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Meet The Provider – Dr. Allison Hickman

One of Dr. Allison Hickman’s favorite parts of being a provider at Keystone Pediatrics Waynesboro is hearing what her patients have to say.

“Working with kids keeps life interesting,” she said. “Children will always tell you exactly what they are thinking.”

While she enjoyed all of her rotations during medical school, she found pediatrics to be the most rewarding.

“I enjoy getting to see kids as they grow into mature, independent individuals. Whether it’s mild illnesses or serious chronic conditions, it’s always very rewarding to watch children grow and thrive and overcome obstacles,” she said.

In addition to working at Keystone, Allison is a married mother of two boys, ages 11 and 2. She also is co-owner and artistic director of A&B Dance Dimensions in Waynesboro where she enjoys sharing her love of dance with young people and the community.

Tobacco Use Disorder- Part Two

May is Mental Health Awareness Month. Psychiatrist and Medical Director of Keystone Behavioral Health, Dr. Irakli Mania, shares some information about tobacco addiction, how it is connected to mental health, and some techniques that can be used to improve one’s chances of quitting successfully.

Should I quit cold turkey, or with the help of a doctor?

People often try to quit by themselves, and many are successful. But if repeated attempts are unsuccessful one needs to consult a physician. It needs to be noted that it is not enough for a physician to only prescribe medication or nicotine replacement therapy. In fact this could be counterproductive as unsuccessful attempts while using medication can lead to lowered confidence in the person that they can ever quit, and it also potentially removes from the options list medications that could have worked under proper circumstances.

Therefore, an informed physician should first assess the patient’s readiness and confidence to quit, and if the patient is ready prescribes medication or nicotine replacement therapy along with psychosocial counseling, such as smoking cessation groups. Participating in a group roughly doubles success rates. In addition, these groups often provide users with free nicotine replacement products. Psychosocial support is available through the phone as well. Hopefully more physicians will become involved in smoking cessation to promote wellness and decrease tobacco use in their patients.

How can I expect to feel when I’m trying to quit/after I quit?

It is very important to talk ahead of time about withdrawals because then you will know what to expect and can better manage them. Some withdrawal symptoms are immediate and short-term (cravings and irritability for example), and some can last longer, up to six months (such as an increase in appetite, weight gain and insomnia).

What should I do when I have the urge to smoke while trying to quit?

Whether you are trying to quit yourself or with the help of a physician prescribing medication, there are some basic things that can be used in order to be more successful. For instance there are four “Ds” of coping with immediate cravings after cessation:

  • Drink water slowly and hold it in your mouth for a little while
  • Deep breathing – breathe in slowly and deeply and then breathe out slowly; repeat five times
  • Do something else for distraction, have this planned ahead
  • Delay acting on the urge to smoke, it will pass in a few minutes

It is wise to let people around you know that you are quitting. Be prepared to say no if a cigarette is offered to you. Don’t keep ashtrays, lighters or anything else that reminds you of smoking. If possible, avoid other smokers or places where the urge to smoke is strong (know your triggers).

It helps to have reasons for quitting written down in order to keep all of this fresh in your mind in the difficult stage of abstinence. Some of the common reasons why people want to quit, or should quit, are listed below but this really needs to be specific to you and a physician can help develop this list.

  • Save money
  • Improve quality of life
  • Not out of breath with ordinary activities
  • Lower risk for chronic health problems
  • Lower rates for cold, flu and other infections
  • Keep family and friends healthy
  • Set good example for children
  • More employment opportunities
  • Food and drink will smell and taste better
  • Skin will have fresher look and you will look younger

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.

Meet The Provider — Dr. Arnauld Oreste

When Dr. Arnauld Oreste of Keystone Pediatrics Waynesboro cares for his patients, he thinks of them as family.

“Each child I examine is like I am examining my own son,” he said. “Taking care of patients and being an advocate for children is my life’s motive. I really enjoy my time with the kids and parents and finally found my place in the medical field. I always feel like being in the hospital or at the clinic is the place where I feel really happy.”

His favorite parts of being a healthcare provider are being with patients and their families, listening and discussing health issues, teaching them, answering their questions, encouraging them, and delivering the best care possible to help the child feel better.

“Seeing a smile on the face of a child or a family member when the child improves is the best thing that can happen in medicine,” he said.

When Keystone Pediatrics Waynesboro opened last year, Dr. Oreste knew it was the right fit for him.

“I was interviewed in Kentucky, Albany, Atlanta, Virginia, and other places,” he said. “But the huge difference between those places and Keystone was that Keystone’s healthcare was people-related. You can feel the humanity at Keystone. Everyone is working to help the population get through this difficult health system, and get children the care that they need. I was really impressed by that and felt that working here would help me put my small piece of rock in this huge building.”

Tobacco Use Disorder – Part One

May is Mental Health Awareness Month. Psychiatrist and Medical Director of Keystone Behavioral Health, Dr. Irakli Mania, shares some information about tobacco addiction and how it is connected to mental health.


Tobacco use disorder is the most common substance use disorder among people with psychiatric conditions, and we as psychiatrists see a lot of this. About 44% of the tobacco sold in the United States is used by mental health patients, and more than half of mental health patients smoke. It is well-known that smoking results in multiple health problems, shorter lifespans, and reduced quality of life; its use even increases suicide risk. Smoking is the number one preventable cause of death in the United States.

Why is it hard for people who use tobacco to quit?

Despite previous thoughts to the contrary (mainly supported and pushed by tobacco manufacturing companies) it has been long established that nicotine is highly addictive. In fact, it is one of the most addictive substances. It triggers the same addictive circuit in the brain that other drugs of abuse do and eventually it is out of the person’s immediate control to decrease use or stop using. This can lead to many unsuccessful attempts at quitting.

What makes nicotine so addictive?

In addition to physical causes there are psychological factors involved. There is a common belief that smoking is used for self-medication, and that it offers some rescue from overwhelming stress and psychiatric symptoms. While there is some research into medications that work through the body’s nicotinic receptors in order to treat illnesses like schizophrenia, an increasing amount of medical literature and studies defeats the false belief that smoking offers mental health benefits. Growing evidence shows significant improvement in mental health and quality of life as a result of quitting tobacco, especially in individuals with psychiatric or substance use disorders.

Often, patients with mental disorders and their medical providers delay talks and decisions about smoking cessation until after their mental health is stabilized and other substance use disorders are addressed. But research shows that psychiatric patients can safely quit smoking even while quitting other substances and stabilizing their psychiatric conditions.

How does stress affect the desire to smoke?

Smoking usually increases in times of stress. It is important to avoid stress as much as possible when trying to quit. If someone has a recurring stress in their life, they should work to develop coping strategies other than smoking.

What steps can someone take to stop?

The first step in any change is the decision to make that change. This comes in stages. Initially people think they do not have a problem, then comes realization that there is a problem, then there is contemplation whether this needs to change. This is followed by preparation for the change, then actual change, and unfortunately, in many cases, this can loop back with relapse to the contemplation stage. In the next article, I will discuss techniques that can be used to improve one’s chances of quitting successfully.

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- Cheryl Grove

The Keystone Health Employee Spotlight for May shines on Cheryl Grove of Keystone Dental Care’s Chambersburg office!

Cheryl began working for Keystone as a part-time Dental Hygienist in July 2006, and within two months asked to become a full-time employee.

“I feel blessed by the opportunities God has given me since being part of this company,” she said. “I’ve had opportunities I thought never possible. I have met people I would have never met any other way. I’ve continued my education and received my Local Anesthesia License, and had the opportunity to obtain a Public Health Dental Hygiene Practitioner License.  I’m so thankful we have a CEO and leaders that support all our hygienists in advancing our skills to better serve our patients.”

Cheryl and her team prepare for each day by previewing charts, and then providing care to their patients. She is glad she is able to make a difference in people’s lives by doing what she loves.

“It’s great to see how a team of people working together can take on the challenge to execute the plan and the needs that arise and conquer the day,” she said. “I love teaching people about their teeth in a way that is easy to understand. It’s awesome to see the lightbulb go on.”

As a native to the Franklin County area, she still enjoys the scenery of streams, mountains, farmland, and grazing animals.

She also enjoys singing in the choir, walking her dogs, gardening, attending Bible study, traveling, and enjoying good restaurants.

“I find it important to surround myself with family, friends and neighbors,” she said.

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

Meet the Provider — Dr. Hina Warraich

Dr. Hina Warraich of Keystone Pediatrics Waynesboro has been interested in the medical field since childhood. Her father is a pediatrician and her mother an OB/GYN, so the thought of becoming a doctor herself came naturally.

“I always saw my parents involved with their patients, especially newborn babies and children,” she said. “They were my inspiration to join the medical field and eventually do pediatrics myself.”

When Keystone Pediatrics Waynesboro opened last year, she was excited to work at a brand new practice so she could know and care for her patients from their very first visit.

“Taking care of newborns and watching them grow and achieve milestones really makes me happy,” she said. “And my colleagues are a pleasure to work with.”

In her free time, Dr. Warraich enjoys participating in her hobbies of dancing, music, and photography.

For more information about Keystone Pediatrics Waynesboro, visit

May is Mental Health Awareness Month

For more information about Keystone Health Crisis Intervention, click here.

What You Need to Know About Hand, Foot And Mouth Disease

Hand, foot and mouth disease is a common virus infection that is especially prevalent in children. Dr. Arnauld Oreste of Keystone Pediatrics Waynesboro shares what you need to know about the virus and how you can protect yourself and your family.

What is hand, foot and mouth disease?

It is an illness that causes one of the most common rashes in children, but can also affect adults. It causes blister-like bumps in the mouth and rashes on the palms of hands and feet. It can also cause rashes on the diaper area, legs, arms, torso and face.

Who is most at risk?

Most cases occur in infants and children younger than seven years of age. It is contagious, and outbreaks can easily spread in places like daycares, schools and camps.

What are the symptoms?

In addition to the blisters, children who are able talk usually complain about mouth or throat pain, and younger children are often fussy and refuse to eat. A low-grade fever, stomach pain, diarrhea and vomiting can also occur. These symptoms should improve within seven to ten days.

How is it spread?

The virus is commonly spread through fecal contact, such as diaper-changing. It can also be spread through coughing or sneezing, close contact, sharing cups or eating utensils and touching infected surfaces. Children with blisters or rashes should not attend school or daycare as the virus can spread easily to others.

What are the treatments?

Since hand, foot and mouth disease is a viral infection, antibiotics are not helpful. Treatment involves managing the symptoms to make the patient as comfortable as possible. Fluid intake to prevent dehydration is important; frequently providing cool, iced fluids in small amounts is recommended. Acetaminophen or ibuprofen can help reduce fevers, and your doctor may also recommend ointments and mouth rinses or sprays to lessen discomfort. Although rare, hospitalization can also be necessary in some cases.

How can you protect yourself and your children from getting HFMD?

Proper hand washing by using soap and water for at least 15 seconds is very important. Disinfecting contaminated surfaces and avoiding close contact with infected people will also reduce your chances of getting the virus. Someone who has been infected can still spread the virus for one to two weeks after their symptoms have stopped.


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


How to Deal with Trauma

The psychological effects of a traumatic incident can last long beyond the event itself. Trond Harman, Licensed Clinical Social Worker at Keystone Pediatrics, shares information about how both adults and children can heal from trauma.

What is trauma?

Trauma is a response to incidents such as accidents, natural disasters, crimes, surgeries, deaths and other violent events. Many of these incidents can occur just one time in a person’s life.  However, trauma includes responses to repetitive experiences as well.  These experiences include abuse, neglect, combat, violence and enduring deprivation just to name a few.

Trauma experiences are defined by the survivor. In other words, the definition listed above does not necessarily mean that these are the only types of events that can cause trauma and some people can go through these events and not have any of the signs or symptoms of trauma.

What are some signs that someone may be suffering from trauma?

There may be a number of different signs or symptoms that signal someone is suffering from a traumatic life event. Again, it is important to note that not everyone suffers from all of these, but that they vary based on each person’s reaction.  Signs and symptoms can include flashbacks, extreme anxiety, extreme emotional reactions, nightmares and being constantly on guard or relaxed in certain situations.  Symptoms can also include thinking about a situation when you do not want to, going out of your way to avoid situations that will cause you to remember the trauma and feeling numb or detached from activities or surroundings, which is known as dissociation.

What are some ways for adults to cope?

There are a number of ways adults can cope with trauma. If left untreated, many use drugs and alcohol to numb the feelings. Some positive ways to cope include journaling or finding some way to tell their story, exercising, prayer/meditation and of course, engaging in therapy. There are many types of treatments therapists use, including one I am trained in called Eye Movement Desensitization and Reprocessing which helps unblock traumatic memories and process them naturally.

How can you help a child deal with trauma?

The way a child deals with trauma is not much different from the way an adult would. The biggest difference for a child is that they need to feel as safe as possible in their environment.  This is true for adults as well, but it is even more important for children.

Can there be lasting effects?

If untreated, trauma can have lasting effects on both children and adults. Many of these effects would be related to the signs and symptoms that people suffer from after going through a traumatic event but the symptoms could be much worse later in life.  For example, if trauma is untreated and a person uses drugs and alcohol to cope, we would probably see an increase in use over the course of their lifetime.

When should you seek professional help?

You should seek professional help when dealing with trauma as soon as possible. People who experience trauma can find help through sources such as a local community health organization or by searching the Internet for a trauma therapist.


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.

Meet The Provider — Angie Wallace, CRNP

Angie Wallace, Certified Registered Nurse Practitioner at Keystone Pediatrics Waynesboro, knew she wanted to work with children as long as she can remember. She started her career caring for babies as a neonatal intensive care unit nurse for four years before becoming a pediatric CRNP.

“My favorite part of being a healthcare provider is getting to work with babies and children and watching them grow and develop,” she said. “I love getting to know the families and being able to help them adjust to each new change or challenge that parenting provides.”

She has now been working as a CRNP for nine years, and finds fulfillment from helping others.

“I am most proud of being a Nurse Practitioner when I can make life easier for a parent or a struggling or sick child by offering advice, referring them for special services, and/or providing them with the treatments or resources they need,” she said. “I am proud when I see a patient smiling and doing well after being very sick and knowing that I had a part in that.”

When she’s not at work, Angie is a wife and a busy mom of two. In her spare time, she enjoys exploring her interests of nutrition and exercise by trying new healthy recipes and staying active with running and cross training.