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Telemedicine. Just a Substitute or the Real Deal?

 

I am going to start by saying this is part of the evolution of medical care.  We have gradually moved toward patient-centered medical treatment. I listen to old radio shows of Dr. Kildare from the 1950s (and yes, there was a TV show by the same name in the 1960s).  He and his mentor, Dr. Gillespie, had a very paternalistic approach toward patient care. Doctors “knew best” and it had been that way for a long time. There is no doubt, however, that they had the patient’s best interest in mind.

Fast forward to the 21st century and especially the past decade. We started what we called “Patient-Centered Medical Home” with the patient, not the provider at the center of care. We included “shared decision making” to make sure patients were educated about their illness and treatment options and were active participants in the decision-making process.

There has also been a push toward making medical care more convenient for patients. Years ago, this began with more convenient outpatient testing rather than hospital admission for diagnostic, the Minute clinics. Patient portals have allowed patients to review medical notes, check on lab and test results, communicate with physician offices, and even schedule appointments.

Mass General Brighman (formerly Partners Healthcare) had been dabbling in telemedicine (telephone and video visits) for several at Express Care (our urgent care center). It was a fun experience for both the patient and me.   Then came the sentinel event that shook up telemedicine and moved it by leaps and bounds—the Covid-19 pandemic.  At Pentucket Medical, we jumped from a few telemedicine visits to 90% of our usual visit volume. We tried different video platforms and now have Zoom integrated into our electronic medical record.  It is anticipated that 20-30% of medical visits will be by telemedicine even after the pandemic has passed.

Just like moving to patient-centered medicine, patient education shared decision making, and increased convenience for patient visits, telemedicine has the power to put patient needs at the forefront. Many patient concerns can be handled by a good telemedicine visit. Great for elderly frail patients and maybe Great for elderly frail patients and may be  very well suited for behavioral health.

Millennials, being so tech-savvy, will also be happy about the telemedicine options. There is even a term now for bedside manner called “Webside” manner. It is a learning curve for all of us. I view this is as progress that once again puts patients at the center. It seemed to happen in an instant and is here to stay.

Kenneth Adams, MD, FACC
Senior Cardiologist and Medical Director at Pentucket Medical

We Are Here for You.

 

Pentucket Medical is dedicated to keeping our patients, staff, and community members safe as we reopen our practice sites. We are fully prepared to provide you with the care you need while committing to keep you safe every step of the way.

What To Expect At Your Next Visit 

Along with prudent safety measures, your experience at our practice sites may have changed since your last visit.

A face mask is required to be worn throughout your entire visit. Our staff will also be wearing Personal Protective Equipment, which may include a face mask, a face shield, and goggles. 

We ask that you arrive no earlier than 10 minutes before your appointment. This will help reduce the number of patients, visitors, and staff in one area.

You will no longer need to stop at the desk after your visit has ended. You will receive your visit summary electronically. If you need to schedule a follow-up appointment, you may do so by telephone or Patient Gateway. 

It’s Time To Take Care of Your Health

 As we reopen, we are fully prepared to provide you with the care you need in a safe environment.

If you have current care needs, please do not delay your care; waiting can make your symptoms and conditions worse, which may require more complex treatment. From the beginning, our clinicians have been implementing innovative healthcare such as virtual visits (telephone and video), and ExpressCare, and will continue to do so that you and your family will have more options when seeking care. 

We encourage you to contact your clinician’s office to learn more and to schedule a visit if you have any health concerns. Thank you. 

Lawrence Community Covid-19 Testing Center

We are pleased to announce a nine-bay drive-thru Covid-19 testing site located on Canal St in Lawrence.   

This testing site is a collaboration between Lawrence General Hospital, Greater Lawrence Family Health Center, and Pentucket Medical/ MassGeneral-Brigham Health in response to the growing need for testing in the community. 

The initial phase of testing will include LGH patients who are scheduled for upcoming procedures, area healthcare workers, symptomatic residents, and non-area residents who meet the following criteria:

Individuals referred through official contact tracing
Patients 65 years of age and older with symptoms
Patients with underlying conditions with symptoms
Homeless individuals
Health care facility workers with symptoms
First responders with symptoms

Please note that a prescription is needed from your primary care physician in order to be screened. Once that is received an appointment will be scheduled.

CDC Symptom Checker:
https://www.cdc.gov/coronavirus/2019-ncov/index.html

Hours of operation:
Monday – Friday from 9 am – 5 pm
Saturdays from 10 am – 2pm
Sundays from 9 am – 1 pm

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Dangers of Vaping

What is vaping?

Vaping uses electronic cigarettes (or e-cigarettes) to simulate traditional cigarette smoking. E-cigarettes are battery-powered or chargeable smoking devices. Some look like traditional cigarettes or pipes. Others are designed to look like pens or USB memory sticks. They use a cartridge (or pod) filled with liquid. The liquid typically contains nicotine, flavorings, and other chemicals. When you puff on the mouthpiece of the device, it activates a heating element. This heats up the liquid in the pod and turns it into vapor. You then inhale the vapor. This is why it’s called “vaping.”

E-cigarettes are often marketed as a safer alternative to smoking. But they’re not safe. They still put an addictive drug and chemicals into your body and into the air around you.

teen girl vaping

How is vaping different from JUULing?

Vaping and JUULing are the same thing. JUUL (a brand of e-cigarettes that look like USB memory sticks) is a very popular vaping device among teenagers. So popular, in fact, that its brand name has become a verb to describe vaping. Teens may also use the term “ripping” to describe smoking an e-cigarette or JUUL. For more on JUULing and how it relates to teens, see “Teens and JUULing,” below.

Disputing common myths about e-cigarettes

The makers of e-cigarettes market them for a variety of uses. Researchers are still in the early stages of studying e-cigarettes. But studies have shown that e-cigarettes still contain harmful chemicals, including nicotine. Myths about e-cigarettes claim that the devices are:

  • E-Cigs are NOT a safer alternative to smoking cigarettes. Makers claim that e-cigarettes don’t contain the harmful chemicals that cigarettes do. Of course, this is not true. Most devices contain nicotine. A JUUL pod contains either 3% or 5% nicotine. A JUUL pod that contains 5% nicotine is equivalent to the amount of nicotine in one pack of cigarettes.
  • E-cigs are addictive. While there are some cartridges that don’t contain nicotine, most do. Any time a smoker inhales nicotine, he or she is inhaling an addicting and harmful chemical.
  • You cannot use e-cigs indoors. At first, makers of e-cigarettes said that e-cigarettes were appealing because they could be smoked in places that didn’t allow traditional cigarette smoking. This is no longer true. Many states have created laws that prohibit vaping in the same areas where traditional smoking is not allowed.
  • E-cigs are not really a way to quit smoking. Marketers claim it is easier to quit smoking if you switch to vaping first. In fact, e-cigarettes contain nicotine and may even lead to a user becoming a traditional cigarette smoker.

What are the dangers of vaping?

Experts have a number of concerns about the safety of e-cigarettes and vaping.

  • E-cigarettes contain nicotine. In large doses, nicotine can be toxic.
  • Nicotine stimulates your central nervous system. This increases your blood pressure, breathing, and heart rate. Higher doses of nicotine can cause blood pressure and heart rate to go up higher. This can lead to an abnormal heart rate (arrhythmia). In rare cases, this can cause heart failure or death. Over time, nicotine can lead to medical problems. These include heart disease, blood clots, and stomach ulcers.
  • Nicotine increases the level of dopamine in your brain. This chemical messenger affects the part of the brain that controls feelings of pleasure. It can motivate you to use nicotine again and again to get that feeling of pleasure. You do this even though you know it is a risk to your health and well-being. That is what makes nicotine addictive.
  • The ingredients in the liquid are not labeled. This means that we don’t know for sure what’s in the liquid.
  • There are often chemicals in the liquid. Some of these are known to cause cancer. One study found a toxic chemical that is found in antifreeze.
  • Tiny particles are released by the heating element and may be harmful. These particles can cause inflammation in the lungs, which can cause bacterial infections or pneumonia.
  • The liquid in the cartridge can be poisonous if someone touches, sniffs, or drinks it. There has been an increase in poisoning cases of children under 5 who have had access to the liquid.
  • “Secondhand smoke” is still a problem for e-cigarettes. Secondhand e-cigarette vapor contains chemicals that harm the lungs and hearts of people who aren’t vaping.
  • They serve as an introductory product for preteens and teens. Many kids start with vaping and then move on to other tobacco products.
  • Right now, there is little regulation when it comes to e-cigarettes. Even if it isn’t a JUUL product, there are many other kinds of e-cigarettes available. Doctors do not know what may be in them.

Teens and JUULing

E-cigarettes are popular among teens and are now the most commonly used form of tobacco among youth in the United States, according to the National Institute on Drug Abuse. As of August, 2018, JUUL accounts for an estimated 71 percent of the teen e-cigarette market. Reasons for this include:

Teenagers face increased risks from JUULs/e-cigarettes. The teen years are a critical time in brain development. This puts young people uniquely at risk for long-lasting effects. Nicotine affects the development of brain circuits that control attention and learning. It puts kids at higher risk of having mood disorders and permanent problems with impulse control. It also affects the development of the brain’s reward system. This can make other, more dangerous, drugs more pleasurable to a teen’s developing brain.

Kids who use e-cigs like JUULs are also more likely to become smokers than kids who do not, according to a three-year study. The study followed high school students as they transitioned from e-cigarettes to traditional ones.

There is much still to be learned about e-cigarettes and vaping. Since it’s relatively new, there aren’t long-term studies on the effects it may have. Until these long-term effects are known, doctors are encouraging patients to avoid e-cigarettes.

How do I talk to my child about JUULing?

If you suspect your child is JUULing (and even if you don’t), ask him or her about it. Start a conversation. Ask if they’ve seen friends doing it or seen JUULing at school. Use this opportunity to tell them the dangers of JUULing. JUULing is addictive. JUULing has been shown to lead to smoking. Smoking causes cancer, heart disease, and emphysema. Smoking is responsible for 1 in 5 deaths in the United States.

What if my child is already JUULing?

Talk to your child about quitting. Make an appointment for you and your child to talk to your family doctor about the best ways to quit JUULing. Your doctor may suggest a plan that includes some of the FDA-approved elements for smoking cessation listed below.

Things to consider

The FDA has approved 7 medications for smoking cessation in adults. These include nicotine gum, nicotine patches, and medicines. (Vaping is not one of the 7 approved methods.) There is little evidence that these same tactics will work for vaping.  If you are trying to stop vaping, here are some tips to consider:

  • Talk to your doctor. He or she may be able to suggest nicotine replacement therapy. They also may be able to prescribe medicines to help you quit.
  • Make a plan. Set a date to begin the quitting process. Set goals as part of your process. These can be as small as having one less e-cigarette a day for a week. Then you can continue to cut back on a schedule until you no longer smoke or vape.
  • Stay busy. Keep your mind off smoking by keeping busy. Do activities with your hands to keep them ovvupied. Plan ahead for times when you know you’ll want to smoke, such as after a meal or when you go out.
  • Put off cravings. Cravings can be hard to resist, but they usually pass. Tell yourself to wait until a certain time, and the urge to smoke will often be gone by then.
  • Get support. Surround yourself with people who support you. Tell your friends and family that you are quitting so they can be supportive. If you don’t want anyone to know you smoke or vape, join an online or in-person support group.

Questions to ask your doctor

  • Can I quit JUULing cold turkey?
  • Is there any sort of nicotine replacement I could try while quitting JUUL? Do you recommend this?
  • How long should it take me to quit JUULing?

Continue reading “Dangers of Vaping”

The Importance of Colorectal Cancer Screenings

The Basics

If you are age 50 to 75, get tested regularly for colorectal cancer. A special test (called a screening) can help prevent colorectal cancer or find it early, when it’s easier to treat.

You may need to get tested before age 50 or after age 75 if colorectal cancer runs in your family. Talk with your doctor and ask about your risk for colorectal cancer.

Continue reading “The Importance of Colorectal Cancer Screenings”

Ensure Your Child Gets Enough Sleep This Summer

It’s almost summer time, school is soon out of session, and your child will gain a lot of extra free time. This is a cycle parents will go through for a number of years, so it’s important to make the most of that time for both you and your child. While being active during the day can certainly help children, having a sufficient amount of sleep each night is equally as important. Is your child getting enough sleep?

Continue reading “Ensure Your Child Gets Enough Sleep This Summer”

Reopening

Pentucket Medical has remained committed to ensuring the safety of our patients during the COVID-19 pandemic.

Since June 1, we have been treating patients on-site per the four-phase guidance issued to healthcare facilities by Governor Baker and the Massachusetts Department of Health and Human Services.

In the coming weeks, we will continue following stringent infection prevention processes and implementing specific precautions to ensure a safe environment for essential patient care services.

Here are some of the changes you will see on your next visit to Pentucket Medical:

When scheduling an appointment with a clinician, you will be provided a phone number to call when you arrive at the office this will allow you to remain safe in your car until it is time to see your provider essentially cutting out waiting rooms

We appreciate your support.