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By PETER BAUMANN, Reporter, The Laramie Boomerang 
lbedit9@laramieboomerang.com
Laramie native and physician’s assistant Rachel Morrow is now treating patients at [Care United’s] Urgent Care of Laramie.
Morrow said her background as an EMT and nurse makes her a good fit for an Urgent Care setting.“Before I went back to school to become a physician’s assistant, I trained with the Laramie Fire Department. They trained me as an EMT, which is how I got into medicine. Then I went into nursing school, and loved it, but I wanted to do more,” Morrow said.Treating patients, many of whom she’s known for years, in her hometown will allow her to do just that, Morrow said.
“I love working with these people, and I know so many of them. To me, Laramie has a rubber band to it. You leave, but you always get drawn back every time,” she said. “Working at Care United of Laramie, you feel like you get to be a contributor in the community you grew up in.”
Her experience treating patients in emergency rooms also means she is well prepared to treat the types of patients Urgent Care clinics typically see.
“When I was a nurse, I primarily did emergency care, and that’s where I feel like my strongest abilities are,” she said. “So when this opportunity to work at Care United of Laramie came along, I jumped at it.”
Urgent Care of Laramie is not aiming to compete with health care providers already established in Laramie, but to reach those that are not being served, Morrow said, from students to travelers.
“Our role is to help out the other practitioners in town. When they have patients with a cough or cold that have to be seen now, but their schedules are full, we can provide those patients an opportunity to come in and be seen for care that’s urgent but not emergent,” Morrow said. “I just look forward to being able to provide that niche in the community that’s been missing for a long time.”
No appointment is necessary to be treated at Care United’s Urgent Care of Laramie, which is also open weekends. For more information, call 721-1794.
Published January 30, 2011
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If you have ever fallen victim to, or possibly even worse, had to care for someone who was suffering from the never welcome and always uninvited flu bug, then you will definitely be glad to know Care United has your back as we move closer to prime time of this year’s flu season.
For millions of people each year, the flu can bring a runny nose, cough, muscle aches, sore throat, fever, chills, and miserable days spent in bed instead of at work or school. However, you may not realize that it’s estimated that more than 200,000 people end up in the hospital from flu complications each year. And while unpredictable, the flu can be deadly. Between 1976 and 2007, the Center for Disease Control estimates that annual flu-associated deaths in the United States have ranged from a low of about 3,000 people to a high of about 49,000 people.
Flu cases have risen considerably the last two weeks, so now is the time for anyone who has not gotten their flu shot to load the family up and come see us. We are currently offering $10 flu shots at both of our convenient Rockwall and Forney clinic locations while supplies last, and free flu shots at our newest clinic that just opened January 1, 2011 in Laramie, WY.
Flu vaccines are updated each year based on worldwide surveillance to select the three viruses that research indicates are the most likely to cause widespread illness. This year’s seasonal flu vaccine will protect against an H3N2 virus, an influenza B virus and the 2009 H1N1 virus that caused so much illness last season. However, some people might worry about the safety of flu vaccines, or have particular concerns this year because of the 2009 H1N1 component of the vaccine. But this year’s flu vaccines are being made using the same production and safety methods that have been standard for decades, during which hundreds of millions of flu vaccines have been safely given.
During last year’s flu season, a special vaccine was made to protect against the 2009 H1N1 virus because it emerged too late to be included in the seasonal flu vaccine. That vaccine was made using the same production and safety standards as regular flu vaccines and it’s estimated that more than 80 million people in the United States were safely vaccinated against 2009 H1N1. The 2009 H1N1 vaccine had a very similar safety profile to seasonal flu vaccines.
“Stringent vaccine safety processes are followed every year for flu vaccines and the same process was followed for the 2009 H1N1 vaccine. Before flu vaccines are approved, they undergo careful testing, and each batch is checked for purity and strength before it is released,” says Dr. Anne Schuchat, Assistant Surgeon General of the U.S. Public Health Service and CDC’s Director of the National Center for Immunization and Respiratory Diseases. “Seasonal flu vaccines have been given for more than 50 years, and have consistently had a very safe track record.
The most common side effects from flu shots have been soreness, redness, or tenderness where the shot was given; fever; and aches. Some people who have gotten the nasal-spray flu vaccine, in use over the past seven years, have had runny nose, cough, or nasal congestion. Neither the flu shot nor the nasal-spray vaccine can give you the flu.
The Center for Disease Control recommends a three-step approach to fighting the flu: vaccination, everyday preventive actions, and the correct use of antiviral drugs if your doctor recommends them. The influenza virus activity typically peaks in February or March, and as of the week ending Jan 29th, the CDC who also monitors the geographic spread of the virus, identified Texas and every state that shares a border with it, as a region that has seen an increase of widespread infection throughout.
Every year, the CDC works closely with the Food and Drug Administration (FDA), health care providers, state and local health departments, and other partners to ensure the highest safety standards for all flu vaccines. CDC and FDA both share responsibility for monitoring the safety of vaccines and ensuring systems are in place to promptly detect unexpected health problems following vaccination. “Vaccines are medicines, and taking any medicine can carry some risk,” adds Dr. Schuchat. “With the flu vaccine, that risk is extremely small. The risks associated with getting the flu are far greater.”
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Gout, and What to do About It
Gout is a kind of arthritis caused by too much uric acid in the joints. The acid causes joint pain.
If you eat a lot of foods that are rich in purines, you may get gout. Some of these foods are salmon, sardines, liver and herring.You may get gout if you’re overweight, drink alcohol or have high cholesterol. Men have gout more often than women.Some medicines may cause gout, such as certain diuretics (”water pills”), niacin (a B-complex vitamin), aspirin (taken in low doses), cyclosporine and some drugs used to treat cancer.
- What is a gout attack like?
It may be sudden. It usually starts at night, often in the big toe. The joint becomes red, feels hot and hurts. The joint hurts more when you touch it. Other joints may also be affected.
- What should I do if I have a gout attack?
The sooner you get treatment, the sooner the pain will go away. Your doctor can prescribe medicine to stop the joint swelling and pain.You should rest in bed. Putting a hot pad or an ice pack on the joint may ease the pain. Keeping the weight of clothes or bed covers off the joint can also help.With treatment, your gout attack should go away in a few days. You may never have another attack.
- What if I don’t get treatment?
If you don’t get treatment, a gout attack can last for days or even weeks. If you keep having more attacks, more joints will be affected, and the attacks will last longer.If you have gout attacks for many years, you may develop tophi (say: toe-fee). These are soft tissue swellings caused by uric acid crystals. Tophi usually form on the toes, fingers, hands and elbows. You may also get kidney disease or kidney stones. Over time, the bone around a joint may be destroyed.
- What can I do to avoid gout attacks?
Your doctor can prescribe medicines to prevent future gout attacks. These medicines wash the uric acid from your joints, reduce the swelling or keep uric acid from forming.You should lose weight if you need to. If you have high blood pressure or high cholesterol, get treatment and follow a low-salt, low-fat diet.Stay away from alcohol and foods that are high in purines.Drinking lots of water can help flush uric acid from your body.
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What is strep throat?
Strep throat is an infection caused by bacteria.
Adults with strep throat may have a sore throat, a fever and swollen neck glands. They usually don’t have a cough or a runny nose.
Children with strep throat have a sore throat and may have tummy pain or a red rash with small spots. The rash is worse under the arms and in skin creases.
How is strep throat treated?
Your doctor may give you or your child an antibiotic. This medicine can help the sore throat go away a little faster. It can also help prevent a few rare but serious conditions that people with strep throat might get. It is important to take all of the medicine your doctor gives you.
Should all sore throats be treated with antibiotics?
No. Not every sore throat is strep throat. Bacteria only cause about 5 to 10 percent of sore throats. The rest are caused by viruses or other problems, and antibiotics will not help. Your doctor can do a test to make sure it is strep throat.
What tests can tell I have strep throat?
Your doctor may use a test called the rapid strep test. For this test, the doctor uses a long cotton swab to take some material from the back of your throat. The results of this test can be ready in about 15 minutes.
Your doctor may also do a culture of the throat material. A sample of the throat material is sent to a laboratory. This test is called a throat culture. It takes more than 24 hours to learn the results of a strep culture.
The rapid strep test and the culture can tell your doctor if you have strep throat. If something else is causing your sore throat, these tests do not tell what it is.
Can other people catch my strep throat?
Yes. You can give the infection to other people until you have been treated with an antibiotic for 1 to 3 days. Children with strep throat should not go back to school or day care until their fever has gone away and they have taken an antibiotic for at least 24 hours.
What can make my sore throat feel better?
Here are some things that might help:
•Ibuprofen (brand names: Advil, Motrin, Nuprin) or acetaminophen (brand name: Tylenol). Children should not take aspirin.
•Gargling with warm salt water (¼ teaspoon of salt in 1 cup [8 ounces] of warm water)
•For adults and older children, sucking on throat lozenges, hard candy or pieces of ice
•Soft foods, cool drinks or warm liquids, or popsicles
For other articles and updates log on to www.careunited.com
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By J.J. Smith. Royse City resident Lisa Fry had experienced the symptoms of post-partum depression before.
After giving birth to her seven-year-old daughter she frequently had insomnia, felt irritable and overwhelmed, shed many tears, plus had many mood swings but didn’t realize she was experiencing post partum blues while her hormonal changes were settling down.
This time, when she noticed that she wasn’t feeling “right” – three months after the recent birth of her second daughter, Isabella, at Baylor Garland – she wanted to treat the symptoms properly.
“I had it before, after I gave birth to my seven-year-old daughter, but I didn’t know it at the time. This time I wanted to get it handled the right way.”
Since it was Sunday – “the Steelers were playing,” she said – and her doctor was unavailable, she decided to visit the Care United Medical Center which she said she’d seen a hundred times before next to the Rockwall Walmart Supercenter on I-30.
“I didn’t want to spend all day at the doctor,” she explained. “So I decided to try it.”
“They were all so nice. I never felt like I was being judged for being paranoid or something. Dr. Mittal was so helpful and she was so nice. It was the best medical experience I have ever had!”
Now Fry says she’s never going back to a doctor’s office again.
“Every time I go in to Care United they are so eager to help for whatever is wrong. I love that place. I’ll never go back to a doctor’s office again. It’s so quick to get in and out of there, too.”
She said even her seven-year-old daughter is not afraid to go to the doctor at Care United now.
“I’ve gone back to Care United for flu shots and several other minor things. Because I took my daughter and she saw first-hand how well they treated me, she’s not even afraid to go to the doctor there now.”
Rowlett resident and Richland Community College student Jenna Bishop says she also has very positive feelings about the way they treat women at Care United, with locations east of Walmart in Rockwall and in Forney on Old FM 548.
When she recently visited the Rockwall clinic for her annual female exam she said the staff was exceptionally friendly and nice.
“They provide really good customer service,” she explained. “They call and remind you about your prescriptions, plus always call to check up on you after an appointment. Dr. Mittal made me feel really comfortable and provided me with lots of information about needed actions.”
“They are also very affordable for people who don’t have insurance,” she added.
Bishop said, for example, she only paid $62 at the time for a female physical, including an exam by a doctor, pap smear, fasting lipid panel and complete metabolic panel. Care United was offering a special “Giving Back To The Community Tuesday” price in August, valued at $299.
At that time men had only to pay $22 for a physical, including an exam by a physician, PSA test (prostate specific antigen), fasting lipid panel and complete metabolic panel.
Free sports physicals were also offered to students going back to school.
Currently Care United is offering flu shots for just $15, plus providing a special, physician-assisted weight loss program for just $249. Patients may pay $125 down for the first month and the balance at their second month visit.
According to Rockwall clinic medical director Shilpi Mittal M.D, who is board certified in family medicine, the clinic regularly staffs board certified physicians and physician’s assistants to quickly diagnose and treat all minor emergencies, family medicine and occupational medicine.
Treatment includes but is not limited to sprains, cuts and bruises, wound care, fractures, eye injuries, ear infections, sore throats and colds, fevers, asthma, bronchitis, pneumonia, allegies, minor skin rashes, infections, minor burns and sexually-transmitted diseases.
They also have state-of-the-art radiology equipment to assist in the diagnosis of fractures and the presence of foreign bodies.
No appointment is needed and lab services are onsite. Cash, check and credit cards are accepted, including VISA, MasterCard, Discover & American Express.
For more information, visit www.careunited.com or call the Rockwall location at 469-689-0936 or Forney at 972-564-0044.
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Seasons Greetings from Care United Medical Centers! Follow these tips and have a safe and happy holiday season. Your home maybe child and pet safe but the holidays can increase accidents and safety issues. Christmas trees and Hanukkah menorah are beautiful and special, but can also be the cause of choking accidents or fire. With the hustle and bustle of the holidays even the safest of homes can become hazardous and accidents waiting to happen. If you follow these basic holiday celebration and decoration safety tips below small children, pets and the whole household will be safe and healthy.
1. If you want to decorate with real plants like holly, poinsetttia and mistletoe remember they are all poisonous when ingested so make sure they are up high out of reach of children and pets.
2 Only light candles or menorahs when adult supervision is available and keep out of reach of children and pets.
3 Choose decorations carefully. Tinsel strands and angel hair can be very tempting to children and pets.
4 Make sure hot drinks are not left where curious children or pets can reach them or bump into them.
5 Kitchen safety is a must! Especially with large groups gathered in the kitchen. Pot handles have to be turned inward on the stove and dont leave hot pots of food on counter edges which little ones can pull down on theirself.
6 Clean up promptly after a Christmas or Hanukkah party or any family gathering. Pick up all cups of alcoholic beverages and cigarette butts because the kids might sample these forbidden items and maybe share with the pets.
7 Many accidents involving small children happen when everyone thinks someone else is watching the kids. At ALL times a responsible family member or friend should be watching the children.
8 Family pets can be stressed out by large crowds and celebration make sure they have a quiet place to go to rest.
The holidays require extra vigilance, to maintain everyones safety. The result will be a happier more relaxed time for everyone. Please refer to www.careunited.com for many topics. Thank you. From Care United Medical Centers we wish all of you a Happy and Safe Holiday Season!
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It’s all over the television and all over the yogurt section of the grocery store….Probiotics. They are in baby formula, in yogurt, some people are even trying to put them in cereal. While I tend to not believe most of what is advertised on television these days, Probiotics warrant a good conversation.
Let’s start out with some definitions. Webster says that a probiotic is “a preparation containing live bacteria that is taken orally to restore beneficial bacteria to the body”. And this is when the questions start, as well they should. “Wait, you want me to EAT bacteria? Aren’t bacteria bad? Don’t we take antibiotics in order to kill those things?”
The answer to that is that YES, antibiotics DO kill those things, which is a good part of the problem. But that is jumping ahead. Let’s go back to the beginning.
Being healthy is a great deal about balance and the ability to restore balance when things get out of whack. Ideally, the body would always be balanced and would have the immune system capability to fight whatever it came into contact with. Part of what creates that balance is bacteria. We talk all the time about bad bacteria. The kind that causes strep throat and abscesses and pneumonia. But what gets often overlooked is the good bacteria. The kind that keeps the bad bacteria at bay. There are both kinds of bacteria on a body all of the time. As long as there is a balance of good and bad bacteria, and the body’s immune system is working really well, the body can usually (but not always) keep itself running pretty well. This is true on the skin of the body and it’s also true in the GI tract.
The GI tract goes from the mouth to the very end of the rectum. But it’s in the realm of the intestines that probiotics play the most. There is a limited amount of space in the intestines and as long as the good bacteria are in charge of that space, the body can process food well, get the nutrients it needs and inform the immune system of environment germs that were swallowed in order for the immune system to have a “heads up” on fighting them. It’s when the bad bacteria start taking over the space that there are problems. And one of the primary ways that the bad bacteria are allowed to take over is when antibiotics are thrown into the mix.
When a body takes antibiotics, the medicine doesn’t usually only go to the area that is infected (there are a few exceptions to this). The medicine goes all over and kills off all the bacteria it can kill, wherever it is able to get to. This is great because it helps a body get over a sinus infection or a skin infection or an ear infection when it really did need some extra help in order to win the battle against the evil bad bacteria. But sometimes we forget about the areas of our bodies that were okay, but still had a lot of bacteria attacked. Like in our intestines.
Fictional Example: Jennie Smith is a 4 year old girl who is complaining of ear pain to her mom for 3 days. Mom did great, gave her ibuprofen and tylenol, but Jennie is running a little bit of a fever and is still complaining that her right ear is very sore. She went to Care United and a nice PA or doctor looked in her ear and said “Jennie, your ear is really really red!” and Jennie got a prescription for an antibiotic to help her body kill off all the ear infection bacteria. Jennie was very good and took all of her antibiotics just like the Dr. or PA said to. But then, Jennie started having diarrhea and Jennie’s mom was kind of concerned. Did Jennie have a stomach bug? Did she have another infection? Does this mean that she is allergic to that medicine?
Jennie got an antibiotic that helped her body fight that nasty ear infection, but the antibiotic also killed a lot of the good bacteria that lived in Jennie’s intestines. When that happened, the bad bacteria grew much faster than the good bacteria and didn’t leave the good bacteria much space to grow at all. This made Jennie’s intestines not be able to process her food as well, and also made them kind of irritated. And that is why Jennie ended up with diarrhea. She didn’t have an allergy to the medicine, because the medicine did what it was supposed to - kill all the bacteria. But she did have a common side effect of antibiotics.
So now we are in a perfect position to talk about probiotics. Probiotics are all the “good bacteria” that live in the intestines. There have been a good handful of studies in the recent years that have shown that people who get sick more often tend to have lower numbers of good bacteria in their intestines, that people who have very regular bowel movements tend to have more good bacteria and even that in asthmatic children who increased the amount of probiotics they ate, they had to use their inhaler’s less. Crazy, right?
It gets a little complicated when we talk about exactly how probiotics mak a difference all over the body, but the main idea is that they help the body be more healthy and when your body is more healthy and balanced, then it can better fight all the germs in the environment (be it allergens, viruses, mold or bad bacteria).
So the next question is “How do I get these good bacteria?” “Are they all the same?”
Probiotics are found in almost all yogurt. Some yogurt advertises that they put more in than other yogurts, and that’s all fine, but most of the time the good-for-you-yogurts (meaning no Trix or Disney Pricess or Chocolate chip yogurts) have probiotics in them. The less processed, the less sugar and the more ‘natural’ the yogurt, the more probiotics it will likely have, whch is a good thing.
Another good source of probiotics is Keifer. For those unfamiliar, Keifer is kind of like a yogurt-ie smoothie, usually fruity, that you can buy at the store. it comes in good flavors and tastes a lot like yogurt.
A not so good source of probiotics is cereal. Because you get very little that way, because your stomach bathes it all in acid before it lets the cereal move on, this is just not that good of a source.
If yogurt is not a practical option or someone would want a big dose of these good bacteria (say, if someone was going on antibiotics), then they also come in capsules. The important part about shopping for capsule probiotics is to make sure of two things: 1. That the capsules are “enteric coated”. This will make sure that the most good bacteria make it to the intestines. 2. That you check whether they need to be refrigerated or not. Some do and some do not and either way it is important to know or to ask someone. These capsule options can be found at any health food store, Whole Foods, Central Market, etc. You can look at Target/WalMart, but just be sure to keep in mind the two things :).
Probiotics are by no means the answer to all problems and are not a miracle drug, but they are just one more tool to know about to help keep ourselves and our children healthy and strong.
Jessica Z. PA-C
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Did you know? Influenza causes more than 200,000 people in the U.S. to be hospitalized every year. About 36,000 die from flu-related causes. Prevention is key.
When to get Vaccinated?Yearly flu vaccination should begin in September or as soon as vaccine is available and continue throughout the influenza season, into December, January, and beyond. This is because the timing and duration of influenza seasons vary.
Who should get vaccinated?everyone 6 months and older should get a flu vaccine each year starting with the 2010-2011 influenza season.
Who should not get vaccinated?
* People who have a severe allergy to chicken eggs.
* People who have had a severe reaction to an influenza vaccination.
* People who developed Guillain-Barré syndrome (GBS) within 6 weeks of getting an influenza vaccine.
* Children less than 6 months of age (influenza vaccine is not approved for this age group), and
* People who have a moderate-to-severe illness with a fever (they should wait until they recover to get vaccinated.)
Afraid of shots?
You can get the nasal flu mist instead.Nasal-spray flu vaccine is always an option for healthy* people 2-49 years of age who are not pregnant.
Will I have to get two flu vaccines again this season?
No. Only one flu vaccine is being made this year and most people will only need to get vaccinated once. There is one exception to this: CDC recommends that children aged 6 months through 8 years of age who have never received a seasonal flu
vaccine get two doses of vaccine spaced at least 4 weeks apart.
What is Fluzone High-Dose influenza vaccine?
Fluzone High-Dose is a new influenza vaccine, manufactured by Sanofi Pasteur Inc., designed specifically for people 65 years and older. Fluzone High-Dose vaccines contain 4 times the amount of antigen in regular flu shots.A higher dose of antigen in the vaccine is supposed to give older people a better immune response and therefore better protection against flu.
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WHAT IS AN EAR INFECTION?
Ear infection is also known as acute otitis media (otitis = ear, media = middle). Otitis media is an infection of the middle section of the ear.Ear infections often develop after a viral infection, such as a cold or the flu. These infections can cause swelling and fluid build-up in the space behind the eardrum (the middle ear). This fluid build-up (called an effusion) can trap bacteria and viruses and increase pressure on the eardrum .The increased pressure causes the eardrum to bulge, leading to the typical ear infection symptoms
EAR INFECTION SYMPTOMS
Symptoms of an ear infection in adolescents and older children include ear aching or pain and temporary hearing loss. These symptoms usually come on suddenly.In infants and young children, symptoms of an ear infection can include:Fever (temperature greater than 100.4ºF or 38ºC, pulling on the ear,fussiness,decreased activity,lack of appetite or difficulty eating,vomiting or diarrhea.
EAR INFECTION DIAGNOSIS
If you suspect that your child has an ear infection, call your doctor or nurse to see if and when the child should be examined.Although the exam is not painful, most infants and children do not like having their ears examined. To make the process easier, hold your child in your lap and hug your child’s arms and body while the doctor or nurse uses an instrument (otoscope) to look inside the child’s ear.
It can be hard to tell for sure if a child has an ear infection. When the clinician is able to see clearly inside the ear and sees all of the typical features of ear infection, the diagnosis is certain. When all of the typical features are not present, the diagnosis is less certain. In this case, the doctor/nurse will work with you to decide what treatment is best.
EAR INFECTION TREATMENT
Treatment of an ear infection may include:Antibiotics,medicines to treat pain and fever,observation. The “best” treatment depends on the child’s age, history of previous infections, and any underlying medical problems. Antibiotics may or may not be used to treat your child’s ear infection.
- Antibiotics are usually given to infants who are younger than 24 months
- Children who are older than 24 months may be treated with an antibiotic or may be able to delay treatment Antibiotics are not given to every child with an ear infection because studies show that many older children with ear infections improve without using antibiotics. Antibiotics can have side effects, and overusing antibiotics can lead to resistant bacteria. Resistance means that a particular antibiotic no longer works or that higher doses are needed next time.
Observation — In some cases, your child’s doctor or nurse will recommend that you watch your child at home before starting antibiotics; this is called observation. Observation can help to determine whether antibiotics are needed.
Observation may be recommended in these situations:If it is not clear whether the child has an ear infection, based upon the exam,If the child is older than 24 months,if ear pain and fever are not severe,if the child is otherwise healthy.You can give pain-relieving medicines during observation to ease pain.If your child is being observed rather than treated with antibiotics, you will need to call or go back to the doctor or nurse’s office after 24 hours for follow-up. If your child’s pain or fever continues or worsens, antibiotics are usually recommended; observation may continue if the child is improving.
Pain management — Pain-relieving medicines, including ibuprofen (Motrin®), acetaminophen (Tylenol®), or ear drops, such as Auralgan®, which contain a numbing medicine, may be used to reduce discomfort.
Complementary and alternative medical treatments — There are a wide variety of complementary and alternative medical (CAM) treatments advertised to treat ear infections. These may include homeopathic, naturopathic, chiropractic, and acupuncture treatments.However, there are few scientific studies of CAM treatments for ear infection, and even fewer studies that show CAM treatments to be effective. As a result, these treatments are not recommended for ear infections in children.
Decongestants and antihistamines — Cough and cold medicines (which usually include a decongestant or antihistamine) have not been proven to speed healing or reduce complications of ear infections in children. In addition, these treatments have side effects that can be dangerous. Neither decongestants nor antihistamines are recommended for children with ear infections.
Follow-up — After starting antibiotics, your child’s symptoms should improve within 24 to 48 hours. If your child does not improve after 48 hours or gets worse, call your doctor or nurse for advice. Although fever and discomfort may continue after starting antibiotics, the child should get a little better every day.
Children who are younger than two years and those who have language or learning problems should have a follow-up ear exam two to three months after being treated for an ear infection. These children are at risk for delays in learning to speak. This follow-up helps to ensure that the fluid collection (which can affect hearing) has resolved.
EAR INFECTION COMPLICATIONS
Tympanic membrane rupture — One possible complication of an ear infection is rupture of a piece of tissue in the middle ear known as the tympanic membrane. The tympanic membrane can rupture when fluid presses on the membrane, reducing blood flow and causing the tissue to weaken. It does not hurt when the membrane ruptures, and many people actually feel better because pressure is released. Fortunately, the tympanic membrane usually heals quickly after rupturing, within hours to days.
Hearing loss — The fluid that collects behind the eardrum (called an effusion) can persist for weeks to months after the pain of an ear infection resolves. An effusion causes trouble hearing, which is usually temporary. If the fluid persists, however, it can interfere with the process of learning to speak.
Effusions usually resolve without any treatment. However, if the effusion persists, the child may need treatment. The decision to treat is based upon how much the effusion affects the child’s hearing and the child’s risk of speech problems.
Children who are not treated for an effusion should be monitored over time. This includes an ear exam and hearing testing every three to six months until the effusion goes away.
Treatment — The best treatment for an effusion that does not resolve is a surgical procedure. During the procedure, fluid is drained from the middle ear by making a small opening in the tympanic membrane (called myringotomy) and placing a tube to maintain the opening (called a tympanostomy tube) .This procedure usually is performed by an ear, nose, and throat surgeon in a hospital while the child is under general anesthesia.
The benefit of surgery is improved hearing. The risks of surgery include a small chance of damage to the tympanic membrane.
EAR INFECTION PREVENTION
Some children develop ear infections frequently. Recurrent ear infections are defined as three or more infections in three months, or four or more infections within 12 months. Several treatments can help reduce the risk of recurrent infections, including continuous antibiotics and surgical placement of tubes in the ears.
Some of the vaccines included in the routine childhood vaccine schedule (such as the pneumococcal conjugate vaccine and influenza vaccine) may help to reduce the frequency of ear infections.
Preventive antibiotics — Children who have recurrent ear infections are sometimes treated with a preventive regimen of a daily antibiotic during the fall, winter, and early spring months. Although preventive antibiotics might help reduce the number of ear infections, it is still possible for the child to get an infection. There is also a risk that taking antibiotics for a long period of time can lead to bacteria that are resistant to standard antibiotics. Talk to your child’s doctor or nurse about the potential benefits and risks of this approach.
Surgery — Some studies show that having surgery to place tympanostomy tubes in the ears helps to prevent recurrent ear infections. Other studies show no benefit of tympanostomy tubes ]. Talk to your child’s doctor about the risks and benefits of surgery.
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Typically, when we see patients at the clinic with sore throats, strep is everyone’s first concern. While strep is a common cause of sore throats, infectious mononucleosis is another frequent cause of sore throats. Infectious mononucleosis, sometimes called the “kissing disease” is an infection caused by the Epstein-Barr Virus. The Epstein-Barr virus does occur world-wide, and it is believed that as many as 95% of adults in the US, between the ages of 35-40, have actually been infected. Infants and children are typically least affected. If children do develop symptoms, they are typically mild enough not to cause parents to seek medical attention. When the virus infects adolescence or adults, it causes infectious mononucleosis about 35-50% of the time.
The triad of symptoms for infectious mononucleosis is fever, sore throat and swollen lymph nodes. Symptoms of fatigue are frequently present with mono and can last longer than would be expected with other viral infections. This is also a risk of the spleen becoming enlarged during an active mono infection. Patients suffering from mono are advised to avoid any contact sports for 4-6 wks, for fear a hit to the abdomen could cause a splenic rupture, which would be life threatening. Complete resolution of symptoms is expected within 2 months, but most recover much sooner.
Infectious mononucleosis is a viral infection so there is no need for antibiotic therapy, the body will fight the infection on its own. Supportive therapy is beneficial in decreasing symptoms. Supportive therapy includes anti-inflammatory medicines such as ibuprofen to help with the pain. In cases with moderate to severe tonsillar or pharyngeal swelling, prednisone may be prescribed also.
Infectious mononucleosis gets its nickname, “the kissing disease” because it transmitted through saliva. Normally, the virus is not transferred by blood or through the air. Once someone has been exposed to the virus, there is typically a 4 to 6 week incubation period to onset of symptoms. Mono is contagious for several weeks, but there is generally not a need for special precautions or isolation. Infected persons should simply not eat or drink after anyone nor allow anyone to eat or drink after them, and they should avoid any activity that would transfer saliva, such as kissing.
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