Category: Primary Care & Pediatrics

By: Alisha Nims, BSN RN

August is Breastfeeding Awareness Month and Breastfeeding Week is August 1-7. Breastfeeding provides many benefits for both mom and baby. Deciding how to feed your baby is a personal choice. Our Birthing Center team at Fisher-Titus is here to support you on your breastfeeding journey.

Benefits of Breastfeeding
In addition to being a special way to bond, breastfeeding reduces the risk of many diseases for both mother and baby.

The cells, hormones, and antibodies in breastmilk help keep your baby healthy. This protection is unique to your baby and will change to meet your baby’s needs as they grow. Research shows that breastfed babies have lower risks of:

Asthma
Childhood leukemia
Childhood obesity
Ear infections
Eczema
Diarrhea and vomiting
Lower respiratory infections
Necrotizing enterocolitis (a disease that affects the gastrointestinal tract in premature babies)
Sudden infant death syndrome (SIDS)
Type 2 diabetes

Babies aren’t the only ones who benefit from breastfeeding. Breastfeeding can help mom’s health and healing after childbirth as well. It leads to a lower risk of the following health problems in mothers:

Type 2 diabetes
Certain types of breast cancer
Ovarian cancer
Supporting Breastfeeding Mothers

While breastfeeding is a great way to feed your baby, it’s not always easy. It takes some learning for both mom and baby and it may take time before you get into a comfortable routine. As you embark on your journey, a good support system is important.

At Fisher-Titus, we have a caring team of Birthing Center staff that support moms in our community with their breastfeeding questions and concerns. All of our Birthing Center staff have had additional training to assist breastfeeding families, with several staff nurses advancing their education to become Certified Breastfeeding Counselors or Certified Lactation Counselors, the premier national certification in lactation management in the U.S. We also have an International Board Certified Lactation Consultant (IBCLC) on staff.

All these staff members are able to support breastfeeding moms in assessing the latching and feeding process, helping with corrective interventions, counseling mothers, and understanding and applying knowledge of milk production. Most importantly, they are a caring source of support for moms as they navigate their new journey in feeding their newborn.

In 2019, Fisher-Titus earned recognition from Ohio’s First Steps for Healthy Babies and was awarded Maternity Care Best Practice Award 2018 for our efforts to encourage and support breastfeeding mothers. We were also honored to be recognized by Newsweek as a Best Maternity Care Hospital for the exceptional care we provide to mothers, newborns, and their families for 2020 and 2021.

While our education programs are currently on hold due to COVID-19, we normally offer several options for both prenatal and postnatal mothers. These include Baby Boot Camp, Childbirth Education Express, and Breastfeeding Support Group. We do still offer one-on-one follow up lactation visits to patients after discharge from the hospital.

Fisher-Titus is also part of the Firelands Area Breastfeeding Alliance which will be hosting a World Breastfeeding Week Celebration & Big Latch On Event Saturday, August 7. This year’s event will be celebrated in-person event at Osborn Park in Huron as well as with a virtual event. The Global Big Latch On takes place around the world with women gathering to breastfeed and offer support to each other. Visit Firelands Area Breastfeeding Alliance on Facebook for more information.

About Alisha
Alisha Nims, BSN RN is the manager of Obstetrics at Fisher-Titus. For more information about the Fisher-Titus Birthing Center, visit fishertitus.org/birthing-center.

A couple weeks ago we talked about the importance of fostering a love of reading at a young age and how you can help your young children develop language and literacy skills through everyday moments. This week to continue better hearing and speech month, we’ll talk about how you can continue helping them develop those skills as they grow.

Reading is an important part of a child’s overall health and well-being. Children who struggle to read or don’t learn to read well may struggle with emotional and behavioral problems later in life. Helping your child develop reading skills early in life can set them up for success all throughout their life.

Here are some tips to get you started and help you on your journey to developing reading and language skills with your school-aged child.

Read to your child. Make reading a part of your everyday routine. Reading for even a few minutes every day can be a special way to bond with your child and can make a huge difference in their development. Even as your child learns to read and can read on their own, reading to them out loud is still very beneficial as you can read books to them that are slightly above their reading level as long as they can still understand and enjoy them. They can even add new words to their vocabulary this way, too!

Read with your child. Just like with anyone learning any skill, practice is important for children who are learning to read. If they are doing well, your child has a chance to show off what they’ve learned. If they are struggling with reading, you are probably the person they trust the most and feel the most comfortable with to practice and work on areas of difficulty.

Be a role model. Your child notices what you do. If they see you enjoying reading (even if it’s a newspaper or magazine) they will come to learn that reading is important, fun, and valuable and a skill they will carry on into adulthood.

Create a designated reading space. If you set aside an area in your home that is quiet and cozy and store books near there, it makes the reading experience even more enjoyable and special for your child.

Use rhymes, games, and songs. Books are not the only things that can help your child develop their language skills. Singing songs and telling stories can also enhance your child’s opportunities for learning and developing their reading skills. Rhymes and songs are also a great way to expose your child to other languages.

Ask the experts. If you’re not sure what books are appropriate for your child’s reading and comprehension skills, teachers and librarians are good sources of advice on what books are right for your child’s age and reading level. The staff at a bookstore can also be helpful as well.

Visit the library and create one at home. Now that life is slowly returning to normal, many libraries—including the Norwalk Public Library—are opening back up to outside visitors. You can make getting a library card for your child a special experience and can make library visits part of your regular routine. If you have as many books (or more) as toys in your house, your child is more likely to want to pick up a book and ready when they’re bored.

Limit screen time. Create time for reading by limiting the amount of time your child spends in front of a screen, including televisions, computers, tablets, smartphones, and video games.

Support your child in challenging themselves. If your child decides to take on a longer book or one that is maybe at the top of their reading level, offer to take turns reading, alternating paragraphs or pages. If they feel supported in taking on a more challenging book, they’re more likely to push themselves and enjoy read tougher books that will help them develop their reading skills.

Let your child choose the book. Offer your child a few books that are the right type, level, and length for your child and let them choose. If you are struggling to help your child choose books that are the right level, outside of their comfort zone, etc., you can make a deal where they get to choose a book and you get to choose one and they (or you) read them both during reading time.

Get them hooked on a series. Wanting to find out what happens next to favorite characters can be motivation to read the next book or the next chapter. Talk to librarians, teachers, or friends with children of similar age to find what book series they recommend for your child’s age group and/or reading level.

Keep track of what your child is reading. Use an incentive chart to help encourage more reading or keep a reading diary or simple list. In a reading diary, children can also write down their thoughts about the book which can help them improve reading comprehension skills and help guide you in picking books that are interesting to them. Keep in mind, however, that while some children may be motivated by keeping track of what they have read, others are not. If your child does not seem to be motivated by keeping track, don’t force them to keep a reading log because it can make them resent reading all together.

Practice writing. Reading and writing go hand in hand. Children can practice writing by helping you make grocery lists, keeping a journal, making a catalogue of their collections, or writing notes or letters to friends and family.

If your child has trouble reading or doesn’t enjoy reading, look for stories they can relate to. Stories they already know or that offer experiences they can relate to or have illustrations they recognize can help pique their interest and help them enjoy reading.

Encourage your child to read to their pets. Pets can be very patient listeners and reading to animals can be especially helpful for young readers who get nervous reading in front of others.

Focus on meaning. Reading well isn’t just about knowing how to say the words on the page but also about understanding the story. If your child is stuck on a word, help them “sound it out” and then talk about its meaning together. Here are some tips to help them not only read new words but understand the meanings:

• Talk about the page and ask questions.
• Help your child figure out the word by re-reading the rest of the page or looking at the pictures.
• Try not to interrupt unless the mistake affects your child’s ability to understand the text.
• At the end of the paragraph, page, or chapter, go back to words your child didn’t know or had trouble sounding out and review them together.

Choose books with movement and activity for impatient readers. Books with short chapters or “cliff-hangers” encourage children to keep reading. Use sound effects and different voices to help keep the story interesting.

Have fun with word play. Tell jokes with puns and play games that involve words like Scrabble, Boggle, and Hangman. Do crossword puzzles together and even play “I Spy” with letters and sounds instead of colors.

Encourage reading everywhere. Show your child how to read street signs, the back of the cereal box, or even sports stats. Your child might also enjoy reading non-fiction or comic books. Helping you cook by reading recipes can help them learn to read for detail. Reading can even be incorporated into limited and supervised screen or internet time.

Give books and magazine subscriptions as gifts. For your child’s next birthday, ask family and friends to gift a book they think your child might enjoy.

Books aren’t just for bedtime. While bedtime is a great designated time for reading, you can also encourage your child to start a habit of bringing something to read when in the car or in a waiting room.

If you find you are taking steps to help your child read and they are still struggling, you can talk to your doctor or your child’s teacher to determine whether they may need some extra help. Here are some signs you may want to talk to a doctor:

• They have trouble paying attention when you read
• They were reading well but now they have trouble
• They are finding it difficult to remember words that they should know
• They seem to read very slowly or make a lot of mistakes when reading
• They frequently avoid reading altogether
• · They complain of headaches when reading
• · They have a lot of trouble completing homework independently
• They are having trouble seeing or hearing
• They become frustrated or depressed by their struggle to learn to read

For more information on Pediatric Therapy at Fisher-Titus, visit fishertitus.org/pediatrictherapy.

By: Kaitlynn Wooten, M.S., CCC-SLP

If you are the parent of an infant or toddler, it’s likely you’re thinking more about rolling, crawling, and walking than about learning to read. However, language and literacy skills begin at birth. No, you don’t have to put them in formal classes or activities that push them to read or write. Rather, everyday moments with your child are the best ways you can help them learn about language and set them of for success in the future.

Here are some ideas for ways you can help build language and literacy skills from a young age:

Have conversations with your child. Research has found that the more parents talk with their children, the larger vocabularies those children develop. It may feel silly at first talking to an infant or young toddler but by chatting with them in the car, during bath time, etc. can help them learn to use more advanced sentence structures as they get older.

Notice and build on your child’s interests. You probably already have an idea of what things your toddler finds interesting and exciting. They let you know through their actions, facial expressions, and speech. Help them find the words for the things they find interesting by narrating activities. For example, if your child points at something out the window or gives you a questioning look, you can say “Yes, that’s a squirrel! Look at him run through the grass.”

“Read” the world around you and narrate your day. Point out everything you can like stop signs, birds, trees, etc. As you narrate your day, use different words to describe your activities, actions, and the objects around you.

Don’t make a big deal about speech mistakes. You don’t need to correct your child to help them learn proper pronunciation. If they mispronounce something, simply repeat their statement with the correct word or pronunciation so they can hear how it sounds. Correcting them directly can make them less likely to try saying new words.

Be a translator. You most certainly understand your child better than anyone. If you are around other adults who have trouble understanding your child’s speech, you can translate what they’re saying. Give your child a chance to speak and then explain what they said.

Sing and play music. Music fosters a love of words, sounds, rhythm, and rhyme. Sing and dance together to your favorite songs with different beats, tempos, etc. to help them experiment with their voice.

Tips for Reading to Your Young Child

A love of reading starts early. Start reading to your child young and they will develop a love of reading as they get older. It will take time for them to truly want to sit and listen to a book, so don’t force them into it. Forcing your child to sit down and read can have the opposite effect you are trying to achieve. Instead of fostering a love of reading, forcing them can make them resent it. Here are some tips to help you as you start incorporating story time into your everyday routine.

Find the books they like. Just like you don’t like every book, TV show, or movie that’s out there, your child won’t be interested in every book you pick up. Follow their lead and let them decide which books to read. Unfortunately for you, that may mean reading the same book ever night for weeks on end, however children learn through repetition and hearing the same story over and over can help them better understand the story as well as learn about the sound, meaning, rhythm, and tone of words. Here are some tips for choosing books that will interest a young child:

• Find books with repeat words and phrases. Children learn new words and pronunciations through repetition. A good example of this is Brown Bear, Brown Bear, What Do You See? by Eric Carle.
• Choose books with pictures of common objects. You can name the pictures in the book for your child and it helps them relate the book to their everyday life.
• Look for books with interesting actions or motions. If your child is pretty active, there are books that will engage them with accompanying movements so they can play as you read. A good example would be a storybook version of the Wheels on the Bus.
• Keep it simple. At this age, simple stories with predictable plots are best.

Connect books you’ve read to their daily life. As you go through your day, if something happens or you see something that was in a book you’ve read recently, point it out to them. For example, if the garbage truck comes, point out the window and remind them how they saw one just like it in the book they read last night.

Ask questions as you read. They may not respond at first but the more you do it, the more they will! Ask them to find things on the page like the dog or the truck. As reading becomes more a part of your routine, ask them if they’d like to read the book and to pick out which one they want to read. Before you know it, they’ll be bringing you their favorite stories and interacting with them as you read!

Let them move. Especially at first, you are not likely to get your toddler to sit on your lap during an entire book. If they get up, keep reading. They may still be listening and in fact, some kids with a strong need to be on the move listen better while in motion. If they seem disinterested, don’t be afraid to stop and come back to the book later.

Let them help read the book. They can help you turn the pages or point to the pictures and have you tell them what it is. As they get used to story time, they may even want to “read” to you. You can hand over the book and follow their lead as they narrate the pictures or even just babble as they turn pages.

Starting your child’s library

Thinking about starting a library of good books for your child can feel overwhelming. Luckily, there is a way for you to get a new, age-appropriate book for your child every month.

Dolly Parton’s Imagination Library is dedicated to inspiring a love of reading by gifting books free of charge to children from birth to age five. You can sign your child up at imaginationlibrary.com/usa/affiliate/OHHURON/.

Last week I discussed what pain is and a few benefits of staying as mobile as possible. For my final installment in this series, I shed light on the role of pain management.

Does a pain management plan make a difference?

Medical imaging is closely utilized for developing an appropriate pain management plan. For instance, MRI exams assist doctors in making determinations about the reasons for and the severity of your pain, especially if the pain is located in your spine, hips, shoulders, or knees. In some cases, however, a short course of a non-steroidal anti-inflammatory drug as well as several physical therapy sessions may be recommended before the MRI exam is suggested. In other cases, CAT scans might be a better alternative as well as basic x-ray films.

What’s more, image-guided pain management is a branch of medicine unto itself. In fact, treatment plans initiated by an image-guided pain management doctor can cover multiple medical disciplines in an interconnected and comprehensive way. The goals are aimed at 1.) reducing your pain complaints; 2.) offering non-surgical interventions; and 3.) improving mobility. A referral to a doctor who specializes in this field is important as early as possible to tackle pain-related issues as soon as possible. Yet, consultations are beneficial during any period in the subacute to chronic phase timeline (from 6 weeks to beyond 3 months).

Doctors utilizing image-guidance, such as x-ray or ultrasound technologies, for injections that treat pain will specifically target the source of pain with a precise dose of drug for diagnostic or therapeutic purposes. The imaging technologies make delivery of medications more accurate. Small doses of anesthetics as well as anti-inflammatory steroids are typically used. The steroids calm down the targeted nerves and tissues.

Following an injection, pain management plans may include referrals to exercise specialists and physical therapists to help patients desensitize from their pain and promote mobility. Here again, the information from MRI findings can have important consequences for guiding care. For example, for many people with localized low back pain, the multifidus is a particular muscle that therapists focus on. Pronounced “mul-tif-ə-dus,” this small muscle of the spinal column is responsible for both mobility and support between the column’s bony segments. Here the physical therapy outcome is linked to giving patients time to strengthen their core muscles across the waistline and low back. Simple flexion and flexibility exercises are important.

There are any number of factors that can cause pain for a wide variety of reasons, yet there are also many image-guided, non-surgical procedures that are well-suited for a great treatment plan. Here examples include minimally invasive lumbar decompression and spinal cord stimulation. Even treatments aimed at reducing facial pain, headaches, or the continuance of pain after back surgery as well as joint replacement surgery are possible. Referral to the appropriate image-guided pain physician starts with a visit to your family doctor.

About Kevin

Kevin Wininger, RT(R) is as a radiology technologist and exercise physiologist at Fisher-Titus Medical Center. This editorial is based on several articles he’s written on the treatment of pain. MRI exams, CAT scans, and x-ray films can be useful in helping your doctors and physical therapists develop a treatment plan aimed at reducing your pain and improving your mobility.

Our nervous systems are marvelously complex. For example, signals for acute versus chronic pain pass through specific regions of the spinal cord. For instance, your brain instantaneously knows when you stub your toe because the accompanying pain signals navigate a unique collection of spinal cord nerves called the spinothalamic tract. And the signals for chronic pain, such as dull and ongoing, arthritic low back pain, transmit within defined segments of the spinal cord known as the dorsal column.

Pain is also classified as mechanical, inflammatory, or neuropathic. Mechanical pain is associated with anatomical irritation. This explains why we feel a shooting pain, also called radiating pain, when a herniated disc or bone spur rub against nearby nerve roots. Inflammatory pain is associated with tissue damage, such as injury, arthritis, or post-operative trauma. This type of pain is localized to specific areas. A good example of neuropathic pain is peripheral neuropathy related to diabetes. Also, sometimes a subset of our nervous system called the sympathetic nervous system is out of control.

However, pain is also protective. Imagine taking a casserole dish out of the oven without oven mitts! And the pain that follows a broken arm serves as a reminder to keep your arm stationary so it heals properly. On the other hand, a lack of movement because of the fear of painful injury or reinjury is known as kinesiophobia, such that “kinesio-” means movement and “phobia” means fear. This type of fear can cause someone to think the worst-case scenarios will happen every time they move. But when the time is right, movement is just what the doctor ordered.

How important is mobility?

The main benefit of mobility exercises for patients experiencing inflammatory pain is the improved circulation in their areas of injury. Here the increased blood flow brings more and more nutrients to the cells while washing away cellular by-products which promotes healing. This is especially true after surgeries or trauma, and particularly in the early to subacute phases (up to 3 months since onset).

When pain is chronic, exercises simply help you move better. After all, exercise is medicine and they say practice makes perfect. For people with arthritis, pain levels are typically elevated in the morning and then subside later in the day as a result of being active. However, if arthritic pain returns during the day, gentle stretching and strengthening exercises can diminish the level of severity. In many cases, aquatic exercises are the perfect fit. For instance, the Water Flex classes held at the Ernsthausen Aquatic Center help ease joint pain and muscle aches. Relaxed in their warm-water pool the water’s buoyancy supports you when stretching, and the light resistance is good for walking and other activities that might seem impossible on land.

Next week I explain the role of a pain management program, including image-guided pain management.

About Kevin

Kevin Wininger R.T.(R) is as a radiology technologist and exercise physiologist at Fisher-Titus Medical Center. This editorial is based on several articles he’s written on the treatment of pain. MRI exams, CAT scans, and x-ray films can be useful in helping your doctors and physical therapists develop a treatment plan aimed at reducing your pain and improving your mobility.

World Stroke Day is October 29. Stroke is the number five cause of death and the leading cause of disability in the United States. This World Stroke Day, educate yourself about stroke so you can take steps to prevent it and know how to recognize it in yourself and your loved ones.

What is a Stroke?

Stroke is a disease that affects the arteries leading to and within the brain. There are two types of stroke. An ischemic stroke occurs when a clot obstructs blood flow to the brain. A hemorrhagic stroke occurs when a blood vessel ruptures and prevents blood flow to the brain.

Risk Factors of Stroke

Strokes can happen to anyone at any age. In fact, about one in four people worldwide will have a stroke in their lifetime. However, there are several risk factors that put you at higher risk for having a stroke.

• High Blood Pressure is the number one preventable risk factor for stroke. Normal blood pressure is below 120/80. If you have high blood pressure, work with your doctor to take steps to lower it. Not only will this lower your risk of stroke, it will also help your brain to function better for longer.
• What you eat. A diet high in saturated fat, trans fat, and cholesterol can raise blood cholesterol levels. Diets high in sodium (salt) can increase blood pressure. High-calorie diets can lead to obesity. All of these things can increase your risk of stroke. Eat lots of fruits and vegetable and work with your doctor on creating a healthy diet that can help lower your risk of stroke.
• Diabetes more than doubles your risk of stroke. Every two minutes, an adult with diabetes in the U.S. is hospitalized for stroke. If you have diabetes, you should work closely with your doctor to ensure you are properly managing your condition and reducing your risk of stroke.
• High cholesterol increases the risk of blocked arteries. If an artery leading to the brain becomes blocked or throws a clot, a stroke can occur. Get your cholesterol checked regularly and work with your doctor to make sure it stays under control.
• Smoking damages blood vessels, leading to blockages and stroke. Don’t smoke and avoid second-hand smoke.
• Atrial fibrillation (AFib) is an irregular heartbeat that causes the hearts upper chambers to quiver rather than beating in an organized, rhythmic way. AFib increase the risk of stroke by five times. The fluttering may cause blood to pool and clot then traveling to the brain. If you have AFib, proper management is the key to lowering your risk of stroke.
• Sleep-related breathing issues may increase stroke risk. Seek medical treatment right away if you suspect sleep apnea or a similar problem.

How to Prevent Stroke

Up to 80% of strokes are preventable through changes in lifestyle and proper management of conditions like high blood sugar, cholesterol, and blood pressure. Not only will these changes help reduce your stroke, they can help reduce your risk of other conditions and help you lead an overall healthier lifestyle. Some lifestyle changes you can make are:

• Managing your blood pressure numbers, aiming to keep them under 130/80. Work with your doctor and stick to the medication and lifestyle plan they created with you.
• Eating vitamin-rick fruits and veggies. This can lower blood pressure and improve brain function.
• Swap salty snacks for almonds or fruits.
• Taking regular walks or introducing other physical activity into your routine. This can help lower blood pressure and help you maintain a healthy weight both of which reduce your risk of stroke.
• Get good sleep every night. 7-9 hours of sleep each night can improve your brain function.

How to Recognize a Stroke?

While it’s important to take all these steps to prevent stroke, it’s still important to understand what stroke looks like so you can recognize it in yourself and others should it ever occur. Knowing the common stroke warning signs and what to do someone is having a stroke can be the difference between recovery and disability. The acronym BE FAST can help you remember these signs:

• B – Balance. Is the person suddenly having trouble with balance or coordination?
• E – Eyes. Is the person experiencing suddenly blurred or double vision or a sudden loss of vision in one or both eyes?
• F – Face drooping. Does one side of the face droop or is it numb? Ask the person to smile.
• A – Arm Weakness. Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
• S – Speech Difficulty. Is speech slurred, are they unable to speak, or are they hard to understand? Ask the person to repeat a simple sentence like, “The sky is blue.” Is the sentence repeated correctly?
• T – Time to call 911. If the person shows any of these symptoms, even if the symptoms go away, call 911 and get hem to the hospital immediately.

Stroke Care at Fisher-Titus

Fisher-Titus is a certified Primary Stroke Center through the Healthcare Facilities Accreditation Program. This means that we have the ability to stabilize and treat acute stroke patients, provide acute care, and administer tPA and other acute therapies safely and efficiently.

Additionally, Fisher-Titus received the 2020 American Heart Association/American Stroke Association’s (AHA/ASA) Get with the Guidelines Stroke Gold Plus achievement award. We were also recognized as a recipient of the Target: Stroke Elite Plus Honor Roll with Target: Type 2 Diabetes Award.

Your Primary Care Provider plays a vital role in the care of your health throughout your lifetime. This primary care week, learn more about the importance of a primary care provider.

What is a Primary Care Provider

Your primary care provider is a doctor, nurse practitioner, or physician’s assistant who manages your overall health over time. Your PCP is someone you can develop a trusted relationship with. They get to know you, your history, and your family history and they have the best picture of your overall health.

Primary care providers may work in family medicine, internal medicine, obstetrics and gynecology, or pediatrics.

Here are some examples of things to see your primary care provider for:

• Regular health screening or wellness visits
• Management of chronic conditions
• Something is causing you concern or advice for a health problem
• Fever, cough, sore throat, cold earaches or rashes
• Unexplained weight changes
• Lingering pain
• Prescription refills
• Minor injuries such as sprains, back pain, minor cuts and burns, minor broken bones, or minor eye injuries
• Bladder or urinary tract infections
• Vaccinations
• Migraine headaches

Benefits of a Primary Care Provider

There are many benefits of having a primary care provider including:

• Understanding your history. Your primary care provider has access to all of your medical records as well as your family history. This helps them see the full picture when it comes to your health rather than the snapshot other providers may get from a single visit at an urgent care or emergency room.
• Building a relationship. You get to know your primary care provider throughout your life and come to build a relationship with them. Because you become more comfortable with each other, they are able to better understand your medical situation and you may feel more comfortable bringing issues to them and asking questions you may have.
• Prevention and early detection. Your primary care provider can recommend regular tests and screenings based on your personal and family history. These regular checkups, tests, and screenings with the same provider make it more likely that any potential health issues will be caught early when they are most treatable.
• Condition Management. If you do happen to encounter a more complex health issue, they are crucial in coordinating care. They can refer you to necessary specialists, review all tests, prescriptions, and make sure everyone on your care team is working together. When multiple specialists are working together or you have multiple health challenges, your primary care provider is the link between them all.

Primary Care vs. Convenient Care vs. Emergency Care

There are many circumstances where you may require medical attention but are unable to see your primary care provider. This could be because it is outside of regular office hours or there are no available appointments and you need to care soon. This is where Convenient Care and the Emergency Department come in.

At convenient care, patients can walk in and receive services on a first-come, first-serve basis for minor illness and injury. Typically, the insurance co-pay is the same as a regular office visit. The convenient care provider will follow up with your primary care provider to let him/her know you were seen.

The ER is open 24/7 for any situation where you need immediate medical attention. The Emergency Room provides care for serious, and/or potentially life-threatening medical situations. If you are considering going, you probably should. If it’s a serious emergency, don’t hesitate to call 9-1-1.

When you arrive at the ER, you will be triaged and receive care based on the severity of the situation. You may have to wait a bit longer if there are other patients there with more serious conditions. The ER is also usually costlier than primary care and Convenient Care so it should be reserved for emergency situations where you cannot wait for care.

Convenient Care and the ER are not replacements for Primary Care. After you visit Convenient Care or the Emergency Room, you should still follow up with your Primary Care to talk about your visit and determine if any follow up with them is necessary.

If you don’t currently have a primary care provider, it’s never too late to find one. Fisher-Titus has providers accepting new patients several locations. To find a provider, visit www.fishertitus.org/find-a-physician or call 419- 660-2900.

About Dr. Canfield

Dr. Christina Canfield is a physician with Fisher-Titus Family Medicine in Wakeman and is the Chief Medical Officer of Fisher-Titus Medical Care. She has been practicing in the area since 1994. Fisher-Titus has five Family Medicine locations in New London, Norwalk, Milan, Wakeman, and Willard. For more information, visit fishertitus.org/access.

Sepsis is responsible for more than 270,000 deaths a year in the United States. Although 65% of Americans say they know the word “sepsis,” only 12% can identify the most common symptoms. September is sepsis awareness month. Take the time this month to familiarize yourself with sepsis so you can recognize it yourself and your loved ones.

What is Sepsis?

Sepsis is the body’s overwhelming response to infection or injury. It can lead to tissue damage, organ failure, amputations, and death. Your immune system usually works to fight germs and prevent infection, but sepsis occurs when your immune system stops and turns on itself.

When patients develop a set of signs and symptoms related to sepsis they may be diagnosed with the disease. Sepsis progresses to severe sepsis when in addition to these initial signs and symptoms, the patient shows signs of organ dysfunction such as difficulty breathing, low or no urine output, abnormal liver tests, and changes in mental status. Nearly all patients with severe sepsis will require treatment in an intensive care unit (ICU).

While there is no simple test or cure for sepsis, it can be prevented by preventing infections and can be treated successfully in most cases with early recognition and treatment.

Causes and Risk Factors of Sepsis

Sepsis starts with the presence of an infection. The infection can be viral, bacterial, or fungal or even caused by a parasite. This infection can start anywhere in the body from something as small as a cut or bug bite to a larger infection like pneumonia or meningitis.

Sepsis can affect people of all ages and health levels. However, it is more likely to affect very young children, older adults, people with chronic illnesses, and those with weakened immune systems.

Symptoms

The major symptoms of sepsis can be remembered using the phrase “It’s about time.” Watch for these four things:

T – Temperature that is higher or lower than normal.

I – Infection present or have other signs/symptoms of infection.

M – Mental Decline characterized by confusion, sleepiness, or lethargy/difficult arousing.

E – Extremely Ill including severe pain, discomfort, and shortness of breath

Time is of the essence when it comes to sepsis. The risk of death from sepsis increases by as much as 8% for every hour treatment is delayed.

If you see any combination of these symptoms especially if the person has a recent history of a cut, surgery, invasive procedure, or infection, you should immediately call 911 or go to the nearest hospital and let the caregivers know you are concerned about sepsis.

How to Prevent Sepsis

Sepsis cannot always be prevented but there are steps you can take to prevent or treat infection as quickly as possible and be on the look out for sepsis when infection does occur.

• Get Vaccinated. Vaccinations can protect you from contracting certain viral infections that could lead to sepsis.
• Properly care for open wounds. Cuts, scrapes, or other breaks in the skin can allow harmful bacteria to enter your body. Be sure to always care for these wounds by cleaning them as quickly as possible after injury and keeping them clean, monitor them for signs of an infection (redness, warm to the touch, increased pain, discharge from the wound), and consult a doctor if there are signs of infection.
• Take antibiotics correctly when they are prescribed. When you are prescribed antibiotics, be sure to take them exactly as prescribed. Follow all the directions for use, take them on time, finish the full course even if you feel better sooner, and store the antibiotics as directed.
• Wash your hands frequently. Always practice proper hand hygiene with warm water and soap before eating or handling food, after using the bathroom, after blowing your nose or coughing, after touching pets or other animals, and after being outside the home such as at school or shopping.
• Sound the alarm. If you suspect your or a loved one may have sepsis, see a medical professional immediately or call 911 and say “I am concerned about sepsis.”

About Cyndi

Cyndi Whetstone, RN is a Performance Improvement Specialist at Fisher-Titus and is stroke coordinator at Fisher-Titus. Fisher-Titus is a Certified Primary Stroke Center. For more information about sepsis, visit sepsis.org.

As we enter the second half of the year, you may be thinking about some of the annual appointments you need to check of your yearly to-do list. If you have had Medicare Part B for longer than 12 months you qualify for a yearly wellness visit.

In most cases this visit will be covered with no out-of-pocket cost to you by Medicare. Some additional costs could accrue if your primary care provider feels additional testing is necessary based on your medical history and risk factors.

During your Medicare Annual Wellness visit, your provider will go over several things.

• A review of your medical, surgical, and family history
• Updating a list of your current providers and prescriptions
• Height, weight, blood pressure, and other routine measurements
• Assessment of preventative measures such as ensuring you are up to date on all recommended vaccinations, screening labs, and diagnostic testing
• Personalized health advice
• A list of risk factors and treatment options for you
• Advance care planning (a plan for care you would get if you become unable to speak for yourself)
• Memory testing which will detect early signs of memory issues

All the of the information gathered during the visit will be used to form a personalized care plan that will be updated at each yearly visit.

About Dr. Schwerer

Dr. Kaitlin Schwerer is a physician with Fisher-Titus Family Medicine-Milan. Dr. Schwerer earned her Doctor of Osteopathic Medicine at Ohio University Heritage College of Osteopathic Medicine and is board certified in family medicine. She currently has same-day and next-day appointments available. Call 419-660-2900 to schedule.

My wife, Dr. Vicki Brown, and I have been in practice together for 25 years. I typically have the unique opportunity to provide care for mainly husbands as she cares for their wives—just the way things go in a rural setting.

It has always been fairly known that women tend to manage (or steer) the health care of the family more than men and thus direct the husbands in for appointments when they commonly might not do so otherwise.

Additionally, with social media and so much access to the internet both men and women have a lot more information to sift through both legitimate and not so legitimate about their health care needs.

For these reasons, I do think it is important to highlight men’s health and encourage them to take responsibility/control of their own health and seek assistance from a primary care physician. This men’s health month, take the time to think about your health and whether you are doing everything you can to care for it.

Read the full article on NorwalkOhioNews.com.

Do your kids have energy to spend without their usual outlets like gym class and recess or organized sports? Keeping kids active in the same ways they are accustomed to while participating in school activities is difficult but also important. Whether you’re looking for fun ways to keep your younger kids active or trying to help older kids stay in shape for athletics, here are some ideas for staying active at home.

For Younger Kids

Simon Says Fitness – Simon says “do 5 jumping jacks!” Simon says “run in place!” Turn a game your kids already love into a fun way to be active. Get creative with your prompts and don’t forget to try and trick them with some “Simon didn’t say so!”

Treasure Hunts – This is a game you can play inside or outside to get the kids up and moving. Either hide items around the house or come up with a list of items you know they will be able to find. See who can find the most items or who can find them the quickest.

Bike Rides – With everyone getting stir-crazy, a bike ride is a great way for the family to get out of the house together. In addition to riding around the neighborhood, we are also lucky to have the reservoir and North Coast Inland Trail here in Norwalk as great places to go for a ride.

Obstacle Course – Set up some obstacles around the yard and take turns going through the course. Time yourselves to see who can complete the challenge the fastest and then rearrange the obstacles and try again!

For High School and Junior High School Kids

Yoga – There are lots of online resources for yoga and it’s a great exercise for core strength, balance, and flexibility. Find a video on YouTube you like and you’re ready to go!

Body Weight Exercises – There are many exercises that use your own body weight and require no equipment and you’re probably already familiar with them. Pushups, lunges, reverse lunges, squats, and planks can all easily be done at home.

Jump Rope – Jumping rope is great exercise and the only piece of equipment required—rope—is easy to find. Be sure to jump on a flat surface and remove any obstacle like rocks or sticks. Challenge yourself to see how many jumps you can get in a set amount of time and have fun with the exercise.

Line Jumps – Draw a line with chalk on the driveway or mark it with tape. Make sure wherever you are doing your drills is an even surface to prevent injury. Using the line as your guide, jump in-place or down-the-line jump alternating using both feet or one foot at a time moving forward and backward and side to side. Use the balls of your feet to jump and keep your body weight on the instep and big toe.

About Jake

Jake Rospert, ATC is an Athletic Trainer with Fisher-Titus. Fisher-Titus Athletic Training Services work within Huron County and surrounding area schools to provide athletic training services. For more information, visit fishertitus.org/athletic-training.

Seasonal Affective Disorder is a clinical depression where problematic symptoms occur for longer than two weeks during a season change reoccurring for two years in a row. According to the National Institute of Mental Health, over 10 million Americans are affected yearly. Seasonal Affective Disorder (SAD) is different from the “winter blues” which can be described as a minor period of time where one has less energy, wants to sleep more, and can feel more down than usual.

Have you noticed your mood being impacted by the weather, especially in the Fall and Winter months? Do you notice others around you saying, “Get over it because you should be used to this Ohio weather?” It may actually not be so easy to “get over it” as it  you could be suffering from a medical condition called Seasonal Affective Disorder or commonly known as SAD.

Seasonal Affective Disorder Symptoms

Symptoms of SAD can include being less physically active and engaging in social isolation. When the weather gets colder out and it’s dark outside when people wake up and get off of school or work, it impacts their mindset. People can even demonstrate a weight gain due to finding comfort in foods and not getting out of the house as often as they would in the Spring and Summer months. Some even suffer from physical aches and pains due to the cold weather and “heaviness” of depression. Many people complain of fatigue even though they are sleeping more either by taking more naps or sleeping longer periods of time at night. SAD can cause feelings of hopelessness, guilt, indecisiveness, and criticism towards themselves and others.

The exact reason why Seasonal Affect Disorder impacts some people and not others is not known. However, it is believed that those who have family history of depressive disorders are more likely to be effected by SAD. It is also thought that chemicals in the brain are a huge influencer as the darker days can lead to more melatonin being produced causing fatigue. Additionally, the lack of sunlight causes dysregulation in serotonin levels as well as vitamin D, according to National Institute of Mental Health. Due to these chemical contributors, treatment for SAD can range from supplements or medication to therapy.

How to Fight Seasonal Affective Disorder

There are many things you can do to combat these feelings including becoming more physically and socially active, eating vitamin D enriched foods and taking supplements, or a referral to a mental health specialist for talk therapy and medication management. Light therapy can also be a benefit for many individuals. Being outside for at least 30 minutes can help boost your morale and serotonin levels. If you cannot go outside, then be mindful of where you sit, choosing to sit near windows where you can enjoy the sunlight. You can also invest in a light lamp you can sit under for 30 to 60 minutes a day in intervals. The bright artificial light mimics outdoor light for a period of time to regulate your brain and mood. This technique is so common that even some libraries in bigger cities allow their patrons to check out light lamps along with their books.

If you are concerned that you or a loved one is affected by SAD then you should speak to your doctor to find the best option for you. And keep in mind, Spring is right around the corner!

By: Dr. John Hughes

Men, it’s never too early or too late to start caring about your health. Men die an average of 5 years younger than women and lead 9 out of 10 of the top causes of death. They also have a higher suicide death rate and do not see physicians for a physical exam as often as women.

So, what can you do to stay healthy and prevent disease? Make your annual appointment. June is Men’s Health Month. This month, schedule your annual exam and have a conversation with your doctor about your overall health and wellness.

What to expect at your annual exam

Your annual exam is an opportunity for your doctor to get a snapshot of your overall health. It’s also an opportunity for you to ask any questions and discuss any concerns you may have so make a list before you go to help you remember your questions once you get there. Here are some things your doctor may check during your appointment.

History: Your doctor will ask you questions about your lifestyle and medical history as well as the medical history of your immediate family. They may ask you about smoking, alcohol use, sexual health, diet, and exercise. It’s important that you’re honest with your doctor because this helps them determine your risk for certain diseases and helps create the best plan for keeping you healthy.

Depression: If you’ve felt “down,” sad, or hopeless, and have felt little interest or pleasure in doing things for two weeks straight, talk to your doctor about whether he or she can screen you for depression.

Sexually Transmitted Diseases: Talk to your doctor to see whether you should be screened for sexually transmitted diseases, such as HIV.

Vital signs: Your blood pressure should be less than 120/80 and anything over 140/90 is considered high. A healthy heart rate is typically between 60 and 100 and respiration between 12 and 16 breaths per minute is considered normal. A temperature of 98.6 is average but yours may be slightly higher or lower and still be normal.

Heart: By listening to your heart with a stethoscope, your doctor can hear if you have an irregular heartbeat, a heart murmur, or may hear other clues that can indicate heart disease.

Lungs: Again, using the stethoscope, your doctor will listen for crackles, wheezes, or decreased breath sounds which may indicate lung disease.

Head and Neck:  Your doctor will likely have you open your mouth and say “ah” so he can get a good look at your throat and tonsils. He’ll also look at your teeth and gums as they can indicate other health problems as well. He’ll also probably look in your ears, nose, eyes, check your lymph nodes, and may check your thyroid and carotid arteries.

Abdominal: Your doctor may have you lay down and do a series of exams in order to check liver size, presence of abdominal fluid, listen for bowel sounds, and checking for tenderness.

Neurological exam: Your nerves, muscle strength, reflexes, balance, and mental state may all be assessed.

Skin: The doctor might check your skin and nails as they can be indications of problems or disease.

Arms and Legs: He may check your arms and legs for physical and sensory changes, check your pulse in both the arms and the legs, and examine your joints.

Male physical exam: Your doctor will likely check each testicle for lumps, tenderness, or changes in size. He or she may also examine your genital area for signs of sexually transmitted diseases. He or she will also do a hernia exam to check for weakness in the abdominal wall between the intestines and scrotum. Finally, he may check your prostate size and screen for any abnormalities that could indicate prostate cancer.

Although the thought of going to the doctor may be intimidating and some of the exams performed and questions done can be uncomfortable, it’s important in order to stay healthy. So, don’t shy away from discussing and caring for your health. Make your annual appointment today!

About Dr. Hughes

Dr. John Hughes is a physician with Fisher-Titus Primary Care-Norwalk. To find a primary care physician close to home, visit fishertitus.org/findaprovider or call 419-660-2900 to schedule an appointment.