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Announcement- HIV & Viral Hepatitis Clinic in Lawrence, MA Now Open

 

HIV, High-Risk HIV & Viral Hepatitis Clinic

 

We are pleased to announce the opening of our specialized clinic focused on treating patients with HIV, high-risk HIV exposure and viral Hepatitis. Located at our Riverwalk/ Lawrence site, the clinic is managed by the highly experienced and welcoming care team of Jessica L. Wisocky, APRN-CNP and Katie Cailleach, RN-BC, CCCTM.

 

Click here to learn more.

Should schools be open or closed during COVID?

By Dr. John Maddox, Pediatrician
Pentucket Medical/ Haverhill

School staff and families are experiencing tremendous fatigue from the heroic work to maintain in-person education during the COVID pandemic. Millions of hours and millions of dollars have gone into mitigation efforts (like masks and distancing and ventilation).

Most schools use a hybrid model, with each student only in the building 2 days per week. Furthermore, close contacts are quarantined. These modifications significantly reduce the likelihood of COVID spread.

Given the benefits of in-person education and the health risks of COVID, decisions about if and when to temporarily shut schools are very complex — requiring wise judgment. It’s important to avoid being reactionary, when fear clouds fact. The fundamental question should be: “is having our school open right now making the pandemic here now worse?”

Massachusetts has its system of red, yellow and green communities, which marks the degree of caution each district should be using in its decisions. This is a particular challenge for urban cities, where both the rates of COVID and the harms of remote education are highest.

To use a baseball analogy, closing a school is like shifting the infield to double play depth when a runner is in scoring position with one out. It’s a tool that gets you out of a pinch. If this school year were a game, we’d be in the top of the 3rd inning. We need to encourage and reward good managers, who keep an eye on the long view and the final outcome.

Teens and Mental Health

By Dr. John Maddox, Pediatrician
Pentucket Medical/ Haverhill

Photo by Polina Zimmerman from Pexels

A recent personal experience with the sadness and shock of suicide weighs on my mind these days. Suicide is the 2nd leading cause of death in the US, among ages 15-24. Rates have increased by 41% over the past 17 years. Males have a rate three times higher than females. Dismal statistics like these can sometimes be numbing, which discourages the hopeful proactive energy we need to bring, in order to prevent future tragedy.

When listening carefully to people who have considered suicide, one element that comes up invariably is psychological pain. The pain of loneliness or unworthiness can be as real and unbearable as physical pain. We humans are built for connectedness: an antidote to isolation. The time and energy invested in relationships reinforces that each of our days matter. We are grateful for those who help us, and we take joy in the opportunity to help others.

World Mental Health Day is this Saturday October 10th. Read more about “10 Things Parents Can Do to Prevent Suicide”

En Espanol

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”

Cold and Flu Season is Here

Fall is here and along with all the Halloween decorations and pumpkin flavored coffees comes the cold and flu season. 

cold-flu-season-here-merrimack-valley

We all have to tough through a cold from time to time but how do we know when it’s more than just  a cold. The common cold usually presents with a mild fever (if any) as well as scratchy throat, nasal congestion and dry cough.  These symptoms are mild, develop slowly over a couple of days and resolve within a week or so.  The flu’s symptoms come on much more abruptly and are much more severe.  If you find yourself experiencing a rapid onset of fevers, chills, body aches, and fatigue along with more than mild cold symptoms you may have the flu.  Continue reading “Cold and Flu Season is Here”

Parenting in an age of personal devices

For decades parents have worried about the amount of time their children spend in front of electronic media. 

Many of today’s parents grew up in the 1980’s and 90’s, when their parents worried about a per-child average of 3 hours a day spent watching network and cable TV. 

Many of those kids have become parents to children growing up in a world of wireless media and limitless bandwidth. New channels of connectivity are literally reshaping our children, socially and developmentally and physically. The average total screen time for children today is an astonishing 7 hours per day, and of course there are many more types of screens. 

From a health standpoint, there are significant concerns about children’s use of handhelds, whether these are smartphones or tablets. 

Clinical concerns include: 

Posture

A human head weighs about 12 pounds, and when standing up straight, it puts that amount of stress on the spine. But as we look down, the strain increases, to as much as 60 pounds as the chin nears the chest, which is the most common posture of texting and iPad use.

Repetitive Stress Injury

Holding a phone and tapping out words puts unnatural stress on the tendons and muscles of the thumb and forearm.  Our powerful thumbs evolved for gripping – to put it simply, they are like the bottom half of a pair of pliers. They were never intended for hunting and pecking at tiny letters. Hours of daily texting can lead to tendonitis, carpal tunnel syndrome and other debilitating problems. 

Accidents

Another real physical risk involving mobile media is accidents. More than 3,000 teens die each year in crashes caused by texting while driving. (By comparison, roughly approximately 2,700 teens are killed in drunk driving accidents.) More than 50 percent of teens admit to texting while driving.

Pedestrian injuries related to cell phones ranged from falling off walkways or bridges to walking in front of moving traffic. The study found that in 2010, 1,500 pedestrians were treated in emergency departments for cell-phone related incidents, as opposed to a mere 559 in 2004.

The attractions of mobile devices are an undeniable challenge to parents who want to limit their children’s screen time, yet there are strategies that can be employed to counter their attraction. 

Enabling and Encouraging Immersive Experiences

You can make a positive impact in your child’s relationship with devices by encouraging them to join in on activities that are engaging and exciting.

  • Team sports
  • Martial arts 
  • Yoga
  • Dance
  • Phone-free walks and bicycling
  • Artistic pursuits
  • Music lessons
  • Painting
  • Theater
  • Community based resources
  • Boys & Girls clubs
  • Social service opportunities

Additionally, most mobile devices have options for that will set time limits on session length. These controls are usually found in the “settings” area of the device. 

Finally, engaging children in face-to-face conversation or games is a means of both building child-parent bonds and creating device-free time. Keep in mind that as adults we are far from immune from the distractions of our phones and iPads. 

Leading by example is one of the best ways to ensure that our kids will develop media habits that are reasonable and balanced.

If you have any questions or concerns relating to these issues, speak with your doctor or pediatrician

LYME DISEASE — What, How, When and Prevention.

lyme disease prevention

As Spring approaches and we think about enjoying the beautiful outdoors please keep in mind a few ways to keep you and your family safe from ticks and possible tick borne illnesses, such as Lyme disease. Knowledge is power, and the following is offered as a basic but thorough overview of what you should do to prevent this common and rather serious disease.

The WHAT

Lyme disease is an illness from a tick bite that has 3 stages:

Early localized disease: 3-30 days after a tick bite.

  • A large red ring (larger than 2inches across) or bull’s eye (called erythema migrans) that starts at the site of the tick bite and can last 2 weeks to 2 months. It is not itchy or painful and is seen in 80% of infected people.
  • A flu like illness with fever, headache, chills, fatigue, joint and muscle pain lasting a few days. Vomiting, diarrhea, abdominal pain and cold symptoms or cough are not typically seen with Lyme disease.

Early disseminated disease: 2-12 weeks after the tick bite in about 20% of people who did not receive treatment will develop these problems.

  • Rashes can be similar but smaller than the primary rash of erythema migrans (chronic migrating redness) with a flu-like illness of fever, fatigue, headache, muscle and joint pain.
  • Eye problems, meningitis, and palsies of the facial nerves can be seen with or without a flu-like illness.
  • Carditis (heart problems) such as heart block can develop.

Late disease: 6 weeks to 2 yr after the tick bite.

  • Arthritis, most commonly the knee but can be other large joints.
  • Rarely neurological problems develop (weakness, numbing/tingling, memory issues.)

Lyme disease is often diagnosed based on history and exams, as lab testing is not helpful in the first 4 weeks of infection and can be difficult to interpret. It is treated with a 2-4 week course of antibiotics. If you have been treated appropriately in the early stage of Lyme disease you almost never develop the later stages.

lyme-ex

The HOW

Lyme disease is caused by a bacteria which is transmitted by the blacklegged tick (in New England, the deer tick). These ticks are very tiny—often the size of a pinhead and do not fly or jump. Tick bites do not hurt or itch. A tick bite can only lead to Lyme disease if the tick is infected with the bacteria and if the tick has been attached longer than 48hrs.

The WHEN

Lyme disease is more common April through October with more than 50% cases occurring during June and July.

PREVENTION

Use repellent

  • Products that contain permethrin or picaridin (Duranon, Congo Tick Spray, Permanone) can be used on clothing and shoes, but not on skin.
  • DEET containing products (20-30%) for children 2mo and older applied on skin (except face and hands) and clothing.

Tick checks

  • Remove all clothing and, if possible shower/bath within 2 hr coming in from area where tick exposure is a concern.
  • Do tick checks especially checking scalp, neck, armpits, and groin.
  • Remove any tick (using tweezers grasp as close to skin as possible and pull gently and steadily straight upwards avoiding twisting and jerking.)
  • Check pets and any outdoor gear.
  • Place clothes in a dryer on high heat for 1 hr to kill any ticks.

A great website with more information is www.cdc.gov/lyme/

Also check with your child’s doctor’s office as they may have more information and handouts.

What You Should Know About Depression.

depression information

Everyone occasionally feels sad. But most of those feelings are related to a trigger and pass within a couple of days but when u have depression it interfers with your daily life, it affects your life and affects the lives of other around you. 

What is depression and what are the symptoms?

Severe symptoms that interfere with your ability to work, sleep, study, eat, and enjoy life, lasting longer than 2 weeks, is something you need to be concerned about.

Symptoms of depression include:

  • Feelings of guilt, worthlessness, helplessness, or hopelessness. 
  • Loss of interest or pleasure in usual activities, including sex. 
  • Difficulty concentrating and complaints of poor memory. 
  • Insomnia or oversleeping. 
  • Appetite changes, which may include weight gain or loss. 
  • Fatigue, lack of energy. 
  • Thoughts of suicide or death. 
  • Slow speech; slow movements.
  • Sleep disturbances.

Why does it happen? Is it my fault I am depressed?

Most likely not. Lot of factors like Genes, Stress, and neurohormones are most likely the cause of depression.

Factors causing and affecting depression include:

  • Genetic factors- many studies have shown its familial. Family, twin, and adoption studies provide very solid and consistent evidence that MDD is a familial disorder and that this familiality is mostly or entirely due to genetic factors.
  • Stress – ongoing or recent stress due to interpersonal adversities, including childhood sexual abuse, other lifetime trauma, low social support, marital problems, and divorce.
  • Cortisol – some subjects with MDD do show abnormalities of that axis of the hypothalamic-pituitary-adrenal axis.
  • Serotonin and GABA – the neurohormones implicated are serotonin and GABA. Reduced central serotonin and GABA both have been associated with mood congruent memory bias, altered reward-related behaviors, and disruption of inhibitory affective processing.

 

If you have any questions anytime about depression, depression care, need help or advise, please feel free to call me.

Tapasya Srivastava, MD, MPH

Phone: 978-794-2112

Pentucket Medical – North Andover

Other resources available for you are:

Counseling Associates of Dracut and Methuen

Phone: 978-683-0133

 Arbour Haverhill

Phone: 978-373-7010

Emily Bergeron, MA, LMHC – Therapist

Located in Pentucket Medical, Haverhill

Phone: 978-794-5401

Pentucket Medical Celebrates Walking Day!

walkingchallenge

We are proud to celebrate National Walking Day by kicking off the 4th annual Walking Challenge amongst the staff here at Pentucket Medical!

The Walking Challenge is a practice-wide event to get employees moving.  There are approximately 10-20 teams each year that participate.  Each team, comprised of 5 employees, is asked to select a team captain and a snappy name (these names are always very creative.)    Each team member wears a pedometer and tracks the steps they take each week.  The steps are then sent to HR and converted to miles.  The miles are then plotted out on a map of the United States.  There are certain checkpoints throughout the journey.  At each check point a few fun facts are disclosed.  A status report is then sent out weekly to highlight where teams are and to further motivate team progress. 

The walking challenge was initially created to provide increased employee engagement and to promote a healthy lifestyle.   People tend to get up and move more to increase their steps.  There is friendly competition between the teams and even within each team.  

In earlier years the winners was determined by the most miles walked as a team.  Due to the varying levels of participation, (we want everyone to participate and feel they have a chance to win even if they don’t walk 10 miles a day) the winner is now determined by a drawing.  Teams that consistently report their steps will  be put into a drawing at the end of the challenge.  The top 3 teams will win a prize. The prize is usually comprised of healthy snacks, water and other things. With all the health benefits to walking – everyone walks away a winner. 

Research has shown that the benefits of walking and moderate physical activity for at least 30 minutes a day can help you:

  • Reduce the risk of coronary heart disease
  • Improve blood pressure and blood sugar levels
  • Improve blood lipid profile
  • Maintain body weight and lower the risk of obesity
  • Enhance mental well being
  • Reduce the risk of osteoporosis
  • Reduce the risk of breast and colon cancer
  • Reduce the risk of non-insulin dependent (type 2) diabetes
     

There really are so many benefits for such a simple activity!

NATIONAL POISON PREVENTION WEEK

national poison prevention week

Did you know that poisonings are the #1 cause of injury related death in the US—most due to drug misuse or abuse?

  • In 2013 there were 2.2 million calls to Poison Control Centers concerning human related exposures to poisons with just under ½ of these calls concerning children under 6 yr old.
  • In 2013 more than 90% poisonings occurred at home.
  • In 2013 more than 70% of the calls to Poison Centers were treated at home thus saving billions of dollars in healthcare expenditure at emergency rooms.

Did you know there are 55 Poison Control Centers across the United States and they are available 24/7 every day of the year?

Poison Control Centers receive only a fraction of their funding through the federal government and have had significant funding cuts. Much of their funding is through state governments, hospital, and other agencies.

Did you know there is no such thing as a POISON PROOF home or environment? Children are often very capable of getting into what we, as adults, think are “child-proof”. ANY medication (prescription or over-the-counter) and almost any household product is potentially poisonous and capable of causing harm in some way.

KEEP 1-800-222-1222 programmed into your mobile phone and this number readily accessible by your home phone in case of any possible poisoning. AND CALL! They will give you advice on how best to handle the situation. It could not only be life saving it could be cost saving!

Reminder: To protect all of our patients, you must wear a mask to enter any of our locations.
Public health guidance for masking related to vaccination status has NOT changed in healthcare settings.

Vaccine Appointment Scheduling

Patients age 12 and older can schedule a vaccine appointment on the State’s website. Please note, any patient under 18 needs a parent or guardian’s consent which can be found here.

COVID-19 Information