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Covid 19

Posted by Denise Jones on May 28, 2020 at 1:25 PM

We must stay up to date and protected.


https://covid19.ncdhhs.gov/" target="_blank">https/covid19.ncdhhs.gov/



  • Wear a mask 
  • Wear a cloth face covering.
  • Wait 6 feet apart
  • Wait 6 feet apart. Avoid close contact.
  • Wash your hands
  • Wash your hands often or use hand sanitizer.
  • Stay Safe, Stay Informed


Signs of Heat Stroke

Posted by Denise Jones on July 3, 2019 at 11:30 PM

"Four Things Extreme Heat Does to the Body"- Copied in part from TheWeatherChannel.com

1. Heat Makes You Feel Ill

Some of the first signs that your body is beginning to have trouble due to extremely hot temperatures are increased sweating and muscle cramps.



When you sweat, you are losing water, and if you do not replace the amount you are losing, an imbalance in salt can result, causing cramps.


In addition, if your sweat pores become blocked, a heat rash, or tiny red dots on your skin, can develop. Another issue that can occur is heat edema, which is when your body dilates your blood vessels in order to avoid overheating, and blood can pool in the legs, especially if the balance of salt in your body is off. The end result can be swelling in the legs, feet or hands.


Prolonged exposure to extreme heat can also result in dizziness and confusion. These conditions are also the result of the increased blood flow to dilate the blood vessels combined with loss of fluid through sweating. Fainting can even occur once enough fluid has been lost and if there is a drop in blood flow to the head as more fluid moves into your legs due to gravity.


Other potential physical impacts are nausea, diarrhea, headache and fatigue. These can result when sweating doesn't cool the body enough on its own and when someone is dehydrated.


2. Heat Exhaustion Can Set In

Heat exhaustion can set in when your body is depleted of either water or salt, due to exposure to the heat.


Symptoms of heat exhaustion include:


Dizziness or fainting


Excessive sweating

Dark-colored urine

Cool, pale or clammy skin


Nausea or vomiting

Rapid and weak pulse

Muscle cramps


If you start to exhibit these symptoms, it's very important to get out of the heat, drink nonalcoholic and decaffeinated beverages, take a cool shower and rest.


An even more serious condition is heat stroke, which can develop if heat exhaustion is not treated. The National Weather Service office in Springfield, Missouri, shared some of the differences between heat exhaustion and heat stroke.


Know the difference between heat exhaustion and heat stroke? It can be serious if not deadly! #mowx #kswx #sgf pic.twitter.com/2E897M2XLF


— NWS Springfield (@NWSSpringfield) June 11, 2016

3. Heat Stroke Is A Possibility

Heat stroke is the most serious form of heat injury, according to the Mayo Clinic, and is usually the result of prolonged exposure to or physical exertion in high temperatures. However, the elderly, children under age 4, those living in homes without air conditioners and people with chronic diseases are also at risk for developing heat stroke.


Symptoms of heat stroke include:

  • Body temperature above 103 degrees
  • No sweating
  • Severe headache
  • Confusion or disorientation
  • Red, hot and dry skin
  • Nausea or vomiting
  • Rapid pulse
  • Seizures
  • Loss of consciousness
  • Muscle weakness or cramps

Heat stroke is an emergency that needs immediate medical treatment, as it can cause damage to your brain, heart, kidneys and other muscles. It often occurs from the progression of milder heat-related illness, but can come on suddenly as well.


4. You Could Die

On average, 130 people in the U.S. die from heat each year, according to the National Weather Service, based on data from a 30-year period. This is more than any other weather event.


(MORE: Heat Is The Deadliest Kind Of Weather)



Heat has caused the most deaths on an annual basis during the last 30 years (1986-2015). (NOAA)


Many of these deaths occur during heat waves, which is a period of abnormally and uncomfortably hot and humid weather that can last for several days to weeks.


When temperatures become dangerous varies wildly, based on an individual’s acclimation to the climate, dress, exertion level and whether any pre-existing conditions, such as heart disease, are present, said Michael N. Sawka, Ph.D., a physiologist with Georgia Tech, previously with the Department of Defense, who has studied human adaptations to extreme weather for 40 years.


“If you’re a trained athlete, and you’re working hard, you can go out and run at very high temperatures — 104, 105 [degrees Fahrenheit],” he said. “The harder you work at higher temperatures, you build up a tolerance for the body to respond.”


Sawka explained that the body cools itself in two ways; when these abilities shut down, problems begin.


First, there’s evaporation, when sweat evaporates off of the skin, cooling the body. Second, there’s convection, or a transfer of heat to the skin. During this process, the body shunts blood away from the core toward the surface of the skin for cooling.


“If you’re wearing heavy clothes, that reduces the ability for evaporation,” Sawka said. “Another factor is how hard you’re working. If you’re sitting, you’re not producing more body heat — because a byproduct of skeletal-muscle contraction is heat — so the harder you work, the greater the body heat you have to dissipate due to the environmental conditions.”


When these processes become ineffective, an individual might progress to heat exhaustion. During this phase, heavy sweating, a rapid pulse, cramps or a headache can occur. Typically, once a person seeks shade and water, he or she is fine.


The Centers for Disease Control and Prevention (CDC) and the National Oceanic and Atmospheric Administration (NOAA) offer some tips to stay safe in extreme heat:


  • Stay in air-conditioning as much as possible.
  • Slow down and reduce, eliminate or reschedule strenuous work or recreational activities until the coolest time of the day.
  • Take frequent breaks during work or play.
  • Drink more water than usual.
  • Avoid using the stove or oven to cook.
  • Take cool showers or baths.
  • Wear lightweight and light-colored clothing.
  • Check on friends and neighbors.

Those who exercise outdoors and the elderly should also take care to adapt to heat slowly and plan for safe cooling all season long.


(This entire post is located at www.TheWeatherChannel.com)  

Four Things Extreme Heat Does To Your Body

By Linda LamJune 20 2016 06:45 PM EDTweather.com



Turmeric enhances mood in depression research trial

Posted by Denise Jones on September 26, 2014 at 9:25 AM


Turmeric enhances mood in depression research trial

by Jo Manning

The antidepressant benefits of the Indian spice turmeric have been supported by the results of a trial run by a Murdoch University researcher.


Dr Adrian Lopresti from the School of Psychology and Exercise Science studied the effects of curcumin, the medicinal compound which gives turmeric its distinctive yellow colour, in a randomised, double blind, placebo-controlled study of 56 volunteers with a major depressive disorder. Half were treated with a patented curcumin extract (500mg twice daily) and the other half took a placebo for eight weeks.

From weeks four to eight of the study, Dr Lopresti found that curcumin was significantly more effective than the placebo in improving several mood-related symptoms in the volunteers. The compound had an even greater efficacy in a small subgroup of individuals with atypical depression, which can be characterised by significant weight gain or increased appetite and hypersomnia.

"In animal-based studies curcumin has been consistently shown to have antidepressant effects and it has been hypothesised that curcumin would have antidepressant effects in people with major depression," said Dr Lopresti, who is a clinical psychologist in a private practice.

"There have been a few positive human-based studies investigating the effects of curcumin in depression. However, this is the first randomised, double blind, placebo-controlled study and over the longest duration."

Dr Lopresti said previous studies had found strong links between inflammation in the body and depression and that curcumin influenced several biological mechanisms including inflammation.

"The findings from this study suggest that depression can be treated with an agent that has anti-inflammatory and antioxidant properties," he added.

"Our findings support consistent research that depression is associated with increased inflammation. Despite what has been previously believed, depression is not all about brain chemicals such as serotonin.

"This could be why there were particularly good results in the subgroup of volunteers with atypical depression because this condition is often associated with higher levels of inflammatory proteins."

Dr Lopresti said he hoped to replicate the study with a larger group of participants and over a longer period of time to provide a more robust evaluation of the clinical effectiveness of curcumin.

"It would be useful to investigate whether a higher dose of curcumin will have a greater and more rapid antidepressant effect," he said.

"But although curcumin has several potential health benefits, I would not recommend it as a first line of treatment for depression yet. More research is required."

Explore further: Oral curcumin may protect gut function

More information: "Curcumin for the treatment of major depression: A randomised, double-blind, placebo controlled study," Journal of Affective Disorders Volume 167, Pages 368–375, October 1, 2014 DOI: 10.1016/j.jad.2014.06.001


You may benefit from having a medical student care for you

Posted by Denise Jones on October 4, 2011 at 9:45 PM

You may benefit from having a medical student care for you

Amid the buzz about whether medical students should be sued and the bill currently debated in Arizona (a state which finds itself in the spotlight more than usual these days), I noticed some commentary from several people who do not think they would like a medical student on their case. Sometimes patients do refuse to be cared for by medical students, often due to overestimating the involvement they will have in their care. Indeed, there is an inherent tension between patient safety and the need to train future physicians. However, it is important to recognize there having a medical student caring for you may actually be a blessing in disguise. There are several reasons why you may benefit from having a medical student caring for you  

  1. You will have a complete history and physical on your chart. There is often not enough time for a resident or attending to do a thorough history or physical. Their documentation is not likely to be as complete as a medical student’s. Interestingly, the best friend of every consulting physician is the “medical student H&P” – the history and physical document that details all the major information about a patient’s stay. While patients often report they are ‘repeating’ their story to everyone they see, part of that is due to an incomplete history that necessitate treating physicians to delve a bit more to confirm the diagnosis. Unfortunately, with the advent of electronic health records, medical student histories are sometimes not part of the medical record. However, it does not have to be the case. At one of our community hospitals, our students notes do appear in the system and are able to contribute to the care provided.
  2. Someone will check in on you frequently and have time to listen to your questions. Because medical students don’t often have the caseload of the resident or attending, the student is able to pay more attention to you throughout the day. A third year student may be following only one or two patients at a given time. While it is true that maybe they don’t know all the answers to your questions, they can relay this to your team and often serve an invaluable role.
  3. They may make you feel better. Students are often less burned out and more connected to their patients since they are learning from each of their interactions. I’ve had students who really connect to patients through a variety of ways to help them heal, including reading to them or bringing them their favorite magazines or books so they don’t get bored.
  4. You may get fewer tests. While it may appear that a medical student may be associated with more testing, the truth is that the job of the medical student is often to ‘get old records’ from the outside hospital or the primary care physician. Unfortunately, this is very time consuming and hard to do and it is not easy to “check the record” as patients often ask us to. Maybe this will get better with electronic health records that talk to each other, but in the interim, we rely on our students. Unfortunately, residents do not have time to do this these days with the caseloads they carry. For example, last year, I had a medical student who secured the invaluable bone marrow biopsy on a patient from an outside hospital on a weekend(!) that saved the patient from getting an unnecessary and painful procedure. A few weeks ago, I had a medical student who secured a bevy of rheumatologic and hematologic labs on a patient with a suspected autoimmune process which saved us from having to redraw all of those tests.
  5. A student may actually make the diagnosis. Students are sometimes assigned to the ‘bread and butter’ cases (routine stuff) but are occasionally assigned to the ‘zebra’ – the interesting case that no one can figure out. While students don’t have all the experience that their more seasoned and older residents and attending have, they do have time to look things up and can sometimes make a breakthrough since they keep a wide open list of possibilities. Over the past few years, I can recall several instances in which a patient’s diagnosis was a mystery and a massive workup was ongoing with multiple consultants involved. In two instances, a student offered the correct diagnosis early in the patient’s course and found key literature to secure getting the right test. In another case, a patient who was in the hospital became very concerned about her nail findings (which was her number one complaint) despite having a serious heart infection. After some digging, our student figured out the diagnosis was Muerkhe’s nails, which is a finding associated with low protein, and he was able to reassure her that they would go away as her nutrition improved.

by VINEET ARORA, MD | in PATIENT | no responses


Face to Face Transmittal

Posted by Denise Jones on February 18, 2011 at 7:56 PM

Face to Face Transmittal It doesn't change anything significant, but CMS issued a transmittal yesterday to "clarify" the face to face rule.  You can obtain a copy here.

The transmittal does clarify that it is okay for the physician to dictate the narrative, etc. for the face to face and to his the physician's staff transcribe it.

 The transmittal also states that the physician cannot transmit the information to the HHA for the HHA to then document as part of the certification for the physician to sign.

The transmittal also provides an exception in the case of the death of the patient before the face to face occurs.  The HHA must have made a good faith effort to facilitate the face to face and have met all of the other certification requirements.  In that case, the certification is deemed to be complete.