Health Articles From Our Providers

     RSV—The Bad Respiratory Virus


            Each winter, one of the most troublesome respiratory viruses of childhood makes the rounds.  Most older children tolerate the respiratory syncitial virus (RSV) well and just suffer the symptoms of a cough, sore throat, runny nose and fever.

            For some children, however, the virus can be very serious.  These are usually children who are between the ages of two and five months.  They are old enough that they have lost the immunity they received from their mothers and too young to tolerate such a harsh virus.  Children who have lung, heart or immune problems are also at greater risk of complications from RSV.  One of the other problems with this virus is that it may take two or three infections before a child develops good immunity to it.

            The virus is spread by coughing and close contact, such as touching hands.  The virus is so common that most children have had the infection by three years of age.  After this age, RSV infections are seldom a problem.

            The virus causes a great deal of irritation to the lining of the airways and lungs.  Increased mucus and sloughed cells cause the tiny airways to plug up.  This plugging slows the air that is leaving the lungs, so the lungs become over-expanded in a way similar to emphysema.  In the more severe cases, the airways become completely plugged up and the airways collapse.

            Treatment is usually aimed at reducing the symptoms and making sure a child is getting adequate oxygen.  Infants often need to be hospitalized for RSV infections.  A steroid syrup or shot is commonly used to decrease the severity of symptoms.  In severe cases, an antiviral antibiotic can be used, but its usefulness is still being studied.


Viral Stomach Flu


            For the most part, a viral stomach flu is an inconvenience—a couple days of moderate discomfort and missed work.

            The main symptoms of a viral stomach flu are malaise, nausea and diarrhea.  These symptoms can be treated but not cured.  With time, the virus will run its course and the body will develop immunity to that particular virus.

            The feeling of malaise is usually treated with rest and pain relievers such as acetaminophen or ibuprofen.

            The diarrhea can be treated with a variety of medicines.  Some very useful medicines are available without prescriptions, such as loperamide or bismuth subsalicylate.  Bismuth subsalicylate must be avoided if you are allergic to aspirin.

            Before taking any medicine, it is important to be sure that the diarrhea is caused by a virus rather than a more serious problem such as colitis, or a bacterial or parasitic infection.  Any fever or blood in the stool could indicate one of these problems and should prompt you to see your doctor.

            During any diarrheal illness, the most important treatment is getting enough fluids.  Dehydration only adds to the discomfort of having the flu.  Nausea can be treated with prescription medicines if needed.

            For fluid replacement, a sports drink which provides potassium as well as sugar and water is very good.  Frequent, small sips are usually well-tolerated and well-absorbed.

            It is best to avoid foods that are difficult to digest or may increase your symptoms, such as caffeine, milk, fatty foods and alcohol.  As the illness resolves, a person can gradually resume his normal diet and activities.



Pneumonia is Common in the Elderly


            Pneumonia is a very common disease that can affect a person at any age, but it becomes far more common as a person ages.  After the age of 70, the chance of developing a pneumonia is about ten-fold more likely than in a young person.  For an elderly person living in a nursing home, the chances are even greater.

            Pneumonias can occur at any time of the year, but are most common in winter and spring.

            You can do many things, however, to decrease your risk of getting pneumonia.  One is getting a vaccine against pneumococcus, the most common bacteria that causes pneumonia.  Two shots are available.  PVC13 is commonly given first, with PPSV23 given as a booster at least eight weeks later.  Many cases of pneumonia are secondary to influenza, so an annual flu shot is important.

            Lifestyle is very important in preventing pneumonia.  Smoking is one of the greatest problems.  It damages the lungs’ ability to clear secretions, and tumors can make it impossible for the body to control an infection.

            Excessive alcohol use causes a greater chance of aspirating bacteria-laden droplets into the lungs and it suppresses the body's defense mechanisms as well.  Limit alcohol to 1-2 drinks per day.

            Poor control of diabetes suppresses the body's immune system.  If your blood sugar is over 200, it is likely to weaken your immunity.  Poor nutrition or chronic illnesses, such as liver disease or kidney failure, also lower one's resistance to pneumonia.

            Pneumonia is still a life-threatening illness.  Do everything you can to prevent pneumonia, and if you do develop a fever or cough, treat it early and aggressively.


Fire and Smoke Detectors


            It's easy to smell smoke.  Who needs a smoke detector?

            Fires are very dangerous, and thousands of people lose their lives in accidental fires each year.  Thousands more suffer from severe burns that cause great pain, heal slowly and leave devastating scars.  Many of the victims are children, and often fires occur when they are asleep.

            It is a great surprise to most people that smoke will not wake a person up from sleep.  It is because the carbon monoxide makes a person sleepier, and the smoke asphyxiates a person without even rousing him.  Do not count on the smell of smoke to wake you up!

            This is why smoke detectors with their shrill alarms are so useful in preventing loss of life from house fires.  They should be placed near sleeping areas where they will be heard easily if they go off.

            It is also important to make sure that the batteries are fresh and functional.  It is all too common that the batteries are "borrowed" to run a toy or some other device, but a person often forgets to replace them, and is left with a false sense of security.  This is an excellent reason for having more than one smoke detector in your house.  Be sure to check the batteries monthly when you pay your bills.

            There are many things you can do to cut down on the risk of house fires.  Maintain your furnace and heaters.  Besides being safer, they will be more efficient and cost less to run.  Do not leave matches or lighters where children can get a hold of them, and warn children against playing with fire.  Keep flammable material safely locked away.

            And most importantly, do not smoke cigarettes—they are the cause of thousands of house fires each year.


Importance of Having a Primary Care Provider

Written by Dr. Rick Jackson


When I came to Pawnee City in 1970 to join Dr. Stewart, I replaced Dr. Anderson. Wait a minute, no one could replace Dr. Anderson. I sat at his desk. Parked my car in his spot, but I didn’t truly replace him. For that matter, no one could replace Dr. Stewart either. As I began to see their patients, I was struck by how brief their office and hospital records were. I soon learned that they could get by with such skimpy notes since they rarely saw each other’s patients. They also had incredible memories and could recall much of a patient’s history without referring to a medical record.


From 1970, until Dr. Stewart’s sudden retirement in December 1979, he and I continued this arrangement. We were incredibly lucky to recruit Dr. Voigtlander in 1981, and he and I decided to arrange a practice that would permit more regular time off for family time and continuing medical education. This meant that we would frequently see each other’s patients, since we took turns being on-call for all emergencies, OB’s and hospitalized patients. This required more complete medical records so that the provider on-call could assume the care of a patient he had never seen before, but still care for them, as if he had known him for years.


Recently, there has been a trend toward more fragmented medical care, with more patients referring themselves to specialists, using the Emergency Room (ER) or minor medical clinics, without having one provider that they call their Primary Care Provider (PCP). Here are 10 reasons you should have a Primary Care Provider.


  1. Holistic Health Care. A PCP usually has a well-rounded medical education and can address such things as preventive medicine, behavioral health, and diet. The patient may just be expecting a prescription but receive much more.  I recall several instances when a patient presented for a routine blood pressure or diabetes check-up and was found to have atrial fibrillation, with no symptoms. Getting the patient on blood thinners may have prevented a devastating stroke.
  2. Better Management of Chronic Diseases. Having one provider see you on a regular basis will assure you that you receive consistent care for your chronic health conditions such as diabetes or high blood pressure. In addition, your provider may more readily identify changes in your condition that might crop up unexpectedly. Sir William Osler, regarded as the founder of modern medicine, said, “The best way to live a long life is to get a chronic disease and take care of it.”
  3. Higher level of Trust. Once you get to know your provider, you can move quickly to addressing your health concerns, since you know each other’s background, goals, and strengths and get down to business. A strong patient/provider relationship leads to greater sharing of information, ultimately improving the care provided to the patient and family.
  4. Transparency of Entire Health History. At the first visit, a lot of effort is placed on obtaining a thorough family and personal health history, which carries forward to each visit automatically. This save time that would have been wasted if you had to fill it out at each visit for a new provider.
  5. Lower Overall Health Costs. Research from The Journal of Health Affairs suggests routine appointments with a PCP can cut overall health costs for patients. Regular screenings and open communication are responsible.
  6. Routine Screenings.  Lisa Benson, our case manager, works with the clinic nursing staff to review patient charts the day before an appointment to see if patients need screenings, such as: colonoscopy, Dexa Scan, mammogram etc. These screenings are designed to identify disease early and improve outcomes. The need for immunizations or boosters is also reviewed to provide patients with added protection from illnesses.
  7. Referrals to other Medical Specialists. If you need to see a specialist, your PCP is usually well-connected in the community of various specialists and can select the one best matched to your needs and might even facilitate things with a personal phone call.
  8. Decrease in ER Visits and Hospitalizations: Research has shown that patients with PCPs are less likely to require emergency care, usually because conditions can be caught early and treated before they become serious.
  9. Better Provider/Patient Communication. As you establish a long-term relationship with one provider, you tend to feel more comfortable discussing things with him or her. This definitely leads to better, personalized care.
  10. Complete Records. Having a PCP keeps all the important elements of your health in one place, providing more consistent sharing of your health information when needed.


So even though we have 5 providers who share call to permit regular time off for family time and education, we encourage you to choose one as your Primary Care Provider. If you need care when your PCP is unavailable, rest assured that you will be seen by a provider who will render the same care, thanks to thorough medical records and up-to date training.


 Guard Against Pneumonia


"Shots" are not just for children. We are getting more and more useful vaccines for more infections and many of these are for older age groups. One of the most important vaccines is the pneumonia shot.


Pneumococcus is a bacteria which frequently causes pneumonia as well as a number of other serious infections, including meningitis. This shot will protect a person against 90% of the important strains of this bacteria and help prevent or lessen the severity of pneumonias. It does not protect against pneumonias from other bacteria or viruses, however.


Often a pneumococcal infection strikes and spreads so rapidly that it becomes life-threatening before antibiotics can take effect. This is especially true in the elderly, whose immune systems are usually weaker and respond more slowly. The vaccine may give a person that extra protection he needs to keep a serious infection at bay or at least slow the spread of infection until antibiotics and white blood cells take effect.


Who should get the vaccine? Like with flu shots, those who are at highest risk are persons over 50 and anyone with chronic illnesses such as diabetes, heart, lung or kidney disease. The vaccine is especially important for anyone who has had his spleen removed. Your doctor can advise you about the many other indications that might exist for you.


PCV13 is the newest pneumonia vaccine. You will receive this vaccine if you have never received a pneumonia shot. PVC23 is an older pneumonia vaccine that will be given one year following the PCV13, or as a booster.


Serious side effects from the vaccine are rare, but soreness at the site of the injection, a low-grade fever, and mild muscle aches are not uncommon.


In most respects it is similar to the flu shot, but the one big difference is that the shot is not given each year. It is given as a series of a couple shots over time according to various regimens determined by an individual’s health conditions.

Treat Low Back Pain


Back pain is something that plagues almost everyone at one time or another. Usually it is from strains or overuse of the lower back, but sometimes there is a disk, arthritis or other causes for the pain.


Determining the exact cause of the pain may be difficult, but the treatment should not be difficult. There are several important things you can do to make the pain go away and stay away in most cases.


The first thing to do when the pain begins is to place the back in a relaxed position. The proper position for this is lying with some bend at both the hips and knees. Pillows can be placed under the knees when lying on your back, and they are also helpful when placed between the knees when lying on your side. You should not lie on your stomach. One or two days of bed rest may be necessary, but usually it is better to intermix frequent rest periods with light activity.


Medicines are very useful in decreasing the pain and relaxing the muscles. Sore muscles always tighten up and cause the pain to worsen. Ibuprofen is very helpful; you should use up to 8-12 per day, taken with food. Acetaminophen helps pain, but it does not decrease inflammation. There are also many excellent prescription medicines that are taken only once or twice a day. It is important to use these medicines early to control the pain and inflammation, rather than wait until the pain is incapacitating.


After an injury or strain to the back, immediately apply ice packs for 15-20 minutes several times a day to limit the pain, swelling and muscle spasm. After two or three days, warm packs or baths can give excellent relief, but if used too soon, heat may make the swelling worse.


Finally, physical therapy is very useful in teaching a person back exercises and appropriate posture that will strengthen the back and help prevent low back pain.

Soap is Hard on the Skin


Cleanliness may be next to Godliness, but it is awfully hard on the skin. Especially in the winter. 


Washing is something we do daily or even more frequently, and we tend to use plenty of hot water, soap and scrubbing. Often the soap has a nice fragrance. But soaps and fragrances do not make the skin any healthier. The skin is healthiest if it is left alone to take care of itself.


As a person grows older, the oil glands of the skin produce less oil, so it is important to protect and preserve what oils you have.


The face, armpits and groin produce adequate oils, but the arms and legs become excessively dry during the winter if the natural oils are removed. Moisturizers are often used but they do not protect like the natural oils.


A person cannot completely stop washing the skin just because of dry skin or eczema, but a person can cut down on the frequency and length of baths or showers and lower the temperature of water of his bath or shower.


The type of soap used can also be helpful or harmful. The stronger, scented soaps are among the worst for drying and irritating the skin. And regardless of what causes the rash in the first place, strong soaps are likely to be what keeps a rash from clearing up. Unfortunately, the natural reaction a person has with a skin problem is to wash more often, use stronger soaps and scrub harder.


The treatment is to use "super-fatted" soaps such as Purpose® or Basis® which contain oils that remain on the skin to help protect it. But even with these, do not wash too often or scrub too vigorously

 Stop Winter Itch


When the humidity drops very low in the winter, the skin suffers. Not only does the skin dry out from the low humidity, but also from many things we normally do, such as bathing which washes away the skin’s protective oils. When the skin gets dry it begins to itch, and scratching it only makes it worse.


The first step in helping the skin is to increase the humidity in your house. Use a vaporizer or humidifier and be strict about keeping it clean. Lowering the temperature also helps because heating dries the air.


A person should bathe less frequently and use a superfatted soap, such as Basis®, Dove®, or Caress®. These help replace the oils and keep the skin moist.


Keri Lotion® or Eucerin® are other oils that can be added to the skin after a bath. If the oils are added to the bath water, they make the tub very slippery and dangerous. After a bath or shower, you should pat your skin dry and then apply the bath oil to seal in the water that has entered the skin.


Carmol® and Nutraplus® are lotions which draw moisture into the skin and help hold it there.


Antihistamines can be used for severe itching, especially at night when itching is much more noticeable. Antihistamines may cause drowsiness which can help you sleep through the night, but drowsiness during the daytime can be troublesome. Cortisone creams will help if there is any inflammation of the skin and help to moisturize the skin if they are in an ointment base.


Using these and similar products, either singly or in combination, will help stop the winter itch. For the best results, remember to use these products regularly during the winter season.


Know Your Medications

Written by Dr. Rick Jackson


According to one study, when a patient is asked, “what medications are you taking?” and the answer is compared with the patient’s medical record, a discrepancy is detected over half of the time. The discrepancy is harmless 61% of the time, but 33% of the time a moderately severe risk is discovered. Six per cent of the time a SEVERE risk is present.


There are many possible causes for these errors. A patient may be seeing several providers from different specialties. Ideally, the specialist should be provided with an accurate list, and not prescribe something that would interact with chronic medications. It’s essential to have an accurate, up-to date list, but this sometimes doesn’t happen. Other times, a patient might not want to pay for the med or stop it due to a real or imagined side effect, and not tell the provider.


Decades ago, an elderly patient was transferred form a nursing home with multiple medical problems. She had an irregular heart beat that required chronic anticoagulation to prevent a stroke. She had a minor bleeding problem, since her blood was too “thin.” We stopped her anticoagulant and planned to resume it at a lower dosage when she returned to the nursing home. When it was time to send her back to the nursing home, we reviewed her medications, and wrote orders for them to be given, but the anticoagulant was left off. Two weeks later, she had a minor stoke. She recovered, but we used that incident to start our own medication reconciliation policy to prevent future problems. The policy assured that the discharge medications were compared with the admitting meds.


Two of our nurses took it upon themselves to develop a more formal protocol, and it was so successful that they gave presentations to local hospitals and health care meetings. We now have a very good program at the hospital and the clinic to assure that every time a patient is admitted or discharged, the medication list is updated. The only way for this to succeed is for the patient or caretakers have an updated medication list that includes over-the-counter meds, supplements, and any dosage adjustments.


Be sure that you take a current medication list with you when you see a specialist, and I’m pretty sure that most specialists provide you with an updated list after you are seen, so that any of the medications they add will be included in your list.,


When you are being seen for a scheduled appointment, it doesn’t hurt to bring along all of your medications in their original bottles to prevent any doubt.


If you have Medicare, you are eligible for Chronic Care Management. Studies have shown that when a patient is phoned 2 weeks after an office visit, they frequently can’t recall what medications they are taking, or how to take them. If you participate in CCM, a nurse will call you from time to time to go over your medications and treatments and ask if you have any new concerns. This would help with medication reconciliation and is covered by Medicare. Your provider may suggest it to you at the time of a visit, or you could contact your provider to enroll you.


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