Blog Posts

A Long Winter May Equal a Vitamin D Deficiency: Tips for Getting More of the Sunshine Vitamin

Posted on Thu, Mar 27, 2014

Let’s face it, this winter was awful. When the Farmer’s Almanac predicted an unusually harsh winter, thoughts of snow days and hot chocolate rushed through the minds of New Jersey residents. Never did we think we’d be shoveling snow on what felt like every other week, battling below-zero temperatures and calling to find alternative childcare when schools were delayed or closed. With an unusually long winter comes vitamin D deficiency. Vitamin D is an essential nutrient that plays an important role in bone health. Historically, vitamin D deficiency in children leads to rickets, a bone-deforming disease. In adults, vitamin D deficiency leads to osteomalacia, the softening of the bone, which produces bone pain and weakness and increased risk of fractures. More recently, vitamin D deficiency has been linked to depression, poor dental enamel health, increased risk for allergies or asthma and perhaps coronary artery disease and diabetes . Who is at Risk? Those at risk for vitamin D deficiency include those who may not get enough sun exposure, such as seniors, hospitalized or institutionalized patients, those who live in countries far from the equator and those with darker skin pigmentation (since melanin acts as natural sunblock). Poor dietary intake also may play a role, especially in seniors and infants exclusively breastfed. Those with malabsorption issues, such as celiac disease, post-gastric bypass and intestinal resection patients, can’t effectively absorb vitamin D. Those with chronic renal disease also have a vitamin D deficiency. How to Get More Vitamin D Say goodbye to electronics and hello to the sunshine. Go outside! Enjoy a picnic in the park, take a walk or ride a bike. Vitamin D is obtained in two major ways: dietary and via the skin. Eating foods like salmon, egg yolk and yogurt help, but enjoying the sun outside is far more entertaining! The recommended daily allowance (RDA) for children and adults under age 70 is 600 IU. Those aged 80 and older require 800 IU. It’s often difficult to get the recommended daily allowance of vitamin D through diet alone, since common fortified foods contain less than the recommended amount. Examples include:

  • 8oz of milk – 100IU
  • 8oz of orange juice – 100IU
  • One serving of fortified cereal – 40-80IU
  • 100g of Swiss cheese – 44IU
Is Sun Exposure Safe? I recommend supplementing your diet with a daily multivitamin and sunlight exposure. When weighed against the risk for skin cancer, sun exposure becomes more important in trying to reach the recommended amount. During winter months when UV-B rays are not strong and snow and freezing temperatures restrict access to outdoor time, vitamin D deficiency rises and additional supplementation becomes very important. However, when the sun and warmer weather returns during the spring, summer and fall, 10 to 15 minutes of sun exposure, without the use of sunblock during the mid-day, is enough to provide the RDA of vitamin D in the lightly pigmented population. Darker skinned individuals require more time in the sun to absorb the RDA of vitamin D. Put aside the chores, turn off the TV and computer and go outside to enjoy the fresh air and sunshine. It’ll do your bones some good! By Kristine Samson, MD About Kristine Samson, MD Kristine Samson, MD, joined eMedical Urgent Care in 2013. She is board-certified in emergency medicine. She completed her residency at Jacobi/Montefiore Medical Centers, Bronx, N.Y. She is an assistant professor of emergency medicine at Jacobi Medical Center.

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Sneezing and Coughing and Aching, Oh My!

Posted on Fri, Jan 04, 2013

By eMedical Offices fluYour daughter came home from college and brought a stuffy nose. Your son came home from a play date and is complaining of a sore throat. Want to start placing bets when you’ll come down with a full blown cold? As colder weather approaches and more people stay indoors -- and in close proximity to each other -- our offices begin to see more patients with upper respiratory infections or colds. As doctors, we begin to see cases develop in October and peak during January and February, then begin to taper off in March. Getting the “flu” is different from the common cold because it’s caused by the influenza virus and can potentially be much more severe than the common cold. In the most susceptible patients, such as the elderly, or those with underlying medical conditions, severe flu illness can be potentially life threatening. Spreading the Virus The flu virus usually is contagious one day before symptoms develop and up to 5 to 7 days after symptoms develop. The virus is spread primarily by “droplet” contamination, meaning when an infected person talks, sneezes or coughs, droplets containing the virus can spread to others, up to 6 feet away. A bit gross to think about, but the droplets can land in the mouths and noses of others, and can be inhaled into the lungs.  This is why it’s important to cover your mouth and nose when coughing and sneezing and wash your hands afterwards. The next most common method of infection is from touching a surface that has the flu virus, such as a door knob, and then touching your mouth or nose. Washing your hands frequently with soap and water or using alcohol-based waterless hand cleansers are the best ways to prevent this transmission. Any items used by infected individuals, such as dishes, silverware, linens and towels, shouldn’t be shared and should be washed thoroughly before reusing. Prevention The most important piece of advice I give regarding preventing the flu is to get vaccinated. Vaccination not only helps prevent the vaccine recipient from illness but also helps prevent the spread of the flu throughout the community. The flu vaccine must be given annually. It contains the 3 most common strains of the influenza virus for the upcoming flu season based on sophisticated computer models that predict which virus will be most likely to be circulating in a particular year. The flu vaccine is recommended by the Centers for Disease Control and Prevention for everyone over the age of 6 months. Another option is the flu vaccine in a nasal spray form, which can be given to anyone who is healthy, not pregnant and between the ages of 2 to 49. Symptoms of the Flu Generally, the common cold and the flu can have similar respiratory infection symptoms.  The flu tends to be more severe and includes:

  • High fever (although the flu can occur without a fever)
  • Dry cough
  • Sore throat
  • Runny or congested nose
  • Body aches
  • Muscle aches
  • Headache
  • Chills
  • Fatigue
Occasionally patients can develop nausea, vomiting and diarrhea. Your fever may last 3 to 5 days, and the cough and exhaustion can last up to 2 weeks. The symptoms generally start abruptly. But Do I Really Have the Flu? Your doctor will determine if you have the flu based on your symptoms and his clinical assessment of your physical condition. The most common testing used is the rapid flu test, when a swab is taken from the nose or throat and analyzed. This test can detect the flu usually within a few minutes. Unfortunately this test is not foolproof, meaning you can have a negative test and still have the flu. Generally if your doctor suspects the flu based on symptoms, patient risk factors and the pattern of flu infections in the community, he or she will begin treating the virus even if the rapid flu test is not performed. Treatment
  • You can treat flu symptoms with and without medication
  • Your doctor may prescribe antiviral medications to help alleviate your symptoms
  • Antibiotics are necessary if your illness has developed into a bacterial infection
Last Words The virus that causes the flu and its symptoms are usually more severe than the common cold, and can be dangerous for high-risk patients with underlying medical problems. The flu virus is contagious, and proper precautions should be taken. Frequently washing your hands and covering your mouth when sneezing or coughing can help eliminate the potential of contamination. The most effective method of prevention for individuals and their communities is vaccination. If treated early, antivirals can reduce the severity and duration of flu symptoms. Call or stop by our office today if you think that you have the flu. If you need medical attention for a non-life-threatening illness or injury, eMedical Offices is open during the evening hours to treat walk-in patients. If you have questions about medical conditions, download iTriage from the iTunes or Android Marketplace, or check out iTriageHealth.com for your healthcare answers.

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‘Tis the Season for Cuts and Lacerations

Posted on Fri, Dec 09, 2011

By eMedical Offices Whether you slip on the ice and suffer an abrasion or are injured while gathering wood for the fireplace, how do you decide if a wound needs stitches? There are several issues that have to be taken into account when answering to that question. You’ll also need to determine if the wound should be treated with antibiotics, if it requires a specialist’s care, such as a plastic surgeon, or if a tetanus shot is needed. In this post I’ll discuss some of the factors doctors use to decide how to treat wounds. What to do First The first thing to do if you or your child is wounded is to put direct pressure on the wound to try to stop the bleeding. If the wound is in an area that can’t be compressed or it’s too painful to apply pressure directly to the wound, try applying pressure above the wound or elevating the area. Ice can also be helpful in stopping the bleeding and can decrease swelling as well. If the would is dirty, it should be washed with soap and warm water and rinsed with warm water to help remove any large particles of dirt and debris. A Physician Evaluation When examining a wound, your doctor will evaluate:

The age of the wound: In general, the longer it takes to heal, the higher the risk of infection. The best approach is to repair the wound within 2 to 4 hours. Bacteria can grow in a dirty wound within 3 to 4 hours. However, wounds in vascular areas (such as the face) can be safely closed within 24 hours as long as the wound is thoroughly cleaned. Because there is no definitive rule, it’s important for each injury to be evaluated by a physician, who can determine the best course of care. Any underlying medical conditions: Certain factors put the wound at higher risk for infection, such as the patient’s age or other medical conditions. Very young and very old patients are at higher risk of infection due to lowered ability to fight infection. Certain medical conditions – diabetes, congestive heart failure, kidney disease, liver disease, blood disorders, immune disorders, cancers and malnutrition – can weaken the immune system and increase risk of infection. Also, treatments such as chronic steroid use, chemotherapy or radiation therapy can put patients at higher risk. Being able to provide your or your child’s immunization history is important. This should include date of last tetanus shot and if the full series of tetanus immunization has been completed. Type of wound:
  • Abrasions are caused by friction of the skin on a hard surface, resulting in injury to outer layer(s) of skin
  • Lacerations are caused by a tear in tissues, which can be produced by shear forces, such as a knife, or compressive forces, such as hitting your forehead on a car dashboard.
  • Crush wounds are caused by the impact of an object against tissue, particularly over a bony surface, which compresses the tissue.
  • Puncture wounds are those with a small opening whose depth can’t be entirely viewed.
  • Avulsions are wounds in which a portion of tissue is completely separated from its base and is either lost or left with a narrow base of attachment (a flap).
  • Combination wounds are the result of a combination of the above types of wounds.
Possible contamination of the wound: All traumatic wounds are contaminated to some extent with bacteria. Any wound that has been exposed to biological fluids (saliva, blood or feces) or those exposed to vegetation, soil or water will be at high risk for infection. Abrasions, crush wounds and avulsion injuries are at higher risk of infection due to injury to tissues. Puncture wounds are at higher risk because it’s more difficult to fully explore, clean and rinse the wound. Location of the wound: Wounds in areas where capillaries carrying blood are close to the skin surface, such as the scalp or face, are at lower risk of infection; wounds on the extremities such as hands, fingers, feet and toes will be a higher risk. Your doctor should only prescribe antibiotics after careful examination, decontamination and review of risk factors for infection. Any involvement of tendons, ligaments, bones, muscles or nerves may require surgery.
Treating the Wound Once the wound has been evaluated and the doctor has decided that it needs to be sutured, the area will be prepped with an antiseptic cleaner. A local anesthetic is injected around the edge of the wound to numb the area and decrease the bleeding. This tends to be the most painful aspect of the procedure since the anesthetic can cause burning and stinging. For children, an anesthetic cream may be applied to the wound before local anesthetic is injected to minimize pain. After the wound has been numbed, it will be thoroughly cleaned and examined for tissue damage, foreign objects and contamination. If you have a deep wound, a layer of dissolvable sutures may be used. The top layer of skin may be closed with nylon sutures strong enough to hold the wound closed. Staples are another option for closing large lacerations on areas such as the scalp. BioGlue, a sterile surgical adhesive, also can be used to close the wound. It works best for straight cuts that aren’t over areas that are frequently bent, such as joints. The adhesive may be used without anesthesia, but wounds still require careful cleaning, rinsing and examination. After Treatment Generally, sutures stay in for five days in areas like the face, and up to 10 days in areas like the scalp. These time frames can vary based on location of wound and how much tension is on the sutures. If the injury was at high risk for infection, antibiotics may be prescribed. If you aren’t prescribed antibiotics, you may be asked to return to your doctor’s office in 24 to 48 hours to check for any signs of infection. The wound should be kept covered with non-stick gauze and triple antibiotic ointment to help keep the wound moist, prevent infection and decrease scarring. All lacerations will result in a scar, which may not be apparent for 6 to 12 months. Avoiding direct sunlight to further decrease scarring. If you need medical attention for a non-life-threatening illness or injury, eMedical Offices is open during the evening hours to treat walk-in patients. If you have questions about medical conditions, download iTriage from the iTunes or Android Marketplace, or check out iTriageHealth.com for your healthcare answers.

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Sore Throat Season: Is it Strep? Do I Need Antibiotics?

Posted on Thu, Nov 03, 2011

By eMedical Urgent Care You’ve tried to ignore it, but every swallow is a chore. You’ve got that big project at work, so there’s no time to be sick. How do you know when a sore throat requires medical attention – or just some hot tea and some R&R? Sore throat, also known as pharyngitis or tonsillitis, is a frequent complaint that brings patients to the urgent care center. I’m going to explain the causes and symptoms of sore throats. To treat them, urgent care centers are a convenient option to get the medical attention you need to get you back to feeling better. Causes of Sore Throats Up to 60 percent of sore throats are caused by viruses. The most common of these are adenoviruses, coxsackieviruses, Epstein-Barr virus, cytomegaloviruses and herpes simplex viruses. The second-most popular type is “strep” throat, which is caused by Streptococcus pyogenes or Group A beta-hemolytic streptococcus (GABHS). Only 5 to 15 percent of adults and 15 to 30 percent of children with sore throats actually have strep throat. Other less frequent causes of a sore throat are fungal infections (oral thrush or candidiasis), HIV-1 infection in the acute phase and gonorrhea. Non-infectious causes of sore throat include heartburn or gastro-esophageal reflux disease (GERD), allergies, post-nasal drip, chemical injuries and smoking. Symptoms of Strep Throat Strep throat most commonly occurs in children aged 5 to 15 years old in the fall and early spring. This usually happens after children come in contract with someone who is infected, like in a classroom or daycare facility, or a family gathering. Classic symptoms of strep throat include:

  • Sudden onset
  • White patches and pus on the throat and tonsils
  • A fever greater than 101˚
  • Difficulty swallowing
  • Tender and swollen lymph nodes in neck
  • Headache
  • Chills and shakes alternating with cold sweats
In children, the above symptoms can be accompanied by nausea, vomiting or abdominal pain. Symptoms of a Virus Signs that the sore throat is caused by a virus include:
  • Cough
  • Runny nose
  • Conjunctivitis (pink eye)
  • Sneezing
Testing and Treatment of Sore Throats Doctors use several methods to determine if a sore throat is in fact strep throat. One of the most reliable methods is the rapid strep test. This test is quick and accurate, and allows treatment to start immediately following a positive result. The American Academy of Pediatrics recommends that doctors perform both a traditional throat culture and a rapid strep test on children. Although it takes 1 to 2 days to get results from a throat culture, because children are more likely to develop strep throat, this dual-testing method provides the most accurate diagnosis. While only a fraction of adults and children with sore throats nationwide actually have GABHS bacterial infections, more than 75 percent are prescribed antibiotics. This practice leads to resistant bacteria, meaning the infection doesn’t improve because it’s gotten used to antibiotics, as well as side effects from treatment, including allergic reactions, diarrhea and yeast infections. Our doctors use rapid strep testing and throat cultures, and follow guidelines for the diagnosis and treatment of GABHS set by the Infectious Disease Society of America. Strep throat responds well to penicillin. It can be given as a single dose injection or in pill form. Other prescription options include amoxicillin, cephalexin and azithromycin. To help relieve the pain and swelling of the throat, your doctor also may prescribe a single dose of dexamethasone, a steroid which is an anti-inflammatory, either by injection or by mouth. Strep Throat Shouldn’t Be Ignored GABHS pharyngitis will improve in a few days even if not treated with antibiotics, but we treat patients so that they feel better faster and are less contagious to others. If left untreated, strep throat can put you at risk for developing rheumatic fever, which can damage the heart valves. Another rare but serious complication is acute glomerulonephritis, an injury to the kidney, which can occur regardless of treatment. If you are on antibiotics and aren’t feeling better or if you’ve developed a rash, jaundice or abdominal pain, contact your doctor immediately, as this might indicate Epstein Barr virus or mononucleosis infection. In most cases, with proper evaluation and treatment, sore throats can be treated quickly and easily, often without antibiotics. If you need medical attention for a non-life-threatening illness or injury, eMedical Urgent Care is open during the evening hours to treat walk-in patients. If you have questions about medical conditions, download iTriage from the iTunes or Android Marketplace, or check out iTriageHealth.com for your healthcare answers.

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Fall Sports: How to Recognize a Concussion

Posted on Thu, Sep 22, 2011

It’s a brisk fall afternoon. You’re sitting in the bleachers, watching your son’s JV football game. In the scuffle during a play he hits his head on the turf. You see him get up a bit slowly, but he shakes it off and lines up for the next play. Should you be concerned? It is estimated there are 3 million head injuries each year related to contact sports, according to the Centers for Disease Control and Prevention. For teens and young adults aged 15 to 24 years, it is second only to motor vehicle accidents as the cause of traumatic brain injuries. Concussions can be caused by mild or more severe blows to the head. They may or may not involve loss of consciousness. Recently, more attention has been placed on recognizing and treating concussions earlier to decrease the risk of long-term neurological damage. The Signs of a Concussion Early signs of a concussion include:

  • Headache
  • Dizziness
  • Nausea or vomiting
  • Confusion
  • Disorientation
  • Vision changes
  • Unequally sized pupils
  • Lack of awareness of surroundings
  • Slurred or incoherent speech
  • Lack of coordination
If your child is injured and shows any of the above signs, he or she should stop participating in the sports activity immediately. The New Jersey State Interscholastic Athletic Association requires that any student athlete who sustains a possible concussion or any loss of consciousness be removed immediately from play. A medical evaluation is required to determine if a concussion was sustained. If it’s determined that your child did have a concussion, he or she must be symptom-free for one week before he or she can return to play. You should seek immediate medical attention if your child’s symptoms persist for more than 10 minutes. If the symptoms are mild, such as mild headache, dizziness, nausea without vomiting or loss of memory for a few minutes, watch to see if the symptoms worsen. The physicians at eMedical Urgent Care can help determine if further care is needed. When to Go to the Emergency Department You should bring your child to the nearest emergency department if the injury involves:
  • Large cuts
  • Prolonged loss of consciousness
  • Severe headaches
  • Drowsiness
  • Inability to walk
  • Slurred speech
  • Seizures
What to Expect After a Concussion A few days to a few weeks after having a concussion your child might experience:
  • A persistent, low-grade headache
  • Light-headedness
  • Poor attention and concentration
  • Memory issues
  • Fatigue
  • Irritability
  • Frustration
  • Anxiety and/or a depressed mood
  • Trouble sleeping

The recovery period for concussions can vary from patient to patient. Some may develop “post-concussion syndrome,” which can last weeks or months and includes chronic headaches, dizziness and nausea.  If your child sustains a more severe concussion, he or she should be seen by a neurologist in addition to your primary physician to manage ongoing care.

 

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