Once in a great while I find that there are no questions from the community for me to address. While I encourage you all to write to me with your medical concerns, I find the timing is right for me to answer a question I have for myself! My family lost a sweet, loving 3-year-old boy this week. He was not feeling well and his mom took him to the pediatrician in New York where they live. He was misdiagnosed as having the flu, and three days later this lovely child died. The hospital diagnosed him as “septic.”

 What would cause sepsis in a young child?

Sepsis is a serious infection usually caused by bacteria that can originate in many body parts, such as the lungs, intestines, urinary tract, or skin. It occurs when a serious infection causes the body’s normal reaction to infection to go into overdrive. With sepsis, bacteria and the toxins they create cause changes in a person’s body temperature, heart rate, and blood pressure, resulting in dysfunction of the body’s organs.

Sepsis can be frightening because it can lead to serious complications that affect the kidneys, lungs, brain, hearing, and can even cause death. Sepsis can affect people of any age, but is more common in:

• Infants under three months whose immune systems have not developed enough to fight off overwhelming infections
• The elderly
• People with chronic medical conditions
• Those with compromised immune systems, such as HIV

Sepsis in newborns and children can produce a wide variety of symptoms. Frequently these babies “just don’t look right” to their parents. Other symptoms may be:

• Disinterest in eating
• Vomiting
• Fever (rectal 100.4F)
• Irritability or increased crankiness
• Lethargy
• Decreased tone (floppiness)
• Changes in heart rate – either faster of significantly slower than usual
• Breathing very quickly or with difficulty
• Periods where the baby seems to stop breathing for a brief time (10 sec)
• Change in skin color (pale or blue)
• Jaundice (skin and eyes look yellow)
• Rash
• Decreased amount of urine

A child with sepsis may have started with an infection such as cellulitis or pneumonia that seemed to be spreading and getting worse.

As you can see, many of these symptoms could be a sign of “the flu.”  Because the symptoms are so vague, laboratory tests play a crucial role in confirming or ruling out sepsis.

• Blood tests and cultures may be taken to determine whether bacteria are present in the blood. Other blood tests to determine the function of the liver and kidneys may be ordered.
• Urine tests are usually done to check for the presence of bacteria.
• Lumbar puncture (spinal tap) may be performed depending on the baby’s age and overall appearance. This would rule out meningitis.
• X-rays, especially of the chest, to rule out pneumonia, are sometimes taken.

             Sepsis or even suspected cases of sepsis in infants will be treated in the hospital where doctors can closely watch the child and administer strong antibiotics intravenously to fight the infection. Doctors usually start infants with sepsis on antibiotics right away, even before the diagnosis is confirmed. If needed they may start them on IV fluids to keep them hydrated, blood pressure medication to keep their hearts working properly, and respirators to help them breathe.

Although there is no way to prevent all types of sepsis, some cases can be avoided.

• Vaccinations against certain strains of bacteria that can cause sepsis are offered.
• Pregnant women can have a swab test during pregnancy to determine if they carry GBS bacteria which can be transmitted to their fetus.
• Hand washing can go a long way toward preventing infection. Making sure that people who come near the baby are not sick, and have been vaccinated.

As noted above, the symptoms of sepsis are vague and many times resemble “the flu” to an untrained eye. ALWAYS act on your gut feeling. If your child is not acting right and you are concerned that the child continues to decline even after seeing the physician, please rush them to the emergency room.  Always better safe, than sorry.

~In memory of Sean Sweetman 2009-2012~

Breast cancer - is the most commonly diagnosed cancer in women.
A mammogram is the best way to find breast cancer early, before it can be felt, which makes it easier to treat. For information about mammograms go to www.cdc.gov/cancer/breast/basic_info/mammograms.htm

Lung cancer - in theU.S., more women die from lung cancer than any other type of cancer. About 75 percent of women diagnosed with lung cancer die from the disease. The most important thing you can do to prevent lung cancer is to never start smoking, or to quit if you currently smoke. For resources to help you quit go to www.smokefree.gov/

Colorectal (colon) cancer - is the third most common cancer in women. It is most often found in men and women 50 years or older. In 2007 about a third of the diagnosed women with colon cancer died from the disease. Death from colorectal cancer can be cut by as much as 60 percent with regular screening. For more information go to www.cdc.gov/cancer/colorectal/basic_info/screening/

Gynecologic cancers – can start in any of the woman’s genitalia/pelvic organs. In 2007, about 34 percent of the women who were diagnosed with gynecologic cancers died from the disease. Pap tests are a dependable screening that can find cervical cancer early, when the chance of being cured is very high. For information about the Pap test go to www.cdc.gov/cancer/cervical/basic_info/screening.htm
A vaccine is available for girls and women to protect against the types of human papillomavirus (HPV) that most often cause cervical, vaginal, and vulvar cancers.

Screening tests and the HPV vaccine can help prevent some of the most common types of cancer in women.

Miri Daly, APRN, MSN – Board Certified in Women’s and Adult Health
Enfield Women’s Health
140 Hazard Avenue, Suite 105
Enfield, CT 06082
860-272-2930

Q. As the new year approaches, senior citizens sometimes have a hard time trying to find effective resolutions. Can you help?

A. Many of us pledge to become “perfect” each January. We pick apart our bad habits and vow to correct our shortcomings. This year try some positive actions to bring you to a more comfortable place both physically and financially.

Health Tips

• See your doctor and dentist every year on schedule
• All medications should be from the same pharmacy. This prevents adverse interactions.
• Take a nap. Studies show a 30-minute nap can refresh you immensely.
• Complete a health care proxy and power of attorney to ensure your wishes are fulfilled.

Wealth Tips

• Take a senior discount.
• Have your furnace checked to optimize efficiency.
• Check your bills for accuracy before you pay them.
• Shop on a full stomach – you will buy less.
• Reduce interest costs by transferring credit cards or refinancing loans.
• Turn things off! Don’t keep things in “stand-by” mode, they still use energy!
• Make an extra payment, could save you on interest costs.
• Reduce features on your phone and TV packages.
• Do only full loads of laundry and use a clothes line to dry.
• Buy ahead – buy a few extra if there is a sale.
• Use a towel to dry the dishes rather than using the dry cycle on the dishwasher.
• Change all bulbs to compact florescent light bulbs, they use 75 percent less energy!
• Go generic, same quality in just a different package.
• Shop online – sometimes you can find better prices, and you save on gas!

Q. I have just lost a loved one and don’t know how I will ever survive the holidays! Can you help me?

A. When a loved one dies, we grieve not only for that individual but also for the life we used to have, the love that special someone gave us and all of the memorable times we spent together. Perhaps there is no time of the year when we’re more aware of the empty space our dear one has left behind than during the holiday season.

Holidays can create feelings of dread and anxiety in those who are bereaved. Holidays by nature are filled with nostalgia and tradition, but in grief, even the happiest memories can hurt. When we’re in the midst of pain, and the rest of the world wants to give thanks and celebrate, we need to find ways to manage our pain and get through the season with a minimum of stress.

Here are some useful suggestions for coping with the holidays:

• Do some things differently this year. Trying to recreate the past may remind you all the more that your loved one is missing. This year, try celebrating the holidays in a totally different way – Go to a restaurant, visit relatives or friends, travel somewhere you’ve never gone before. If you decide to put up a tree, put it in a different location. Buy a poinsettia for your home as a living memorial to your loved one for the holiday season. Do other things more simply. You don’t have to discard all of your old traditions, but you can choose to observe the holidays on a smaller scale this year.
• Take good care of yourself. Build time in your day to relax, even if you’re having trouble sleeping. Eat nourishing, healthy meals, and if you’ve lost your appetite, eat small portions more frequently throughout the day. Get some daily exercise, even if its just a walk around the block. Avoid drinking alcohol which intensifies depression and disrupts normal sleep.
• Pay attention to yourself. Notice what you’re feeling and what it is you need. Feelings demand expression and when we acknowledge them and let them out, they go away. Feelings that are “stuffed” don’t go anywhere, they just fester and get worse. If you need help from others, don’t expect them to read your mind. Its okay to ask for what you need, doing a favor for you during the holidays may make them feel better too.
• Expect to feel some pain. Plan on feeling sad at certain moments throughout the season, and let the feelings come. Experience the pain and tears, deal with them, then let them go. Have faith that you’ll get through this and that you will survive.
• Seek support from others. Grieving is hard work, and it shouldn’t be done alone. You need to share your experience with someone who understands the pain of your loss. If your spouse, relative, or friend cannot be the source of that support, you can find it elsewhere. Look for programs aimed at helping you cope with the holidays.
• Give something of yourself to others. As alone as you may feel in your grief, one of the most healing things you can do for yourself is to be with other people, especially during the holidays. Caring for and giving to others will nourish and sustain you, and help you to feel better about yourself. If you can bring yourself to do so, visit someone in a nursing home, or volunteer your time at your church, synagogue or animal shelter. Do whatever you can, and let it be enough.

By: Joseph Mitchel, D.O., Board Certified in Cardiology

Accepting New Patients!
7 Magauran Drive, Stafford Springs
384 Merrow Road, Suite L, Tolland
860-684-3745

Physical therapists can be employed by various organizations including hospitals, skilled nursing facilities, outpatient clinics and more – those employed by JMMC work at Johnson Memorial Hospital (JMH) in the inpatient setting, Evergreen Health Care Center in a skilled nursing facility setting, in the home care setting at Home & Community Health Services, and as an outpatient clinic in Enfield as a part of JMH services.

The role of a physical therapist is quite different setting to setting but ultimately the goal is to maximize the patient’s independence and provide education about how to reach their functional potential.

For example:

• You could be hospitalized and a physical therapist may be ordered to come and assess your ability to move in the bed, transfer to a chair, and assess the way you walk to help with the decision making about the next step in your eventual discharge. They may provide you with exercises to get started on building up your strength and they may educate you about ways to prevent side effects from bed rest. This could be talking about pressure relief measures, using an incentive spirometer (a tool that helps your lung function), or discussing what activities are save for you to be doing.

• You could be a patient who just underwent a total knee replacement who lives alone and is not able to go straight home from the hospital. You end up at a skilled nursing facility for short term care receiving long sessions of torturous (but ultimately helpful) physical therapy! The physical therapist sees you there and works on restoring your knee range of motion, working on your abilities to walk so you can eventually resume walking without a device, and helping to manage your pain. They will assess your ability to successfully walk up and down stairs, and work on making sure your balance is the best it can be so you can return home safely.

• You could be an elderly person who has had multiple falls in your home and went to see your physician who ordered home therapy. The physical therapist comes to your home and assesses your living environment, your ability to function in that environment, and works with you to ensure that you can stay in your home as long as possible. The physical therapist will initiate a home exercise program with specific balance exercises geared toward preventing falls in the future along with providing ongoing education about risk factors for falls. They will work on your walking and try to improve your function in the home so you can resume doing the things you love to do.

• You could be a 21-year old male who recently hurt his back and now has lower back pain that extends into the right leg. You will most likely find yourself in an outpatient setting for physical therapy. The physical therapist will do a very specific evaluation of your posture and spine and will then initiate a treatment program that will help decrease your pain and improve your function. Pretty soon you are able to tolerate doing exercises that build up your core strength and before you know it you are able to do everything you could before – with a much better idea of body mechanics and how to prevent future injury.

Physical therapists within JMMC are working each day with patients like this and helping to improve patient’s lives regardless of age, functional status, or gender. Physical therapists are an integral part of the medical team and they have many stories of success to share.

So, take the time to thank the physical therapists in your life for doing what they do each day to improve the quality of lives of the patients they work with.

For more information about the profession of physical therapy visit: www.apta.org.

By: Jenny Hutchison PT, DPT
Home & Community Health Services
Rehabilitation Supervisor

It is estimated that 99% of American women use birth control at some point in their lives and that about 95% of unintended pregnancies occur in the absence of consistent use of birth control. Almost half of all pregnancies in the United States – about 3 million a year – are unplanned and many end in termination of pregnancy.

A pack of birth control pills cost, on the average, $30 a month with health insurance coverage. That is about $10,800 life time cost for a woman who wants to have control of her reproductive life.   

It took us a long time to get here but I believe it is the right decision and the right thing to do for women’s health.

For additional information about the guidelines and other preventive services to be covered, go to www.hhs.gov.

By: Miri Daly, APRN, MSN – Board Certified in Women’s and Adult Health

Accepting New Patients!
Enfield Women’s Health
140 Hazard Avenue, Suite 105, Enfield, CT
860-272-2930

Symptoms do not appear until the later stages of the disease and often include bone pain or tenderness, fractures with little or no trauma, drastic loss of height, and an arched posture.

Treatment of osteoporosis typically involves the use of pharmacological agents. Studies suggest that exercise can have a preventative effect on bone loss in postmenopausal women and has the potential to be a safe and effective way to avert the disease. Some recommended exercises include walking, jogging, dancing, yoga, tai chi, riding a stationary bicycle, using resistance bands, rowing machines and free weights. Exercises that present a risk of falling or that are high impact and may cause fractures should be avoided.

For more information on osteoporosis, visit the U.S. National Library of Medicine, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001400/

Miri Daly, APRN, MSN – Board Certified in Women’s and Adult Health

Accepting New Patients!
Enfield Women’s Health
140 Hazard Avenue, Suite 105, Enfield
860-272-2930

The chances of a woman getting invasive breast cancer some time during her life is almost 1 in 8, and the chances of dying from breast cancer is about 1 in 35 – making it the second leading cause of cancer deaths in women.

Having a clinical breast examination is recommended for women in their 20′s and 30′s every three years and for women in their 40′s, each year. The earlier breast cancer is found, the better the chances are that treatment will be successful.

Miri Daly, APRN, is providing free clinical breast examinations and referrals for mammograms to women who are not covered by medical insurance. For more information or to schedule an appointment, contact the Enfield Women’s Health office at 860-272-2930. Offer valid now through October 31.

The Enfield Women’s Health office is also offering women’s physical examinations at a discounted price of $95 – a 60 percent savings - for women who are not covered by medical insurance. Please contact the office at 860-272-2930 for more information or to schedule an appointment. Offer valid now through December 31.
 
Miri Daly, APRN, MSN – Board Certified in Women’s and Adult Health
Enfield Women’s Health
140 Hazard Avenue, Suite 105, Enfield
860-272-2930

Learn more about early detection and various clinical exams from the American Cancer Society, http://www.cancer.org/Cancer/BreastCancer/OverviewGuide/breast-cancer-overview-diagnosed

Q. My aching feet! Used to be just a saying to me, but recently my feet are aching and hurting – never the same pain, different locations on my feet, different feet. Please help me figure out what is going on!

A. Foot pain may have a variety of causes. The types, causes and severity (sharp vs. dull ache) are also good indicators of the seriousness of the injury.

Pain and tenderness are the immediate indicators that something is wrong in a specific area. The onset of pain, whether suddenly or over time, is an important indicator of the cause of the problem. The following questions are also important:

• Is there pain with movement of the affected area?
• Is it affected by weight-bearing?
• Does it change your walking gait?

Sprains: bones of the foot are joined together by ligaments. A sprain occurs when the ligaments that hold the bones together are overstretched and the fibers tear. Point tenderness and looseness of a joint are indicators of a sprain.

Fracture: injury to the bones of the foot can be caused by a single blow or twist to the arch or also by repetitive trauma that can result in a stress fracture. Fractures are indicated by a focal point of pain that may be exquisitely tender on the bone. There may be a distinguishable lump or gap at the site of the fracture. A rotated toe or forefoot may also be a sign of a fracture.

Strains: muscle and tendons move the body tissues around the joints. A strain occurs when a muscle or group of muscles are stressed to the point where there is tearing of the muscle fibers. The muscles and tendons of the foot may be strained by overstretching, overuse, overloading, bruising or even being lacerated. Weakness in contraction of a joint, difficulty in stabilizing body parts and pain working against resistance are signs of muscle problems. Swelling, tenderness, loss of function and discoloration over and around the injury can be symptoms of a strain.

Bruises are most commonly the result of a direct impact injury to the foot. A bruise can occur from stepping on something or by having something step on your foot. Blows to the foot resulting in discoloration, swelling or changes in gait may indicate more serious damage such as a fracture.

Pain and tenderness associated with planter fascia strains are usually felt on the bottom of the foot between the heel and the base of the toes and may occur either as a specific pain or an area of tenderness. In mild cases the pain may subside when the soft tissues of the foot warm up. In more severe cases pain may increase when the arch is stressed.

A sensation of rubbing or burning on the surface of the foot is usually the first signs of a blister. Itching and burning sensations between the toes may indicate a skin infection or athlete’s foot. Pain and redness at the edge of a toenail are usually the result of an ingrown toenail.

When the pain begins to interfere with your activities of daily living you should consider seeking medical attention. You may first begin treatment at home with ice, compression and elevation. Over the counter medications may also be used to reduce discomfort. If the area looks deformed, if you have loss of function, change of sensation, swelling, prolonged change in skin or toenail color, heat or tenderness you must not wait to see a doctor.

By: JoAnn Slosek, R.N., Support Services Supervisor and Hospice Clinical Manager at Home & Community Health Services