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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

Prevention is the Key to Good Health

 

Preventive care is important because it establishes a relationship with your healthcare team who can help you be your healthiest.  By scheduling an annual physical exams, screenings, and being mindful of your lifestyle choices, you are more aware of how to maintain or improve upon your overall health.   

Continue reading “Prevention is the Key to Good Health”

Mindful Monday: New Year Resolutions

With the New Year upon us, we often reflect on the year and begin to plan for the coming year. We do this by making resolutions- however; most of us break them- so this year, let’s keep it simple and see how long we can stick to our goals.

Continue reading “Mindful Monday: New Year Resolutions”

Free Blood Pressure Walk-in Clinics this December

 

Hypertension when left untreated is the leading cause of heart disease and stroke. Knowing your numbers is the first step in managing this treatable condition.

During the month of December Pentucket Medical is offering free blood pressure walk-in clinics at the dates/ times below. If you cannot get to one of our locations during these times, you can provide your latest BP numbers by posting them on https://pmaonline.com/patient-guide/patient-gateway/or calling your clinician’s office.

 

 

Cold and Flu Season is Here

With cold and flu season amost here one of the frequently asked questions from patients is, “when should I get vaccinated?” The answer is, you should get a flu vaccine before flu begins spreading in your community.

It takes about two weeks after vaccination for antibodies that protect against flu to develop in the body, so make plans to get vaccinated early in fall, before flu season begins.

CDC recommends that people get a flu vaccine by the end of October. Getting vaccinated later, however, can still be beneficial and vaccination should continue to be offered throughout flu season, even into January or later.

Children who need two doses of vaccine to be protected should start the vaccination process sooner, because the two doses must be given at least four weeks apart.

To schedule your flu shot contact your primary care clinician. (Schedule below).

Should you get sick know that you can be treated at one of our ExpressCare locations. (Andover or Riverwalk/ Lawrence) visit https://pmaonline.com/express-care/ to schedule an appointment online and for site hours.

 

8 Ways to Treat Sunburn at Home

Home remedies for sunburn

Summer’s here, and that means it’s time to head outside and soak up the sun. However, along with the all those hours spent outdoors during the summer season, there usually comes one inevitable thing: sunburn. Fortunately, for all of us, there are plenty of household items you can use to cool the burning, itching, and peeling that come with damage from the sun.

Keep reading to learn about home remedies that can help heal and soothe your skin.

Cool water

Sunburn, basically, is inflammation of the skin. One of the easiest ways to treat inflammation is to cool down the affected area. An effective way to immediately help sunburn, even while you are still outside, is to hop in the water, whether it is an ocean, lake, or stream. Dipping in and out throughout the day can help keep sunburn from worsening. Be wary of pools, as chlorinated water can irritate the skin more. You should also avoid directly applying ice. Although it may look appealing when your skin is burning, it could actually cause even more damage to your extra-sensitive sunburned skin.

You can also try hopping in the bath to help cool and soothe your skin.

Baking soda and oatmeal

Throwing a few heaping tablespoons of baking soda into a bathtub full of cool water and soaking for about 15 to 20 minutes helps minimize sun damage. Adding a cup of oats to the bath also soothes irritation and helps the skin retain its natural moisture.

Do not scrub your skin, either in the bath or after getting out. Dab yourself dry with a towel — do not rub.

Aloe vera

If you do not have an aloe vera plant in your house, you should get one. The gel inside this succulent plant has been used for centuries for all sorts of ailments, from upset stomachs to kidney infections. It is also the sunburn relief most commonly found over the counter.

Breaking off a chunk of the plant and applying the gel directly to the skin provides immediate, soothing relief from the sting of minor sunburn. If you can’t get your hands on a plant, try a 100 percent aloe vera gel (not an aloe-based lotion or ointment). You can find these gels in most pharmacies.

Chamomile tea

Chamomile tea can be soothing to your spirit, but it can also soothe your sunburned skin. Brew the tea as you normally would and let it cool. When it is ready, soak a washcloth in it and apply it to the affected area.

If you are allergic to pollen, you should not use this treatment. It may cause an allergic reaction in your skin.

Vinegar

Opinions are mixed about using vinegar for sunburn relief. Some say adding two cups of vinegar to cool bath water can help take the sting out of burn, while others say the high acidity in vinegar only makes things worse. If you haven’t used the treatment before on smaller, lighter sunburns, it’s best not to try it for larger, more serious burns.

Wear loose clothing

As your skin is repairing itself, make sure to wear clothing that doesn’t stick to your skin. Your skin is your body’s largest organ, so it’s best to give it some room to breathe as it heals from a major traumatic episode like sunburn. Natural fibers, such as cotton or bamboo, make for the best post-sunburn coverings.

Drink lots of water

As your skin is battling the damage from the sun’s rays, it needs moisture that it lost during your time out in the sun. If you aren’t already drinking your eight glasses of water a day, a nasty sunburn should be reason enough to get you to start doing so.

Don’t forget the moisturizer

After the initial treatment, you skin will still need some tender loving care. One of the most important things you can do to prevent skin from peeling — or at least keep it to a minimum — is to regularly apply moisturizer to the affected areas. Use scent- and dye-free moisturizer (marketed for “sensitive skin”) to keep skin irritation to a minimum.

Get more information

Stay hydrated, keep cool, and if the sunburn is too painful, you can take some ibuprofen. You should also make sure you stay covered up next time you go outside so your sunburn isn’t exposed to even more sun. Call your clinician or visit ExpressCare  if a sunburn causes you to have a fever or if you are showing signs of dehydration.

And remember, the easiest way to treat sunburn is to avoid it.

Cite: https://www.healthline.com/health/sunburn

 

Pollen Allergies

What is a pollen allergy?

Pollen is one of the most common causes of allergies in the United States.

Pollen is a very fine powder produced by trees, flowers, grasses, and weeds to fertilize other plants of the same species. Many people have an adverse immune response when they breathe in pollen.

The immune system normally defends the body against harmful invaders — such as viruses and bacteria — to ward off illnesses.

In people with pollen allergies, the immune system mistakenly identifies the harmless pollen as a dangerous intruder. It begins to produce chemicals to fight against the pollen.

Woman blowing nose due to pollen

This is known as an allergic reaction, and the specific type of pollen that causes it is known as an allergen. The reaction leads to numerous irritating symptoms, such as:

  • sneezing
  • stuffy nose
  • watery eyes

Some people have pollen allergies year-round, while others only have them during certain times of the year. For example, people who are sensitive to birch pollen usually have increased symptoms during the spring when birch trees are in bloom.

Similarly, those with ragweed allergies are most affected during the late spring and early fall.

About 8 percent of adults in the United States experience hay fever, according to the American Academy of Allergy, Asthma, and Immunology (AAAAI).

About the same percentage of American children were diagnosed with hay fever in 2014, according to the National Health Interview Survey, conducted by the U.S. Department of Health and Human Services.

The allergy is unlikely to go away once it has developed. However, symptoms can be treated with medications and allergy shots.

Making certain lifestyle changes can also help relieve the symptoms associated with pollen allergies.

A pollen allergy may also be referred to as hay fever or allergic rhinitis.

What are the different types of pollen allergies?

There are hundreds of plant species that release pollen into the air and trigger allergic reactions.

Here are some of the more common culprits:

Birch pollen allergy

Birch pollen is one of the most common airborne allergens during the spring. As the trees bloom, they release tiny grains of pollen that are scattered by the wind.

A single birch tree can produce up to 5 million pollen grains, with many traveling distances of up to 100 yards from the parent tree.

Oak pollen allergy

Like birch trees, oak trees send pollen into the air during the spring.

While oak pollen is considered to be mildly allergenic compared to the pollen of other trees, it stays in the air for longer periods of time. This can cause severe allergic reactions in some people with pollen allergies.

Grass pollen allergy

Grass is the primary trigger of pollen allergies during the summer months.

It causes some of the most severe and difficult-to-treat symptoms. However, the AAAAI reports that allergy shots and allergy tablets can be highly effective in relieving symptoms of grass pollen allergies.

Ragweed pollen allergy

Ragweed plants are the main culprits of allergies among weed pollens. They’re the most active between the late spring and fall months.

Depending on the location, however, ragweed may begin spreading its pollen as early as the last week of July and continue into the middle of October. Its wind-driven pollen can travel hundreds of miles and survive through a mild winter.

What are the symptoms of a pollen allergy?

Pollen allergy symptoms most often include:

  • nasal congestion
  • sinus pressure, which may cause facial pain
  • runny nose
  • itchy, watery eyes
  • scratchy throat
  • cough
  • swollen, bluish-colored skin beneath the eyes
  • decreased sense of taste or smell
  • increased asthmatic reactions

How is a pollen allergy diagnosed?

Your doctor can usually diagnose a pollen allergy. However, they may refer you to an allergist for allergy testing to confirm the diagnosis.

An allergist is someone who specializes in diagnosing and treating allergies. To schedule an appointment visit us online today!

The allergist will first ask you about your medical history and your symptoms, including when they started and how long they’ve persisted.

Make sure to tell them if the symptoms are always present or get better or worse at certain times of the year.

The allergist will then perform a skin prick test to determine the specific allergen that’s causing your symptoms.

During the procedure, the allergist will prick different areas of the skin and insert a small amount of various types of allergens.

If you’re allergic to any of the substances, you’ll develop redness, swelling, and itchiness at the site within 15 to 20 minutes. You might also see a raised, round area that looks like hives.

How is a pollen allergy treated?

As with other allergies, the best treatment is to avoid the allergen. However, pollen is very difficult to avoid.

You may be able to minimize your exposure to pollen by:

  • staying indoors on dry, windy days
  • having others take care of any gardening or yard work during peak seasons
  • wearing a dust mask when pollen counts are high (check the internet or the weather section of the local newspaper)
  • closing doors and windows when pollen counts are high

Medications

If you still experience symptoms despite taking these preventive measures, there are several over-the-counter (OTC) medications that may help:

  • antihistamines, such as cetirizine (Zyrtec) or diphenhydramine (Benadryl)
  • decongestants, such as pseudoephedrine (Sudafed) or oxymetazoline (Afrin nasal spray)
  • medications that combine an antihistamine and a decongestant, such as Actifed (triprolidine and pseudoephedrine) and Claritin-D (loratadine and pseudoephedrine

Allergy shots

Allergy shots may be recommended if medications aren’t enough to ease symptoms.

Allergy shots are a form of immunotherapy that involves a series of injections of the allergen. The amount of allergen in the shot gradually increases over time.

The shots modify your immune system’s response to the allergen, helping to reduce the severity of your allergic reactions. You may experience complete relief within one to three years after starting allergy shots.

Home remedies

A number of home remedies may also help relieve pollen allergy symptoms.

These include:

  • using a squeeze bottle or neti pot to flush pollen from the nose
  • trying herbs and extracts, such as PA-free butterbur or spirulina
  • removing and washing any clothing that has been worn outside
  • drying clothes in a dryer rather than outside on a clothing line
  • using air conditioning in cars and homes
  • investing in a portable high-efficiency particulate air (HEPA) filter or dehumidifier
  • vacuuming regularly with a vacuum cleaner that has a HEPA filter

When to call the doctor

You should tell your doctor if your symptoms become more severe or if your medications are causing unwanted side effects.

Also, be sure to consult your doctor before trying any new supplements or herbs because some can interfere with the effectiveness of certain medications.

The takeaway

Pollen allergies can interrupt your everyday activities with sneezing, stuffy nose, and watery eyes. Lifestyle changes and medications can help reduce your symptoms.

Avoiding the trees, flowers, grasses, and weeds that trigger your allergies is a good first step.

You can do this by staying indoors when pollen levels are high, especially on windy days, or by wearing a dust mask to avoid breathing in the pollen.

Medications, both prescription and OTC, can also help reduce symptoms.

Your doctor may also recommend immunology (allergy shots).

Continue reading “Pollen Allergies”

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”

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.