragms, or unlubricated or spermicide-treated condoms, can all contribute to bacterial growth.

6. Adjust clothing by wearing cotton underwear, avoid tight-fitting pants and switch out of sweaty clothing soon after a workout.

7. Take showers and avoid prolonged baths. Bacteria can easily contaminate bath water. Sitting in a tub allows these bacteria to reach the urethra.

8. Don't hold it in!  When you feel the need to empty your bladder, do so immediately rather than waiting for later. Holding in urine for prolonged periods of time perpetuates bacteria to infect the bladder.

9. Consider using tampons instead of sanitary napkins or pads during your menstrual cycle. Using tampons keep the bladder opening area clear, thereby limiting bacterial overgrowth.

10. Take cranberry supplements, more so if you are prone to UTIs. Cranberries contain proanthocyanidins, which are thought to prevent bacteria from sticking to the bladder. However, be aware that cranberry supplement products are unregulated and don't all contain the same amount of proanthocyanidins.

How to Get Medical Information in 2017

By Ns1ghter Provider: William Jantsch, MD; Emergency Medicine, Internal Medicine

The human body is a remarkably constructed mechanism which, if properly nurtured, will serve its owner well for many decades. Things do go wrong, on occasion, and the medical profession has developed over centuries to try to help sick and injured people with their illnesses and debilities. Even with incredible scientific advancements, however, there are still major gaps in medical knowledge, associated with multiple controversies.

Modern healthcare in the United States is a gargantuan, intimidating process that unfortunately has lost sight of its primary objective- that is, to relieve suffering and to improve the quality of life for individuals. Primary doctors, such as Family Practice, Pediatric, and Internal Medicine specialists try to help their patients through the maze of confusing and often conflicting information that is available to almost anyone with a web browser.

But whom do you believe?

I certainly do not profess omniscience, but here is what I can recommend:

a. If you have a primary doctor whom you trust, and who is available to answer your questions, you are lucky. You will know in your gut when your concerns are taken seriously, and recommendations will make logical sense. If something doesn’t seem to make sense, ask about it. A good doctor is open to questions, and will even revise advice based upon your preferences and circumstances.

b. If you don’t have a primary doctor, you have some options:

c. On-line web searches

d. Telehealth chat (such as Ns1ghter)

e. Urgent Care centers

f. Hospital Emergency departments

g. Asking your (best friend, mother…)

Here are the advantages and disadvantages of the above options (briefly)

a. On-line searches are free, and easy, readily available. There is so much information at times, however, that it is difficult to apply it to your personal problem. You also run the risk of over-diagnosing serious conditions, that just adds to your worry. You will not be able to order tests or prescribe treatments in most cases.

b. A telehealth chat is another low-cost, easily available option. With a service like Ns1ghter you can ask a question and get a doctor’s opinion very quickly.  Ns1ghter can also provide face-to-face contact with a doctor who can suggest and prescribe medication for some straightforward medical conditions. For instance, if you know you have a bladder infection based upon symptoms that are familiar to you, and all you need is an oral antibiotic, then Telehealth is a good option. I would be cautious of any service that says it can confidently diagnose and treat a wide variety of medical disorders, such as ankle injuries, earaches, abdominal pain or trouble breathing.

c. An Urgent Care Center is basically the doctor’s office, but without the ability to provide on-going care. This is a really good option for earaches, asthma attacks, sudden fevers, and minor injuries. Most Urgent Care Centers have some degree of medical testing, and possibly even x-ray capability.  The expense to visit an Urgent Care is often just a fraction of what an Emergency Department visit would be at the hospital. However, Urgent Care is not a good option for potentially serious problems, such as severe abdominal pain, chest pain, or possible stroke.

d. The hospital Emergency Department is designed to handle all emergencies. This is the place you want to be if you are having a stroke or a heart attack. This is where you will go if you call 911 and get transported. However, if you go to the ED without an obvious acute medical emergency, you may have to wait a long time to complete your assessment, and the charges to you or your medical insurer will be very high.

There are no easy rules to help you to sort out which option to choose! So here is what I hope would be some common-sense advice:

- If you feel a sudden, severe change in your medical condition that you can tell is “very wrong”, call 911 and/or get to an Emergency Department immediately.

- If you can sense something does not feel right, but is progressing gradually and slowly, make use of your “free” options first: look to the Internet for information, and contact a Telehealth chat service for help with the best way to proceed with your evaluation.

- If you start a Telehealth video chat or go to an Urgent Care Center, and the practitioner does not feel that he or she can diagnose and treat you appropriately in that setting, you may be directed to the Emergency Department. That’s OK, it’s difficult even for doctors to know where to go initially for medical assistance.

The most important thing is that you get the best medical care available to you. Don’t be afraid to ask questions, and research on-line to the extent you feel comfortable. Contact the Telehealth chat service. That should get you started in the right direction.

Measuring Your Blood Pressure at Home

By Ns1ghter Provider: William Jantsch, MD; Emergency Medicine, Internal

Having uncontrolled high blood pressure is not good for anyone. Over time, elevated blood pressure increases a person’s chances of having a stroke, heart attack, heart failure, or kidney failure. Many medications are available now for safe and effective blood pressure management, and the proper use of these medicines will help a person stay healthy longer.

But how do you know if you have high blood pressure? How do you know if your blood pressure medications are working effectively?

This is where measuring your own blood pressure at home can help. Pressure readings in a doctor’s office or automated machine can be misleading: your blood pressure rises if you are even a bit anxious or in pain. The most reliable pressure readings are obtained when you are resting comfortably and feeling well.

If you take the time to monitor your blood pressure at home, and document multiple readings over time, you can take this information to your primary doctor and make important decisions regarding the need to initiate or adjust medical treatment for high blood pressure (also known as hypertension).

You will need a blood pressure monitoring device, and these come in 2 varieties. “Manual” and “automatic”. With a manual cuff (also known as a sphygmomanometer), you will also need a stethoscope to listen for the beating sounds in the artery while the measurement is being taken. This is difficult for a person to do by him or herself, and takes a bit of practice and training. So, even though manual cuffs are inexpensive ($10-20), they may not be good for you. The automated devices can be purchased for $40-60, and even less when used. Such a device works simply by turning the monitor on, applying the cuff to the upper arm, and the pushing a button. The reading is automatic. Easy!

A word of caution: make sure you get a blood pressure cuff that fits your arm properly (extra-large cuffs are made for people with large arms). Also, some people have had good results with monitors that take the pressure at the wrist, but I have found these to produce inaccurate readings on occasion.

Understanding the numbers:

Blood pressure is recorded with two numbers, divided by a slash mark:

Systolic blood pressure/diastolic blood pressure

“Systolic” pressure is the maximum pressure (in millimeters of Mercury) when the heart is beating

“Diastolic” pressure is the minimum pressure in the arteries when the heart is in between beats

Good blood pressure levels:

120/80 is generally considered “normal”

Many doctors will not advise starting blood pressure medications until the numbers go over 140/90 or higher, depending on a patient’s age and other medical conditions.

What if the blood pressure reading is really high?

Well, first of all, don’t panic. Elevations as high as 180/100 can be seen in otherwise healthy people if they are under acute stress or in severe pain. People with known hypertension will occasionally generate blood pressures of 220/120 under certain circumstances.  It is important to keep a log of these pressures.  You do not want to stay at these levels for long periods of time.  Always discuss your findings with your doctor.

The New Perspective on Healthcare

By Ns1ghter Provider: Joseph Accursio, NP

As technology advances at breakneck speed, so the world of healthcare evolves along with it. The traditional hospital-based systems that dealt with illness and death have been replaced with a new concept of medicine. The current trends are customer-centricity, convenience store access, the ability to shop for healthcare like it’s a grocery store, and being able to visit with a provider visit through a laptop or a smartphone. Style and delivery now play a major role in medicine.

From a professional perspective, healthcare is concerned with treating customers based upon the most up-to-date scientific guidelines. Gone are the old-wives’ tales and the guesswork. Also electronic medical record permit providers to have a more complete picture of the patient, so that medical care can be comprehensive and patient-centered, giving people the best improved outcomes for their dollar.

Even the definition of health has changed many times over many years, bringing us to the current understand of “health” as not just the absence of illness; instead we speak of “wellness” as the optimal functioning of a person’s life across all spheres. The shift from health to wellness is significant, because it moves the needle closer to reality. But despite the good intentions and aim of all these changes, the best system in the world is still going to fall short without one single and necessary key ingredient – patient responsibility. No amount of technology, science or networking comes close to what can be achieved with a little preventative care.

Where’s the catch? Prevention takes time and energy. It’s about discipline and responsibility for the choices you make. And it can be tough to get started. Granted, it’s a big chore to wade through the sheer volume of misinformation and nonsense that is available to us through the internet. But the fact is, there will never be any match for internal motivation – no one will take care of you or your family better than you will.

That’s where Ns1ghter comes in. With the free consultations, video visits and site content, reliable health information can be tailored to your specific needs and questions. And this puts the profession of healthcare into its proper place – not as a schoolteacher, but as a partner. Instead of dealing with illness and injury after it’s taken a toll on your quality of life, having a healthcare provider who partners with you in crafting smart lifestyle choices not only extends your years, but makes them more fulfilling.

So where do you start in this transformation toward wellness? The first step is honesty. You must take a good hard look at your life – what you value, where you want to be, how far away you are from there, and all the while constantly looking to clear up any health misconceptions that you may have. You have to know what you don’t know, and know where to look for reliable answers. After you gain a perspective on your own health and wellness, you need to have a plan to integrate the changes that need to be made into your life on a permanent basis. This is where it becomes difficult, because sacrifices will be made. These sacrifices and changes will affect not only you, but your close friends, family and daily routine. Change usually comes quickly at first, but after the novelty wears off and the reality sets in, your old ways will rise up against you, and you’ll be in for a fight. Nevertheless, just like eating an elephant, its one bite at a time toward better choices and better quality of life. There will be setbacks, but there can also be great success.

It comes back around to those two ugly words - discipline and responsibility. Because no matter what else may be involved, your health is ultimately in your hands. Anyone who tells you otherwise is selling something.