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HIV and AIDS – Facts and Prevention

December 1 was World AIDS Day. According to the Centers for Disease Control and Prevention, more than a million people in the United States are living with HIV. It is estimated that one out of five Americans with HIV do not know they have the infection. Dr. Raghavendra Tirupathi, medical director of Keystone Infectious Diseases and Keystone Health’s HIV program, and physician at Keystone Internal Medicine says it’s important that everyone educates themselves about HIV facts and prevention.

What is HIV? HIV, or human immunodeficiency virus, damages a person’s body by destroying specific blood cells which help the body fight disease.

What is AIDS? HIV, if left untreated, can develop into AIDS — acquired immune deficiency syndrome. At this stage of the HIV infection, a person’s immune system is severely damaged and has difficulty fighting disease and certain cancers.

How is HIV/AIDS spread and not spread? HIV is not spread by saliva, kissing, shaking hands or sharing utensils. It is not spread through insect bites, air or water. HIV is transmitted through sex with either a man or woman without the use of condoms. HIV can also be spread through using IV drugs or having a partner who uses IV drugs. Pregnant women can pass HIV to their baby by pregnancy or through breastfeeding. Getting tattoos or body piercing does present a potential risk if obtained from an unlicensed facility or if performed in an unsterile way.

Who should be tested? Everyone between the age of 13 and 64 should be tested at least once in their lifetime, even if you don’t think you are at risk. For those who have had more than one sexual partner in the last six months, have a history of sexually transmitted disease in the last year or have a history of IV drug use, you should be tested at least once every year. For those who have high-risk sexual behaviors, multiple partners, have sex in exchange for money, or use injection drugs, testing is recommended every three to six months.

Free Testing Available In Franklin County, free and confidential HIV testing is provided on a walk-in basis at these locations: Keystone Internal Medicine (830 5th Ave Suite 201, Chambersburg) and Keystone Community Outreach (455 Lincoln Way East, Chambersburg). The completely confidential testing is very quick—it only takes a few minutes and results are ready in less than half an hour. This non-invasive test is done by simply swabbing the gums—no blood is involved. No appointment is needed; you can simply walk in during business hours.

Know your status Getting tested is the only way to know your status. If HIV is detected early and treated, you can expect a higher quality of life and a longer life. And the good news is there is help available in our community for those who are HIV positive.  The Keystone Health HIV Program provides medical and support services to HIV positive individuals.


This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.

Employee Spotlight – Greg Hoover

The Keystone Health Employee Spotlight for December shines on Greg Hoover, Speech-Language Pathologist at Keystone Pediatric Therapies!

Greg became part of the Keystone team in May of 2016 when Keystone acquired Edlantis Achievement Center and renamed it Keystone Pediatric Therapies. It didn’t take long for Greg to feel at home.

“I felt a sense of family and overwhelming kindness upon meeting everyone at Keystone from the top, down,” he said.

On a typical day, Greg sees about 12-16 patients who have communicative disorders.

“I love working with clients with social-cognitive impairments, especially teens,” he said. “I’m passionate about helping them establish and maintain meaningful relationships with friends and family throughout their lifespan. I’m proud that I am allowed the opportunity to help shape a child’s speech or language into meaningful and effective communication. It excites me to know that my clients will use the skills they learned at Keystone Pediatric Therapies to accomplish great and fulfilling things in the academic, social, and vocational settings.”

Like most Keystone employees, Greg sees the impact the company makes in our community each day.

“I am proud to work for Keystone Health because the company focuses on serving the needs of all of residents of Franklin County despite their ability to pay,” he said. “Also, I feel like everyone has a voice here; everyone has the ability to communicate their thoughts and ideas to help make the company a better place for all.”

When he’s not at work, Greg enjoys playing guitar, watching movies, biking rail trails, and cooking traditionally prepared foods. He also enjoys reading, and his favorite book is All The Light We Cannot See by Anthony Doerr.

While he now calls Franklin County home, Greg grew up in DuBois, Pennsylvania as the youngest of four boys.

“What I like most about the Franklin County region is the access to fresh, local produce, the minimal amount of snow compared to my hometown, and access to beautiful state parks and hiking trails within a short driving distance,” he said.

Thank you, Greg, for all that you do for Keystone and our patients!

What You Need To Know About Marketplace Insurance Enrollment

The enrollment period for 2019 Marketplace insurance coverage is now underway. While many people view the process as complicated, there are places to turn for help. Pam Laye, supervisor of outreach and enrollment at Keystone Health, offers some answers to frequently asked questions.

Why is it important to have health insurance?

No one plans to get sick or hurt, but most people will need medical care at some point. Health insurance covers most costs, protecting you from unexpected, high medical bills and offers many other important benefits as well. You pay less for covered in-network health care, even before you meet your deductible. Without health insurance, you are faced with paying the bills yourself and those bills could amount to a lot of money and debt which could take you years to pay off.

A three-day hospital stay could cost you as much at $30,000 if you don’t have insurance; a broken leg from skiing, bicycling or playing sports could cost you $7,500 if you don’t have insurance. The American Diabetes Association estimates that the average cost of diabetes is $13,700 in medical expenses per person per year. To help address the affordability of health insurance, tax credits and cost-sharing subsidies are available from the government that may make premiums more manageable or may help lower out-of-pocket expenses such as co-payments at the doctor’s office or the pharmacy.

When is the open enrollment period?

The Marketplace opened November 1, and will remain open until December 15 for coverage to begin on January 1. After the Marketplace closes, you can enroll or change plans only if you qualify for a special enrollment period. Circumstances that may qualify you for special enrollment include: marriage, a birth, adoption or fostering of a child and a change in your current insurance, income or citizenship.

What are the main options when it comes to plans?

In Franklin County the only two options are Capital Blue Cross and Highmark. Capital plans which are  offered are Preferred Provider Organization (PPO) plans. This means if you go to a provider who accepts Capital Blue Cross insurance, you will pay a lower cost for care. If you go out of network (to a provider who does not accept your insurance plan) the cost will be higher than in network, but still lower than full cost. Highmark is offering only Exclusive Provider Organization (EPO) plans. This means if you go out of network, insurance is not going to cover your service and you will have to pay full price.

The deductible and out of pocket cost are about the same for both options which could be as high as $15,800 and as low as $2,000 depending on your plan.

When will my coverage begin?

If you enroll or change plans by December 15, 2018, your coverage will begin January 1, 2019.

Do I need to do anything if I enrolled last year?

If you do not update your application by December 15, 2018, you will probably be re-enrolled automatically. However, it is best to review your options every year. Prices and plans change annually and there may be a new plan that is more affordable for you. If the plan you selected last year is no longer available, you will likely be enrolled in a similar plan. It is important to make sure your healthcare provider accepts the plan you are using.

If I choose to be uninsured, will I have to pay a penalty?

Yes. If you were uninsured in 2017, you had to pay whichever amount was greater: 2.5% of your total adjusted gross household income, or $695 per adult and $347.50 per child, up to $2,085 per family. The fees have typically risen each year with inflation, but the final 2018 fees have not yet been announced. Starting in the 2019 calendar year, there will not be a penalty for remaining uninsured. (This will take effect with 2019 taxes, which are filed in early 2020.) 

How do I enroll?

There are several ways you can enroll. Most people choose to enroll online at www.healthcare.gov but you can also enroll by phone, with a paper application or with a trained helper or certified Marketplace counselor. The department I oversee, Keystone Health’s outreach and enrollment department, is one community resource that provides this service for free. Our certified enrollment navigators can meet with you and walk you through the process, and can also help you complete charity applications. You can call (717) 709-7969 for further information or to schedule a free appointment to meet with a Keystone Certified Assistance Counselor.

Marketplace agents can also help complete applications, but there is typically a fee for the use of this type of assistance. There is no cost or charge if you use a Keystone Certified Application Counselor.

Antibiotic Resistance Facts

November 12-18 was Antibiotic Awareness Week. Antibiotics save lives every day and have been one of the most important discoveries in the last century. However, using them incorrectly can have life-threatening consequences. Dr. Raghavendra Tirupathi, Medical Director of Keystone Infectious Diseases, shares some important information everyone needs to know about antibiotic safety.

What are antibiotics?

Antibiotics are medicines that help to stop infections caused by bacteria by killing the bacteria or by stopping bacteria from reproducing. The discovery of penicillin in 1928 transformed the treatment of infections. However, antibiotics only treat bacterial infections and cannot treat infections caused by viruses.

What is antibiotic resistance?

When antibiotics are used incorrectly, bacteria can change or adapt in a way that makes the antibiotics ineffective. This is usually caused by using antibiotics too frequently or when they are not needed.

Why should I care about antibiotic resistance?

It could literally save your life. This problem continues to grow and leaves us with fewer effective antibiotics to treat deadly infections. As bacteria become resistant to antibiotics, even minor infections can turn deadly. In the United States, antibiotic resistant bacterial infections lead to 23,000 deaths and more than 2 million illnesses annually.

What causes antibiotic resistance?

Some of the main causes of antibiotic resistance are: the overprescribing of antibiotics, patients not taking antibiotics as prescribed, patients not completing their antibiotic course, poor infection control in hospitals and clinics, unnecessary antibiotic use in agriculture and poor hygiene and sanitation practices.

How do I know if I need an antibiotic?

Your healthcare provider will be able to decide whether an antibiotic is necessary to treat your condition. Some common illnesses are caused by viruses, and antibiotics will not be helpful.

Some common conditions that are caused by bacteria that do require antibiotics are: strep throat, urinary tract infections and whooping cough.

Some common conditions that may require antibiotics are: sinus infections and middle ear infections.

Some common conditions that are caused by viruses and do not require antibiotics are: common colds, runny noses, bronchitis or chest colds in otherwise healthy patients, the flu and sore throats (that are not strep).

What are some ways to feel better when I don’t need antibiotics?

Make sure you get rest and drink plenty of fluids when you aren’t feeling well. For upper respiratory infections (including sinus infections, ear infections, colds and bronchitis), things that may help include: using saline nasal spray or drops, avoiding smoking and secondhand smoke, breathing in steam from a hot bowl of water or shower, taking an over-the-counter pain reliever or decongestant (make sure to follow directions carefully) and a warm, moist cloth over aching sinuses or ears.

For sore throats, you can drink warm beverages, gargle with salt water, use sore throat spray, and suck on ice chips, popsicles or lozenges (for those not at risk of choking). For coughs, humidifiers or vaporizers, breathing in steam, lozenges and honey may provide some relief. (Never give honey to a child under 1 year of age.)

What can I do to protect myself from antibiotic resistance?

If your illness does require antibiotics, make sure you take them exactly as prescribed. The entire dosage should be finished, even if you are feeling better. Your healthcare provider should prescribe you the shortest duration of antibiotics necessary. You should talk to your doctor if you have any questions or develop side effects to your antibiotics, including diarrhea, as it could be a sign of infection.

Make sure you never share antibiotics, practice good hygiene (wash your hands frequently, cover coughs, stay home when sick, etc.) and get recommended vaccinations, including the flu vaccine.

I hope that everyone will do their part to use antibiotics properly so we can make sure these life-saving medicines will be available for generations to come.


This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.

Employee Spotlight – Betty Parker

The Keystone Health Employee Spotlight for November shines on Betty Parker from our Billing Department!

Betty is among Keystone’s most tenured employees. She began her career with us in June of 1999 as a part-time receptionist in an office Keystone then had in Dry Run, PA. That location has since closed, but she wanted to continue working for the company.

“In 1999 I was going through medical secretary schooling and did my shadowing at the Dry Run office,” Betty said. “After a couple weeks and toward the end of my course, the office manager there offered me a part-time job as a receptionist. I accepted and here I am 19 years later.”

During that time she has held several different job positions within Keystone including receptionist, medical records technician, data entry technician, collections representative, and now billing representative. Through the years she has always appreciated working for a company that is making a positive impact on our community.

“I’ve learned so much from what Keystone Health stands for and from what Joanne (Cochran) does for our community,” she said. “We offer health care to a lot of people who cannot afford it otherwise.”

On a typical work day Betty keeps busy with posting insurances, assisting patients, resolving issues related to insurance companies and contacting the companies for payment.

“I enjoy working with our patients,” Betty said. “I like to help them understand their billing statements and help them resolve any issues they’re having with their insurance company. I also work with the best group of people. They make it a joy to come to work every day.”

Betty also gets a lot of happiness out of spending time with her family. She lives in Shippensburg with her husband of 37 years, Erick.

“My husband is my best friend and he inspires me to always be me and to reach for whatever I want to achieve,” she said. “We have two beautiful children, Shawnna Lynch and Derek Parker, and two adorable grandchildren. We also have our big boy Maximus, our chocolate lab who we all adore.”

Before moving to Shippensburg Betty and her family lived in Path Valley where her children grew up.

“We waited to move until our children were out of high school so they could graduate with their classmates; that was our promise to them,” she said. “We love living in Shippensburg now. We enjoy walking around our neighborhood and meeting our neighbors. We also enjoy camping with our family, vacationing at the beach, and I love shopping with my daughter and being connected at the hip to my husband. I constantly want to make people happy and have always been like that.”

Thank you, Betty, for all that you do for Keystone and our patients!

2018 Diabetes Health Fair

 Join us on Saturday, November 10th, for our 2018 Diabetes Health Fair!

TMS Therapy For Depression – Frequently Asked Questions

Approximately 7% of Americans are suffering from Major Depressive Disorder (MDD). Unfortunately, this disorder can be debilitating and many people who live with it struggle to find a treatment that works for them which doesn’t also cause unpleasant side effects.

Dr. Irakli Mania, Psychiatrist and Medical Director of Keystone Behavioral Health, has begun providing a new type of treatment to some of his patients – Transcranial Magnetic Stimulation (TMS). While this type of treatment has been deemed safe and effective for years, patients previously had to travel out of the Chambersburg area to receive it. This non-invasive procedure targets the brain directly instead of going through the patient’s bloodstream, and has shown positive results in worldwide studies, and with Mania’s own patients.

If you have been diagnosed with MDD and medications are not working or are causing strong side effects, you may be a good candidate for TMS. In today’s article, Mania answers some frequently asked questions about this type of treatment.

What is Major Depressive Disorder?

Major Depressive Disorder (MDD), also known as clinical depression, is a serious and often chronic condition. Symptoms include a depressed mood, lack of interest in previously enjoyable activities, changes in appetite and weight, and changes in sleep and energy level. It is often accompanied by concentration and memory problems and in some cases can lead to suicide.

Usually MDD is treated with medications and/or psychotherapy. Despite the advances in our ability to recognize this illness and advances in pharmaceuticals and psychotherapeutic techniques, we still have a huge number of individuals who have what we call Treatment Resistant Depression. Their quality of life is very poor. In fact, MDD is one of the leading causes of disability worldwide according to World Health Organization.

What is TMS?        

TMS involves directly stimulating neurons of the brain through the skull. It has been FDA approved for the treatment of MDD since 2008. This is a treatment that is getting a lot of attention and we will soon be able to treat more psychiatric conditions with it. In addition to depression it was recently approved by the FDA for the treatment of Obsessive Compulsive Disorder. It has been successfully used for substance use disorders, anxiety, and many other psychiatric and non-psychiatric conditions.

What’s the treatment like?

TMS is a non-invasive procedure done in a doctor’s office. The patient sits comfortably in a chair and a magnetic coil is placed on his or her head. The patient may feel a tapping sensation on their head during the treatment, which lasts for about 30 minutes. There is no anesthesia or recovery time, and the patient is able to leave right after the procedure without any limitations to driving or activities. In order for the treatment to be effective it has to be done on a daily basis (five days a week) for 4-6 weeks. It may seem like a big commitment to visit a doctor’s office this frequently but often it is well worth the effort. Most people see results within two to four weeks, but some require more time.

Who are good candidates for TMS?

TMS is usually recommended upon failure of one or more antidepressant medications and/or psychotherapy. Also, individuals with MDD who are not able to tolerate medications could be good candidates for this treatment.

If someone has a ferromagnetically sensitive object (metal) in or near their head, TMS therapy is not an option. Examples may include implanted devices like cochlear implants and aneurism clips but also any metal containing tattoo or eyeliner. Of course there are other conditions that a doctor has to evaluate in order to proceed with treatment. For instance, a history of seizures, stroke, or a brain tumor may eliminate someone from TMS treatment.

Does it have side effects?

Side effects for TMS are rare and usually subside within days. TMS has very low dropout rates compared to medications that have side effects. Common side effects of TMS include headache, neck pain, irritation of the stimulation site, and ringing in the ears. They tend to go away within few days of treatment because the patient gets used to the stimulation. On the more severe spectrum there is a risk of seizure, though this is extremely rare (less than 1 in 30,000). This particular side effect is getting more and more rare because of the precautions doctors are taking and the care that TMS teams deliver on a daily basis.

Is it effective?

TMS is a very effective treatment for depression. Rates of success vary from clinic to clinic and from study to study. Response rates are as high as 70% and remission rates (complete absence of symptoms) are as high as 40%. It is important to note that individuals receiving this treatment have treatment resistant depression and the chances of them getting better with other traditional methods are nearing zero. The best predictor of success is the degree of treatment resistance, meaning that if TMS is used earlier the success rates are even higher.

Even though my personal experience with this treatment is limited, with only four patients having undergone the treatment so far, we are proud to report that all four are doing better.

For more information on TMS therapy, call (717) 709-7933.

This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.

National Prescription Drug Take Back Day

The National Prescription Drug Take Back Day addresses a crucial public safety and public health issue. According to the 2016 National Survey on Drug Use and Health, 6.2 million Americans misused controlled prescription drugs. The study shows that a majority of abused prescription drugs were obtained from family and friends, often from the home medicine cabinet.

The DEA’s Take Back Day events provide an opportunity for Americans to prevent drug addiction and overdose deaths.

National Take Back Day is October 27, 2018. To find a collection site near you, visit https://takebackday.dea.gov/


Employee Spotlight – Dr. Jagdeep Kaur

The Keystone Health Employee Spotlight for October shines on Dr. Jagdeep Kaur, Psychiatrist at Keystone Behavioral Health!

Jagdeep, who is board certified in both general psychiatry and addiction psychiatry, began working at Keystone in July of 2014. She had just graduated with her addiction psychiatry fellowship, and a friend recommended she apply at Keystone.

“Dr. Kawish Garg is a very close friend and he was working at Keystone at that time,” she said. “My daughter, Naaz was an infant and my husband was in Brooklyn, New York doing his pediatric residency training. I did not want to live in a busy city but did not want to be very far from family either. Chambersburg was the perfect location and I decided to join Keystone.”

More than four years later, she’s glad she did.

“My favorite part of my job is seeing my patients doing well and achieving their goals,” she said. “It is hard for me to see them suffering and anything we can do, to alleviate that suffering as a team, is done at Keystone. Seeing patients appreciating these efforts is very fulfilling, and saving lives and saving families makes me very proud.”

Jagdeep spends her work days providing psychiatric and substance abuse medical services to her patients, and then keeps just as busy at home with her family. She lives in Greencastle with her husband, 5-year-old daughter, and 3-year old son. While her days can be hectic, she makes family time a priority and also makes sure to take some time for herself each day.

“I wake up at 5 am every weekday,” she said. “For 20 minutes in the morning I do physical exercise and/or meditation. After dropping off my kids at daycare, I start work at 8 am. I work full time and get off at 5 pm. As you know evenings and mornings are always busy for working moms but I make sure to go to bed on time.”

When she does get some free time, Jagdeep’s hobbies include reading, writing, and time with her children. She also enjoys keeping a balanced diet, getting regular physical activity, and doing meditation to help her stay healthy and active.

Thank you, Jagdeep, for all that you do for Keystone and our patients!

Emergency Department Or Urgent Care – Choosing The Option That’s Right For You

When some people feel sick or have a minor injury, their first thought is to visit the emergency department at their local hospital. However, there are other options. Urgent care offices are able to treat a variety of illnesses and minor injuries, often more quickly and with less cost to the patient than if the patient would visit an emergency department.

In today’s Take Care article Shannon Fegan, a Certified Physician Assistant at Keystone Urgent Care, explains the difference between urgent cares and emergency departments, and gives some tips about selecting the option that’s right for you.

What are the main differences between an urgent care office and the emergency department?

An urgent care office is designed to treat minor injuries and non-life threatening illnesses, particularly when you are unable to be seen by your PCP (Primary Care Provider) or when it is after your normal PCP’s hours. Emergency departments are for severe injuries and life-threatening illnesses. Typically, wait times are less in an urgent care due to less severe ailments being treated than those seen in an emergency department. Appointments are not needed at urgent cares, and often insurance copays are lower as well.

What types of ailments can be treated at an urgent care office?

Most urgent care centers treat things such as minor fractures (particularly of the wrist, arm, ankle and foot), sprains/strains, cold or flu-like symptoms, seasonal allergies, urinary tract infections, rashes, minor lacerations, minor headaches, ear/sinus pain, nausea/vomiting/diarrhea, eye irritation/swelling/pain and mild asthma symptoms. Chronic health problems should be managed by your PCP and not an urgent care. Urgent care centers typically do not do ongoing follow-up care or routine lab work. Some physical examinations, like school sports physicals, can be done in urgent cares; however, routine yearly physical examinations and routine childhood vaccinations must go through a PCP. Flu shots, however, are given at most urgent care centers.

How should you decide whether to go to the emergency department or an urgent care?

With true emergencies, time is of the essence. Do not delay your care by going to an urgent care first if you are experiencing chest pain, difficulty breathing, signs/symptoms of a stroke, head trauma, loss of consciousness, severe bleeding, fractures where the bone is protruding through the skin, severe abdominal pain (particularly in the lower abdomen), loss of vision or severe headache.

What are some benefits to choosing an urgent care facility for minor health problems?

The majority of patients who go to an urgent care are seen by a provider within 30 minutes of arrival. It is convenient for those who are unable to see their PCP for minor illnesses due to work/school schedules.

What should patients know about insurance and payments before selecting where to seek healthcare?

The copay at urgent care offices is often lower than that of emergency department copays. Most urgent care centers take insurance. If you aren’t certain if your insurance is accepted by the urgent care you are going to visit, call ahead and talk to the staff. They will be able to help you determine if your insurance is accepted. Recognize that because an urgent care office is not a PCP, medical advice is not given over the phone.

Will your wait at the hospital be shorter if you visit an urgent care first?

Unfortunately, I frequently hear from patients that they knew they needed to be in an emergency department but thought if they came to urgent care first, it would mean they wouldn’t have to wait as long in the emergency department. There are many factors that go into the length of time one waits in an emergency department, none of which are impacted by being sent to the emergency department from an urgent care. If you have a serious health issue, as discussed above, do not delay your care; go directly to the emergency department.


This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.