Ask the Doctor- Primary Care


Q: Is it true that you can get the flu from getting the flu shot?

Q: I was recently diagnosed as being pre-diabetic. Can you provide me with a basic overview of diabetes?

Q: Since moving to the Poconos last winter, I've developed seasonal allergies. What seasonal allergies should I expect for the summer?

Q: What is an advanced directive, and how should I start the process of getting one for myself?

Q: I'm a diabetic and I smoke, but I'd like to quit. How bad is smoking for diabetics, and where can I get help to quit the habit?

Q: I've just been diagnosed with celiac sprue disease. How can I deal with this disease?

Q: I am a smoker and often develop white spots on my tonsils. Should I be concerned about this?

Q: The last time I got a prescription filled by my doctor, he sent it directly to the pharmacy via computer instead of writing out a script on paper. Is this a new way of filling prescriptions?

Q: I've been diagnosed with pre-diabetes. Is there any way I can avoid becoming diabetic?

Q: I am an excessive bleeder. Even the smallest cut draws a lot of blood. Is this a sign of a more serious condition? Do I have a blood disorder?

Q: I have a very sick parent. What are some important things I should know about hospice care?

Q: Can you really "catch" pneumonia from cold weather?

Q: Every time I eat, my abdomen becomes bloated as if I am stuffed to maximum capacity, and I experience sharp pains in various areas in my abdomen and lower quadrants. What could this be?

Q: Why do the taste buds dull when you get a cold?

Q: What is Internal Medicine? What services do Internal Medicine doctors provide?

Q: My child just started school. What are the most common illnesses that I should expect and how can those illnesses be treated?

Q: Is there a difference between aspirin and Tylenol, and is it true that a person can take aspirin and then two hours later take Tylenol?

Q: Do you know anything about the new weight loss drug Alli? How is it different from other drugs? Is it safe to use?

Q: What is irritable bowel syndrome? What foods should people with it avoid?

Q: Q: I typically get my flu shot every fall, but are there any other vaccinations that I should be aware of to ward off winter illness? 

Q: Is it true that you can get the flu from getting a flu shot?

Influenza, which is commonly called the “flu,” is a serious and contagious respiratory infection that is caused by various strains of the influenza virus. According to the Centers for Disease Control and Prevention, influenza accounts for approximately 36,000 deaths and 200,000 hospitalizations each year in the US alone.

Influenza is characterized by the sudden onset of fever, headache, muscle aches, nausea or vomiting, congestion and/or fatigue. Depending on a person’s age and overall health, these symptoms can range anywhere from mild to severe.

Even before these symptoms emerge, however, most adults can begin to infect others as early as two days before they become sick and can continue to spread the flu up to five days after they are ill; children can spread the flu for up to seven days after becoming sick. Therefore, you may be able to spread the flu before you even know you have it and you can infect others while you are sick.

As the flu season nears, the best way to protect yourself from getting the flu is to receive an influenza vaccine. Contrary to what some believe, you cannot contract the flu from getting a flu shot. When you receive a flu shot, inactive or “dead” strains of flu viruses are injected into the body. This enables the immune system to develop antibodies against these strains. Therefore, if the body comes into contact with any of the flu viruses, it is able to fight off these germs and prevent an influenza infection.  In general, most people tolerate their flu shots very well and many things inappropriately get blamed on flu shots.  Side effects occur in less than five percent of patients that are inoculated.  They are usually mild, causing a local reaction such as a sore arm or a systemic reaction with a low-grade fever and muscle aches.  A severe anaphylactic reaction is very rare.

Since the viruses that cause influenza change almost every year, it is important to receive a flu vaccination each year.  Although the best times to receive a flu shot are early-to-late fall, the flu season can last until May, so having a flu shot after the peak flu vaccination period can still be beneficial. Everyone ages six months and older is encouraged to receive a flu shot, and those who are at high-risk for complications from the flu are strongly recommend to have a flu shot. High-risk groups include:

  • Children between six months and six years of age
  • Adults ages 50 and above
  • Pregnant women
  • Individuals with chronic illnesses
  • Patients living in nursing homes or other healthcare facilities
  • Individuals who live or care for those who are at high-risk

 Although the healthcare industry is not expecting a shortage of flu vaccines this year, it is always best to plan for your flu shot as early as possible. Many local clinics, physician practices and healthcare facilities—including Pocono Medical Center—offer the flu shot. You can also search for a local flu clinic online by visiting the American Lung Association’s Free Online Flu Clinic Locator, which is available at www.flucliniclocator.org. Receiving a flu vaccination is the single most effective preventive measure you can take against this insidious respiratory disease. 

Jonathan Goldner, DO, FCCP is Board-certified in Critical Care Medicine, Internal Medicine and Geriatric Medicine. Dr. Goldner is a Clinical Assistant Professor of Medicine at Penn State College of Medicine, President of the Medical Staff at Pocono Medical Center and practices at Pocono Internal Medicine Specialists in East Stroudsburg.

 

Q: I was recently diagnosed as being pre-diabetic. Can you provide me with a basic overview of diabetes?

 

More and more people are being diagnosed as pre-diabetic and it is wise to understand the implications of this disease if you don’t heed the warning signs. The statistics about diabetes are so staggering that the numbers may make you blink in disbelief. According to the American Diabetes Association, almost eight percent of the population in the United States is diabetic. Another 57 million are pre-diabetic and five to seven million remain undiagnosed. The ever-increasing incidence of diabetes in recent years is cause for alarm and has generated multiple approaches to educate with the hope of preventing future cases. One of the most disturbing trends is the increase of diabetes among children.

You must first understand that there are two types of diabetes: Type I and Type II. Type I, formerly known as juvenile diabetes, is found in children and young adults and is caused when the body is unable to produce insulin, the hormone needed to convert sugars, starches, and other foods into energy needed throughout the day.

Type II diabetes is when the body does not produce enough insulin or the cells ignore the insulin in the body. Type II is the most common among certain ethnic groups as well as the elderly population. Although genetic factors play a role in being diagnosed with this disease, obesity is the most common cause.

Pre-diabetes is the on-ramp to diabetes and serves as a warning sign to change your lifestyle. Lean, green, and marine is a healthy diet mantra. This motto translates into eating more vegetables, fish and foods low in fat content. A healthy, balanced diet can be described as 40 percent protein, 40 percent carbohydrates, and 20 percent fat. A healthy diet also stresses avoiding simple sugars (e.g., cakes, candy, and ice cream) and high-fat foods (e.g., fried food, baked goods, and shortening).

Healthy eating must also be paired with a more active lifestyle. Even though every person needs to figure out what works best for them, moderate activity for at least 30 minutes a day, five times a week is widely recommended. Prevention should be stressed with this disease, especially if you have a genetic predisposition. People need to be aware of the risk factors and avoid behaviors that may lead to becoming pre-diabetic or, if left unchecked, diabetic.

Marc Keuler, MD is Board Certified by the American Board of Internal Medicine. He currently practices at PMC Associates: Internal Medicine at the Mountain Healthcare Center in Tobyhanna.

 Q: Since moving to the Poconos last winter, I've developed seasonal allergies. What seasonal allergies should I expect for the summer?

After the long, cold days of winter, many look forward to the warmer, sunny days of spring and summer. For allergy sufferers, though, spring is also a time of high pollen counts, which can trigger "hay fever" or allergic rhinitis. Allergic rhinitis affects nearly 40 million Americans and accounts for over four billion dollars in lost work and school days each year. Furthermore, the condition is linked to other health conditions, including asthma and sinusitis.

Allergic rhinitis is a condition involving inflammation of the mucous membranes in the nose, which is triggered by exposure to an antigen. An antigen is a substance in the environment that the body recognizes as foreign, thus provoking an immune response. This immune response can cause a runny nose, watery eyes, sneezing, sinus congestion and/or itchy skin. For some people, these symptoms may even impair daily activities like sleep and work or school performance.

Weeds are normally the most common allergy irritants during the spring and summer, with ragweed being the most pervasive allergen. Pigweed, tumbleweed, sagebrush and other members of the weed family can also produce excessive amounts of pollen, which triggers allergic rhinitis. Molds, household dust, leaves and late-blooming trees can also cause allergies to flare up in the spring.

The keys to treatment are avoidance of allergens and the use of decongestants and daily antihistamines. Avoidance involves maintaining an allergen-free environment at home by covering pillows and mattresses with plastic covers and eliminating dust-collecting household fixtures; for instance, you can remove carpet or use air purifiers. In regards to antihistamines, the most commonly used medications are Claritin, Allegra and Zyrtec. Antihistamines work to prevent the body's immune response to an exposed, "non-harmful" antigen. For best results, these medications should be taken on a daily-not on an "as needed"-basis.

Other options for allergy treatment include nasal corticosteroid sprays, which help to shrink inflamed nasal mucosa, and allergen immunotherapy. Allergen immunotherapy involves exposing a patient's body to trace amounts of an antigen via shots, in an effort to desensitize a patient's immune response to a particular allergen.

If you experience allergies this spring, rest assured that you are not alone; allergic rhinitis is a very common condition that impacts the quality of life for many individuals. With proper treatment by a physician, though, you can achieve better control of your allergies, all year round.

Aparna Tamaskar, MD is Board certified in Family Medicine and is a member of the Medical Staff of Pocono Medical Center. Dr. Tamaskar practices at PMC Physician Associates: Family Medicine in Brodheadsville.
 

Q: What is an advanced directive, and how should I start the process of getting one for myself?

This is a great question, and because it deals with a difficult subject, it is often not addressed properly. Each year, we strive to educate our community about this crucial topic via National Healthcare Decisions Day, a nationwide effort to increase public awareness of the importance of documenting one’s healthcare wishes, especially before being diagnosed with a debilitating or terminal health condition. At PMC, we see firsthand the difficult decisions families must make when the wishes of their gravely-ill loved ones are unknown.

Advanced directives are important considerations for all adults. Advanced directives are a legal way to make your healthcare treatment choices, just as they state,   in “advance,” if you are unable to speak for yourself. These decisions can be written down in advance so family members and medical personnel are clear about your wishes. Advance directives come in two main forms. The first choice is a healthcare power of attorney. This documents the person you select to be your voice for your healthcare decisions if you cannot speak for yourself. The other form is commonly known as a living will. This outlines what kinds of medical treatments you would or would not want at the end of life.

The Federal Patient Self-Determination Act also requires facilities, like Pocono Medical Center, to provide community education on advance directives. All healthcare facilities are required to provide information about health care decision-making rights, ask all patients if they have an advance directive, educate their staff and community about advance directives, and not discriminate against patients based on an advance directive status.

In observance of National Healthcare Decisions Day, the departments of Pastoral Care and Case Management will once again provide advanced directive and living will information this Friday, April 16 in the B lobby at Pocono Medical Center from 10:00 a.m. to 5:00 p.m. We also make information regarding advance directives available yearlong via our site, www.PoconoMedicalCenter.org.

Reverend Dr. Sherrie L. Sneed is the Director of Pastoral Care at Pocono Medical Center

  

Q: I'm a diabetic and I smoke, but I'd like to quit. How bad is smoking for diabetics, and where can I get help to quit the habit?

Diabetes is caused by an insulin disorder in the body. People with diabetes either produce too much insulin or not enough. Insulin affects the level of blood glucose. Elevated levels of blood glucose can damage all of the major organs, particularly the heart and the eyes.

Smoking is particularly dangerous for diabetics, because it increases the risk of a number of health complications. Perhaps the greatest risk of smoking for diabetics is that it elevates blood glucose levels and impairs circulation throughout the body, conditions that already exist for diabetics. In fact, the added danger of smoking puts diabetics at three times the risk of dying from cardiovascular disease. 

Diabetics who smoke are also at greater risk for developing kidney disease. The kidneys act as a filter for the body’s nutrients. Due to their high blood glucose, kidneys of diabetic patients can get overworked.

Eventually if blood sugar levels remain high, the kidneys will sustain enough damage to shut down or fail, an extremely serious health condition which can be remedied only by dialysis or a kidney transplant. Smoking exacerbates these issues by reducing circulation and impeding blood flow to the kidneys.

While smoking clearly puts diabetics at risk for a number of health complications, we at Pocono Medical Center understand and recognize that smoking is first and foremost an addiction. Through our Smoking Cessation Program, we adopt judgment free tactics to help our patients kick the habit. To register for smoking cessation counseling, send your email, name & contact information to a.simon@pocnp.com.

Ellen Anuszewski, MSN CRNP, is a certified Family Nurse Practitioner and the Nurse Practitioner for the

Pocono Health System Palliative Care Program. She is also the Vice President the Pocono Association of Nurse Practitioners.

 

Q: I've just been diagnosed with celiac sprue disease. How can I deal with this disease?

Celiac sprue, also called celiac disease or gluten-sensitive enteropathy, is an inflammatory disorder of the small intestine that results in the malabsorption of nutrients. This hereditary disorder is caused by a sensitivity to the protein substance called gluten which is found in wheat, barley, and rye. Although oats do not contain gluten, they are typically harvested with the same machinery and, unfortunately, cross contamination is likely to occur. Therefore, oats should be added to the list. The disease is worldwide in its distribution, but it is rare among those of African, Chinese, and Japanese ancestry. The prevalence in the United States and Europe ranges between 0.5 to 1 percent. Those at highest risk are of Irish, Scottish, and Northern English ancestry.

Celiac disease may be asymptomatic, but the classic form of the disorder is characterized by chronic and persistent diarrhea. However, there is no typical manifestation of the disease. Many symptoms and signs such as anemia, weight loss, bone pain, edema, skin disorders, infertility, short stature, recurrent mouth sores, painful abdominal bloating, yellowing of the teeth, mood changes, and depression occur as a consequence of the malabsorption of essential vitamins, minerals, and electrolytes that are necessary for good health. Any of these symptoms may occur in the absence of diarrhea.

Since the symptoms and signs may be subtle, a high level of suspicion is necessary to accurately identify and diagnose this disease. Celiac sprue screening is performed with a special serological blood test and the confirmation of the disorder is established with the gold standard upper endoscopy. The visual appearance of the small intestine may be a revealing clue, and the essential biopsy will establish the diagnosis based on the pathological flattening of the intestinal mucosa.

The treatment of celiac sprue is exclusively dietary with the avoidance of all gluten containing grains. The gluten-free diet is a lifetime commitment. This is especially challenging because gluten is found in so many different varieties of packaged, bottled, and canned foods. Eating out at restaurants is a significant concern as menus rarely list all cooking ingredients. Since there is no medical or pharmacological cure for sprue, I generally recommend a dietary consult for all newly diagnosed patients. Supplementary vitamins and minerals may be given for a period of time shortly after diagnosis depending on the deficiencies. The immediate recurrence of diarrhea in the classic patient almost always signals the indication of dietary cheating or the incomplete removal of gluten from the diet.

Patients should always consult with a healthcare professional if they have any issues or questions related to their diagnosis. There are also many celiac disease support groups, hotlines, websites and blogs, which offer support and information to individuals afflicted with this disease. However, when referencing information on the internet, it is important to be sure the source is credible, evidence-based medicine.

Charles F. Cohan, DO, FACP is a gastroenterologist at Pocono Gastroenterology in East Stroudsburg and Mountain Healthcare Center in Tobyhanna. He is Board certified in internal medicine, gastroenterology.

   

Q: I am a smoker and often develop white spots on my tonsils. Should I be concerned about this?

The tonsils are found in the back of the throat and help the body fight against infections.  Tonsils are made of small tubes linked together, which are known as tonsular crypts.  As we know, the human mouth is home to many germs. There are certain anaerobic germs—germs that live without the aid of oxygen—found in the oral cavity, which accumulate around these tonsular crypts.

As a result, these germs produce sulfur granules, which accumulate along with dead mucous cells. Together they produce white, foul smelling granules, which appear as white spots on the tonsil. Usually these white spots are less than one half centimeter in size. While these white spots can be irritating, they often come off spontaneously by themselves. This condition causes discomfort or a feeling that something is stuck in the back of the throat, but it is generally not cause for alarm.

In contrast, tonsillitis, which also causes white spots on both of the tonsils, is associated with throat pain, fever, and swelling of the tonsil. When a patient develops tonsillitis, the tonsils become so overwhelmed by a bacterial or viral infection that they swell and become inflamed.

It bears repeating that quitting smoking should be one of your first priorities to help alleviate this problem. This will help in your overall health as well your ear, nose, and mouth health. If someone has swelling of the tonsils and has a history of smoking, than I would advise them to see an otolaryngologist for further evaluation.

Drupad Bhatt, MD, FACS, is a Board certified otolaryngologist who practices at Monroe, Ear, Nose, Throat & Facial Plastic Surgery in East Stroudsburg.

 

Q: The last time I got a prescription filled by my doctor, he sent it directly to the pharmacy via computer instead of writing out a script on paper. Is this a new way of filling prescriptions?

Our doctor used a new method of filling prescriptions called electronic prescribing or e-prescribing. This system allows health care professionals to electronically send an accurate, error-free, and legible prescription directly to a pharmacy from the point-of-care. This technology has existed for a number of years but has not been embraced by physicians until recently.

E-prescribing offers many important patient safety benefits. For starters, this system makes potential errors from a doctor’s poor handwriting on paper prescriptions a thing of the past. Prescriptions filled electronically over e-prescribing systems can also alert physicians to dangerous drug interactions or known allergies. The systems are developed and deployed to inform prescribers of the formulary status of medications to be prescribed. They have the ability to tell the prescriber of other drugs the patient is taking even if a different provider prescribed the drugs. This feature could significantly reduce the risk of adverse drug interactions.

E-prescribing can also potentially save patients time and money. With e-prescribing, patients no longer need to drop off prescriptions and wait for them to be filled. In addition, the system can link with a patient’s health plan to determine which medications are covered by their insurance. The system can also electronically notify the physician’s office when a refill is needed.

Our office has been using the technology for two years with great success. Some patients still prefer to get a paper prescription to take to the pharmacy the old fashioned way. In this case, these systems are equipped with printers to accommodate those patients with a printed version.

E-prescribing first became known after the Medicare Modernization Act of 2003. An Institute of Medicine report stating that e-prescribing would reduce the risk of medication errors also raised awareness of this new technology. The Federal Government and Medicare have now established e-prescribing standards. Medicare has set a goal of e-prescribing for all physicians by 2014.  Physicians who are not using e-prescribing technology by that time will be receiving reduced payments from Medicare for the services that they provide.

In summary, e-prescribing is here to stay. As systems are enhanced, the safety of our patients improves. If your personal health care provider isn’t e-prescribing, please ask them why not. The safety enhancements as well as the convenience and potential savings are worth the effort.

Vincent Francescangeli, MD is Board-certified in Internal Medicine and is a member of the Medical Staff of Pocono Medical Center. Dr. Francescangeli practices at Pocono Internal Medicine Specialists in East Stroudsburg.



Q: I've been diagnosed with pre-diabetes. Is there any way I can avoid becoming diabetic?

Left unchecked, pre-diabetes can turn into diabetes, a group of diseases marked by high levels of blood glucose, also called blood sugar, resulting from defects in insulin production, insulin action, or both. Diabetes can lead to serious complications and premature death, but people with diabetes and pre-diabetes can take steps to control the disease and lower the risk of complications.

An estimated 57 million adults aged 20 and older have pre-diabetes, which is a condition in which blood glucose levels are higher than normal. Pre-diabetes is also known as glucose intolerance in the current medical literature. Because of the prevalence of diabetes in the United States and especially in Northeast Pennsylvania, a new category of pre-diabetes or glucose intolerance was developed to enable us to treat those with elevated blood sugars early, prior to developing diabetes.  

Today, a normal fasting blood glucose is defined as less than 100 mg/dl.  Glucose intolerance is defined by patients who have a fasting blood glucose over 100. In comparison, patients who meet the criteria of diabetes have a reading of over 126 mg/dl on two separate occasions.  

If you have a fasting blood glucose in the glucose intolerance range (100-126 mg/dl), the good news is that by taking small steps and making modest lifestyle changes, it’s possible to delay and possibly prevent the onset of diabetes. People with glucose intolerance who lose weight and increase their physical activity can return their blood glucose levels to normal. By losing five to seven percent of their body weight and getting 150 minutes of physical activity a week such as walking 30 minutes for 5 days, people with pre-diabetes can cut their risk of developing Type 2 diabetes by more than half. In fact, research has shown that these lifestyle interventions are more cost-effective than medications.

It’s important to know your risk factors for developing glucose intolerance which could lead to diabetes. An inactive lifestyle (exercising fewer than three times a week) raises your risk. Your risk increases with age, especially if you’re 40 years and older. If you have a Body Mass Index (BMI) of 25 or higher (23 or higher if Asian American, 26 or higher if Pacific Islander), your risk also increases. If you’re not sure about your BMI, visit your healthcare provider to calculate it for you. A family history of diabetes such as having a parent, brother, or sister increases your chances of becoming diabetic. In addition, race and ethnicity play a role. African American, American Indian, Alaska Native, Asian American, Pacific Islander, or Hispanic American/Latino heritage are all high risk groups. Women with a history of gestational diabetes or who have given birth to a baby weighing more than nine pounds are also at risk.

It’s important, as well, to “know your numbers” for blood pressure and cholesterol. A blood pressure of 140/90 or higher and HDL cholesterol less than 40 for men and less than 50 for women; and triglyceride levels 250 or higher are all red flags.

The key to fighting both diabetes and glucose intolerance is to take small steps and consult your healthcare provider for help. Begin by setting realistic goals and making small changes. For example, try to get 15 minutes of physical activity a day this week. Each week add five minutes until you build up to the recommended 30 minutes a day, five days a week.

Next, make better food choices. Try to eat more fruits and vegetables, beans, and grains and reduce the amount of fat in your diet. Choose grilled or baked foods instead of fried. It’s important to record your progress. It’s important to keep a food diary, and write down everything you eat and drink. This is one of the most effective ways to lose weight and keep it off.  You can then review this diary with your health care provider.

In battling pre-diabetes, the most important thing is to not give up. Making even modest lifestyle changes can be tough in the beginning, but by adding one new healthy change a week you can reverse the course of this condition.

Jonathan A. Goldner, DO, FCCP, FCCM practices at Pocono Internal Medicine Specialists. He is Board certified in internal medicine, critical care, and geriatrics. He is a clinical assistant professor of medicine at both the Penn State College of Medicine and the Commonwealth Medical College


Q: I am an excessive bleeder. Even the smallest cut draws a lot of blood. Is this a sign of a more serious condition? Do I have a blood disorder?

The clotting of the blood, also known as coagulation, involves a complex interplay among vascular performance, blood cell or platelet number and function, clotting or coagulation factors and fibrinolysis (the breaking down of blood clots).

Bleeding that is spontaneous, excessive or delayed following tissue injury can result from a localized pathologic process (i.e., abnormal blood vessels) or a systemic disorder (i.e., the circulating cells and proteins responsible for blood clotting). Any of these can be either inherited or acquired.

A dialogue between the patient and physician is essential and can provide important clues as to where a defect might reside and whether the defect is inherited or acquired.

An inherited disorder is suggested by the onset of bleeding shortly after birth or during childhood and a positive family history with a consistent genetic pattern. However, a negative family history does not exclude an inherited coagulation disorder. For example, up to 30 to 40 per cent of patients with hemophilia, a blood disorder that prevents the blood from clotting normally, have a negative family history.

For treating inherited blood disorders, a careful history of medication use is important, including prescribed medications, over-the-counter medications and herbal products.

Disorders of the hemostasis (i.e., the normal clotting of blood) can be divided into two major categories: defects of the primary hemostasis and those associated with the presence of bleeding inhibitors.

Defects of primary hemostasis include the following:

  • Disorders of platelets (blood cells) or blood vessels —Characteristically associated with small bruises or immediate bleeding with minor skin cuts. Patients with platelet abnormalities tend to bleed immediately and rarely experience delayed bleeding.
  • Coagulation disorders — Characterized by large, palpable bruises and deep soft tissue hematomas (internal bleeding). Hemorrhage into joints (hemarthrosis) most often indicates a severe inherited coagulation disorder, such as hemophilia. Bleeding after trauma or surgery can be extensive.
  • Von Willebrand disease - The most commonly inherited bleeding disorder, with an estimated prevalence of up to one percent among the population. Most patients have moderate to severe bleeding due to reduced levels or abnormal function of von Willebrand factor (VWF, named after the scientist who discovered it), which necessitates proper blood clotting.

The presence of acquired bleeding inhibitors occurs when the body develops anti-bodies that work against a blood-clotting factor. Bleeding inhibitors can cause excessive bleeding or, ironically, a tendency to overproduce blood clots. These inhibitors are sometimes an isolated finding, but usually they coexist with a malignancy or an autoimmune disease, such as lupus.

In summary, spontaneous bleeding or prolonged bleeding after minor cuts can be linked to a wide range of blood disorders, which can be benign or related to a serious disease. It is recommended that you be evaluated by a physician to determine your condition and treatment.

Kaoutar Tlemcani, MD is a Board-certified specialist in Hematology/Oncology and member of the Medical Staff at Pocono Medical Center. Dr. Tlemcani practices at PMC Physician Associates: Hematology/Oncology in East Stroudsburg.

 
Q: I have a very sick parent. What are some important things I should know about hospice care?

The goal of hospice care is to provide physical, emotional and spiritual support to end-of-life patients and their loved ones. Contrary to what many believe, however, hospice care is not a last-ditch option for dying patients. Rather, it can be used as a renewable resource for helping terminally ill patients and their caregivers better manage and cope with their situation.

Whether provided in the patient’s home or in a medical facility, hospice care can be requested up to six months before the patient’s expected death, regardless of the patient’s age. Should the patient’s condition improve, he/she is still eligible to reapply for hospice care in the future. 

Hospice care is often described as a concept of caring—one that attends to both the physical as well as psychological needs of the patients and their loved ones in a dignified manner. In addition to providing patients with palliative care (i.e., pain and symptom relief), hospice care also helps the patients’ loved ones (i.e., children, spouses and caregivers) cope with the emotional and practical obstacles that emerge during such a difficult time. Helping these individuals deal with their loved one’s illness and manage end-of-life decisions are just some of the many benefits hospice care provides.

Many facilities use a multidisciplinary approach to hospice care, meaning that doctors, nurses, social workers and volunteers (namely, clergy members, spiritual counselors and/or bereavement support specialists) all play important roles in the patient’s care.  These multifaceted perspectives and services enable hospice providers to provide more patient-centered and family-oriented care.

A common concern regarding hospice care is cost. However, in most cases, Medicare, Medicaid and/or private insurance or veteran’s benefits will cover the cost of hospice care (depending, of course, on the patient). Moreover, many non profit hospice providers will cover the cost of care or offer financial assistance to individuals with limited or no financial resources.

When selecting a hospice care provider, you may want to seek the advice of your family physician; he or she may be able to recommend providers that are available in your area. You should also ask the hospice care provider some specific questions related to the quality of their patient care, such as the patient-to-caregiver ratio, frequency of at-home visits and availability for after-hours questions or concerns. The ability to provide a clear, yet flexible patient care plan and the frequency of visits and the continuity of care are important factors to consider when choosing a hospice organization.  In addition, you should also ensure that the facility is accredited by the Joint Commission (an independent organization that accredits quality care providers), is certified by Medicare and is licensed by the state.

For more information about Hospice Care, visit the National Hospice and Palliative Care Organization Web site at: http://www.nhpco.org or the VNA/Hospice of Monroe County at: http://www.vnahospiceofmc.org. For Medicare eligibility, coverage and reimbursement, visit the Centers for Medicare and Medicaid Services at: http://www.cms.hhs.gov/center/hospice.asp.

Vincent Francescangeli, MD is Board-certified in Internal Medicine and is a member of the Medical Staff of Pocono Medical Center. Dr. Francescangeli practices at Pocono Internal Medicine Specialists in East Stroudsburg.


Q: Can you really "catch" pneumonia from cold weather?

At some time or another, we’ve probably all heard the old wives’ tale that you can catch pneumonia by being in cold weather without a coat or with wet hair.  Although some have argued that lower body temperatures can weaken the immune system and thus make us susceptible to illness, there have been no definitive studies showing a correlation between cold weather and decreased immune function. And, while it is estimated that there are approximately 30 causes of pneumonia, exposure to cold weather is not one of them.

Pneumonia is an infection of the lungs whereby fluid blocks the alveoli (air sacks) from delivering oxygen to the blood. Without oxygen being circulated in the blood stream, the body is not able to receive the fuel it needs to work properly. The most common causes of pneumonia are bacteria and viruses.

Bacterial pneumonia occurs when the immune system is weakened by age, illness, malnutrition or some other immune-compromising circumstance and bacteria that cause pneumonia, which are already present in the system, multiply and infect the lungs. The infection causes part or all of the lung(s) to be filled with liquid. The infection can quickly spread in the bloodstream and affect the entire system. The most common cause of bacterial pneumonia is the organism streptococcus pneumonia and the illness is characterized by the sudden onset of fever, chills, chest pain, fatigue, difficulty breathing and a mucus-producing cough.

Although it is often not as serious as bacterial pneumonia, viral pneumonia accounts for approximately half of all pneumonia cases. Different respiratory viruses, including those associated with cold and flu infections, can invade the lungs and cause pneumonia. Symptoms of viral pneumonia are often the same as the flu (i.e., fever, headache, muscle weakness/pain, congestion and fatigue) and include difficulty breathing with coughing.

While there are other, less common types of pneumonia that are caused by other agents (i.e., fungi, toxic materials and organisms), none of these have been linked to exposure to cold weather. Pneumonia is most commonly contracted by a preexisting viral respiratory infection or by breathing infected air particles from someone who has pneumonia.

If you experience any of the symptoms mentioned above, you should see your physician right away. Early treatment for pneumonia is especially important for those considered high-risk for pneumonia complications (i.e., young children, elderly adults, those with a chronic illness and anyone with a medical condition that may compromise the immune system). These individuals should receive a pneumonia vaccine called Pneumovax, which helps prevent the most common form of pneumonia associated with the streptococcal pneumoniae bacteria. These patients are also candidates for annual influenza vaccines.

Jonathan Goldner, DO, FCCP, is Board-certified in Critical Care Medicine, Internal Medicine and Geriatric Medicine. Dr. Goldner is a Clinical Assistant Professor of Medicine at Penn State College of Medicine, the President of the Medical Staff at Pocono Medical Center and practices at Pocono Internal Medicine Specialists in East Stroudsburg.

 

Q: Every time I eat, my abdomen becomes bloated as if I am stuffed to maximum capacity, and I experience sharp pains in various areas in my abdomen and lower quadrants. What could this be?

I suspect that you are suffering from functional bloating, which most likely is a manifestation of Irritable Bowel Syndrome or IBS.

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder affecting approximately 10 to 20 percent of the population. In fact, it is second only to the common cold as a cause of absence from work. Women are twice as likely as men to be diagnosed with IBS in the United States and other western countries. Although the condition cannot be cured, treatments are available to alleviate symptoms.

No single cause of IBS has been identified, although there are theories that gastrointestinal abnormalities, food intolerance, and psychological issues may be involved.

The primary symptoms of IBS are abdominal pain and changes in bowel habits (e.g., diarrhea and/or constipation). Abdominal pain can vary in location and severity. Patients can experience primarily diarrhea, primarily constipation, or an alternating pattern of the two. Additional gastrointestinal symptoms may also occur, such as abdominal distension (i.e., "distended abdomen") and bloating, as in this case.

There is no single diagnostic test for IBS and several other gastrointestinal conditions can produce similar symptoms. A patient's history, physical examination, and blood test results are all reviewed to rule out other disorders and establish a diagnosis of IBS.

There are many different treatments available to relieve the symptoms of IBS. These include the monitoring of symptoms and patterns, adjusting one's diet to increase fiber and eliminate foods that can worsen symptoms, psychosocial therapy (since stress may aggravate IBS), and medication. Treatments are often used in combination and, because of the variability of symptoms, different treatments work for different people. Many herbal and natural therapies have been advertised for the treatment of IBS; however, these therapies have not been proven effective.

Although IBS can cause pain and stress, the majority of patients are able to control their symptoms and live a normal life without developing serious health problems.

Your own healthcare provider is the best source of information for questions and concerns related to your medical problem. Because no two patients are exactly alike and recommendations can vary from one person to another, it is important to seek guidance from a provider who is familiar with your individual situation.

Dr. Keuler is a Board-certified Internal Medicine physician and a member of the Medical Staff at Pocono Medical Center. He practices at PMC Physician Associates: Internal Medicine, located at the Mountain Healthcare Center in Tobyhanna.

 

Q: Why do the taste buds dull when you get a cold?

When people get a cold, they typically experience lack of taste. Contrary to what many believe, however, having a cold does not cause the taste buds to dull. Rather, they loose the ability to smell food, due to nasal congestion.

Our tongues are covered by thousands of taste buds, but these only register four basic types of taste: sweet, salty, sour and bitter. Typically, things we normally associate with “taste” (i.e., flavors and spices) are really a product of “smell.” In fact, our olfactory receptors, located in the nasal passages, are responsible for up to 80% of what we consider to be taste. When the nose is congested due to mucous or polyps (growths), we loose the ability to smell and taste food. Although the taste buds can still tell the difference between sweet, salty, sour and bitter, having a cold typically causes most foods to taste bland.

While having a cold does not afflict the taste buds, there are some conditions that can affect them.

Exposure to extreme temperatures (hot or cold), infections, smoking and some medications can dull and even damage the taste buds. Over time, though, the taste buds may restore themselves.

Likewise, once you recover from a cold, you should regain your ability to fully smell and taste food. If you continue to experience tasteless meals after having a cold, it is important to speak to your physician.

Hussain Malik, MD is Board-certified in Otolaryngology and Head and Neck Surgery, and he is a member of the Medical Staff of Pocono Medical Center. Dr. Malik practices at Pocono Ear, Nose, Throat & Facial Plastic Surgery in East Stroudsburg.


Q: What is Internal Medicine? What services do Internal Medicine doctors provide?

The term “internal medicine” originates from the German phrase “innere medizin,” which was used to describe the work of German physicians who, in the late 1800s, conjoined the science of medicine with the art of caring for patients. American physicians who studied medicine in Germany brought the discipline to the United States in the early 20th century.
 
Today’s internal medicine doctors, also known as “internists,” have specialized training in the diagnosis, treatment and prevention of illnesses, infections and diseases that afflict adolescents, adults and the elderly. Internists study many illnesses, including those that affect the heart, kidneys, lungs, digestive system, and other parts of the anatomy. While internal medicine doctors can provide primary care to their patients, it is often not their specialty. However, with our aging population, general internists frequently fulfill the role of primary care physicians to the elderly in the community.
 
Acting as “puzzle solvers,” internal medicine physicians typically care for patients who have perplexing, rare and/or chronic illnesses. Nevertheless, doctors of internal medicine are trained to treat virtually any illness, regardless of how rare or common that illness may be. While some internal medicine doctors remain general internists, many go on to sub-specialize in cardiology, oncology, hematology, nephrology, etc.
 
In addition to establishing medical diagnoses and treatment, internists also specialize in the prevention of illness and the promotion of wellness. They have also been noted for their roles as “life-long” partners in their patients’ health, providing comprehensive care in both the office and hospital settings.

Vincent Francescangeli, MD is Board-certified in Internal Medicine and is a member of the Medical Staff of Pocono Medical Center. Dr. Francescangeli practices at Pocono Internal Medicine Specialists in East Stroudsburg.

 

Q: My child just started school. What are the most common illnesses that I should expect and how can those illnesses be treated?

By and large, the most common illnesses for children are ear infections and tonsillitis.

Ear infections are especially common for younger children and are typically caused by bacteria. At times, enlarged adenoids and allergies are also factors. The onset of an ear infection usually produces cold-like symptoms (i.e., fever and congestion). Other characteristics of an ear infection could include pressure behind the eye, headache and, of course, ear pain.  If your child exhibits these symptoms, or if he or she is seen incessantly tugging at or fidgeting with the ear, this is usually a sign of an ear infection.

Children who attend school or daycare are more prone to developing ear infections, due to the increased interaction with other children. Complications from an ear infection could include short-term hearing loss and possible damage to the eardrum. It is therefore essential to seek medical treatment, preferably from an Ear, Nose and Throat (ENT) specialist, as soon as possible. It is especially important to consult an ENT specialist if your child has multiple ear infections, as this could be a sign of structural damage or an abnormality.

Another common ailment for children, tonsillitis, is an inflammation of the tonsils that is caused by bacteria.  Once the tonsils, which are meant to fight off germs that enter the body via the mouth, become infected, they become swollen and can exhibit a red, white or yellowish color. Other symptoms of tonsillitis include fever, sore throat and difficulty swallowing. Tonsillitis can be caused by either a bacteria (streptococci, more commonly known as “strep throat”) or a virus. While tonsillitis can be treated with antibiotics, children who experience recurring tonsillitis may need a tonsillectomy, or the surgical removal of the tonsils. In this case, you should consult an ENT specialist.

Unfortunately, all types of tonsillitis are contagious and can be easily passed through contact with an infected person’s nasal or throat fluids. To help protect your child against tonsillitis, be sure to teach them proper hand washing habits and regularly clean their school and at-home clothes, utensils and supplies. If you think your child has tonsillitis or has come into contact with a tonsillitis carrier, be sure to see your physician right away.

Drupad Bhatt, MD is a Board-certified Otolaryngologist and Chief of Surgery at Pocono Medical Center. Dr. Bhatt practices at the Monroe Ear, Nose, Throat & Facial Plastic Surgery in East Stroudsburg.

Q: Is there a difference between aspirin and Tylenol, and is it true that a person can take aspirin and then two hours later take Tylenol?

Yes. Aspirin is an anti-inflammatory and Tylenol is a pain reliever. They are two entirely different drugs, and each is used for specific symptoms. Tylenol is safer for patients who are allergic to aspirin or cannot tolerate the effects aspirin can have on the stomach. Although Tylenol can be very beneficial, it is among the most abused drugs in America. People give little thought to its potential side effects, because it’s a common over-the-counter remedy. It can cause liver damage, however, so it should not be taken in excess. Sometimes doctors will prescribe one or both drugs, but a person should not take the two drugs together on their own. A person who has pain that persists for more than two weeks should see a doctor.

- Dr. Barnes Orthopedic surgeon Frederick Barnes   

 
Q: Do you know anything about the new weight loss drug Alli? How is it different from other drugs? Is it safe to use?

Alli (pronounced Al-eye) is the first FDA-approved, over-the-counter form of orlistat (a generic drug that inhibits the absorption of fat) for weight loss.  Although Alli has only about half the strength of Xenical (the prescription-based version of orlistat), Alli’s efficacy and side effects are similar to Xenical’s.

Recognizing the increased rates of obesity and diabetes in children and adults, the FDA decided to approve a weight loss drug they deemed safe enough for over-the-counter sales. Because Alli does not contain harmful stimulants like ephedra and has not been linked to any severe side effects, the FDA approved its use as a weight loss supplement. Essentially, Alli’s safety and FDA approval separates it from other weight loss drugs on the market.

Alli claims to help people lose 50% more weight than diet alone, but this translates to losing an average of only 3-5 pounds over a six month period

Although the drug prevents the absorption of about 75% of fat in a meal, Alli users should be advised that the unabsorbed fat does not altogether disappear; it still needs to be passed through the system. Common side effects from taking Alli could therefore include urgent and oily stools, as well as rectal seepage (i.e., spotting).

For best results while taking Alli, you should limit your total fat intake to 15-20 grams of fat per meal, which is equivalent to the amount of fat found in a small cheeseburger, a 3-ounce steak, or a tablespoon of oil.

You should also take a multivitamin at bedtime, since Alli can reduce the absorption of fat-soluble vitamins A, D, E and K as well as beta-carotene.

The decreased absorption of vitamin K from taking Alli could also increase the effects of blood thinners, possibly causing harmful levels of bleeding. Patients taking blood thinner medication should therefore consult their doctors before taking Alli.

Patients waiting for a magic-bullet weight loss pill or the approval of a wonder drug like Accomplia (also known as Rimonabant, designed to help people lose weight, stop smoking and reduce cardiovascular risk all at once) should not hold their breath.

Accomplia has been shown to increase the risk of seizures, depression, anxiety and suicidal thoughts. Likewise, finding a weight loss drug that is both safe and effective is proving to be very difficult.

Ultimately, success with Alli—and the success with any weight loss plan—depends on making and sticking to key lifestyle changes, like practicing healthy eating habits and exercising regularly.

- Marc Keuler, MD of Pocono Medical Center

Dr. Keuler specializes in internal medicine with Pocono Medical Center. He practices in the PMC Physician Associates: Internal Medicine office at the Mountain Health Care Center.

 
Q: What is irritable bowel syndrome? What foods should people with it avoid?

As one of the most commonly diagnosed conditions by physicians, Irritable Bowel Syndrome (IBS) afflicts nearly 20% of the American adult population; that’s one in every five adults.

The condition is characterized by abdominal discomfort, which could include pain and bloating, as well as loose or irregular bowel movements. While some may experience constipation, others may experience frequent diarrhea, constant or sudden urges to pass a bowel movement, or an alternating of each of the above. The duration of IBS varies among patients and the symptoms can range from very mild to severe.

While we have yet to link IBS to a particular cause, it has been associated with an oversensitive colon (the large bowel), the immune system, stress, and bacterial infections in the gastrointestinal (GI) track. Most recently, researchers have discovered a link between IBS and serotonin, a neurotransmitter that communicates information between the body and the brain. Research has shown the only 5% of the body’s serotonin is found in the brain and the remaining 95% is located along the GI track. It has been theorized that individuals with IBS may have an excess amount of serotonin in their GI track, thus causing overly productive bowels and sensitive pain receptors along their GI track. Research has also demonstrated that, for women, IBS can be particularly active during the menstrual cycle.

Although there is no cure for IBS, there are certain foods you can avoid. These include drinks containing caffeine (i.e., coffee, tea and soda), alcoholic beverages, milk-based products, chocolate, and wheat or barley products. You should also avoid eating large meals whenever possible. Because each person’s IBS may be different, it is best to keep a journal of the foods and beverages you consume, so that you can determine which foods you should avoid.

If you have experienced a sudden change in your bowel movements, or if you have had consistent abdominal pain, especially if the pain has lasted for 12 weeks or more, you should consult your physician.

Darell Covington, MD is Board certified in Colon & Rectal Surgery and is a member of the Medical Staff of Pocono Medical Center. Dr. Covington practices at the 447 Office Plaza in East Stroudsburg and at the Mountain Healthcare Center in Tobyhanna.

Q: I typically get my flu shot every fall, but are there any other vaccinations that I should be aware of to ward off winter illness?

Once the annual influenza vaccine becomes available each fall, many patients focus on getting their “flu shot” at the doctor’s office.  It’s an important health measure, because an average of 36,000 Americans die each year from influenza and its complications – most are people 65 years of age and over.  For adults as well as children over the age of six months, the best way to prevent the flu is to get vaccinated during the fall season.  Because strains of the influenza virus change from year to year, it’s important to get revaccinated annually.  Besides your flu shot however, there are additional measures for preventing respiratory illness which each patient should discuss with their physician.

Be sure that your other adult vaccinations are up to date, which may include the pneumococcal vaccine sometimes referred to as the “pneumonia shot” by patients.  This multivalent vaccine has activity against different subtypes of pneumococcal bacteria which can cause respiratory infections, and is recommended for all persons over age 65 as well as persons under age 65 with certain chronic medical conditions.  Your physician can help you understand whether you fall into a category where vaccination is recommended.  For those enrolled in Medicare, both influenza and pneumococcal vaccines are covered without any copayment or deductible.

Another precaution is during the winter when heating systems are operating, indoor humidity typically goes down and many people feel that their air at home is too dry, particularly in sleeping areas.  Many of those people use a humidifier during the winter months, with a popular style being the “ultrasonic nebulizer” or “cool mist” type.  Be aware that these units can be a reservoir for bacteria and molds sprayed into the air, causing nagging cough and sinusitis symptoms, unless they are cleaned weekly.  Follow the manufacturer’s directions, usually disinfecting with a dilute solution of chlorine bleach.

Robert Wallen, MD is Board Certified by the American Board of Internal Medicine. He specializes in Cardiology and practices at the PMC Immediate Care located in Bartonsville Plaza, Stroudsburg.

 

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