But it's so itchy!!

If you’re anything like me, the mosquitoes love you! It’s always nice to be popular, but in this case, I’d rather be a wallflower. I made the mistake of stepping outside for about ten minutes a couple evenings ago and, well, here’s the result:

Being that we’re a medical clinic, there are a lot of people here who tell me to stop scratching! So what in the world can you do when you’re covered in itchy mosquito bites and you can’t scratch?????

Please note that this is not meant as medical advice. If you’re not sure what to do, contact your doctor, or come see us.

First, the best defense is a good offense, right? So invest in a good insect repellant and apply according to the manufacturer's directions. Did you know some need to be applied more often than others? If you prefer to avoid the chemicals in many bug sprays, there are options like citronella, peppermint oil or even garlic oil. Consult with an expert, however, before you try applying essential oils to your skin. Some essential oils can be concentrated enough to burn or even blister your skin if used incorrectly.

If you’ve been bitten, here’s where your self control needs to kick in. Wash off the effected areas as soon as possible, using mild soap and cool water. Pat it dry with a towel rather than rubbing. The reason it itches is because the mosquito has injected you with an anticoagulant (to drink more of your delicious blood) and your body is fighting its and having a minor allergic reaction.

For minor bites like these, a paste made of a teaspoon of baking soda mixed with a few drops of water and apply it gently. Or another option is to apply some vinegar to the bite.   Scratching, though it may feel good for a little while, can actually make the bite worse and make it last longer.

Here in the US, the risk of catching a serious disease from a mosquito bite is low, but you should seek medical help if you’re having a severe allergic reaction, like a racing heartbeat, difficulty breathing and severe swelling. If you’ve scratched your bites and they have become infected, that’s when it’s a good idea to see your doctor.

http://www.skeeterbite.info/article_10.html

http://www.globalhealingcenter.com/natural-health/mosquito-bites/

http://voices.yahoo.com/how-easily-treat-mosquito-bite-naturally-stop-6650586.html?cat=5

http://mosquitobitetreatment.org/hello-world/

Group B Strep Awareness

It’s July, and that means summer fun, 100-degree+ heat and (if you’re lucky) water slides! It also means it’s International Group B Strep Awareness month, which is a very common but little-known (apart from mommies and doctors) bacteria that effects babies in utero, newborns and babies up to six months old.
Huh? What is that, and why have I never heard of it?
GBS (Group B Streptococcus), or Streptococcus agalactiae--not strep throat--is a type of bacteria that can potentially effect babies as they pass through the birth canal or when the mother’s water breaks. Though up to 25% of women have this naturally-occurring bacteria in their digestive tract and/or birth canal, few babies who are exposed become ill.

However, that illness can be severe, such as meningitis, pneumonia or a permanent handicap like blindness, deafness or cerebral palsy. In some cases, GBS has caused stillbirth or miscarriage.
It’s a good idea to get tested for GBS before your baby is born (even if you’ve been tested on a previous pregnancy, that doesn’t mean you don’t currently have GBS living in your system). There are little to no symptoms associated with GBS for the mother, with the most common being yeast-infection-like symptoms or even a bladder infection. If your doctor suspects GBS when you are pregnant and have a bladder infection, they will likely perform a urine culture apart from the routine urine tests performed on all pregnant women. In the US it’s now standard practice for GBS testing to be part of your routine prenatal testing. If you test positive for GBS, you may be placed on IV antibiotics when you go into labor. Just four hours of IV antibiotics given to the mother in labor can prevent up to 90% of newborn GBS infections. Taking these prior to the onset of labor won’t help much, as the bacteria can grow back very quickly.
Just a side note: testing positive for GBS does not mean you’ve done anything wrong during your pregnancy, or are unclean. GBS can live in just about anyone.
Now your beautiful baby has been born, and you want to provide them the absolute best in care. There are some strategies you can follow to avoid infecting your baby (not just with GBS; some of these are common-sense guidelines to protect against bacteria in general)

• Everyone, yourself included, needs to wash their hands before handling your baby. Antiseptic wipes won’t cut it--get out the soap and water.
• If you’re able to breastfeed, it’s a great choice to supply your little one with antibodies to help fight infection.
• Make sure everyone who takes care of your baby knows the symptoms of GBS infection in babies and how to respond.

Most cases of GSB will start in the first few hours after birth. Symptoms may include:

• High-pitched cry, shrill moaning, whimpering
• Constant grunting as if constipated
• Projectile vomiting
• Sleeping too much, difficulty being aroused
• High or low or unstable temperature; hands and feet may still feel cold even with a fever
• Blotchy, red, or tender skin
• Blue, gray, or pale skin due to lack of oxygen
• Fast, slow, or difficult breathing
• Body stiffening, uncontrollable jerking
• Listless, floppy, or not moving an arm or leg
• Tense or bulgy spot on top of head
• Blank stare
• Infection (pus/red skin) at base of umbilical cord or in puncture on head from internal fetal monitor
• Problems with temperature regulation
• Grunting sounds
• Fever
• Seizures
• Breathing problems
• Stiffness or extreme limpness

Of course, if you have questions about GSB it's a good idea to ask your doctor! If you'd like to read more, check out these useful sites. There's even a Facebook page:

http://www.groupbstrepinternational.org
http://www.groupbstrepinternational.org/gbs-articles/
http://www.drum.amedd.army.mil/news/2010/0710/Strep_Awareness.htm
https://www.facebook.com/GroupBStrepInternational
http://sites.conversionplanet.com/group-b-strep-awareness
http://en.wikipedia.org/wiki/Group_B_streptococcal_infection
http://groo.com/newgbsi/wp-content/uploads/2012/12/GBS_Awareness_brochure.pdf
http://www.cdc.gov/groupbstrep/index.html
http://www.strepb.ca/
http://www.aap.org/ 

Why is my child limping?

You’re wor­ried about your child. They’ve been wak­ing up com­plain­ing their knee hurts, or you notice their fin­gers seem swollen, but they can’t remem­ber hurt­ing them­selves. Maybe they’ve been limp­ing a lit­tle in the morn­ing, or they seem to have a mild flu with a  pink­ish rash that comes and goes. What could be happening?

All of these are symp­toms of Juve­nile Arthri­tis, which effects more than 250,000 chil­dren under the age of 18 in the US alone. If your child has swollen, ten­der joints that last for more than six weeks, he/she could be among their num­ber. Com­monly, the knees, hands and feet will be the most effected, though some­times chil­dren with JA can also have inflamed eyes.

Diag­no­sis comes at the end of exten­sive test­ing per­formed by a juve­nile rheuma­tol­o­gist, who will exclude other con­di­tions through imag­ing, lab work and phys­i­cals before diag­nos­ing your child with arthri­tis. Most forms of arthri­tis are known as autoim­mune dis­or­ders, where the body’s own immune sys­tem attacks its own healthy tis­sues, caus­ing swelling, sore­ness and stiff­ness in joints and the sur­round­ing mus­cles and sup­port­ing tendons/ligaments. The result­ing inflam­ma­tion can dam­age the joints.

Some­times the dam­age done to joints can effect a child’s growth, caus­ing one leg or arm to grow longer than the other, or even slow­ing the child’s over­all growth.

Unfor­tu­nately, there is no cure for Juve­nile Arthri­tis. It’s con­sid­ered a chronic con­di­tion that will require care and treat­ment with exer­cise, phys­i­cal ther­apy and pos­si­bly med­ica­tion. Since every child is dif­fer­ent, there is no one right treat­ment plan for every­one. Your child’s doc­tors will work with you to come up with an indi­vid­ual plan that works for your child. Some chil­dren will have one or two flare-ups of arthri­tis and never suf­fer again, while oth­ers may have to deal with it on a day-to-day basis.

Some doc­tors may pre­scribe med­ica­tion right away, while oth­ers will advise treat­ment dur­ing flare-ups like swim­ming, which allows the child to exer­cise and move their joints with­out putting pres­sure on them. It’s impor­tant to sup­port your child not only with their phys­i­cal but also their men­tal needs to sup­port them through JA.

There are a lot of great resources avail­able to learn more about Juve­nile Arthri­tis online. We rec­om­mend the fol­low­ing sites for more detailed info:

http://www.arthritis.org/conditions-treatments/disease-center/juvenile–arthritis/

http://www.niams.nih.gov/Health_Info/Juv_Arthritis/

http://www.mayoclinic.com/health/juvenile-rheumatoid-arthritis/DS00018

http://orthoinfo.aaos.org/topic.cfm?topic=a00075

http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/juvenilearthritis.asp

http://www.findarthritistreatment.com/five-common-symptoms-of-juvenile-arthritis/

http://www.aaos.org

http://www.rheumatology.org

http://www.arthritis.org

http://www.kotb.com

https://www.carragroup.org

www.arthritis.org

www.arthritis.org/ja-article.php?id=15

www.niams.nih.gov

www.rheumatology.org/Foundation

Photo credit: danieljohn­sonjr / Foter / CC BY-NC-SA

Photo credit: Lau­ren Grace Pic­ture Place / Foter / CC BY-NC

Have a safe and happy 4th!

We're working today 8-8 in case you need help. Walk in to either location or check in online and we'll txt you when it's your turn!

Allergies or strep?

It’s sum­mer time here in San Anto­nio, and while that means soar­ing tem­per­a­tures and kids out of school, it’s also allergy sea­son. We’ve writ­ten before about what causes aller­gies and some ways to com­bat them, so I won’t go into too much detail about that here. What’s con­cern­ing is that we’re start­ing to see some cases of strep throat mixed in among peo­ple com­ing in for their allergies.

You can mud­dle through allergies on your own (or we can help you if you’re really mis­er­able), but strep needs extra attention.

How can you tell if you have strep or just bad allergies?

Strep

• Sud­den sore throat
• Sore throat and tonsils
• Painful swal­low­ing
• Ten­der, enlarged cer­vi­cal nodes
• White exu­dates on tonsils
• Fever
• Headache
• Occa­sion­ally nausea/loss of appetite or abdom­i­nal pain
• Occa­sion­ally a rash 12–48 hours after onset of symptoms
• Usu­ally no res­pi­ra­tory or nasal symptoms

 Allergies

• Usu­ally pro­longed dura­tion of illness
• Runny nose
• Sneez­ing
• Itchy, watery eyes
• Nasal dis­charge
• Recurs at a par­tic­u­lar sea­son or with expo­sure to allergen
• Occa­sion­ally cough, hoarse­ness, sore throat (from drainage)

Here at Impact Urgent Care, we have rapid strep tests avail­able that can con­firm our doctor’s find­ings if we believe you have strep. Then, we can pre­scribe antibi­otics and other med­ica­tions if they’re needed. Untreated strep can leave you sus­cep­ti­ble to nas­tier dis­eases, and it’s not a good idea to see if it’ll clear up on its own.

Even if it’s just a sum­mer cold or bad aller­gies, we can help you feel better.

Try out our new online check in sys­tem to beat the crowds. Just look for this

 in the upper right cor­ner of our web­site, and you’ll be auto­mat­i­cally placed in our queue. You can wait at home or any­where you please once you’re checked in online, and our new sys­tem will txt you when it’s your turn!

Struggling to speak: a personal view of Spasmodic Dysphonia

This week we take a look at a rare vocal disorder called Spasmodic Dysphonia. It can greatly effect your vocal cords, resulting in a strangled-sounding or hoarse voice. For some, it seems like they have lost their voice. It can be treated with a combination of speech therapy and Botox, but there is currently no cure.

My name is Mark and I am 36 years old. I have always relied heavily on my communication and people skills to get me ahead of everybody else. I never would have thought that I would struggle with something everybody takes for granted.

I can’t pinpoint the exact moment where my life changed but I know for a fact that it happened in early 2006 while I was working for the San Antonio Express News in their call center as a Customer Service Representative. I was struggling to speak and was hesitating with certain words and phrases. It was extremely embarrassing!

I kept asking myself: Why is this happening? Will it ever go away? Will I lose my voice? Could it be stress related? Is it psychological?

There were certain words and letters that I really struggled with. The letter “h” was the hardest for me and to this day still is. The opening phrase at the San Antonio Express News was: “Thank you for calling the San Antonio Express News, this is Mark, how can I help you?” Two “h” words! So, I changed this to: “Thank you for calling the San Antonio Express News, this is Mark, what can I do for you?” A simple change but this really helped me on the phones.

Despite my speech issues, I never got any complaints or questions from customers or co-workers who couldn’t understand me. I thought it would eventually go away, but it never did. It was getting more difficult every day for me to speak clearly and be understood and I was embarrassed.

On May 1, 2006, I saw Dr. Yvonne Page, a Speech Language Pathologist.

As I soon started talking, Dr. Page knew exactly what I had. She asked me a lot of questions trying to pinpoint my problems and took a lot of notes. She eventually had me read these phrases: “Early one morning, a man and a woman were ambling along a 1-mile lane, running near Rainy Island Avenue” and "He saw half a shape mystically cross a simple path, at least 50 or 60 steps in front of his sister Kathy's house."

I read the first with ease but really struggled with the second sentence.

Dr. Page referred me to Dr. Blake Simpson, an Otolaryngologist, who works at the University of Texas Health Science Center. He would be able to get a better look at my vocal cords and verify my speech problems.

Dr. Simpson also wanted me to read those phrases. With the second phrase, it felt as if I forgot how to read. I couldn’t even say the word “house.” My mouth opened but nothing came out. It took a few seconds for the word “house” to finally come out and it didn’t sound good at all. By using a fiber optic Laryngoscopy, Dr. Simpson showed me what was happening with my vocal cords.

In May of 2006, I was officially diagnosed with a rare voice disorder called Abductor Spasmodic Dysphonia. According to the Dysphonia website:

Spasmodic dysphonia (SD), a focal form of Dystonia, is a neurological voice disorder that involves involuntary "spasms" of the vocal cords causing interruptions of speech and affecting the voice quality. SD can cause the voice to break up or to have a tight, strained, or strangled quality. There is no cure. It is treatable by speech therapy and Botox injections in the vocal cords.

I started speech therapy with Dr. Page immediately after I was diagnosed. Our sessions were weekly for 12 weeks. For the first four weeks, we met twice a week. I was very lucky that my work schedule allowed me to have two consecutive days off during the week. Otherwise, I would have had to use all of my sick and vacation time.

We did a lot of breathing and relaxation exercises. We worked on the voiceless sounds. Every few weeks we would try words that began with the letter “h.” Dr. Page wanted me to have a soft voice; no yelling or talking loud on the phones. She had software that measured how loud my voice was and how much roughness I had. It was really interesting to see these changes before, during, and after a session. I was also able to hear my voice; it was good sometimes, bad sometimes, and sometimes just plain laughable!

I was relieved that the Speech Language Pathologist knew what I had as soon as I started talking.  Unlike other people I have met with Spasmodic Dysphonia, I didn't have to wait months or years and see several other doctors to get the correct diagnosis.  After lots of research, talking with Dr. Page and Dr. Simpson, and consulting with my parents, I decided to try the Botox injections. I was aware there could be side effects. But I was ready to take the plunge.

On August 14, 2006, I was in the waiting room at University Hospital in San Antonio, Texas. I was extremely nervous.  My mother came with me and her support really helped me get thru the anticipation of getting my first Botox injection.

Dr. Simpson sprayed my nose to numb it.  It didn't taste like anything, but it really made my nose runny!!  He then inserted a needle into my neck to numb it.  The numbing medication tasted really gross and made me cough a lot; but that means the numbing was working.  A Neurologist, Dr. Carlayne Jackson, put some sensors on my stomach; this helps locate the proper spot for injection.  A resident from the hospital was also in the room and he was the one who inserted the fiber optic Laryngoscope from my nose to my vocal cords.

I coughed a few times and said the letter "E" for a few seconds.  I even read these phrases again “Early one morning, a man and a woman were ambling along a 1-mile lane, running near Rainy Island Avenue” and "He saw half a shape mystically cross a simple path, at least 50 or 60 steps in front of his sister Kathy's house."  

Dr's. Simpson and Jackson located the correct spot for a unilateral injection and I didn't even feel the Botox. Wow!  Afterwards, I was coughing a lot, had some discomfort in swallowing, and my voice was very strained.  But, those side effects wore off quickly and I was very glad.

I went back for my 2nd Botox injection on October 23, 2006. I was more eager this time and was looking forward to how my voice would fare. It was the same procedure for the treatment. I had the same side effects but again they vanished quickly.

Since my diagnosis, I have had 17 Botox injections and I am getting fantastic results and do notice a HUGE difference in my voice.   I always have the discomfort in swallowing, a strained voice, and lots of coughing.  But, they go away quicker each time.  My last 3 Botox injections have lasted about 6 months. I will probably schedule another Botox injection toward the end of the year.  Each injection I get lasts longer than the previous.

If you heard me talk, you probably wouldn't even know I have any issues.  I do struggle at work occasionally but nobody notices it. I am kinda curious to see how my voice would do without Botox?

I made my first podcast to share recently.  I gotta admit, I was extremely nervous when I recorded this last night in my car on the way home from work.  Yes, my recording studio was my car; hey, it was quiet and nobody bothered me.

At least I thought it was quiet...when I replayed it afterwards, I heard my keys jiggling and my turn signal clicking.  Next time, I will unhook the car key from the miscellaneous keys and find a straight path to nowhere in particular.  Other than that, I am very excited  to debut my voice and hope you enjoy it.

This post was reproduced with permission from Mark at mdlblog.com. 

Children's Mental Health Awareness Day

Today we hear from Dr. Dan Powell, our soft-spoken and much-loved provider who mainly works at our Woodlake location. Here, he teaches us how to speak about mental illness without the stigma that's commonly associated.

Today is Children's Mental Health Awareness Day.  The National Federation of Families has declared this year's theme to be: "Out of the Shadows: Exposing Stigma."

As healthcare providers at Impact Urgent Care, we frequently have the privilege of providing care for children with mental health issues who present with acute illness.  While addressing the child's acute illness is paramount, an equally important issue (as with all children we treat) is addressing any associated family or parental concerns.  Without a doubt, one of the greatest challenges parents face when caring for their child with any mental health diagnosis is dealing with the stigma of mental illness.

Whether your child is struggling with Depression or Situational Anxiety, or more chronic conditions such as ADHD or Autism Spectrum Disorder/Aspergers, you are already well-aware of the overt and sometimes subtle ways that the stigma of mental health illness can impact a child and his or her ability to navigate the waters that other children breeze through at school or athletics, or even just going out to eat and going to the movie theater.  Reversing the stigma of childhood mental health illness will not happen overnight, but efforts are definitely underway to begin the process, and events such as Children's Mental Health Awareness Day are critical in raising public awareness and educating all of us on how we can make a difference.

The Hogg Foundation for Mental Health (www.hogg.utexas.edu) has produced a brochure titled Language Matters in Mental Health that gives excellent guidelines for HOW WE TALK about persons with a mental health condition.  Saying, "He has a mental health condition" instead of, "He's mentally ill" - or "She has Anorexia Nervosa" instead of, "She's an Anorexic" may seem like potato - po-tah-toe to folks who don't have (or live with a family member who has) a mental health condition but for those of us who do, it's a night-and-day difference that expresses volumes about a person's attitude toward mental health and/or the stigma of being labeled.  Educating your child's siblings, friends and teachers on the impact of the word choices we make when talking about a child with a mental health diagnosis is crucial to helping shape a healthy and encouraging environment for them to thrive.  This approach is called "people-first language" and can open up communication lines with others that take a concern for your child's well-being.

Caring for a child with mental health issues can be an enormous challenge for their parents, and we hope you will consider us a resource you can depend on at Impact Urgent Care.  We count it as a privilege.

Dr. Dan Powell

Dan Powell, M.D.

Staff Physician, Impact Urgent Care

Photo credit: alles-schlumpf / Foter.com / CC BY-NC-SA