Health Articles From Our Providers

   What is Depression? 


When a person feels sad over the death of a loved one, he or she cries easily and has emotional changes.  This is grief.  Depression is different from grief and often can be much harder to identify.  It is caused by a decrease or imbalance of chemicals in the brain.  It is similar to other diseases where there is lack of a chemical, such as the lack of insulin in diabetes.  It is a medical illness, not a personality weakness or disorder, as some people have thought. 


Grief is a normal reaction to a loss in one's life and is a perfectly normal emotion.  It also resolves with time.  Depression, however, does not have to come on from losses in a person's life.  And it is not as likely to resolve with time. 


A person's symptoms of depression are often vague.  The most common symptoms are fatigue, difficulty sleeping, chronic pain such as headaches or muscle aches, and symptoms from the stomach or gut. 


A person with depression may fall asleep easily only to awaken in the middle of the night and have trouble falling back to sleep.  He might feel more awake at two in the morning than he will during the day.  In the morning he will wake up tired and remain fatigued the rest of the day. 


In older people, depression may dull a person's interaction with life and the people around him.  He may appear withdrawn and be careless about personal hygiene.  The family often suspects Alzheimer's disease or thyroid problems. 


Such medical problems must always be considered, but if depressionturns out to be the cause, medicines can do much to resolve the brain's chemical imbalance and improve the symptoms. 

What's Your Medical Family Tree? 


Just as you may have inherited blue eyes, brown hair and “your father’s nose,” you may have inherited traits for certain illnesses.  During a routine exam, your doctor is likely to ask about illnesses your parents and grandparents had or died from, how old they were, and if any relatives suffered from familial illnesses. 


These traits are inherited in different ways.  Dominant traits require only one gene from either parent to get the illness.  If a parent had it, you have a 50% chance of having it.  Recessive traits need genes from both parents, making them much less common.  Other illnesses, such as diabetes, hypertension, and certain cancers, depend on a number of interacting genes.  A couple genes involved in breast cancer have now been identified, but account for a low percentage of all breast cancers. 


One of the most important times to review genetic illnesses is during pregnancy.  Your doctor will ask if any relatives had miscarriages or children with birth defects, or if relatives suffered from illnesses during pregnancy, such as toxemia, diabetes, or other medical problems that may relate to childbirth. 


Since your family history can be very important, it is wise to take a few minutes before your appointment to write down the illnesses your relatives have had and their ages at the onset of their illnesses.  It is much more significant if a parent had heart disease at age 40 than at age 80.  This record should be given to your doctor to review and keep in your chart. 


Knowing your family's medical history can help find and treat illnesses at an earlier stage.  Equally important can be doing tests that show you do not have an illness that runs in the family, lifting a burden of worry from your mind. 

We’re Your Medical Home 


Written by Kathy Ideus, Clinic Manager 


Approved by Dr. Rick Jackson 


Pawnee Rural Health Clinic serves as our patients “Medical Home”.  We are the collection point of your medical information, whether it be from pharmacies, specialists or our providers.  This information is available for you or other physicians you are seeing at anytime, with your permission.  This provides continuity of care, to reduce duplication of services and prevent errors in your healthcare experience.  In order to be your medical home, our providers need to maintain your information correctly and keep it current.  To do this it is required that you are seen annually to address each diagnosis for which you take medication.  We attempt to do this with an annual physical exam.  This facilitates refilling your prescriptions at your pharmacy on a regular basis. 


If you are of Medicare age, we will be calling you once a year also, to do an annual wellness screen, which is encouraged and funded by Medicare.  This annual screening interview is used as a baseline to determine what your normal activities are.  As the years go by then we can monitor your health and welfare in your home.  We assess for falls, medication management, management of meals, and activities of daily living.   We strive to keep people healthy and in their homes.  Our healthcare is now focused on preventative health needs.  We are trying to help our patients by addressing any issues they may be having before it becomes a problem that may decrease their independence. 

Sprains and Strains 


We all sprain an ankle at one time or another.  Usually we can just ignore it and the pain and swelling goes away over a few days. 


Sprains, however, can be more troublesome than most people think.  A person may easily re-sprain the ankle once there has been a bad sprain, especially if proper rehabilitative exercises have been ignored. 


Sprains vary from mild ones, where there is just a minor stretching of the ligaments, to severe sprains where the ligaments on the outside of the ankle are completely torn. 


When the ligaments are completely torn, the ankle joint is unstable and needs to be given time to heal.  Since ligaments heal as slowly as bones, treatment must be continued for six weeks or more.  If the tear does not heal well, an unstable ankle joint is apt to cause further problems with "weak ankles," recurrent sprains and eventually arthritis and possibly the need for surgery to stabilize the ankle.  


When you sprain your ankle, there are three things to do to help speed recovery.  These are applying ice immediately to keep the swelling down, elevating the leg, and using an elastic wrap to compress the swelling.  Resting the joint used to be included but it is now considered better to use the ankle to the point of inducing mild pain. 


These days, early rehabilitation is a part of therapy.  An air splint is often used for support and compression.  This allows the foot to flex up and down while preventing the unwanted side to side movement. 


A person is advised to keep the ankle healthy by gentle exercises to stimulate the nerves that sense ankle motion and control muscle balance.  This is done by "writing the alphabet" in foot-high letters in the air or on a surface with the great toe several times a day

Watch For Teenage Depression 


Teenage depression is more common than most people think.  Teenagers have many social pressures and often other significant stresses in their lives.  Changes in their personalities cannot always be dismissed as "phases" they are going through. 


The depression can appear similar to that of adults with symptoms of fatigue, changes in appetite and sleep disturbances.  At other times, it presents as rebelliousness or antisocial behavior with drug or alcohol abuse and sexual promiscuity.  There will likely be a loss of interest in normal activities and a drop in grades at school. 


If these changes occur in a teenager, it is important for him or her to consult a doctor or counselor.  Medical problems, such as an abnormal thyroid, could be the cause.  But whether it turns out to be depression or a medical illness, it is always very important to explore the causes and treat when possible. 


The number of teenage suicides is increasing, and depression is a major factor.  Girls are far more likely to attempt suicide, but boys more frequently succeed because they often use guns.  The suicide rate for white males has doubled since 1970 and it is second only to accidental deaths in teenagers. 


The depression can be treated with medicines which help restore the normal levels of certain chemicals, called neurotransmitters, in the brain.  The new antidepressants are very effective and are much safer than the older ones. 


Helping the teenager identify and understand his stresses and conflicts also helps him or her to cope with them.  A caring and concerned counselor can be very helpful and should provide close medical supervision during the period of recovery. 


                               Swollen, Allergic Eyes


August is the time of year for hay fever from ragweed. More people will get worse symptoms now than any other time of the year because of the high pollen counts from ragweed and several other weeds.


The eyes are a common site of symptoms since they are a good trap for the small pollen grains, especially when there is a little wind. The pollen makes certain white blood cells release histamines and other substances that make the eyes get watery, itchy and red.


When this happens, people usually rub the eyes to try to relieve the irritation. This only helps for a few moments and often leads to further swelling of the lining of the eyes and even greater itching. The swelling of the whites of the eyes may get so bad that they bulge out similar to a large water blisters. This looks bad and is very alarming to the person, but it is actually harmless and will improve.


This swelling quickly resolves with proper protection and treatment. Keeping the eyes closed and using cool compresses to relieve the itching is most helpful. Medicines that decrease the redness and inflammation of the eyes are useful, and antihistamines can also reduce the symptoms. Avoid rubbing the eyes.


There are many other things you can do to limit your symptoms. Protect your eyes with wrap-around sun glasses that limit how much pollen reaches your eyes. Stay indoors during windy weather. Do outdoor chores in the morning before the wind stirs up pollens for the day. Keep windows shut and use an air conditioner to limit the amount of pollens that enter the house.


If symptoms are prolonged or difficult to control, a person should consider allergy testing. This can help a person identify what to avoid and to prescribe shots which can be very helpful in preventing swollen, allergic eyes.


                      Excuses to Ignore Heart Pain


A person often has warning signs of heart disease—chest pain or shortness of breath—before having a heart attack. Unfortunately, many people find reasons to ignore these important symptoms. "I wouldn't want to bother my doctor," or, "The pain always goes away," many people say.


People know that chest pain is a warning sign for heart disease. Yet, heart pain may not feel quite like the pain of a toothache or stubbed toe. It is often difficult for a person to describe. It may be a tightness or pressure in the chest, an uncomfortable shortness of breath or a feeling of doom. So some people ignore it because it is not a typical “pain.”


Another reason many people talk themselves out of seeing a doctor is because the pain goes away if they take it easy—a little rest and everything appears to be back to normal. Often the heart pain comes on most easily in the morning, but is gone the rest of the day even though a person may be more active. This gives a person a false sense of security.


Some people feel heart pain in the neck, stomach, shoulders or arms. It may act like indigestion. A person cannot worry about the heart every time he gets a little pain in the stomach, neck or arms, but if the pain occurs with exertion, after meals, or is new and different from usual, it should not be ignored. Even if it's not the heart, it may deserve medical evaluation and treatment.


No one wants to have heart disease or to take the tests that may give the bad news that the pain is angina, but with early treatment much can be done to decrease the symptoms and protect against having a dangerous heart attack.


Do not ignore these important warning symptoms. Whether it is pain, pressure, tightness or a shortness of breath, it could be your heart.


Poison Ivy 


“Leaves of three, let them be,” is a way to remember how to avoid the misery of poison ivy dermatitis. Unfortunately, poison ivy can mingle with other weeds, and can still cause a rash in the fall and winter after the leaves turn brown.  Additionally, the oils from the leaves can cling to pets, boots, clothing, tires and can affect any skin that comes in contact with these items.  Washing with a strong detergent  within minutes of coming in contact with the oils can prevent the rash, but this is rarely possible. 


The oils penetrate the skin immediately and after a short time they will no longer be passed from person to person or from one part of the body to another.  Zanfel is a lotion which can prevent the rash if applied as soon as possible after exposure or after the first signs of a rash are present.  Prescription corticosteroids can help; a gel, lotion  or spray is preferred over creams and ointments. Most of the time we have to use systemic corticosteroids, either orally or by injection.   I prefer to use prednisone starting with 60 mg daily ( 3 tablets , 20 mg each)for 2 days, then 50 mg  for 2 days, 40 mg for 2 days,etc. The patient can refill the prescription if it flares up as the dosage is lowered. I tell the patients to take the daily dose all at once as early in the day as possible, since it can cause insomnia.  If a patient prefers an injection, we use Depo-medrol (a long-lasting cortisone) and dexamethasone in the same syringe. Dexamethsone acts more quickly but wears off sooner. 


Do not use bleach, alcohol, other irritating chemicals. You can try Calamine lotion when it is wet and weepy, then Keri lotion when it gets dry. Try to avoid scratching the rash, unless you scratch it with an ice cube, which will calm the itching for several hours and won’t introduce infection.  

                                  Infectious Mono


Infectious mononucleosis, or "mono," is an infection caused by a virus similar to herpes. It is well-known for the rather severe symptoms it causes in teenagers and young adults.


It often starts out much like strep throat with a sore throat, swollen glands and a fever. Excessive tiredness usually becomes the predominant symptom and the person may be bed-ridden for days or even weeks.


About half the time the spleen enlarges along with the lymph glands of the neck. The enlarged spleen can rupture and bleed internally, especially if there is any trauma such as in football or from falls skiing. An enlarged spleen needs to be followed by your doctor until it resolves. Occasionally the liver is involved with hepatitis-like symptoms.


The skin may develop a rash. If antibiotics, such as amoxicillin, are used, this rash is much more likely to develop. Antibiotics should not be used for mono unless there is a definite bacterial infection.


Mono is spread through body fluids, especially oral secretions. Thus, the virus is usually spread through kissing or communal use of eating utensils, but mono is not particularly contagious. We are all exposed to mono numerous times in our lives, but do not develop the infection unless the conditions are right. People who have had the illness will frequently continue to excrete the virus for years and can expose others for years.


There is no specific treatment for mono. Antibiotics do not help, but in more serious cases steroids may be used to alleviate the symptoms. Other helpful steps are to get plenty of rest, use pain pills and throat lozenges, and treat the symptoms until they resolve.

                             Preventing Constipation


Constipation is a common problem affecting millions of Americans. There are also medical reasons for preventing constipation. Many doctors believe that a person can decrease the risk of colon cancer by having regular bowel movements using fiber or bulk-forming laxatives, probably by more quickly eliminating any cancer-causing chemicals.


There are numerous methods of preventing and treating constipation. The first is by developing good bowel habits and a routine time to use the bathroom each day. Another simple measure is to increase the amount of water you drink. Physical activity is also helpful. Walking routinely or participating in other sports can help promote good bowel habits.


Good dietary habits are especially important. By eating foods high in fiber, a person will help keep his body healthy in many ways. First, fiber makes the stool larger and softer and bowel movements will be more frequent. Bulkier stools will also decrease the chance of developing diverticulitis which is a common problem as a person grows older. Other advantages of fiber include a lower cholesterol level, a decrease in the risk of colon cancer, and a more steady rate of absorption of nutrients from the bowel. This is especially important in diabetes.


If other measures are needed, there are a variety to choose from. Some medicines, such as polyethylene glycol or milk of magnesia, help draw extra water into the gut to keep the stool softer. There are also "stool-softeners" and lubricants, to make bowel movements easier. Laxatives work by stimulating the colon to empty but they can harm the colon if used on a long term basis.


If constipation is a new symptom, you must also consider bowel cancer or other illnesses and consult your doctor for an evaluation.


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