Sports Injuries – Spring into Action

by Tim “Trapper” O’Connell MS, LAT

MCHS Divisional Director/Pro Care Orthopedics/CHW Family Med/Occupational Med

 

As seen in Odessa American Medical Matters:

http://www.oaoa.com/people/health/medical_matters/article_de944cda-3eba-11e8-959f-af0df70315ea.html

Sports injuries occur in the spring due to many conditions and it is now the time of the year to address preventive measures. As a parent, coach or athlete, preparation and understanding your level of fitness will help reduce pain, injury, lost playing time and money.

The first tip is to continue to hydrate.

Yes, you have to drink more water to compensate for fluid loss during exercise. A loss of body fluid is a set up for dehydration and cramps. This will ultimately be a step in prevention of muscle strains and possible tendon injuries. Drink water before, during and after practice and games. Warming up five to seven minutes before your activity is essential and good time to start drinking water. Are sports drinks good to drink before your activity? Let’s address that at a later time. The short answer for now is, drink more water.

A consideration for all age groups is skin care.

Use generous amounts of sunscreen products and of course SPF 30 is recommended as starting strength in most cases. Take into account for younger age group, face protection and wearing clothing and/or a hat in peak UV exposure. Burns are painful and can be debilitating.  Re-application is a strong method to boost skin coverage for those extended hours in the sun.  Follow instructions on the container.

Shoes

Great fitting and supportive shoes will prevent the blisters, shin splints and “kneecap” (patellar) bony and tendon inflammation.

Warm up and Cool down

Another good rule of thumb for all athletes is “warm up and cool down”. Use heat to increase circulation before the event and ice after the event to decrease pain and inflammation. Rest and recovery are good to allow the body to charge back up. Take frequent breaks and ease back into activity after your break.

Basic first aid kits are an excellent tool to have available in your car or at sports events. If you do incur an injury, here are some simple tips.

Bleeding

If bleeding occurs, apply pressure with a clean cloth. Clean and/or rinse area. Cover with bandage and secure area. If bleeding continues, seek advanced medical help.

Swelling

If swelling occurs, assess area for instability (dislocated, unable to walk or move body part). Compare to opposite limb if possible, ice or cool compress for injured area. Seek advanced medical help in regard to his/her perceived level of pain or level of disability.

Prevention

Consistency in exercise is a key factor to physical conditioning and starting your spring and summer outside activities. Short periods of exercise each day need to include a functional, dynamic warm up. Take a walk or jog, depending on your physical restrictions. I recommend walking for time and not distance. This will allow you to exercise in minutes and not concern yourself with how far you have moved in your activity. We will also address your heart rate and exercise heart rate in another article. For now, address your exercise and heart rate with your primary physician.

If you have questions or concerns about an injury, please don’t hesitate to call Trapper, ProCare Orthopedics, at 432-640-2793.

Get outside and have a SUPER SPRING! 

 

Colon Cancer: One of the deadliest, yet most preventable cancers

by Ramalinga Kedika

March is colon cancer awareness month.  Have you had your screening colonoscopy yet?

Colon cancer is the second leading cause of cancer death in the United States. Approximately one out of 25 Americans will develop colon cancer in their lifetime. The median age of diagnosis is 67. However, we are seeing a rise in colon cancer in younger patients. Of the new diagnoses, 10 percent occur in patients under 50 years old.

Although colon cancer is a common and deadly cancer, there are very effective screening techniques. Colonoscopy is a powerful screening technique because you can not only diagnose polyps that are precursors to colon cancer, but also remove them during the procedure. It is this removal of polyps which reduces colon cancer risk. If everyone had a colonoscopy when they should, colon cancer would almost be non-existent!

However, many Americans are not participating in colon cancer screening. Approximately one in three aged 50 to 75 have not been tested for colon cancer. Benjamin Franklin once said, “An ounce of prevention is worth a pound of cure.” This is true across the medical field, but especially pertinent when it comes to colon cancer screening. It is a lot easier to prevent colon cancer than to treat it once it occurs.

Colonoscopy is often performed using deep sedation which allows the patient to not have any awareness during the procedure. In fact, the most memorable part of a colonoscopy is not the procedure, but rather the prep you have to drink the night before. Laxative preps have reduced in volume over the years and are easier to consume. The procedure is also very safe. The risk of a serious complication such as perforation is one in 1,000. Colonoscopies performed for screening are often covered by insurance plans … so take advantage of this!

 

Make Physical Activity a Priority for Heart Health

by Millie Gonzales, RN, BSN Cardiac Rehab Nurse

 

As seen in Odessa American Medical Matters:

http://www.oaoa.com/people/health/medical_matters/article_369863fa-0d09-11e8-a896-cb44244d4a62.html

With Heart Disease on the rise, it is vital to make cardiovascular exercise a priority. Most of us find it challenging to make time in our day to invest in our health. Although, rearranging your daily schedule and setting a reachable exercise goal every day is a start!

Benefits of cardiovascular activity

  • Decreases risk of coronary artery disease and stroke
  • Reduces symptoms and decreases chances of another heart attack
  • Improves heart and lung performance while creating healthy habits
  • Improves blood pressure, blood sugar and blood cholesterol levels
  • Maintains a healthy body weight
  • Increases energy and stamina while decreasing stress levels

 

How to get started and what to do. (Hint – Make it fun!)

Create a specific exercise goal including frequency, intensity, time and type of exercise. Make a personal commitment to your plan. And get started!

Walking is an easy, safe and effective way to begin. Be flexible and make it fun! Start slowly and build up gradually to at least 30 minutes a day on most, or all, days of the week.

Make this a priority for one month and work out at the same time every day. By doing so, it will become a habit. After a month, evaluate your progress and make changes accordingly.

With time, this will create great changes and benefits to your health. The American Heart Association recommends at least 150 minutes per week of moderate-intensity aerobic activity such as brisk walking and at least 75 minutes of vigorous activity, or an equal combination of both. Please note that heart patients and individuals with specific medical questions or needs should consult with their physician regarding what type of physical activity is safe for them.

Your health is so important and is worth the investment of time. Your heart will be happy you made this a priority!

 

 

Parents’ questions about the everlasting flu season of 2017-2018

by Dr. Kevin Benson, Board Certified in Pediatrics, ProCare Healthy Kids Clinic

As seen in the Odessa American’s Medical Matters:

http://www.oaoa.com/people/health/medical_matters/article_8d4cb80c-142c-11e8-89ec-0f7e6ed22b8c.html

There is endless information about the flu available to anyone with a smartphone. Rather than reprint information that is available elsewhere, I would like to answer a few questions that parents ask every day at my office.

Can you get the flu twice?

I chuckled seeing a report on one of those sensational nightly news shows that highlighted “This boy has had the flu TWICE!” I didn’t realize that any of the many patients I have seen with the flu twice this season could make national news. Unfortunately, catching one strain of the flu does not protect a person from catching one of the many other strains. Flu just doesn’t play fair … you can even have multiple strains at the same time! It is unlikely that you would get the same strain more than once though … if that makes you feel better.

The flu test was negative, does that mean my child doesn’t have the flu? 

Unfortunately, no. They still might have the flu. The flu test is very specific. So, if you have a positive, it is extremely accurate. However, the sensitivity of the test varies with the quality of the specimen (yes, we need boogers) and the length of illness. I have had families where every child is positive but one, but they are all symptomatic. A child can be diagnosed clinically with the flu.

Is Tamiflu (osteltamivir) good?  Is it bad?  What if they can’t finish it? 

This medication decreases the flu virus’ ability to reproduce. It does not “kill the flu” like an antibiotic might kill a bacteria. It is supposed to shorten the course of the illness. It is best started within the first 48 hours of illness.

Like every medication, Tamiflu (osteltamivir) has side effects. Most commonly, the side effects include stomach issues, but there are many more. I tell parents, if the side effects are worse than the illness, stop the medicine. The clear majority of us will still make it through the flu. Before the introduction of this medication, humans still survived the flu, and probably continue to.

Is it too late to get a flu vaccine?

Flu season, as a rule, is from October to April. So we give vaccines through March. Remember – the vaccine takes at least two weeks to be effective. This year’s effectiveness rate has been about 30 percent, which sounds low. However, remember that according to the Centers for Disease Control and Prevention, 85 percent of children who have died this flu season were unvaccinated.

 

 

H. pylori – Who should be tested?

by Ramalinga Kedika

 

As seen in the Odessa American’s Medical Matters:

http://www.oaoa.com/people/health/medical_matters/article_846c9ea8-03c1-11e8-844a-176e0df84d1a.html

 

Did you know there is a stomach infection present in approximately half of the world’s population? That infection is a bacteria called Helicobacter pylori, or H. pylori for short.

Signs and symptoms of H. pylori

Most people with H. pylori will never have signs and symptoms and therefore routine screening is not needed in the United States. Some people will have stomach symptoms including pain, nausea, poor appetite, burping/belching, bloating and/or weight loss. It is these patients that should be tested for H. pylori infection by their healthcare provider.

Long-term complications

Some of the long-term complications of infection include stomach and intestinal ulcers, irritation of the stomach lining (gastritis) and stomach cancer. It should be noted that the presence of H. pylori infection combined with excess over-the-counter NSAID (Motrin, Advil, etc.) use will significantly increase your risk of developing ulcers. It is a common misconception that stress alone is a cause of ulcers!

How do people get infected with H. pylori?

The exact way is not known, but most people acquire the infection in their childhood. What we do know are the risk factors for infection. These include living in crowded conditions, lack of clean water, living in a developing country and living with someone who has the infection.

How is H. pylori diagnosed?

  1. pylori can be diagnosed in multiple ways. The easiest way for patients is often a breath test that can be done at most laboratories. Other ways include a stool test or upper endoscopy (scope test into the stomach) with biopsy. If diagnosed, H. pylori should be treated with a 10 to 14 day regimen of antibiotics and acid reducers.

One interesting historical tidbit. In 1984, scientist Barry Marshall drank a Petri dish containing H. pylori to help show that the infection caused gastritis and ulcers. For this, Marshall and his colleague Robin Warren earned the Nobel Prize in 2005!

 

RSV and the Nose Goblins

By Dr. Bonnie Carter, Board Certified in Family Medicine

 

As seen in OA Medical Matters:

http://www.oaoa.com/people/health/medical_matters/article_24b41b36-f344-11e7-9bdf-5304c112ea19.html

 

RSV … three simple letters that strike fear into the hearts of parents everywhere. Probably everyone knows someone whose child has been hospitalized due to the respiratory syncytial virus (RSV). We’ve all heard the horror stories and, if diseases had a Most Wanted List, RSV would definitely be on it. According to the CDC, RSV accounts for approximately 2.1 million office visits, 57,000 hospitalizations in children under five, 177,000 hospitalizations for adults over 65 and 14,000 deaths in adults over 65.

The peak season for RSV is late fall to early spring, with January and February seeing the highest numbers. It is estimated that by the age of two, 90 percent of children will have had RSV at least once. RSV is the leading cause of bronchiolitis and pneumonia in children under the age of one. There are multiple strains of the virus, which means you can get it more than once. At this time, there is no vaccine available.

The symptoms of RSV are similar to the common cold: fever, cough, congestion and runny nose. What distinguishes RSV from other upper respiratory infections is the diffuse wheezing and difficulty breathing. For most healthy children over the age of two and healthy adults, RSV is just a bad cold. While uncomfortable, it does not present a danger to most in this age group. However, for children under the age of two, and especially those under six months, RSV can be a ticket to the hospital.

So why is RSV so bad for babies? One of the main reasons babies have so much trouble with RSV is that they don’t know how to breathe out of their mouth until they are older. When a baby’s nose is congested, they can’t breathe. This is why it’s important to use the bulb syringe and suck out any of those nasty nose goblins and boogies that get in there. And there are a lot of nose goblins with RSV! It creates an excessive amount of nasal drainage and secretions. It also causes inflammation of the air tubes, or bronchioles, causing bronchiolitis.

Signs that are concerning for respiratory distress in an infant or small child are tachypnea (rapid breathing), nasal flaring, retractions (caving in between the ribs with inspirations), use of accessory muscles (arm muscles and abdominal muscles) to breathe and perioral cyanosis (turning blue around the mouth).

One question I’m often asked is, “How do I know whether to take my baby to the doctor’s office or the emergency room?” Obviously, our goal is to keep you out of the ER as much as possible. They are busy and don’t need to be bogged down with non-emergent visits. But if your child is having respiratory distress with any of the signs listed above, that is where they need to be. If your kiddo has a runny nose, cough, fever, sore throat or earache, then call your physician and bring them into the office.

Treatment of RSV is symptomatic and it requires the tincture of time to resolve. RSV is a virus and therefore does not respond to antibiotics. Likewise, antibiotics do not prevent the illness from worsening. Like the commercial says, “That’s not how this works…that’s not how any of this works!” Parents often pressure physicians to prescribe antibiotics, especially when the child appears moderately ill. When we tell you antibiotics are not necessary, it’s not that we don’t believe your child is sick, or that we want your child to suffer longer. Trust me, if I had the magic wand to wave and make it all better, I would do it in an instant. Unfortunately, I never got my letter to Hogwarts, so I went to medical school instead. Also, we do not recommend cold medication such as cough medicine, decongestants and antihistamines for small children because studies have not shown an improvement of symptoms with their use and they often cause adverse side effects. The one therapy that has shown any consistent improvement is bronchodilator therapy (nebulized breathing treatments). I do recommend frequent nasal suctioning to help keep their nose clear and Tylenol to help fever. On average, an infection with RSV lasts about a week, with the worst symptoms being in the first three to four days.

As the old saying goes, “An ounce of prevention is equal to a pound of cure.” Preventing RSV infection is always the best plan, but sometimes the best laid plans go astray. Do not take your baby out to stores, church or anywhere there is a group of people who could be sick. If you do have to take your baby out, keep their carrier covered with a blanket to protect them from respiratory droplets. I know that everyone wants to see and hold the new baby, but it is safer to keep away from Grandpa Bill and his germs if he is sick. If someone in the house gets sick, try to keep them isolated in a separate room, especially at night. Cover your mouth and nose when you cough or sneeze and wash your hands. You can use Lysol to spray surfaces such as countertops, door knobs, or toys that might be contaminated with respiratory droplets. As tempting as it is, don’t Lysol the baby (or the dog, or your sibling, or your husband …)!

Soup and Salad for Cold and Flu?

by Deborah McPherson MS,RD, LD, CDE and Mia Gibson RDN, LD, CDE

As seen in the Odessa American Medical Matters: http://www.oaoa.com/people/health/medical_matters/article_7651392c-e298-11e7-9893-2b7b151c4e84.html

We may have all heard that chicken soup is good for what ails you, but can it actually cure a cold?

The answer is, of course, no. However, it has been proven to help relieve congestion, act as an anti-inflammatory and prevent dehydration … which may come in handy when you have a cold or flu.

How can salad help? 

A salad, especially a dark green leafy salad with spinach, contains beta-carotene and vitamin C that both enhance immunity … which might help prevent us from getting sick in the first place. Add some grilled salmon to the salad, which contains omega-3 fatty acids, for additional anti-inflammatory properties.

A healthy diet, getting enough exercise and rest … and keeping stress levels down … may be our best defense against cold and flu this season. A well-nourished body may more easily ward off infections. Other nutrients that may help increase our immunity are:

  • B-6 in fortified cereals, poultry, seafood and a variety of fruits and vegetables
  • Vitamin E in nuts, protein in dairy, meat, poultry, fish, beans and peas
  • Selenium and zinc in seafood and beef

So why can’t we just take a vitamin or herbal supplements instead of eating these foods? 

Whole foods offer several benefits over dietary supplements. Whole foods provide more than one nutrient, dietary fiber and other protective substances such as phytochemicals and antioxidants that may also help protect us against disease.

Before taking dietary supplements, other than those prescribed by your doctor, remember that dietary supplements don’t undergo the same testing and quality control that prescription medications do. Just because the bottle says “all natural” does not mean that it will not interact with your current medications or cause side effects. Use caution and remember that supplements such as Echinacea and Ginseng, when taken longer than a few weeks, may actually lower immunity.

Some people may benefit from supplements, but ask your doctor before jumping on the supplement band wagon.

Dietary guidelines do recommend doctor-prescribed supplements or fortified foods during pregnancy and for adults over 50. In addition, we might need supplementation if we have a medical condition or surgery that leads to a deficiency in certain nutrients, consume less than 1,600 calories daily or follow a special diet (vegan or vegetarian) that may limit the variety of foods consumed.

Just remember:

  • Too much of a good thing (vitamins, herbs) may not be good.
  • Too many of those “candy-gummy” vitamins could be toxic.
  • Eat whole foods first and discuss dietary supplements and vitamins with your doctor.

 

Consult your doctor before making changes in your diet. If you have a medical condition, certain items may need to be reduced or eliminated. Seek the advice of your physician and Registered Dietitian before making any changes in your diet or lifestyle.

NUTRITION TIP OF THE DAY: Hot drinks with lemon or lime may help relieve sore throat or cough symptoms. And try spicy, hot soups to help clear nasal passages and possibly help an inflamed throat.

 

(Sources: Mayo Clinic, Nutrition Action, CSPI, JADA, Eatright.org, Web MD and MCHS Dietitians)

CHICKEN TORTILLA SOUP

Serves Eight

 

INGREDIENTS

1 small onion, chopped

1 tsp. cumin

1 (4-5 oz.) can chopped green chilies

½ tsp. black pepper

2 cloves garlic, minced

1 (14.5 oz.) can beef broth

2 Tbs. water

1 tsp. chili powder

1 (14.5 oz.) can no salt stewed tomatoes

2 tsp. Worcestershire sauce

1 ½ c. water

8-10 corn tortillas, cut in strips (bake in oven to crisp)

1 (14.5 oz) can fat free reduced sodium

1 c. diced cooked chicken breast

chicken broth

1 c. fat-free or low fat shredded cheese

1 (13.5 oz) can tomato juice

 

INSTRUCTIONS

In large soup pan, soften onion, chilies and garlic in 2 Tbs. water. Add liquids, tomatoes and seasonings. Bring to a boil and simmer one hour, covered. During last ten minutes, add chicken. Top with cheese and tortilla strips before serving. Add one or two slices of avocado before serving, if desired.

 

NUTRITION INFORMATION

Calories – 130

Carbohydrate – 24 gms

Protein – 8 gms

Fat – 0.5 gm

Saturated Fat – trace

Percent calories from fat – 3 percent

Sodium (w/o cheese) – 650 mg

 

 

 

 

 

Urinary Incontinence

by Dr. Avelino Garcia

As seen in the Odessa American Medical Matters: http://www.oaoa.com/people/health/medical_matters/article_5e237dea-dd36-11e7-b864-efb69ed2f589.html

Though many are embarrassed to discuss it, urinary incontinence is very common among women. Urinary incontinence is leakage of urine. It can range from leaking just a few drops of urine to complete bladder emptying. Other accompanying symptoms include having the strong urge to urinate, urinating frequently, waking up several times during the night to urinate, burning with urination or leaking urine while sleeping.

There are three main types of urinary incontinence in women.

  • Stress Urinary Incontinence (SUI) is leakage of urine when laughing, coughing, sneezing or exercising.
  • Urgency Urinary Incontinence (UUI) is a sudden urge to urinate that cannot be stopped. Many women leak urine before they can make it to the restroom.
  • Mixed incontinence combines the symptoms of both SUI and UUI.

Several things can cause or worsen urinary incontinence. Urinary tract infections can cause leakage of urine. Certain types of medications, like diuretics, caffeine and alcohol, can contribute to urinary incontinence, as these are substances that cause your body to create more urine and/or are bladder irritants. Different disorders caused by weakening of the muscles of the pelvic floor can cause problems controlling urination. Long term constipation is often a trigger for urinary incontinence, especially in older women. Neuromuscular or anatomical problems can also cause problems controlling urinary leakage.

Urinary incontinence is diagnosed by medical history and a physical exam. A pelvic exam is necessary to determine if there is pelvic organ prolapse. Certain tests may be done during the physical examination to see if there is complete emptying of the bladder after urination. In some cases, imaging and bladder function tests can be ordered for further information.

The first line of treatment for urinary incontinence is nonsurgical. This may include lifestyle changes, like discontinuing caffeine and alcohol, and managing fluid intake during the day. Weight loss in overweight patients is beneficial for reducing leakage of urine. Bladder training may be discussed by your provider. According to the American College of Obstetricians and Gynecologists (ACOG), “the goal of bladder training is the learn how to control the urge to empty the bladder and increase the time span between urinating to normal intervals (every three to four hours during the day and every four to eight hours at night).”

Performing Kegel exercises helps strengthen pelvic muscles and can improve all types of urinary incontinence. There are many medications that help improve UUI by controlling bladder spasms, manage to relieve the urge to urinate and urinary frequency.

A pessary may be recommended for nonsurgical management of SUI and to improve pelvic support. A pessary is a small device that helps to support the walls of the vagina, thereby lifting the bladder and urethra. These devices come in many shapes and sizes and can be fitted by the provider during the pelvic exam. Pessaries can easily be removed for cleaning and re-inserted by the patient at home, making them a very convenient alternative to surgery for many women.

There are several surgeries that can be completed by the provider in a hospital setting to improve SUI. There are many different slings are available for the treatment of urinary leakage. A sling is a narrow strap made of synthetic materials that is placed under the urethra to lift and provide extra support. Other surgical procedures include lifting and securing the bladder neck to nearby supporting structures using stitches.

 

If you are suffering from urinary incontinence, call ProCare Women’s Clinic today and make an appointment at (432) 640-2491.

Winter Weather Safety

by Amanda Everett, MCHS Emergency Management Coordinator

Vehicle Preparedness and Safety:

  • Plan your travel and check the latest forecasts.
  • If you encounter snow, sleet or freezing rain, drive extremely cautiously. Even four-wheel drive vehicles will have difficulty on icy roads.

Dressing for the Weather:

  • Wear loose-fitting, lightweight clothing in several layers.
  • Outer garments should be tightly-woven and water-repellant.
  • Wear a hat. Nearly half of your body heat loss is from the top of your head.
  • Wear gloves or mittens. Mittens snug at the wrist are better than gloves.

Preparing Your Home:

  • Bring your pets inside.
  • Have a flashlight and extra batteries available. Do not use candles if the electricity goes out.
  • Use a battery-powered NOAA Weather Radio and a portable radio to receive emergency information.
  • Be sure to wrap any exposed pipes.

Handwashing – The “do-it-yourself” vaccine that reduces the spread of germs.

By Veronica Montano, MSN, RN – Bridge Nurse Residency Coordinator, CNE Planner

National Handwashing Awareness Week is Dec. 3 through Dec. 9. According to the Centers for Disease Control and Prevention (CDC), handwashing is like a “do-it-yourself” vaccine that reduces the spread of germs. You can reduce the spread of diarrheal and respiratory illnesses by correctly washing your hands.

 

The CDC recommends washing hands with soap and clean, running water to avoid getting sick and spreading germs to others. You should wash your hands before eating food, before and after caring for someone who is sick, after using the toilet, after changing diapers or cleaning up a child who has used the toilet, after blowing your nose, coughing or sneezing, after touching your pets and after touching garbage. Washing your hands correctly by using soap and clean water can protect you, your family and others. Hand hygiene is one of the most important measures to take to avoid getting sick and spreading germs.

 

The CDC recommends washing your hands as follows:

  • Wet your hands with clean, running water (warm or cold) and apply soap.
  • Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers and under your nails.
  • Scrub your hands for at least 20 seconds. (Hum the “Happy Birthday” song from beginning to end twice.)
  • Rinse your hands well under clean, running water.
  • Dry your hands using a clean towel or air-dry them.

 

When and how to use hand sanitizer:

  • When soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60 percent alcohol.
  • Apply the product to the palm of one hand and rub the product all over the surfaces of your hands until your hands are dry.
  • Alcohol-based hand sanitizers can reduce the number of germs on hands in some situations.
  • They do not eliminate all types of germs.
  • If hands are visibly dirty or greasy, hand sanitizers may not be as effective.
  • Swallowing alcohol-based sanitizers can cause alcohol poisoning. Keep out of reach of young children.

 

Content Sources: Centers for Disease Control and Prevention, 2017 National Health Observances, National Health Information Center, Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, Washington, DC.